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THE
HOUSEHOLD  PHYSICIAN;
FOR THE USE OF
FAMILIES, PLANTERS, SEAMEN, AND TRAVELLERS.
BRIEF DESCRIPTION, IN PLAIN LANGUAGE,
                   OF ALL THE

DISEASES OF MEN, WOMEN, AND CHILDREN,
WITH THli
NEWEST AND MOST APPROVED METHODS OF CURING THEM.
            B Y

   IRA WARREN, A. M., M. D.
FELLOW OF THEMASSACHUSETTS MEDICAL SOCIETY, ETC.
            ILLUSTRATED
BY THIRTY-SIX FIGURES ON EIGHT SPLENDID COLORED LITHOGRAPH PI^T,E§i ;LX"£  'i
      AND TWO HUNDRED AND THIRTY-SIX EN»l**|KG».p JU pffJCfJil *<s OFl'lf^

                              AUG 1   1910
             BOSTON:
   BRADLEY,  DAYTON, & CO.,
        20 WASHINGTON STREET.   1 /) > / (7 2
            MELBOURNE:      <,V I
       R. J. BURR, 4L FLINDERS LANE EAST,
           SAN FRANCISCO:
 B. GUY McLELLAN,  305 MONTGOMERY STREET.
                186 3. 
WB/J
 W288*
   1&G3
      Entered, according to Act of Congress, in the year 1859, by
                   IRA  WARREN,
in the Clerk's Office of the District Court of the District of Massachusetts.
     Entered, according to Act of Congress, in the year 1863, by
                   IRA  WARREN,
In the Clerk's Office of the District Court of the District of Massachusetts.
   ELBCTROTTFEI) AND PRINTED BT

W. F. DRAPER, ANDOVER, MA8S. 
PREFACE.
   This book is written for the people.   It is based on the assumption
 that every man —the mechanic, the farmer, and  the day laborer, as
 well as the professional man — has a right to all the knowledge he is
 capable of acquiring, on all subjects, — medicine not excepted.  The
 book aims, therefore, to popularize, and adapt  to the many what has
 been claimed as belonging only to the few.
   I do not hesitate  to  avow that my sympathies, as a man, are with
 the great masses, who may be called the bone and muscle of the race.
 They  are, in the main, more shrewd, more endowed with* common
 sense, more  simple'and  true in their natural instincts, and conse-
 quently less  perverted, than those who claim more refinement, and a
 higher place in  the social  scale.  They are endowed with intellect
 enough to master science, and with sense enough to make a proper
 use of whatever knowledge they may have occasion to acquire.
   " All men," says Hippocrates, one of the great fathers  of medicine,
 " ought to be acquainted with the medical art.  I believe that  knowl-
 edge of medicine is the sister and companion of wisdom."   Such
 knowledge would shield the many from the impositions of quackery.  «
 No one, I venture to say, who reads this book  thoroughly, will be
 often imposed upon  thereafter by quack nostrums, or quack doctors,
 for he will be conscious of knowing more, in most cases, than those
 who seek to  make him a victim.  Every man's physical  organization
 is  his own ; and  he  is charged with the responsibility of taking care
 of it.   To do this properly, he needs  knowledge of it; and to with-
hold this  from him,  is another form of the old oppression, which de-
creed knowledge  and power to the few, and ignorance and obedience
to  the many. 
IV
PREFACE.
  In accordance with the design of the work, it has been written in
plain, simple English,  and brought within the comprehension of all
who have medium powers of mind.  It has not been thought needful
to reduce its language to  the  simpering style of baby-talk;  that is
done only by those who don't know  much about the people.  I believe
every man who can push a plane, can comprehend good Saxon Eng-
lish, even when put together in a style sufficiently elevated to  please
scholars.
  In preparing this book, a great number of authors have been care-
fully consulted, to whom I acknowledge  large indebtedness; yet the
work is not a mere compilation.  With the exception of a few  minor
parts, as those on Hydropathy, the Management of the Sick-Room,
and the  Symptoms of Diseases, it has all taken shape,  coloring, char-
acter, and language, in my own mind.  In dealing with each disease,
I have aimed  to  sketch a  brief pen-and-ink portrait, so  like it, that
every reader shall know  the  original  whenever he sees it; and then
to give, in the fewest words, the best treatment.
  No  wofk of the sort has ever explained the reasons, or given the
whys and wherefores of medicine  to anything like the extent of this ;
nor has  any  one  been so  extensively illustrated.   The  engravings
amount  to two hundred and thirty-six in number,  and  have been,
with few exceptions, done expressly for this work, in an exceedingly
neat manner, by Mr. Theodore G. Turner, of Virginia, now a medi-
cal student in my office.  Of  the colored lithographs, there are Thirty-
six Figures on eight splendid plates.   It is enough to say of them that
they are done, in  his  best style, by J. H. Bufpord, of this city^^
probably the best lithographer in the  country.  They are  inserted at
great expense,  and add much  to the  value of the book.
                                                         I. W.
   No. 3 Avon Place, Boston, 
GENERAL INTRODUCTORY REMARKS.
                    Progress  of Medicine.

   Medicine may be divided into a science and an art.  It is a science
 as it presents facts and evolves principles;  an art as it consists  of
 rules for practice.  For its present attainments, it is indebted partly
 to researches  scientifically conducted, and partly to empyrical and
 hap-hazard discovery.
   As a science, medicine is chiefly indebted, and must ever be, to the
 members of what is  called the " regular profession."  This  body of
 men, while it  contains  numerous  persons whose talents and attain-
 ments do not raise them above the merest quacks, does  yet  embrace
 large numbers of men who are alike ornaments of the race, and lights
 of their profession.   It  is to the writings of this class that every stu-
 dent must go who would qualify himself for the proper discharge of
 the duties of a physician; and he who attempts the practice of medi-
 cine without a knowledge of standard medical writings, is  either a
 fool  or a knave — either without the brains to understand science, or
 destitute of the honesty to deal fairly with men.
   While this is said, however, it must be granted that a respectable
 portion of the  facts which make up the science of medicine, have been
 contributed by the  industry of men  who have not had what  is called
 a regular standing- in the profession.   I am sorry to be obliged to add
 that the great body of  this class  have been  quacks  and charlatans,
 while only  a few of them have had talents and acquirements.
   Nevertheless, they have been too indiscriminately condemned. Their
 labors have been useful in various ways, and have contributed to the
 advancement of medical knowledge.  A regard for truth, not less than
 justice to these persons, requires this statement.
  One Idea Men. — The "irregulars," as they have  been called, have
 generally had  their hobbies, which they have ridden with  singular
 diligence, and often in little better than John Gilpin plight.  Yet they
 have  drawn attention to great truths, which  the regular profession
 either did not see, or would not  commend; and they have done this
 by dwelling incessantly  upon some single idea.
 ' The one  idea men, of every class, have been ridiculed  in all ages;
 and  indeed have always exhibited some  singular  obliquities.   Yet
when they  have  been men of learning and talents, they have accom-
 plished great things, either for good or evil. 
6              GENERAL  introductory  remarks. .
     Martin Luther was strictly a one-idea man.  The whole force of his
  extraordinary character was given to the propagation of the single
  doctrine of justification by faith; and by the incessant efforts he made
  for this purpose, he sank the doctrine deeper into the heart of Europe
  than»a hundred equally powerful  men could have done by giving  it
  only an ordinary share of  attention.
     William  Ellery  Channing  was a  one-ideaist.   Man, the  noblest
  work of creation, to be developed, educated, adorned, loved, made like
  unto  God, was the thought of  his life — a thought which he embel-
  lished and moulded into  all the forms of beauty which our  flexible
  language is capable of producing.  Under the mild promptings of his
  genius, and the workings of this thought, philanthropy, quickened into
  a new life, spread out her arms, and embraced the world.
     Sir Isaac Newton was a one-ideaist.  So entirely did he devote his
  great powers to astronomy and the higher mathematics, that he be-
  came unfitted for the duties of social  and domestic life — so unfitted,
  that when induced by his  friends  to give a little attention to courtship,
  he fell into one of his abstractions, and detected himself in using his
  lady-love's fore  finger to  poke down the ashes in his pipe!  But Sir
  Isaac advanced mathematical science to a point far beyond its previ-
  ous  attainments,  and  laid it under such obligations as  no  general
  scholar could have done.
     It is in this way, though in a vastly lelss degree, and without the
  scientific method,  that one-ideaists  in medicine benefit  the  world.
  They seize upon some single remedy,—generally one which has been
  overlooked, — and using  it themselves to the exclusion of all others,
  they  press it upon the world as the panacea for  all its  ills.  With
  them disease is a unit, and  they have  found its one all-important
  remedy.  Thus convinced, they  press it upon others  with the  enthu-
  siasm of fanatics.   Testing it in all cases, they develop all its virtues.
  Those  who  have the  good sense to turn their attention to  it, have
  only to use it in those cases for which its adaptation is proved.
     It  is in this way that these  men become, incidentally, medical dis-
  coverers ; and not being  burdened with modesty, they never withhold
  their importunities till the world acknowledges whatever value there
  is in their discovery.  And although  they may do some mischief with
  the  single-edged  tool which  they handle so industriously, I doubt if
  they do much more than many better workmen who use too many.
   At all  even i s, wise and generous men thank them for their gift to the
  profession, small though  it may  be, and use it in the  light of a clearer
  knowledge.

     Hydropathy. — As an illustration of what I have just been saying,
   I may refer to  hydropathy,  or  the  plan of Hreating all diseases  by
  water.
     The singularly careful avoidance, by the whole medical faculty, for
  many  ages, of the article of pure water  as a  medicinal, or rather,
  health-imparting agent, was anything but creditable to the profession.
     It is now admitted  by all sensible men that water, cold and warm,
!  used at proper limes and to a reasonable extent, has great power over 
GENERAL INTRODUCTORY REMARKS.              7
several diseases, and is a powerful promoter of health.  No physicians,
except those who are too indolent to know what is going on in the
world, or too fast locked in old prejudices  to touch  new things, now
omit its use in many cases.  How warm and sincere  my own approval
of water as a remedy is, almost every  page of this volume will fittest.
  Indeed it may honestly be allowed that the hydropathists have fairly
drowned the  almost criminal professional  prejudice  against water.
They are in all the more need of this concession, since in their absurd
zeal to cure all diseases by water, and make aquatic animals of men,
they have also drowned their own common sense.

  Homoeopathy. — This  mode  of practice is of comparatively recent
origin ;  but it has  already sunk itself deep into the popular heart, and
has drawn  to its support many of the wealthy, the cultivated, and the
intelligent, in our most refined communities. I do not profess to com-
prehend and appreciate its principles, nor would it be honest in me to
pretend to see  how its infinitesimal doses can produce the results
which it often shows, and which  it is fair to confess  look like singular
success; and saying this, I can neither adopt nor approve the violent
denunciations and censures which so many are induced  (by fashion, I
fear) to employ towards this generally well-cultivated class of practition-
ers.   I hold them  as useful members of the profession, and mean ever
to cultivate towards them fraternal feelings.  They give great attention
to exercise, diet, the use of water, etc.,—things which contribute very
powerfully to preserve health, and to restore it when  lost.  In this
thing, the" old school  practitioners  ought to learn a most important
lesson from them.   In  truth, they are  learning it, but very slowly and
reluctantly, I am sorry to say.
   The  central idea of the homceopathist, that  'like  cures  like," the
" great law of cure," as he styles it, I  do not feel called  upon to dis-
cuss— theories being of much less consequence than rules of practice.
The  old school men have certainly much to learn from him respecting
the augmented power of medicine from the greatest possible division
by trituration.  We have learned from him, too, — though many are
too ungenerous to confess the source of  the information, — that we
may  gain  our purposes with  much less medicine than  we were once
in the habit of giving.
   Eclectics.— There is a large and growing class of physicians, called,
at first, after the founder of the school, Thomsonians.  Subsequently,
they  were generally known  as Botanic Physicians.  Now they pass
under the  title of  Eclectics.
   These men, directing their attention, at first, chiefly to cayenne and
lobelia, have gradually extended  their  zealous researches over the veg-
etable kingdom, and have gathered much information  worthy to be
preserved.   These  researches have revealed a  sadly neglected duty
on the part of old  school practitioners, and, in 1852, drew from the
 " Committee on Indigenous Medical Botany," appointed  by the "Amer-
 ican Medical Association," the confession that  our  practitioners gen-
 erally have been  extremely ignorant  of the medicinal plants even in
 their own neighborhoods; and to this fact the  committee attributed 
8              GENERAL INTRODUCTORY REMARKS.
it, that the  Eclectic physicians had in so many instances supplanted
the " regulars " in the confidence of the people.
   The education and talents of this class of practitioners have gradu-
ally risen, year by year, until they have several medical schools, where
students are well instructed in the principles of medicine, by men of
real ability.   This is particularly  true of  the school at  Cincinnati.
They  have  also  a  literature of no mean  significance,  especially in
the department of materia medica.  The list of remedies they have
given  to the world, drawn  from our home plants, are a boon of  no
small value.  I regard them as equal in value to all we were pre-
viously in possession of from the vegetable kingdom.  Thepodophyllin
and leptandrin, as substitutes, in most cases, for mercurials, can hardly
be too highly prized.
   And yet, it is mortifying that the remedies  which these men have
given  us, are, by hundreds  of  our old  school practitioners, not even
known by name, and where  known, generally not honored with a'trial.
King's " American  Eclectic Dispensatory," a book of 1300 pages, in
which they  are well described, is almost unknown among us.  Aside
from the copy in  my own library, I do  not knoio that one is owned by
any member of the  Massachusetts Medical Society in Boston.  I con-
sider this a  disgrace, for however learned a man may be, he is  not
fully equipped as a practitioner, until he is acquainted with this class
of medicines.
  Physiologists. — Beside these various direct practitioners of medi-
cine, there is the large and quite intelligent class of physiologists, in-
cluding the phrenologists, who nearly discard medicine, and, appealing
to the laws of life established by the Creator, urge temperance in eat-
ing  and drinking;  exercise in the open air;  securing of pure air by
ventilating dwellings,  school-houses, and churches ;  bathing in  cold
and warm water;  cheerfulness of mind ; and the cultivation of the
Christian virtues, as  the,only  rational modes of securing health and
life.
  I confess myself inclined to forgive this class their error in banishing
medicine, in view of their zeal and success in disseminating  hygienic
information  of the  utmost  value and  importance to mankind.  Put
man into harmony with nature, and establish over him the empire of
reason, and their  theory would  be excellent; but as things are, medi-
cines, like prisons, and alms-houses, and large cities, are  " necessary
evils."

  Other Practitioners---Finally,  we   have  Mesmerists,  Pathetists,
Electro-biologists, Spiritualists, Nutritivists, and  what  not,  all  pre-
tending to cure disease by processes  peculiar to  themselves.  They
are all experimenters in different departments of nature, — now spread-
ing over our eyes a large plaster of humbuggery* and now drawing a
smail curtain and giving us  a peep into the large and well-furnished
rooms which nature  has fitted up for  our reception, by and by, when
we are better instructed.

  All Useful in a Degree. — On the whole, I am disposed to regard
all  the  operators in the different  departments of medicine as useful 
GENERAL  INTRODUCTORY  REMARKS.             9
in their degree; excepting always those mercenary quacks, who lie
about their remedies to make money.  Each of all these (I mean all
sincere and true men who believe what they teach), is aiding in some
measure the general advancement.   And  though the truths, as they
gather and present them, are but fragmentary, they are useful in the
hands of those true Eclectics, who have the wisdom and independence
to select the best things out of all systems.

   General  Conclusion. — This brings me to remark that there is but
one  truly  liberal and  philosophical school of medicine.  It is the
Eclectic, —'composed  of those who have liberality enough to  reject
every exclusive system, and to select out of all systems those things
which are  approved by experience and reason.
   I  have already spoken of a school of practitioners called Eclectic.
To a certain extent they  are entitled to the name, but I think not
entirely.   They have formed a separate and  exclusive school.  They
have turned some articles  out of the materia medica possibly for no
better reason than because their party is committed to their rejection;
whereas they should have  no party, but  allow each man to act as if
he were a citizen of the world only, and not a member  of any re-
stricted association.   But I will  not quarrel with them on this point.
I think they are becoming eclectic.
   Progress of Medicine.— There have been  long  periods when the
science and the art of medicine made scarcely any progress.  They
are now advancing, — in some departments quite fast.
   The Chemistry of  Man, commonly called Animal  Chemistry, is
opening new  sources of light.   Few of  the profession have yet
studied this essential  branch of medical science; but the delinquents
are sleeping in the rear, and will soon awake to find themselves among
the ghosts of a dead generation.
   The writer was in the habit of asserting, many years ago, that most
 of the true progress in medicine  must come through Animal Chem-
 istry ; and the developments of the last few years have made good the
 assertion.   Liebig, a diligent student in chemistry, has done much to
 open the way for inquirers in this department.  Simon has perhaps
 done  more.  Mialhe  is a yet later explorer, and has made  valuable
 discoveries.                                     .
   The result is, that students have now  before their minds, and are
 endeavoring to solve and act upon as fast as possible, inquiries and
 propositions like these:
   What is the chemical  composition of the solids and fluids ot the
 healthy human body ?                                        ■
   What is the nature of the changes which occur in the composition
 of the solids and fluids during disease ?
   What  alterations in the chemical composition  of the  solids and
 fluids take place during the operation of medicines ?
   Before  it can  exert any remote action on the animal economy, a
 remedy must be absorbed.
   Before  it can be absorbed,.it must be soluble in  the fluids ol tne
 living body. 
10'
GENERAL  INTRODUCTORY  REMARKS.
   Medicines  are  subject to chemical changes during their  passage
 through the system.
  • These changes are regulated by ordinary chemical laws, and may
 therefore, to some extent, be foretold and made available in the cure
 of disease.
   These chemical laws are disturbed and varied, to some extent, by
 the law of vitality,—just as the needle is made to vary by disturbing
 forces.
   What are  those disturbances, and to  what extent, and under what
 circumstances, do they occur ?
   With these and  similar inquiries and  propositions before his mind,
 diligently studied, a  man will in  time learn to prescribe  with  some
 intelligent aim.  He will not  know everything, to be sure, but what
 he does know, he will have  a reason for knowing.   If he give  a medi-
 cine, he will have in view the chemical changes of the solids and fluids
 of the  body, known to be produced by  the disease  he is combatting.
 He will also keep in mind the  solution of the medicine  in the fluids
 of the  body, and  the  chemical reaction  between its components and
 the acids, alkalies, etc., found in the alimentary tube  and  elsewhere.
   As the science of  medicine advances,  and becomes liberal and
 eclectic in its  character, gathering  from all systems  the best attested
 facts, and using them to the exclusion of all mere theories, these facts
 must not themselves degenerate into  mere petted theories, but must
 be held in subordination to future  experience.   Medical practitioners,
 who would meet the wants  of the  age, must be men of progress.   The
 light of to-morrow, with them, must modify and improve the  light of
 to-day.   They must knock,  every hour, for admission into  some  new
 apartment of  nature.

   Need  of Liberality—That medical progress may be real, physicians
 must be free  from bigotry.  They must have no* narrow prejudices
 against any man, or class  of men; but be ready to examine candidly
 any new thought  or  new remedy  brought to their notice, from what-
 ever source it  may come.
   They should not hedge themselves about with  such restrictive by-
 laws and societary rules as are  calculated to fetter  their thoughts, and
 turn their investigations, by a sort  of moral necessity, into the  narrow
 channels of party conservatism;  remembering that he who  is  once
 enclosed by such restrictions, must hew  a  path for  his feet through
 bigotry, and even malevolence itself, before  he  can  escape them, or be
 a free man in  any  noble sense.
   The members of medical societies do themselves no credit, in the
 nineteenth century, by putting on airs, and  telling  others to stand at
 a distance.  This  would do better, had  medicine become an exact
science; but while the primary  effects of even opium are not settled —
some physicians considering it  as primarily stimulant, others as seda-
tive, others as  stimulant to the nerves and sedative to the muscles  oth-
ers as neither, and still others as alterative, — such exclusiveness seems
neither wise nor modest.   When the professors of  the healing art can
board medical  knowledge as misers hoard gold, and can submit its 
GENERAL INTRODUCTORY REMARKS.
11
  purity to equally certain tests, it will appear in better taste for them to
  grow exclusive.  Until then, the most becoming badge they can wear
  is the Christian  direction : " Let each esteem others better than him-
  self."
     Medical societies, with liberal  by-laws, are fitted to do good; but it
  would be  hard to  show  that  those with stringently-restrictive rules
  can operate otherwise than as checks upon progress.   In truth, th^ey
  are apt to  become  mere catacombs in which to embalm dead ideas.
  They are  very liable  to be  made the  instruments  for accomplishing
  the ambitious purposes of a  few  leading men.  They tend to suppress
  all sympathy with everything outside their organization;  and they
  beget a feeling like that which would forbid the fixed stars to drop
t  their light  into our atmosphere without first coming down and joining
  the solar system.

     Conservative  Leaders. — There  are  ho influences  which  hold so
  steady a check upon medical progress as the conservative leaders in
  many of our medical associations.  Not that they are opposed to im-
  provement in the medical art,  or would  object to any amount of dis-
  covery, if it could come to the  profession through channels which they
  have the honor of opening.   But against all lignt from outside, or from
  obscure sources, they will  draw down the curtains,  and  close the
  doors ;  and if it chance by any means, in spite of them, to get within
  the sacred enclosure, they will call it  darkness, and, as priests of the
  temple,  will attempt to atone  for the  indignity offered to the god of
  medicine,  and fill the whole  sky  with murky clouds from their altars.
     These men have strong faith  in caste, and in the right of the few
  to govern  the many.  In the low places of society, they look for noth-
  ing but ignorance and poverty.  Notwithstanding that the light of
  every natural day  breaks in the  horizon, and ascends, they so far des-
  pise  analogies as to insist that all medical  light  breaks  at  what they
  call the zenith of  the profession, and comes down.  With  them the
  temples of Esculapius are all rebuilt, and they are the priests;  arid to
  offer in sacrifice the smallest  medicinal  plant is a sacrilege, unless  it
  be entrusted to their hands.
     Such persons measure and  weigh a man by the  amount of money*
  he has.  Property is their god, which gives laws to everything.   With
  them, knowledge", like property, goes to posterity by will, — they being
  the principal testators.  Like their money,  too, it goes chiefly to their
  sons, and to certain favored institutions, by whom, and in which, it is
  to be hoarded, and whence it  is to go out only in certain approved
  channels, weighed and stamped, like coin from the mint.
    " These are the men who regard knowledge  as a contraband article,
  unless regularly entered at the  custom-house, with bills of lading prop-
  erly certified by the conservative magnates at some other metropolis.
  With them, knowledge is not like the west wind, fanning the brow
  of the peasant as gently as that of the king, — not like the light of
  heaven,  entering the small, clean window of the hut, as readily as the
  larger one of the palace ; not a boon which comes alike freely to all,
  and which is to be everywhere  amplified, changed,as circumstances 
12             GENERAL  INTRODUCTORY  REMARKS.
and conditions require, and  especially  adapted to the present  hour.
It is rather, as they too often view it, like  lithographed letters of advice,
printed upon stamp  paper, and carefully sealed up and addressed to
posterity.  And then, if they can be made  the mail-carriers, and be
permitted to  pass, unchallenged, with the precious bag, from post to
post, and pass it over,  carefully sealed, to the next generation, they
Wjill think it has done its  work, and that they have fulfilled their mis-
sion.
   I would not be unjust or severe, but  I cannot but  remark further,
that these men present but one view of humanity.   They are monoto-
nous objects of inspection.   Look at them a thousand times, and you see
only the  same unaltered phase of life.  To the mariner on life's ocean,
they are  not  safe lights.  If  he approach them on the dark side, they
remain black as night to him, until he comes round to their shining
front.  They are  not  revolving lights.   They have light; it may be
bright  and genial; but it gleams out  upon the  waters only in one
direction.  It does not sweep round, and  throw its rays upon every
mariner's path.
   Such men  are useful, but only to a certain  class.  They have in them
no true omnilogy—they are not all-teaching.   Their lives are instruc-
tive to their friends, their clique, their party, their school; but a stum-
bling-block, a hindrance, an oppression,  an offence to everybody else.
They are like porcupines,  with fronts smooth and easy of access ; but
their backs bristle with quills to stick into  those  on  the wrong side.
They are not whole men.   Humanity has infused  into them only one
or two of its  elements.  They have length, but no breadth. They are
citizens of Boston, New York, Philadelphia, or Cincinnati, but not of
the world.  Within certain circles, they are genial friends, but cynics
and haters outside of  them.  From their high places, they come down
to their humble followers with tokens of friendly recognition ; upon
others  they frown and lower like armed  castles.

   The  True Physician. — How different  the character  of the true man
and  physician!  He is genial in his disposition.   He  has no dislikes
and antipathies, and hates  no men except tyrants.   He accepts knowl-
edge, though  it come from the humblest  source ; believing there is no
experience but will repay a study of it, and no husbandman's plough-
share but turns up a soil worth analyzing.   He belongs exclusively to
no party, and can be  approached easily by respectable men of every
stamp.   Whether belonging to the same society with  him or not, you
may take hold of his nature and draw it out, without having it slip
from your fingers, and spring back from  your presence into a thousand
kinks, like an overtwisted  thread.   He  is a  whole man.   God made
him  for  the world, and  not for a party.  By some strong influence
you  may possibly, for a time, draw  him  from the world into some
narrower sphere, but not only will his reluctant nature, like a retiring
tide, run back  continually to embrace  the  continent, but will soon
break from its confinement, and like a full sea, come back, boiling and
running over.
   What is now Wanted. — The foregoing remarks indicate one great, 
GENERAL  INTRODUCTORY REMARKS.             13
leading want, in order  that medical  knowledge may increase.  It is
liberality, in  the true and full sense.  We want true men in high
places, who will not only let their own light shine everywhere, but will
cease to hinder other men's light from shining.
  Beyond this, and of nearly equal importance with it, vie want medi-
cal knowledge diffused among the people.  We want,—what the world
has never seen, — a popular medical literature.   We want the temples
of Esculapius pulled down, and the priests turned into the streets -to
become  teachers of the multitude, rather  than worshippers  in  the
inner sanctuary.
   I  know this want will be stoutly denied, but not, I think, on well-
considered grounds. We do not think it necessary to confine a knowl-
edge of  the soul to the  ministers of religion.   There is no branch of
theology which we do not deem it  proper for laymen to study;  we
even popularize  it  for our  children.   In  the obscurest towns of New
England, laymen who  follow the plough or push the plane, become,
in many cases,  eminent theologians.  Why  should they not study
the  lower science which relates to the  body ?  They have not been
able to heretofore, because its  mysteries have  been  purposely  hidden
under technicalities.  These coverings should be torn off.
   It is  said that those who begin to  read upon medicine are very  apt
to imagine themselves afflicted with  the various symptoms they find
described.  To  some small extent this is true ; but it is also true that
the  light they obtain relieves  them from many apprehensions which
their previous ignorance allowed to prey, upon them;  as  boys lose
 their fears when the light of the  morning changes  to some familiar
 object the ghost of the preceding night.
   Physicians oppose the  popularizing of this kind  of knowledge  too
 often, I  fear, upon the sordid ground of self-interest.  They think their
 own services will be less sought.
   We do not  dispense with  the services  of ministers because  the
 people study theology, neither shall we cease  to employ teachers  and
 practitioners of  medicine when each man and woman is wise enough
 to study the healing art.  The principal change we shall witness  will
 be much larger attainments in knowledge among practitioners, —  just
 as the ministers of religion now know, and are obliged to know, ten
 times as much as in those darker  periods when the people received all
 spiritual knowledge from their mouths.  The teachers of  any art or
 science  are obliged to keep in  advance of their pupils.   Let medicine
 become a popular study, and we shall have very few  ignorant physi-
 cians and quackery will become  one of the impossibilities.  Homce-
 opathists, Eclectics, Hydropathists, and Physiologists, believe  m scat-
 tering medical  books, stripped  of  their  technicalities, among  the
 multitude, and  their people purchase very few secret, advertised medi-
 cines;—these being chiefly bought and consumed by the followers ot
 those'who believe £b» kind of reading fosters quackery!
w 
ANATOMY.
  Anatomy describes the structure and organization of living beings.
  Special Anatomy treats of the weight, size, shape, color, etc., of
each organ separately.
  General Anatomy investigates the tissues or structures from which
organs are formed.
  Surgical Anatomy or Regional  Anatomy considers the relations of
organs to one another.
  Physiological Anatomy treats of the uses or functions of organs in
health.
  Pathological Anatomy describes the alterations made upon different
organs by disease.
  We shall here  introduce a very brief compendium only of Special
Anatomy.
  It is of great consequence that every person should have  some
knowledge of anatomy  and physiology.   Self-knowledge ought to
extend to the body as well as the  mind.   To know  one's self, physi-
cally, is to gain a new insight into  that wonderfully skilful adjustment
of means to  ends which is never absent from the works  of God.
Without this knowledge, one cannot know how to take care of the
health ; and without health, life loses most of its value.


                  Structure of the  Body.

  The human body is composed of solids and fluids.
  The fluids  are  most abundant  in children  and youth.  It is  this
which gives softness and pliancy to their flesh.  In old age the fluids
are  less abundant, and the flesh is  more hard and wrinkled.
  The fluids contain the whole body, as it were, in a state of solution*
or rather, they hold the materials out of which it is manufactured.


            Chemical  Properties of  the Body.

  The four elements, oxygen, hydrogen, carbon, and nitrogen, make
up nearly the whole bulk of  the fluids and  soft solids of the human
body.  A number of other elements, chiefly in a state of combination
and in much smaller quantities, enter into sevjral of the tissues.
  Binary Compounds. — Thus, we have carbonic acid in blood  urine 
ANATOMY.
15
and sweat;  and we have water universally diffused through the sys-
tem, — each  of  these  substances  being a binary compound, that is,
composed of two elements.
  Compounds of more than two Elements, are widely distributed over
the body; as,
   Carbonate of  Soda in serum, saliva, bile, mucus, sweat, and tears.
   Carbonate of  Lime in cartilage, bone, and teeth.
   Phosphate of  Lime in bones, teeth, and cartilage.
   Phosphate of  Iron in blood, gastric juice, and urine.
   Chloride of Sodium in blood, brain, muscle, bone, cartilage and pig-
ment.
   Chloride of Potassium in blood, gastric juice, milk, and saliva.
   Chloride of Calcium in gastric juice.
   Sulphate of Potassa in urine, gastric juice, and cartilage.
   Sulphate of Soda in sweat, bile, and cartilage.
   Sulphate of Lime in bile, hair, and scarf-skin.
   Oxide of Iron in blood,  black pigment, and hair.
   Organized Compounds.— Beside the above  inorganic elements and
compounds,  several organized substances, or proximate  elements, as
they are called, exist largely  in  the  body.    The chief of these  are
albumen, fibrine, gelatine,  mucus, fat, caseine, and  osmazome.  Oth-
ers need not be  named.
   Albumen is found  in great abundance in the human  body.   It is
the raw material out of which the flegh and other  tissues are  made.
The white of an-egg, which  is nearly pure  albumen, is a good speci-
men of it.
   Fibrine, when removed from the human body, changes  from a solu-
ble to an  insoluble state.   In other  words, it  coagulates  in a kind
of net-work.  Nearly the  same  thing takes place constantly  in  the
living body, when the liquid fibrine  leaves its soluble  state, and is
deposited as solid flesh.  Fibrine bears the same relation to albumen
that woollen yarn does to wool;  it is spun  from it in the busy wheel
of organic  life.   And the  flesh or muscle is related to fibrine as  the
cloth is to yarn; it is woven  from it in the  vital loom.   Fibrine  has
been called liquid flesh.
   Gelatine  exists largely in the ligaments, cartilages, bones, skin, and
cellular  tissue.   When dissolved, five parts  in one  hundred  of  hot
water, it forms  a thick jelly.   Isinglass is a  form of gelatine obtained
from the air-bladder of the sturgeon  and the cod-fish.   Glue  is still
another  form of gelatine.  It  is extracted from the bones, and parings
of hides, and the hoofs and ears of cattle, by boiling in water.  Black
silk, Varnished over with a solution of gelatine, forms court-plaster.
   Mucus is  a sticky fluid  secreted by the  gland-cells.   It is  spread
over the surface of the mucous membranes,  and serves to moisten and
defend them from injury.
   Fat consists of cells held together by cellular tissue and vessels, and
contains glycerine, stearic acid, margaric acid, and elaic acid.  It  has 
16                          ANATOMY.
 no nitrogen.  If the stearic acid be  in excess, the fat is hard;  if the
 elaic acid preponderate, it is  soft.   The  stearine extracted from fat,
 is used for making very hard candles.
   Caseine is abundant in milk and constitutes its curd.   It is held in
 solution in milk  by a little  soda.   When  dried, it is  cheese.   It is
 found in blood, saliva, bile,  and the lens of the eye.   It forms the
 chief nourishment of those  young  animals which live  on milk.  It
 is found  in peas, beans, and  lentils.   Vegetable and animal caseine
 are precisely alike in all their properties.  Fibrine and  albumen con-
 tain almost exactly the  same  amount of oxygen, hydrogen, carbon,
 nitrogen, and sulphur, which  is found in  caseine.  This latter, when
 taken into the stomach, therefore, goes, without much change, to the
 formation of the albumen and fibrine of the body.


            Physical  Properties  of  the  Body.

   The Tissues. — The solid organized substances of which the human
 body is  composed, are called  tissues.  There are various kinds of
 tissues.
   The Cellular Tissue, commonly called areolar, is  made up of small
 fibres and bands woven together into a sort of net-work, with numer-
 ous little spaces opening into each other.  These spaces are filled with
 a watery fluid; and when this is greatly  increased by disease, so as
 to cause the parts to swell, and the skin to shine, the person has ana-
 sarca, or cell dropsy.   The usefe of this tissue are to give parts and
 organs a kind of elastic cushion to rest upon, so that they may not be
 bruised and injured by the shocks of life; to  make a kind of safe high-
 way for delicate vessels to pass from one part of the body to another;
 and to furnish a beautifully arranged  lodgement  for the watery fluid
 which gives such roundness, smoothness, and  grace  to the  human
 form.  The opening of the cells into each  other explains the reason
 why feeble persons have swelled  feet and ankles in the evening, and
 not in the morning, — the fluid settling down from cell to cell, into
 the lowest parts, while they are up during the day, and running back
to its proper place while they are lying down during the night.
   The Mucous Tissue, or mucous membrane, lines all the cavities which
 communicate with  the air, as the mouth,  stomach, bowels, lungs, etc.
 It is supplied with numerous small glands which  secrete a sticky kind
 of fluid called  mucus, to  protect the surface  from any injury which
 might be inflicted by air, or by irritating substances suspended in it.
   The Serous Tissue, or membrane, lines all the cavities which do not
communicate with the air, that is, all  those  which are shut, and have
 no outward opening.  The skull, the chest, and the belly are lined by
this kind of membrane.  The  membrane itself forms the closed sack,
— one layer of  it being attached to the cavity H lines, while the other
is  folded back upon and around the contents of the cavity, which are
left outside of the sack.  A watery fluid oozes from the inner surface
of the sack, to  make  its sides  glide easily  upon each other.   When 
ANATOMY.
17
some disease causes this water to be poured out too freely, so as to
fill, or partly fill the cavity, we have dropsy of the brain, or chest, or
belly, as the case may be.

  The Dermoid Tissue covers the whole outside  of the body.  We
call it the skin, or cutis.  It is similar in structure to the mucous mem-
branes, which are a mere continuation of it.   It is harder than the
mucous membrane, because more exposed  to  injury.   In health,  it
never ceases to secrete and throw off a fluid which we  call insensible
perspiration while it is in the form of an invisible vapor, and perspira-
tion,  or sweat, when it is so increased as to be  seen.  So great is the
sympathy between this dermoid covering of the body and the mucous
membranes, that when it is chilled so as to stop the invisible perspira-
tion,  the  internal membrane becomes  affected, and we  have a sore
throat, or diarrhoea, or running at the nose; that is to say, when the
skin cannot sweat, the mucous membrane begins to sweat.

   The Fibrous Tissue consists of  closely united fibres,  and for what-
ever purpose used, forms a fine, dense, and  enduring body.   In some
cases it takes the form of a membrane, as the dura mater, which lines
the interior of the skull and spinal column.  The ligaments which hold
the bones together, and the tendons or cords, which fasten the muscles
to the bones, are fibrous bodies.  It is  this firm  substance of which
rheumatism frequently takes hold, and this is the reason why it lingers
so  much  about the  joints.  It sometimes takes hold of the ligament
which fastens the cfeltoid muscle to the bone of the upper arm, about
twTo-thirds of the way from the elbow to the shoulder.  This muscle
lifts up the arm.  In this form of rheumatism, therefore, the arm hangs
helpless at the side.

   The  Cartilaginous Tissue covers the ends of the bones  where they
come together to make a  joint.  It  is well fitted to make the joint
work easy, being smooth, hard, and elastic.

   The  Osseous or Bony Tissue varies in its composition, density, and
strength,  according to the age of the person, and the uses of the bone.

   The  Muscular Tissue, or muscle, being made for a  great deal of
             Fia. 1.             pulling  and lifting, is formed some-
                               thing  like a rope, except that there
                               is no twisting.  Many small fibres,  or
                               filaments unite to  form fasciculi.   A
                               fasciculus  is a  bundle of  fibres  sur-
                               rounded by  a delicate  layer  of  cell
                               tissue called sarcolemma, — just as a
                               cord is a number  of smaller  threads
                               of cotton or hemp bound together.   A
                               number of  these  fasciculi united  to-
                              gether, make a muscle, — just as  sev-
                              eral chords, called  strands, twisted to-
gether, make a rope.  Figure 1  gives us a good view of the fibres and
bundles, highly magnified.
                              3
 
18                          ANATOMY.
    The Adipose Tissue is the material which the human body works
  up into pots and  cells containing fat.   It is found chiefly under the
  skin and muscles of the belly, and around the heart and  kidneys.
  By the  increase of this  tissue, persons may become  enormously en-
  larged without having their muscles at all increased in  size.   Such a
  condition  is to be deplored, — the body having become merely the
  store-house or depot^of myriads of pots of fat.

    The Nervons Tissue is composed of two distinct kinds of matter,
  — the one gray and pulpy,  called cineritious, the other white  and
  fibrous, called  medullary.  The external part of the brain and the in-
  ternal portion of the spinal cord are composed of the gray or ash-
  colored tissue; the nerves are made only of the white or fibrous matter,
  and are inclosed in a delicate sheath called neurilemma.


                 Vital Properties of the  Body.

    Bodies  begin their growth with a simple cell, which is a  delicate
  little bladder or shut  sack.  Cells take their rise in that portion of the
  blood which is capable of being organized, and which is  called blas-
  tema.
    In animal bodies,  each cell generally begins as a minute  point in
  the blastema, and grows until a transparent bladder or vesicle springs
  out from one side of it,  and soon appears to enclose it.  The bladder
  is then called the cell, and the point or dot is its nucleus.  Within this
»  nucleus appears another dot, which is called the nucleolus.    When
  fully ripened, the  cell bursts and sets the nucleus free, and this, in its
  turn, matures and yields  up its contents.   Thus all cells have their
  origin in germs produced by previously existing parent cells.  They
  are multiplied  with great rapidity.  Having grown to a certain extent,
  they lose their fluid contents, and their walls collapsing or coming to-
  gether, they form simple  membranous discs.   In this way, with some
  variations, the simple tissues of the body begin to be, and the founda-
  tion is laid for the noble structure of man.


                    Anatomy of  the Bones.

    The human skeleton is composed of two hundred and eight bones,
  the teeth not included.
    When fastened together by natural ligaments, the  bones  are said
  to form a natural skeleton; when attached by wires, an artificial skele-
  ton.
    In Figure 2, — 1,  1, represent the spinal column;  2, the  skull; 3,
  the  lower jaw; 4, the breast bone (sternum); 6, the ribs ; 7, the col-
  lar bone ;  8, the bone of the upper  arm (humerus);  9, the  shoulder
  joint; 10, the radius; 11, the ulna; 12, the elbow joint;  13, the  wrist;
  14, the hand; 15, the haunch bone;  16, the sacrum; 17, the hip joint;
  18, the thigh bone;  19, the  knee cap (patella); 20, the knee  joint;
  21, the fibula;  22, the tibia; 23, ankle joint; 24, the foot; 27, 28, 29, 
ANATOMY.
19
the ligaments of the  shoulder, elbow, and wrist; 30, the large artery
of the arm;  31, the ligaments of the hip joint; 32, the large blood
vessels of the thigh; 33, the  artery of the leg;  34, 35, 36, the liga-
ments of the knee cap, knee, and ankle.
Fia. 2.
   The protuberances or swellings in certain parts of bones are called
processes, and are the points  to which muscles and ligaments are
fastened.
   The bones are supplied with nutritive vessels, and, like other parts
of the body, are formed from  the blood.  At first they are compara-
tively  soft, and cartilagenous.   After a time, in the young animal,
they begin to change to bone at certain places, called points of ossifi-
cation.  They are  covered with a strong fibrous membrane called the
periosteum.  A somewhat similar covering upon the cartilages has the
name of perichondrium, and that which covers the skull is the pericra-
nium.
   The bones are  compounded of earthy and .animal matter.  From 
20
ANATOMY.
the former, — phosphate and'carbonate of lime, — they receive their
strength ; from the latter, — cartilage, — they derive their life.
   Put a bone for a few days into diluted muriatic acid, — one part of
acid to six of wTater, — and the phosphate and  carbonate of lime will
all be removed, while the  bone will remain the same in shape.  It
                 Fro-3-                will now  be comparatively
                                      soft, and may  be  bent,  or
                                      even tied into a knot, with-
                                      out breaking.  Place a simi*
                                      lar  bone in  the fire for a few •
                                      hours,  and it will also retain
                                      its'  shape,  but the cartilagi-
                                      nous  portion will  be  gone.
                                      It is now brittle, and  may be
                                      picked in pieces with the fin-
                                      gers.
   The  bones are divided into those of the  head, thirty ; of the body,
fifty-four; of the  upper limbs, sixty-four; and of  the  lower limbs,
sixty.

                      Bones of  the  Head.

   The bones of the head are divided into those of the skull, the ear,
and the face.
   The  skull has eight  bones.  They are  composed of two  plates,
one above the other,  with a porous partition  between.  These two
plates are capable of giving the brain very powerful protection against
injury, the outer one being fibrous and tough, — the inner one, hard
and glass-like, and  hence called vitreous.
   The middle layer has the name of diploe.   Its spongy nature deadens
the jar from a blow inflicted upon  the outer table. h\ early life, when
the bones are tender  and  yielding, this  porous layer is  not  needed,
and is not found.
   That the  bones  of the  skull may  not
easily slip  by each other,  and  get  out
of place,  they are  dovetailed together in
curious lines called sutures.   In advanced
years, these generally  close up, the bones
uniting firmly  together.   In  early  life
they  are  quite open,  the  firm bones  not
covering the whole brain.   The  opening
of the coronal suture in childhood  is called
a fontanelle.   It presents a soft place  up-
on the  top of the  head, where the finger
could be pressed down into the brain.  In
Figure 4, — 1, 1, show the  coronal suture
on the front and upper part  of the skull; 2,
the sagittal suture on the top of the skull;
and 3, 3,  the lambdoidal suture,  running down on each side of the
back part  of the skull.
 
ANATOMY.                        21
  Figure 5 shows the skull bones separated from each other at the ,.
                                          sutures:  1, the  frontal
                                          bone;  2, the  parietal;
                                          3, the  occipital;  4, the
                                          temporal;-5, the  nasal}
                                          6, the malar;  7, the su-
                                          perior  maxillary; 8, the
                                          unguis ;  9,  the inferior
                                          maxillary.   Arnott  has
                                          demonstrated   that  the
                                          form of  the skull is the
                                          best possible for sustain-
                                          ing weights, and resist-
                                          ing blows.   The summit
                                          of the head is a complete
                                          arch, like that of a bridge.
                                            The ear has four small
                                          bones,   which  aid  the
                                          sense of  hearing.
                                            The bones of the face
are fourteen in number.  They hold the soft parts in place, and aid in
grinding the food.
                    Bones  of the Trunk.
  In the trunk there are twenty-four ribs ; twenty-four pieces in the
back bone or spinal column ; four bones  in the  pelvis and hips; one
breast-bone, called sternum;  and a bone at the base of the tongue,
called  os hyoides.   They are so put together  as to form two great
cavities, namely, the thorax or chest, a^id the abdomen or belly.
  The  ribs, connecting  with the back bone  behind, and  the breast
bone  in front, form the thorax,               Fig. 6.
which   contains the lungs  and
heart.   The Figure 6  shows the
natural form of the healthy chest:
1, is the  spine; 2,  2, the collar
bones;  3, 3, the seven upper, or
true ribs ;  4, 4, the five  lower or
false ribs;  5, the breast  bone, to
which the true ribs are united; 6,  3>;
the sword-shaped cartilage which
constitutes the lower end  of the
breast bone, called ensiform  car- n
tilage;  7, 7, the upper part of the
two lungs; 8, 8, the right lung
seen between the  ribs;  9, 9, the4<...
left lung;  10, 10,  the  heart; 11,
11, the diaphragm, or midriff; 12,
12, the liver; 13,13, the stomach;
14, 14, the second' stomach,  or duodenum ; 15,  the transverse colon ;
16, the upper part of the colon on right side; 17, upper part of colon
on left side.
 
22                         ANATOMY.
   Each piece of the spinal  column is called a vertebra.  Upon every
 one of these  are  seven  projections, called
processes, — a part of which are for linking
 the bones together, and the  rest to furnish
 attachments for the muscles of the back.
   The  projections are linked together in
 such  a way, that  a continuous channel or
 opening runs  down  through the whole, in
 which is  lodged the spinal cord, or medulla
 spinalis.  This  nervous  cord  is connected
 with the base  of the brain, and is a kind of
 continuation of it.
   Between all the vertebras  are certain car-
 tilaginous  cushions, which,  when compressed, spring back, like India
 rubber, and thus protect the brain from being injuriously jarred by
 running, leaping, or walking.
   The pelvis has four bones; the two nameless bones, — innominata,—
 the sacrum, and the coccyx.  In the side  of each  of the nameless bones
                fig. 8.                is  a deep,  smooth cavity,  called
                                   the acetabulum.   Into this  the
                                   round head of the thigh bone is
                                   nicely fitted.  When the bone is
                                   thrown  out  of this cavity, the
                                   hip is  said to be  out of joint.
                                   The sacrum took its name from
                                   the fact that  the  heathens used
                                   to  offer it in sacrifice.   With
                                   them, it was the  sacred  bone.
                                   The  coccyx is the lower termi-
                                   nation of the back-bone.  These
                                   bones are  represented in Figure
8 : 1, 1, being  the innominata; 2, the sacrum; 3, the coccyx ; 4, 4, the
acetabulum ; a, a, the pubic portion of the nameless  bones;  d, the
arch of the pubes ; c, the union of the  sacrum  and the lower end of
the spinal column.

            Bones of the  Upper  Extremities.

   The shoulder blade (scapula), the collar bone  (clavicle), the bone of
the upper arm  (humerus), the two bones of the fore-arm (ulna and radi-
us), the bones of the wrist (carpal bones), the bones of the palms of the
hand (metacarpal bones), the bones of the thumb and fingers (phalan-
ges),— these.are the bones 6f the upper limbs.
   The collar bone is fastened at one end to the  breast-bone, at the
other end to the shoulder blade.  It keeps the shoulders from dropping
forward.  Many persons allow it to  fail of this end  by getting very
much bent in early life.  This happens at school, when children are
allowed to sit  in a stooping posture.  In the French, a race remarka-
ble for a straight, upright figure, this bone is  said to be longer than in
any other people.
 
ANATOMY.
23
  The shoulder blade lies upon the  upper part of the back, forming
the shoulder.  It has a shallow cavity (glenoid cavity), into wThich is
inserted the head of the upper arm bone.  Several strong muscles are
attached to the elevations of this bone, which keep it in its place, and
move it about as circumstances require.
  The upper arm bone has its round head fastened in the glenoid cav-
ity, by the strong  capsular ligament, forming a joint capable of a
great number of movements.   At the elbow it is united with the ulna
of the fore-arm.  It is a long cylindrical bone, represented by Figure
9:  1, is the shaft of the bone ; 2, the large round  head which fits into
the glenoid cavity; 3, the surface which unites with the ulna.
   Of the two bones of the fore-arm,  the ulna is on the inner side, and
unites with the humerus, making an excellent hinge-joint.  The other
bone of  the fore-arm, the radius, lies on the  outside of the arm, — on
the same side with the thumb, — and unites, or articulates, as we say,
with the bones of the wrist.  In Figure  10: 1, is  the  body  of the
ulna; 2, the shaft  of  the radius; 4, the  articulating surface, with
which the lower end of the  humerus  unites;  5, the upper extremity
of the ulna, called the olecranon process, which  forms the elbow joint;
6, the point where the ulna articulate with the wrist.
  The eight bones of the wrist or carpus are ranged in two rows, and
being bound close  together, do  not admit of very free  motion.   In
Figure  11: s, is the scaphoid bone;  l, the  semilunar bone;  c, the
cuneiform bone ; p, the pisiform bone ; t, t, the trapezium and  trape-
zoid bones; m, the os magnum;  u, the cuneiform bone.  The last/owr
form the second row of carpal bones.  11,11, are the metacarpal  bones
of the hand; 2, 2, the first range of the finger bones ;  3, 3, the second
range of finger bones ; 4, 4, the third range of finger bones ; 5,  6, the
bones of the thumb.
                                   ________________________a____ 
24
ANATOMY.
  Of the five metacarpal bones, four are attached below to the first
range of the finger  bones,  and the  other  to  the  first  bone  of the
thumb, while the whole are united to the second range of the  carpal
bones above.
            Bones  of the  Lower Extremities,

  These are the thigh-bone (femur), the knee-pan (patella), the shin-
bone (tibia), the small bone of the leg (fibula), the bones of the instep
(tarsal bones), the bones of'the middle of the foot (metatarsal bones),
and the bones of the toes (phalanges).
  The thigh bone is the  longest bone in the system.  Its head, which
is large and round, fits  admirably into the cavity in the    fig. 12.
innominatum, called  acetabulum, and forms  what is
called a ball-and-socket joint.  In  Figure 12: 1, is  the
shaft of the thigh bone (femur); 2, is a projection called
the trochanter minor, to which some strong muscles are
attached ; 3, is the head of the femur which fits into the
acetabulum ; 5, is the external projection of the  femur,
called  the  external condyle; 6, the internal condyle ; 7,
the surface which articulates with the tibia, and on which
the patella slides.
  The knee pan or knee cap (patella)  is  placed on the
front of the knee, and being attached  to  the tendon of
the extensor muscles above, and to the tibia by a strong
ligament below, it acts as a pully in lifting up the leg.
  The shin bone (tibia)  is the largest.#of the two in the
lower leg, and is considerably enlarged at each end.
   Fig. 13.     The small bone of the leg (fibula) lies on
           the outside, and is bound to the larger bone
           at  both ends.   Figure 13  shows  the   two
           bones of the leg: 1, being the tibia; 5, the
           fibula ; 8,  the space between the two ; 6, the
           junction of the tibia and fibula at the upper
           extremity ; 3, the internal ankle ; 4, the lower'
           end of the tibia that unites with  one of the
           tarsal bones  to form the ankle  joint; 7, the upper end  of
           the tibia which unites with the femur.
             The instep (tarsus) has seven bones, which, like those  of
           the wrist,  are so firmly bound  together as to allow but a
           limited motion.
             The metatarsal bones, corresponding with  the  palm  of
           the  hand, are five  in number, and  unite at one end with
           the tarsal  bones, and at the other, with the first ranoe  of
           the toe-bones.
             The tarsal and metatarsal bones are put together in the
           form of an arch, the spring of which, when the weight  of
           the body descends  upon it in walking, prevents injury to
           the organs above.  (Fig.  14.)
             The p/ialanges have  fourteen bones.  The great toe has 
ANATOMY.                          25
two ranges of bones ;  the  other  toes have three.  Figure 15  gives a
view of the upper surface of the bones of the foot:  1, is the  surface
of the astragalus  where it unites  with the tibia; 2, the body of the
       Fig. 15.
Fw. 14
astragalus;  3, the heel bone (os calcis); 4, the scaphoid  bone; 5, 6,
7, the cuneiform bones ;  8, the cuboid; 9, 9, 9, the metatarsal  bones ;
10, the first bone  of the  great toe; 11, the second bone; 12, 13,14,
three ranges of bones forming the small toes.

                          The  Joints.

  That  bones may  be  of  any use, they must be jointed together.
Joints are of the greatest importance.   It is necessary they should be
so constructed that there shall be no harsh grating of the bones upon
each other,  and no  injurious jars in walking, etc.  To prevent these
things, a hard,  smooth, and yet  yielding, cushion-like substance is
required  between them in joints.  Such are the cartilages.   Figure 16
                  fig. 16.                  gives a specimen of these
                                         intervening cartilages.   D,
                                         is the  body of a bone, at
                                         the end of which is  a sock-
                                         et ; C, the cartilage lining
                                         the socket, thick at the sides
                                         and thin in the  centre; B,
the body of a bone, at the end of which is a round head; C,  the  in-
vesting cartilage, thin at the sides  and thick in the centre.
  Cartilage grows thinner, harder, and less elastic in old age.  Hence
old  people are not quite as tall as in middle life, and a little stiffer in
their joints.
  The synovial membrane is a thin layer covering the cartilage, and
being bent  back upon the inner surface of the ligaments, it forms a
closed sack.  From its inner surface  a sticky fluid oozes out, which
helps the joints to  play easily.
 
26
ANATOMY.
  There are other smaller  sacks  connected with  the  joints,  called
bursa mucosas.  They secrete a fluid similar to that  from the syno-
vial membrane.
  The ligaments.  To retain the bones in their places at the joints,
some strong, flexible straps are required to stretch across from one to
the other, and to firmly unite them.  Such are the ligaments.
  They are  the pearl-colored, lustrous, shining parts about the joints,
in the form of straps  and cords.   There are a number of them so
woven together as to form a complete covering of the joint, called a
capsular ligament.  In Figure 17 : 1, 2, are ligaments extending from
the  hip bone, 6, to the femur, 4.  In Figure 18:  1, is the socket of
Fig. 17.                    Fig. 18.              Fig. 19.
the hip joint; 2, the head of the femur, lodged in the socket;  3, the
ligament within the socket.  In Figure 19:  1, is the tendon of the
muscle  which extends the leg; 2, the knee cap (patella) ; 3, the ante-
rior ligament of the patella; 6, the long  external lateral  ligament;
4, 4, the synovial membrane ; 5, the internal lateral ligament; 7, the
anterior and superior ligament that unites the tibia with the fibula.


                     Uses of the  Bones.

  The bones are to the body what the frame  is to the house.  Thev
hold up and  retain the other parts in their proper places.   Thev fur-
nish points of attachment for the muscles, to  hold the body together
and to give it motion.  They also furnish strong, bony cavities for the
lodgement and protection of such delicate organs as the eve. the brain
and the heart.
  A single bone, examined by itself, might not seem to have  much
beauty or design about it; it might even look clumsy and misshapen.
But when all the bones are inspected with reference to each other we
immediately discover a general plan upon  which they are  made and
are compelled to admire their beautiful harmony, and'the symmetrical
grace with which  they act.  They show us that God can  command
our wonder, even in the bony frame of our bodies. 
ANATOMY.
27
                         The  Muscles.

  That part of the animal's body which  we call lean meat is com-
posed of muscles.  We have already explained that muscles are com-
posed of threads, etc., put together in great numbers, forming bundles.
So numerous are these threads and bundles in some cases, that the mus*-
cles which are composed of them, have a  strength truly wonderful
  Toward the end of the muscle, the  fibres cease, and  the structure
is so modified as to become a white cord of great density and strength.
This  cordy substance is fastened to the bone  so strongly, that it is
impossible, except in  some  rare case, to detach it.  Generally  the
bone will sooner break than  this attachment will give way.   Some-
times this cord spreads out like a membrane.  It is then called fascia
or aponeurosis.
  The fibres  of a muscle have the peculiar property of  contracting
under a nervous stimulus sent  to them by the will.  These contrac-
tions  cause them to act as pullies, and to  move the bones,  and conse-
quently the limbs and body, in such direction as the will commands.
This is the special use of the muscles.   All our movements are  caused
by them.   They pull us about, not blindly and at random, but under
the direction of an intelligent will.
  The manner  in which a muscle  acts, with the cord attached, may
be seen by examining the leg. or " drum-stick " of a fowl.  If the cord
on  one side be pulled, the claws are  shut; if that upon the other
side be drawn, they will open.  If both be pulled, they  are held fast
in one position, neither opening nor shutting.
   An examination of a piece  of  boiled lean  meat, will show  the
threads of which it is composed.  With proper instruments, these may
be unravelled, as it were, until fibres will be found not  larger than a
spider's web.  These, covered with sheaths of great delicacy, extend
beyond the fleshy fibre, and with the  cell  substance connecting  the
fibres, are condensed into tendon.
   Millions of these  sheathed fibres are gathered into a bundle, and
covered  with a sheath, and thus form  what is called a fasciculus.   A
muscle is a number of these fasciculi made into  a bundle, and covered
"with  a sheath called a, fascia.  (Fig. 1.)
   The arm is a number of muscles bundled together,  and covered,
likewise,  by a fascia.
   The fibres in a fasciculus being parallel, act together.   But the fas-
ciculous bundles, which make up a  muscle, act in various ways.
   Shape  of the Muscles. — Some  muscles  are  fusiform  or  spindle-
       fig. 20.      shaped,  so that  the  attachment  occupies but a
 --g-^BgBg—Tss*8»"3___ small space.   (Fig. 20.)
    ■"■^^^^i-*  -   Other muscles are radiate or fan-shaped. (Fig.21.)
Such  is the temporal muscle,  the  thin edge of        Fig. 21.
which is attached to the side of  the head,  without
producing an elevation or deformity.
   In  some cases* the fasciculi are arranged upon
one or both sides of a tendon.  In this  way a
 
28
ANATOMY.
great number may concentrate their action upon a single point.  Such
muscles are called penniform, — being shaped like       fig.22.
the feather end of a pen.   (Fig. 22.)
   In  other instances, the fasciculi form circular
muscles, — orbiculares, or sphincters, as they  are  called.   These sur-
round  certain openings  into the body, which they are  designed to
 fig. 23.  close, either in  whole or in part.   They surround the eye-
        lids, the anus, the mouth of the womb, etc.  (Fig. 23.)
           In still other instances the fasciculi are ranged side by side
        in rings, forming muscular tubes.  By the successive contrac-
tion of these rings,  any  substance is  driven  through the tube, — as
fpod or drink through the
gullet  of a cow.   Figure
24 is a section of the gul-
let: a, b, show the circu-
lar fibres ; c, the longitudinal.
Fig. 24.
Fig. 25.
Sometimes the fasciculi curve around in parallel layers, or interlace
                               with each  other, forming a bag or
                               pouch. By the contraction of these
                               fasciculi, the  contents of  the bag
                               will be turned  from side to side,
                               as  in  the  case of  the stomach,
                               or  driven  out  as in  that  of  the
                               heart.  Figure 25 shows the mus-
                               cles of the stomach : l, represents
                               the  fibres  running  in one direc-
                               tion ; c, in another;  e, lower end
                               of  gullet; o, pylorus;  d,  begin-
                               ning of  duodenum* or  second
                               stomach.
  Number of Muscles. — The muscles of the body are as  numerous
as the ropes of a ship, — there being five hundred or more.  Some
anatomists reckon more, some less.
  They are divided into those of the head and neck, those  of the
trunk, those of the upper extremities, and  those of the lower extremi-
ties.
  They are too numerous to be named and individually described in
this brief account of them.  A part of them  are  voluntary, that is,
under  the  control of the  will;  while another part are involuntary,
moving without reference to the will.  The heart is of the latter kind,
it being necessary for it to keep moving when the will and mind are
asleep.                                     .
  On the back there are  six layers of muscles, one above another.
Such  a number are  necessary to  perform the  numerous movements
of the back, neck, arms, etc.  Every expression of the human face, as
joy, sorrow, love, hate, hope, fear,  etc., is produced  by the gentle pul-
ling of muscles, made expressly to indicate these emotions.
  The diaphragm is a  large flat  muscle, reaching across  the great
cavity of the body, and dividing the chest from the belly.  It is pen- 
J.
ANATOMY.                         29
etrated by the food-pipe going to the stomach, and by the great blood
vessels leading to and from  the  heart.  It is shaped like the cover
of a dinner-dish, the convex surface  being turned up.  When the
breath is drawn in,  it sinks  down towards a level, thus enlarging
the chest at the  expense of the belly.   When the  breath is thrown
out, the reverse takes place.                  •

  Mode of Action. — The  contractibility of  a muscle, of which I have
spoken, is simply its power of shortening itself.   The  hand is  raised
by  the  shortening of a muscle in  front, attached to the bone  above
                 fig. 26.                 the elbow, and to a bone be-
                                     * low the  elbow.  The  con-
                                      traction  of an antagonistic
                                      muscle behind, also attached
                                      above and below the elbow,
                                      brings the hand back to its
                                      place.  Figure 26 shows how
                                      all joints *are  moved:  1,  is
                                      the bone of the arm  above
                                      the elbow ;  2, one  of the
bones below the elbow ;   3, the muscle which bends the elbow ; 4, 5,
attachments of muscle to  bones;  6, the  muscle that extends the
elbow ; 7, attachment to elbow;  8, weight in hand.   The muscle, 3,
contracts at the central  part,  and  brings the hand up to 9, 10.
  * The  complication, variety, and  swiftness of motion, executed by
muscles, are past  conception.  Every movement which a human be-
ing makes, from the heavier motions of the farmer in cultivating his
fields, up to the magic touches of the painter's brush, and the method-
ical frenzy with which the great master's fingers sweep the piano, are
all made by muscles obeying an intelligent will.


                          The  Teeth.

   The teeth are not like other bones, either in composition, method of
nutrition, or growth.  When broken they do not unite, not being fur-
nished with the necessary power  of reproduction of lost parts.
   Both the  upper and lower teeth are set into bony sockets, called
alveolar processes.  These, with the fibrous  gums, give the teeth a
very  firm setting.

   Origin. — The teeth have their origin in little membranous pouches
within the bone of the  jaw; and in their interior, have a fleshy bud.
 From the surface of this the bone or ivory exudes.   The tooth and
the bony socket are developed and rise up  together, — the  former,
when sufficiently long, pushing itself through the gum.

   Number. — The first set of teeth are only temporary, and are called
milk  teeth.  There are  but twenty of them.  Between the age of six
and fourteen, these  become loose, and  drop out, and  the permanent
teeth appear in their places. Of these there are  thirty-two, sixteen
in each jaw.
 
30                         ANATOMY.
  Names. — The four front teeth in each jaw, a, b, Figure 27, are the
cutting teeth (incisors); the next one, c, is an eye tooth (cuspid); the

                              Fig. 27*'
next two, d, e, are small grinders (bicuspids); the last three,/, g^h, are
grinders (molars).   One appears late  on each side, from the age of
twenty to twenty-four,  and is called wisdom tooth.

  Composition. — A tooth is composed of ivory and enamel.   The
internal part is ivory, which  is harder  than bone.   The coating upon
the surface is enamel, which is still harder than ivory.   That  part
which rises  above the  jaw bone is called the crown; it is this only
which is covered with enamel.  The part within the jaw is called the
root or fang;  this is composed of bony matter, through which small
vessels pass in to nourish the tooth.   Small white nerves also pass
into the tooth, — of the presence of which we have terrible evidence
in tooth-ache.

                      Use  of the  Teeth.

   The incisors  cut the  food asunder; the molars  break down its
solid parts, and grind it to a fineness which fits it for the stomach.
   In masticating the food, the lower jaw has two movements, the up
and down motion, like a pair of shears, and the  lateral  or grinding
motion.   These two movements are  performed by different  sets of
muscles.   Flesh-eating animals have  only the up and down motion ;
vegetable eating animals have only the lateral or grinding  motion;
while man has  both the up and down and  the lateral.  This seems
a pretty clear intimation that he  is to eat both flesh and vegeta-
bles.
   The teeth aid us in articulating words, and they give a roundness
and symmetry to the lower part of the face.   When well formed, and
kept in good condition, they add much to the beauty of the face, and
their deoay is an  irreparable  loss.  Their proper care and treatment
are spoken of in another place. 
ANATOMY.                         31
                   The Digestive Organs.
  The alimentary organs are the mouth, the teeth, the salivary glands,
the pharynx, the  stomach-pipe (oesophagus), stomach, bowels (intes-
tines), chyle vessels  (lacteals), thoracic duct, liver, and  sweet bread
'pancreas).
  The preparatory process of digestion, the mastication of food, takes
place in the mouth, where the food is mixed with saliva, a secretion of
the salivary glands.  Of these glands there are six, three  on each side.
  The Parotid  Gland lies in front of the external ear.  It has a duct
opening into the mouth opposite the second molar tooth  of the upper
jaw.   This is  the  gland that swells in  the disease called mumps.
Hence the disease is also called parotitis.
  The Submaxillary Claud is inclosed within the lower jaw, in front of
                                       its  angle.   Its duct opens
                                       into the mouth by the  side
                                       of the  bridle of the tongue
                                        (fraenum linguae).
                                          On each side of this string
                                       or bridle, and under the  mu-
                                       cous membrane of the floor
                                       of the mouth, lies the sublin-
                                       gual  gland, which  pours
                                       its  saliva into the mouth
                                       through seven or eight small
                                       ducts.   A disease called the
                                       frog, consists  in the swel-
                                       ling of this gland.  Figure
                                       28:  1,  the  parotid gland;
                                       2, its duct; 3, the submaxil-
lary ; 4, its duct; 5, the sublingual.
   The Pharynx is  a continuation of the
mouth, and is the cavity just below the
soft palate.  The two  passages#going to
the nose  (posterior  nares),  the one  going
to the stomach (oesophagus), and the one
going to  the lungs  (larynx and  trachea),
all meet in this cavity.  In  Figure 29: 1,
is the trachea; 2, the larynx ; 3, the oeso-
phagus ; 4, 4, 4, muscles of the pharynx ;
5, muscles of  the  cheek;  6, the muscle
which surrou nds the mouth; 7, the  mus-
cle forming the floor of the  mouth.

  The Stomach Pipe is a  long  tube, like
the fireman's hose, descending behind the
wind-pipe, the lungs, and the heart, through
the diaphragm into the stomach.   It is composed of two membranes
!aid together, like two pieces of cloth.  The inner one is mucous, the
 
32
ANATOMY.
outer muscular.   The two sets of fibres composing the muscular coat
are arranged circularly and longitudinally.   (Fig. 25.)
  The Stomach lies in the upper part of the belly, to the left, and di-
rectly  under the diaphragm.   It has  an upper opening, where the
stomach-pipe enters it, called the cardiac orifice.   This is the  larger
end of the stomach, and lies on the left side; the smaller end con-
nects with the upper bowel, at which pSint it has an opening  called
the pyloric orifice.   In addition to mucous and muscular  coats, simi-
lar  to  those which compose the oesophagus, the stomach  has  still
another over both, a serous coat, very  strong and tough, to give this
working organ additional  endurance.   Within, it has many glands to
secrete the gastric juice.
  The Intestines  or alimentary tube, or bowels, are divided  into the
small and the large intestines.
  The small intestine has a length of about twenty-five  feet, and is
divided into three parts,—the duodenum, the jejunum, and the ileum.
  Of these  three divisions, the duodenum is the largest, and is  about
a foot in length.  It begins at  the pyloric orifice of the  stomach, and
passes backward to the under surface of the liver, whence  it drops
down perpendicularly in front of the right kidney, and  passes across
the belly behind the colon, and ends in the jejunum.
  The Jejunum continues  the above, and terminates in the ileum.
  The Ileum is a continuation  of the jejunum, and opens, at an obtuse
angle, near the haunch bone, into the colon.  A valve is located here, to  «
prevent the  backward passage  of substances from the colon into the
ileum.
  At this  point the large  intestines begin, and here is situated the
ccecum, a blind pouch, or cul-de-sac,  attached to which is the appendix
vermiformis, a worm-shaped tube, of the size of a goose quill, and
from one to  six inches long.
  The Colon or large intestine, is divided into the ascending colon, the
transverse colon, and the descending colon.
  The Ascending Colon  rises from the right haunch bone to the under
surface of the liver, whence it  bends  inward, and crosses the  upper
part of the belly, below the liver and stomach, to the left side.   This
portion which crosses over is the transverse colon.  From this point, on
the left side, it turns down to the left haunch, and has the name of the
descending colon.  Here it makes a curve like the  letter S, which is
called the sigmoid flexure.
  The Rectum is the lower portion of the large intestine, terminating
at the anus.
  TI. »• Lacteals are small  vessels which  begin  in  the  villi, upon the
mucous membrane of the small bowels. From  here they pass be-
tween membranes of the mesentery to small glands, from which larger
vessels run  to another  collection of glands;  and after  passing, for a
space, from one collection  of glands to  another, at each  stage of their
progress increased in size and diminished in number, the lacteals pour 
ANATOMY.                          33
their contents into the thoracic duct.   This having passed up through
the diaphragm, out of the belly, makes a sudden turn downward and
forward, and empties its burden  into a large  vein which ends in the
right  heart.  Figure 30 : 1, is  the bowel; 2, 3, 4, the mesenteric
                         glands through  which the  lacteals pass;
                         5, the  thoracic duct;  7, the spinal column ;
                         8, the diaphragm.
                           By  the  help  of a magnifying  glass, an
                         infinite number of these small vessels may
                         be seen starting from the rough, shaggy in-
                         ternal coat of the bowel.
                           The mesentery is a thick  sheet of mem-
                         brane, formed of several folds of the peri-
                         toneum, and spread out from  the vertebras
                         like a fan.  The  bowels  are attached to
                         its edge, and are held by it  in their place,
                         and at the same  time, have  free motion.
                         Between its layers are a great number of
                         glands, which sometimes  become diseased
and swollen in childhood, and prevent the chyle from passing along to
the thoracic duct.  Thus affected, children are not nourished, and waste
away with a disease sometimes  called mesenteric consumption.
   The Liver is a large gland, lying under the short ribs  on  the  right
side, below the  diaphragm.   It
is convex on the upper  surface
and concave on the under, and
is  composed  of several  lobes.
Its office is to secrete bile.   It
weighs about four pounds, be-
ing the  largest organ in  the
body.  Figure 31 represents the
liver:  1,  being  the  right lobe;
2, left lobe ; 3, 4, smaller lobes;
10, gall  bladder ;  17, the  notch
into which the spinal column is
fitted.
   The Gail-Bladder  lies on  the  under side of the liver, and receives,
it is  supposed,  the  surplus bile, which is reserved  for  special  occa-
sions.  It opens into the gall  duct, which carries the  bile along, and
pours it into the duodenum.
   The Pancreas, Figure 32, is a long, flat gland, something like the sali-
                                        vary glands.  It lies trans-
                                        versely across the back wall
                                        of the abdomen, behind che
                                        stomach.  It secretes a fluid
                                        called the pancreatic juice,
                                        a  peculiar  kind  of saliva,
                                        the  office of which  is to
                                        emulsion  fat, so that  the
                                     5
 
34
ANATOMY.
lacteals can absorb it.  This  fluid is  carried by a duct, and poured
into the duodenum just where the bile  duct enters.
  The Spleen or milt, has  an oblong, flattened form.  It  lies on the
left side, just under the diaphragm, and close to the stomach and pan-
creas.  It is supposed to be a reservoir for holding the surplus blood
of the liver.  It was  thought by the ancients to be the seat of melan-
choly.   The blood in passing  through it loses a portion of its red
globules.
  The Omentum  or  caul  is a  doubling  and  extension of  the  peri-
toneum.   It is  a kind of  fatty body, which lies upon the surface of
the bowels, and is attached to the stomach.   Its use seems to be to
lubricate the bowels, and  especially to protect and keep them warm.
Hence it is often called the apron.

                    The  Urinary System.

  The organs of this system are devoted to separating the urine from
the blood,  and  carrying it out of the  body.   These organs are the
kidneys, the ureters, the bladder, and the urethra.
  The Kidneys  lie one  on each side of the back bone, in the lumbar
region, behind  the peritoneum. They are four or five inches long,
and two and a half broad.  They are in shape like the  kidney bean,
and weigh about  half a  pound each.   In the centre there is a bag
called  the  pelvis, which tapers like a  funnel, and forms the ureter
which  conveys  the urine to the bladder.  The texture of the kidney
is  dense, presenting  in its  interior, two structures, an external  or
cortical, and an internal or medullary.  • The  cortical portion has the
blood vessels, the medullary is composed of tubes which carry away
the urine.
  The  Ureters are membranous tubes  of the size  of a goose quill,
and eighteen inches long, which run down the  back wall of the abdo-
men, behind the peritoneum, to the bladder,  into each side of which
they empty their contents.
  The  Bladder  is located  in the pelvis or basin, in  front of the rec-
tum.  It is composed  of three coats ; the external is serous, the middle
muscular, and the internal mucous.   The external coat is  strong and
fibrous; the internal is drawn into wrinkles, which makes it thick and
shaggy ; it secretes a mucus which prevents it from being  injured by
the corrosiveness of the urine.  The urine is retained in the bladder by-
means of a circular muscle, called  a sphincter, which draws the mouth
of the organ together.   When  the quantity of urine  is so increased
as to give some uneasiness or pain, this muscle, by a sort of instinct,
relaxes and lets it out.
  The bladder is attached to the rectum, to the hip bones, to the peri-
toneum, and to the  navel, by several ligaments.   In the  female the
bladder has the womb between it and the rectum.
  This organ is wisely provided as a receptacle for the urine; which,
without it, would  produce great  inconvenience by being constantly
dribbling away. 
ANATOMY.                          35
  The Urethra is  a membranous canal which leads  from the neck
of the bladder.  It is composed of two layers, a mucous, and an elas-
tic fibrous.  Through this  channel, which  is curved in its course, the
urine passes out of the body.


                  The  Respiratory Organs.

   These  organs consist of the wind-pipe (trachea) ; divisions and sub-
divisions  of the wind pipe (bronchia);  air  cells; and the lungs  or
lights.

   The Windpipe (trachea)  extends from the larynx, — the seat of the
voice, — to the third dorsal vertebra, where it divides into  two tubes,
called  bronchia.   It runs down the  front part of  the throat, with the
oesophagus behind and between it and the spinal column.   It is com-
posed mainly of rings of cartilage, one above another.

   The Bronchial Tubes are, at the division  of the windpipe, two in
number, but they divide and subdivide until  they become very  nu-
merous.
   The Air Cells or Vesicles are small, bladder-like expansions at the
ends of the  tubes.  They are  elastic, and  swell out when the air
passes in.
   The Limgs fill the greater part of the  chest, the heart being the only
other organ which occupies much space in the cavity.  The size of
these organs is large or small, according to  the capacity of the chest.
Each lung, — for there  are  two, — is a kind  of  cone, with its  base
resting upon  the  diaphragm, and its apex  behind the collar  bone.
They are concave on the  bottom, to fit the diaphragm, which is con-
vex on its upper side.
   There are two lungs, a right and a left.  These are  separated from
each other by a partition formed from the  pleura,  and called the med-
iastinum.   Two  portions  of the pleura, coming off from the  spine,
form this partition ;  and  the heart, covered by the pericardium, lies
in the centre,  between them.   The  right lung is  divided into three
lobes;  the left into two.
   Each lobe of the lungs  is divided into a great many lobules, which
are connected by  cellular tissue.  These  lobules are  again  divided
into very fine air-cells.   Beside these,  the substance  of the lungs is
composed likewise of blood vessels, and lymphatics, and is well sup-
plied with nerves.
   In the  fetal state, before the lungs have been filled with air, they
are solid  and  heavy, something like other flesh, but after all their cells
have been filled with air, and breathing has been established, they are
exceedingly light and spongy, and float upon water.
   In cases where the murder of children is suspected, and where it is
desirable to know whether  they were still-born, or born alive and killed
afterwards, the specific  gravity of the  lungs,  compared  with water,
will often settle the question. 
36
ANATOMY.
                The Organs  of Circulation.

  The food having been digested, changed to chyle, absorbed by the
lacteals, carried  to  the  veins, poured into the right heart, sent up to
the lungs, and prepared for nourishing the body, will still  be useless,
if not distributed to every'part of the system.   The organs for effect-
ing this distribution, are the heart, the arteries, the veins, and the cap-
illaries.
  The  Heart is  placed  obliquely in the chest, with one lung on each
side, and is enclosed between the two folds of the  mediastinum.   Its
form is something like a cone.  Its base is turned  upward  and back-
ward in the direction of the  right shoulder; the apex forward and to
the left, occupying the  space between the fifth and sixth  ribs, about
three inches from the breast-bone. It is surrounded by a membranous
case or sac, called the pericardium.
  The heart is a muscular body, and has its fibres  so interwoven that
it is endowed with great strength.   It is a double  organ having two
sides, a right and a left, which are divided from each other by a mus-
cular partition, called a septum.  The right heart sends the blood to
the lungs; the left heart distributes it to the general system.   Each
side is divided into two compartments, an auricle and a ventricle.
  The  Auricles have thinner walls than the ventricles, being only reser-
voirs to hold the blood until the ventricles force it along to other parts.
  The  Ventricles  have  within them fleshy  columns, called columnar
carnece.   The walls of the left ventricle  are  thicker than those of the
right, being required  to contract with more force.   Each of the four
cavities will contain from one and a half to two ounces of blood.
  The  Tri-cuspid valves are situated between the auricle and ventricle
on  the right side, and  consist of three folds of  a thin, triangular
membrane.   The mitral valves occupy the same position on the left
side.   Small white cords, called chordce tendince, pass from the floating
edge of these to  the columnar carnese, to prevent the backward pressure
of the blood from carrying the valves into the auricles.
   The pulmonary artery is the outlet of the right ventricle; the larger
artery, called aorta, of the left ventricle.   At the
opening of these  arteries, are membranous folds,
called  semilunar valves.  Figure 33 gives  a fine
view of the heart: 1, is the  right auricle;  2, the
left auricle ; 3, the right ventricle; 4, the left ven-
tricle ; 5, 6, 7, 8, 9, 10, the vessels which bring the
blood to and carry it away from the heart.
  The Arteries  are the round tubes which  carry
the red blood from the left side of the heart to
every part of the body.
   The sides of  arteries are stiff and hard, and do
not  fall together when  empty.   They may often
be seen open in a piece of boiled beef.
   The arteries have three coats, — an external, which is cellular, firm
 
ANATOMY.                          37
and strong; a middle, which is fibrous  and elastic; and an internal,
which  is serous, and smooth, being a  continuation of the lining of
the heart.  They are surrounded by a  cell vestment called a sheath,
which  separates them from surrounding organs.

  The  Pulmonary Artery starts from the right ventricle in front of the
opening of the aorta, and ascends to the under surface of the aortic
arch, where it  parts into two branches, sending one to the right, the
other to the left lung.  Having divided and subdivided to a great extent,
they end in the capillary vessels, uniting, joining their mouths, and
becoming continuous with the pulmonary veins just where they pass
around the air-cells.

  The Aorta is the largest  artery in the body.  It takes a slight turn
in the  chest, called the arch of the aorta, from which are given off the
arteries which  carry the  blood  to the  head, etc.;  thence it  descends
into  the belly along the side of  the back bone, and at the bottom of
the abdomen it divides into two arteries, called the iliacs — one going
to each of the lower limbs.   The branches the aorta gives off supply-
red blood to every part of the body.

  The  Veins carry the dark or purple  blood.  Being made red and
vital by meeting atmospheric air in the lungs, and then conveyed to
every part of the body in the arteries, the blood loses  its redness in
the capillaries, and comes back to  the  heart in the veins, dark and
purple, and unfit to support life.  The veins are more numerous and
nearer the surface than the arteries.   They have, likewise, thinner
walls,  and  when  empty, they collapse  or fall together.  They begin
in the small capillaries, and running together, they grow larger and
larger, and finally  form* the great trunks which pour  the dark blood
into the right auricle.  The veins are composed of three coats, similar
to those of the  arteries, with the exception of being thinner and more
delicate.   These vessels have valves all  along their inner surface, to
aid in  circulating the blood.
   The large vein which  receives all the dark  blood from  above, and
pours  it into the right, auricle, is called  the vena cava descendens; the
one which  takes it from below, and disposes of it in the same manner,
is the  vena cava ascendens.
   The pulmonary veins bring the red blood from the lungs to  the left
auricle, and thus  are exceptional in their use, — being the only veins
which carry red blood.

  The Capillaries  are  the extremely fine net-work of vessels between
the ends of the arteries on the one side, and of the veins on the other.
They  inosculate,  or join their mouths to the very small arteries at
one end, and  to the  equally small veins  at the other.   They  are the
industrious little builders of the human frame.   Receiving the blood,
red, and  full of life, from the terminal extremities  of the arteries, they
take the living particles out of it, and apply them to the renewing
and vitalizing of  the body, and then pass it along into the hair-like
beginnings of the veins, dark and bereft of vitality, to be carried up for 
38
ANATOMY.
another freight of chyle, and to be again  vitalized by being touched
in the lungs by the breath  of heaven.
   In Figure 34 we have a good ideal illustration of the whole circu-
lation.  From  the right ventricle
of the heart, 2, the dark blood is
thrown into the pulmonary arte-
ry, 3, and its branches, 4,4, carry
it to both  lungs.  In the capillary
vessels, 6, 6, the blood comes in
contact with the air, and becomes
red  and vitalized.  Thence  it is
returned to the left auricle of the
heart, 9, by the veins, 7,8. Thence
it passes  into  the  left  ventricle,
10.  A forcible contraction of this
sends it forward into the aorta, 11.
Its branches, 12,13,13, distribute
it to all parts of the body.   The
arteries terminate in  the capilla-
ries, 14,14.  Here the blood loses
its redness, and goes  back to the
right auricle, 1, by the vena cava
descendens,  15,  and  the  vena
cava ascendens, 16.   The tricus-
pid valves, 17, prevent the reflow
of the blood from the right ven-
tricle to the right auricle.   The
semilunar valves, 18, prevent the
blood from passing back from the
pulmonary artery to the right  ventricle.   The mitral valves, 19, pre-
vent  its being forced back from  the  left  ventricle to the left auricle.
The semilunar valves, 20, prevent the  backward  flow from the aorta
to the left ventricle.
.   By a careful examination of this diagram, with these explanations,
the reader may understand the circulation  very well.
   The  passage of the blood from the right heart, through the lungs,
and back  to the left heart,  is called the lesser, or pulmonic circulation;
its passage from the left heart through all  parts of the body, and back
to the right heart, is the greater or systemic circulation.

                   The Absorbent Vessels.

   The  vessels  which absorb the chyle from the  small intestines, and
convey it onward towards  the blood, are the  lacteals.  They have
been described.  The veins are also  supposed to have the  power of
absorption, particularly the small commencement of the veins.  These
have likewise been described.
   The Lymphatic vessels  resemble the lacteals.  They abound in the
skin, the mucous membranes, and the lungs.   They are very small at
their origin, and, like the veins, they increase  in size, as they diminish
 
ANATOMY.
39
Fig. 35.
in numbers.  Like the veins, too, they travel towards  the  heart, and
their contents are poured into it.  Their walls are composed of two
coats ; the external is cellular, and distensible ;  the internal is folded
into valves, like that of the veins.
   These vessels, on their way to the  heart,  pass  through soft  bodies,
called  lymphatic glands,  which bear to  them the  relation that the
                                 mesenteric  glands do to the  lac-
                                 teals.  These glands are a collection
                                'of  small  vessels.  The  lymphatic
                                 glands  are  most numerous in the
neck, chest, abdomen, arm-pits, and groins.  They are  also found, to
some extent, in other parts of
the body.  Figure 35 shows  a
single lymphatic vessel, much
magnified ; Figure 36 exhibits
the valves along one  of the
lymphatic trunks; Figure 37
shows a lymphatic gland, with
the vessels passing through it.
Fig-
Fig. 37.
  Figure 38  represents  the
lymphatic vessels and glands.
1, 2, 3, 4, 5, 6, show these  ves-
sels of the lower limbs; 7, the
inguinal glands; 8,  the com-
mencement  of  the  thoracic
duct, into which the  contents
of the  lymphatics are poured ;
9, the  lymphatics  of the  kid-
neys ;  10, those of the stom-
ach ;  11, those  of the liver;
12, 12, those of the lungs; 13,
14, 15, those of the  arm; 16, 17, 18, those of the face and neck; 19, 
40                         ANATOMY.
20, the large veins ; 21, the thoracic duct; 26, the lymphatics of the
heart.
   A cold will often  cause lymphatic glands to swell.   These swell-
ings are called kernels.   They often swell, also, without the irritation
from cold, and become very much and permanently enlarged, particu-
larly in scrofula.  In scrofulous subjects  they sometimes  suppurate
and break, forming bad sores upon the neck.

                 The  Organs of Secretion.
   The exhalants, the follicles, and the glands are the organs of secre-
tion.
   The Exhalants are the sweat-glands.   These have external termina-
tions  upon the skin, thus communicating with the air, and internal
terminations  upon the surfaces of organs not having an outward ex-
posure.
   The Follicles are small sacs, located in the true skin and mucous
membranes.   The pores of the skin  are the mouths or outlets of these
little bags.  Veins and organic nerves are sent to these vessels.
   Glands  are  soft organs, having a variety of structure, and perform-
ing many kinds of  secretion.   A  gland is
made up of  several lobules, united in one
mass, and each of these  lobules  has a small
duct  communicating  with  a  main  duct
which forms the  outlet.   Figure 39 shows a
gland;  2, the  small ducts spread through its
body,  and running  together;  1, the  large
duct,  through which the secreted substance
is. carried away.
   The  mesenteric   and lymphatic  glands
merely  modify the fluids which pass through them;  others secrete
from  the  blood  either fluids to be used in the body, or  such as are to
be cast away.

                     The  Vocal  Organs.
   No sounds touch the  heart like those of  the human voice, for no
mechanic, however scientific  and skilful, has ever been able to make
an  instrument which could  produce sounds as beautiful, tones  as
varied, a timbre as melodious, and inflexions as manifold and agree-
able.   It has been compared to wind, reed, and stringed instruments.
In touching expression, it is most resembled by the concert-horn, the
bassoon, and the hautboy.
   Vocal sounds, past all question, are produced  in the larynx,  but
these  sounds  are grouped,  or formed  into articulate speech, by  the
pharynx, the nasal cavities, the tongue, the teeth, etc.
  The Larynx is a kind of cavity or tube at  the top of  the  windpipe,
formed by the union  of five cartilages, namely, the thyroid, the cricoid,
the two arytenoid, and the epiglottis.   Ligaments bind these together,
and muscles move them.
 
ANATOMY.
41
Fig. 40.
Fig. 41.
   The Thyroid Cartilage  is composed  of two parts, and has a con-
nection with  the bone of the tongue above, and with the cricoid car-
tilage below.
   The Cricoid Cartilage is  shaped like a ring, and hence its  Greek
                  name.   It is narrowest in front, and  broadest  be-
                  hind.  It connects with the thyroid cartilage above,
                  and with the first ring of the trachea below.  Fig-
                  ure 40 gives a side view  of the cartilages  of  the
                  larynx  : 1, bone at the base of  the tongue (os hyo-
                  ides) ;  2, the  ligament connecting hyoid bone  and
                  the thyroid  cartilage ; 3, the front of  the thyroid
                  cartilage; 4, the  thyroid  cartilage ;  6, the cricoid
                  cartilage ; 7, the windpipe.
                    Figure 41 is a back  view of the  cartilages  and
                  ligaments of the larynx : 1, is
                  the back surface of the epiglot-
                  tis ; 3,  3, the os  hyoides; 4, 4,
                  the lateral  ligaments connect-
ing the os hyoides  and the thyroid cartilage ; 5,
5, the back face of the  thyroid cartilage ; -6, 6,
the arytenoid  cartilages ;  7, the cricoid cartilage ;
8, the first ring of the windpipe.
   The Arytenoid Cartilages are upon the back
part of the  cricoid, and are connected with  the
thyroid cartilage by the vocal cords.
   The Epiglottis is a fibro-cartilaginous lid, shaped
like a leaf of parsley, which covers the upper open-
ing of the larynx.   It is connected  by a cartilage
to the bone  of the  tongue (os  hyoides) and  to  the thyroid cartilage.
Breaching opens and shuts it; and in swallowing, it closes down upon
the top of the larynx, to prevent food  and drink from  passing  down
the windpipe.
   The Vocal Cords are two ligaments, formed of  elastic  and parallel
                         fibres, enclosed in a fold of mucous  mem-
                         brane.  They are about two lines in width,
                         , and inserted behind  into the  anterior pro-
                          jection  of  the  arytenoid cartilages, and
                         passing forward, are fixed to  the  anterior
                         angle of the thyroid.   There are four liga-
                         ments crossing the larynx,  two  superior,
                         and two inferior, — the  latter being called
                         vocal cords.  The interval between them
                         is the glottis.   The  ligaments themselves
                         are sometimes called the lips of the glottis.
                         The depression between the  superior and
                         inferior ligaments  is the ventricle of  the
                         larynx.
   Figure 42 represents a  view of the larynx  from above : a, b, c, the
thyroid cartilage,  enclosing the ring of the cricoid; h,  h,  e, ey the
Fig. 42.
 
42
ANATOMY.
arytenoid cartilages connected by the transverse  arytenoid muscle;
i, i, the vocal cords ; o, o, the crico-arytenoid ligaments.            »
   The muscles  which are attached to the cartilages, have the power
of pulling  them about so  as to change in various ways the shape of
the laryngeal cavity ; to enlarge  or diminish the size of the glottis ;
and to relax or tighten the vocal  cords.  By these means, and some
others, the sounds  of the  voice receive their various modifications.
Tightening the cords, for example raises the pitch.             ,


                           The  Skin.

   The skin  is a membrane composed of two  layers, covering the
entire person.  The outer layer is the scarf-skin or cuticle; the inner
is the true skin or cutis  vera.  These layers  differ in their structure
and uses.
  The  Scarf-Skin,  called also cuticle, and epidermis, is  a thin  mem-
brane,  partially transparent, like a thin shaving of horn.   Having  no
blood vessels or nerves, and conse-         ,      ,„  .„
                     '                   *      i ig. 43.
  The lower, softer, and more  newly-formed  layers of the scarf-skin,
are the seat of color.   In this part, the cells contain a pigment, incor-
porated with  the elementary  granules, which gives to the various
races their several  shades of color.   The  depth of hue is dependent
entirely on the amount of this  coloring matter.
  Some  physiologists describe the skin as composed of three layers,
— reckoning this colored part of the cuticle as one, and naming  it
rete mucosum, or the mucous coat.

  The True Skin, which is called cutis  vera, and corium, is a kind of
web, woven of small fibres collected  into  strands.   In the upper por-
tion, the web is fine and firm, but grows coarser below.  Connected
with  its  under surface is a fibrous web in which the fat is deposited.
Upon its  upper surface is the sensitive or papillary layer, composed
of blood vessels  and  nerves, doubled  into  loops, which  give little
prominences called papillae.  Figure 43 gives an ideal  view of these
elevations, composed, as they are, of a nerve, an artery, and a vein,
lying side  by side: 1, 1, represent the  true skin; 2, 2, the papillary 
ANATOMY.
43
layer;  3, 3, the arteries; 4, 4, the  veins;  and 5, 5, the  nerves of the
papillae.
  The arteries, veins, and nerves  are spread over the true  skin in
great numbers, — so  profusely, that it is impossible to push the point
of the finest needle into it, without  piercing a blood  vessel and a
nerve.
  Figure 44 gives a  view of  the skin: a,  a, the  cuticle ; b, b, the col-
ored layer of  the  cuticle ;  c, c, d, d, the true skin;  e, e, e, fat cells,
f>fif>  sweat tubes.
                                              Fig. 46.
                                                 4
Fig. 45.
  The lymphatics are very numerous  in  the  skin, beside  which there
are oil glands and tubes, and sweat glands and tubes.
  The Oil Glands are  imbedded in the  skin, and communicate  with
the surface by small  tubes.  They are  most abundant  on the  face,
nose and ears.   Figure 45 shows an  oil gland*, —a, being  the gland,
b, the tube, and c, its mouth.
  The Sweat Apparatus  consists of small  tubes which pass  down
73 
44                          ANATOMY.
through the  true  skin, and terminate in the  meshes at the bottom,
where it coils upon itself into a kind of bundle, called the perspira-
tory gland.  Figure 46 gives one of these tubes, with the gland, mag-
nified forty diameters:  1, being the coiled tube  or gland ;  2,  2,  the
two excretory ducts from the gland.   These uniting, form one spiral
tube, which opens at 4, which is the surface of the cuticle ;  3, are the
fat  cells.
  The hair and the nails are appendages of  the skin.
                    The Nervous System.

  The Nervous System consists of the brain and spinal cord, connected
with each other, and called the cerebrospinal axis; the cranial nerves;
the spinal nerves and the sympathetic nerve.

  The Brain is that mass of nervous matter lodged within the skull
bones.  It is made up of three parts, — the cerebrum, the cerebellum,
and the medulla oblongata.   These are  nicely covered and  protected
by three membranes, the dura mater, the arachnoid, and the pia mater.
  Figure  47 shows  a considerable portion  of the brain,— the skull
bones  and  membranes  being  re-
moved.   The scalp  turned  down is
represented by a,  a ; e, e, e, show
the cut edge of the  bones ; c, is  the
dura mater, drawn up with a hook ;
f, the convolutions of the brain.
  The Cerebrum is  the upper  and
larger portion  of  the brain, and is
divided  into two  hemispheres  by a
fissure.  A portion of the dura mater'
dips into  this cleft, and from its re-
semblance to a sickle, is called  the
falx  cerebri.   The   design  of  this
seems to be to support  each half of
the brain, and  to prevent it  from
pressing upon the other half when
the head reclines to one side.
  The  undulating  surface  of  the
cerebrum  is  produced by what are called  convolutions.   The lower
surface  of this organ is  divided  into three  lobes, — the anterior, the
middle, and the posterior.
  The  surface of  the cerebrum  is of a gray color, calle'd  cortical, or
cinerilious; the central portion is white, and is called medullary.

  The Cerebellum is about  one-sixth the size of the cerebrum.  It
lies just under the posterior lobe of the  cerebrum, and is  separated
from  it by an  extension of the dura mater, called the tentorium.  It
is composed of white and gray matter; when the  former is cut  into,
there is presented  the appearance of the trunk and branches of a tree,
called arbor vitce.
 
ANATOMY.                          45
  The Medulla Oblongata is the top of the spinal cord ; but being with
in the enclosure of the skull, it passes for a portion of the brain.  It
consists of three pairs of bodies, united so as to form a bulb.
  The Dura  Mater is a strong, fibrous membrane which lines  the
skull and spinal column, and sends processes inward  to  support the
brain, and  forward, as sheaths for the  nerves which go out from the
brain and spinal cord.
  The Araclmoid  is a serous  membrane, and like all other serous
membranes, is a closed sac.  It is reflected upon the inner surface of
the dura mater.
  The Pia Mater is a vascular membrane, and lies next to and invests
the whole  surface of the brain, — dipping into its convolutions.  It
furnishes nutriment to the brain.
  The Cranial Nerves which go out  from the brain  are in  twelve
pairs.  In  reading a description of them, let the reader keep his eye
on  Figure  48.
  The First. Pair,  olfactory (6),  passes  through several  small open-
                                      ings in the ethmoid bone, and
                                      is  distributed  to  the  mucous
                                      membrane  which  lines  the
                                      nose.   Destroy this, and  the
                                      sense of smell is gone.
                                        The Second Pair, optic nerve
                                      (7), passes  through the  base
                                      of the skull, and enters  the
                                      cavity of the eye, where it is
                                      expanded  upon the retina.  It
                                      is  a  disease  of   this  nerve
                                      which occasions  a  gradual
                                      loss of sight, called amaurosis.
                                        The Third Pair, motores oc-
                                      ulorum (9), passes through the
                                      sphenoid bone to the muscles
                                      of the eye.
  The Fourth Pair,  patheticus  (10), passes to the superior oblique
muscle of  the eye.
  The Fifth Pair,  trifacial  nerve (11), like  the spinal nerves, has two
roots, and  divides into three branches,— one going to the eye, fore-
head, and  nose, and called the ophthalmic branch;  another going to
the eye, the teeth of the upper jaw, etc., called the superior maxillary;
and the third going to the ear, the tongue, and the teeth of the lower
jaw, and called the inferior maxillary.  It is a painful condition of
the branches of the fifth pair, which  constitutes the terrible neuralgic
affection called tic douloureux.
  The Sixth Pair, abducentes  (12), passes through the  opening by
which the carotid artery enters  the cavity of the skull, and goes to the
external straight muscle of the eye.
 
46                          ANATOMY.
     The  Seventh Pair, portio mollis (13), is distributed upon  the inter-
   nal ear.
     The  Eighth Pair, facial nerve (14), is  distributed over the face.  It
   sends nervous filaments to the muscles.
     The  Ninth  Pair, glosso-pharyngeal nerve (14), passes through the
   same opening with the jugular vein, and is distributed upon the mu-
   cous membrane of the tongue and throat.
     The Tenth  Pair, pneumogastric nerve (15), sends its branches to the
   pharynx, larynx, stomach-pipe,  lungs, spleen, pancreas, liver, stomach,
   and bowels.
     The  Eleventh Pair, spinal accessory nerve (16), connects  with the
   ninth and tenth pairs, and is distributed to the muscles of the neck.
     The  Twelfth Pair, hypo-glossal nerve (17), goes to the tongue, and
   is its motion-producing nerve.   It is a nerve of great energy in those
   who talk much.
     The  Spinal Cord extends from the medulla oblongata, where  it is in
   connection with the brain, down to the second lumbar vertebra.  The
   upper  end of the cord presents a bulbous  swelling, or enlargement.
   Another swelling is found where the nerves are given off which go to
   the upper extremities; and  a  third  near the end of the cord, where
   the nerves begin which go to the lower extremities.
     Fissures dip into the cord before and behind, and divide it into two
   lateral  parts,  which are united by a thin layer of white substance.
     These lateral columns are divided by furrows into anterior, lateral,
   and posterior columns; —the anterior  being  supposed to be  the
   motor column, the posterior that of  sensation, and the lateral divided
   in function between motion and sensation.

     The  Spinal Nerves, connecting with the cord, are in pairs, of which
   there are thirty-one.
   Each pair has two
   roots, — a   motor
   root, C, Figure 49,
   arising  from  the
   anterior columns of
   the   cord,  and  a
   sensitive  root, D,
   springing from the
   posterior columns.
   A,  is a section of
I   the  cord, surround-
j   ed   by  its  sheath.
I   B, is the spinal nerve, formed by the union  of the motor and sensitive
j   roots.   After  the  union, the nerve, with its motor and  its sensitive
|   filaments, divides  and subdivides as it passes on, and is distributed to
!   the tissues of the  several organs.
     The thirty-one pairs of spinal nerves  are divided into eight pairs of
   cervical, twelve pairs of dorsal, five pairs of lumbar, and six pairs of
   sacral nerves.
 
ANATOMY.
47
  Figure 50 gives a view of the brain and spinal cord, with the nerves
given off by the latter:  1, 1, being the two hemispheres of the brain ;
3, 3, the cerebellum ;  4, the olfactory nerve; 5, the optic;  7, the third
pair; 8, the pons varolii, so called; 9, the fourth pair; 10, the lower
portion of the medulla oblongata; 11, 11, the spinal  cord ;  12, 12,
the spinal nerves; 13, 13, the brachial plexus;  14, 14, the lumbar and
sacral plexus.
Fig. 50.                                Fig. 61.
  The Brachial Plexus is formed by the interlacing of the four lower
cervical and  upper dorsal  pairs of "nerves.   It  gives off  six nerves,
which are distributed to the muscles and skin of the upper extremities.
  The Lumbar and Sacral Plexus is formed by the last dorsal and five
lumbar nerves, from which nerves go to the muscles and skin of the
lower extremities, and  the  last lumbar and four sacral, from which
nerves are sent to the muscles and skin of the hips and .lower extremi-
ties.
  The Sympathetic Nerve consists of a series of knots (ganglia), lying
along on each side of the spinal column, and forming a knotted chain.
There is a knot for each intervertebral space, the neck excepted.  These
knots are  composed of both cineritious and medullary matter. 
48                          ANATOMY.
  Each knot is a distinct centre,  and gives off branches upward,
downward, externally, and internally.   All the internal  organs are
supplied  with branches from the sympathetic nerve.  It is called the
nerve of  organic life,  and is supposed to preside over nutrition, secre-
tion, etc., as the nerves of the brain  and cord preside over motion and
sensation.
  Figure 51 is a fine representation of the great sympathetic, with
its knots, and connections with other nerves.   A, A, A, is  the semilu-
nar ganglion and solar plexus, lying just under the diaphragm and
behind the stomach.   Its presence  in this region is the reason wThy a
blow upon  the pit of the stomach sometimes  destroys life.  D, D, D,
are the thoracic ganglia ; E, E, the external  and internal  branches
                         of the same ;  G, F, the right and left coro-
                         nary  plexus upon the heart;  I, N,  Q, the
                         inferior, middle, and superior cervical gan-
                         glia ;  1, the  renal plexus  around the kid-
                         neys ; 2, the lumbar ganglion; 3, the inter-
                         nal branches; 4,the  external branches; 5,
                         the aortic plexus.
                          Figure  52 represents  a plexus, showing
how the filaments of one nerve  pass to be enclosed in the sheath of
another.  In this way they change at once the direction of their jour-
ney, and their companions upon the way.


                   The Organs  of Sight.

  The organs  of vision are  the optic nerve, the globe of  the eye, the
muscles of the eye, and the organs of protection.

  The Optic Nerve begins by two roots at the base of the brain, the
fibres from  each of which meet, as they
come  forward, and some of them cross
each other.   The two nerves then sepa-
rate, and enter the  back part of  the
globe of  the eyes, and then  spread  out
into a kind of membrane.  In Figure
53: 1,1, show the  globe of the eye;
2,  the crossing  of the optic nerve ; 8,
the origin of two pairs of cranial nerves.

  The Globe of the Eye is a better con-
structed  optical instrument  than man
ever made.  Its interior  is filled with
what  are  called refracting humors or
mediums, which are surrounded  and  held in their place by membranes,
called coats.

  The Coats are the sclerotic and cornea;  the choroid, iris, and ciliary
processes;  'and the retina.

  The Sclerotic Coat is a fibrous membrane, covering the largest portion
 
ANATOMY.
49
of the globe.  To this the muscles are attached.  It is th# part which
is  called  the  white of the eye.   It  has a beveled  edge in front, into
which the cornea is fitted.

  The Cornea is a transparent layer which projects in front, and forms
about one-fifth  of the globe.  It is  shaped like  a watch glass.  Its
blood-vessels are too small to receive the red particles of blood.

  The Choroid Coat is a vascular membrane.  Its color is brown exter-
nally, and black within.   It  is connected with the sclerotic coat ex-
ternally, and internally with  the retina.   It  is composed of three
layers.                                     .

   The  Iris  is named  from its  having a variety of color in different
persons.  It is'the partition between the anterior and posterior cham-
bers of the  eye, and has a circular opening in the centre called the
pupil.   Of its two layers, the fibres of the anterior one are radiating,
and dilate the pupil, while those of the  other  are circular, and cause
its contraction.

   The  Ciliary Processes are  a number of folds formed from the inter-
nal layer of the choroid coat.

  The  Retina has  three layers.   The external is extremely thin ; the
middle  is nervous, being an  expansion  of the  optic nerve;  the
internal is vascular, and  consists of a ramification of minute blood
vessels.
   The  divided  edge  of  their  coats, may be seen  in Figure  54,
namely, the sclerotic, the  choroid, and  the retina;  2, is the pupil; 3,
the iris ;  4, the ciliary process ; 5, the scolloped border of the retina.
Fig. 54.                             Fig. 65.
  The Humors of the Eye are the aqueous, the crystalline, and the
vitreous.

  The Aqueous or watery humor is situated in the chambers of the
eye.  It is an albuminous fluid, with an alkaline reaction, and a spe-
cific gravity a little greater than distilled water.
                                 7 
50                         ANATOMY.
      The Crystalline Humor is immediately behind the pupil.   It is a
   lens, and is convex both on the posterior and the anterior surface.

      The Vitreous Humor is also an albuminous fluid, something like the
   aqueous humor, but more dense.
      In Figure 55 we have in E  a good view of the cornea fitted into
   1 he sclerotic coat;  A, is the choroid; B, the pigmentum nigrum ;  C,
   the retina; K, the vitreous humor;  D,  the optic  nerve;  I, the lens;
   G, the iris, painted on the back side with pigment;  F,  the aqueous
   humor.
      The muscles of the eye, six in number, are attached to the bones
   of the orbit  behind,  and to  the cornea in front, by their  tendons.
   These tendons  give  the  eye its  pearly appearance.    In  Figure
   56, five of the muscles are indicated  by a, b, c, d, e; f,  is the optic
   nerve.
      If the  internal muscle  be
   too short, the eye is  drawn
   in towards the nose, and the
   squinting  called " cross eye "
   is  produced.

     The Orbits  are bony sock-
j   ets which enclose the eye. The
   optic nerve passes through a
   large hole at the bottom.
     The Eyebrows are the pro-
   jecting arches above, covered
   with short hair.  They prevent the sweat from running down'into the
   eyes, and also shade them from strong light.

     The Eyelids are  the curtains which  rise and fall in  front.  The
   smooth  membrane which  lines them,  is called  the  conjunctiva.   It
   secretes a fluid which  makes the eylids open and shut easily.

     The Lachrymal Gland is at the upper and outer angle of the orbit.
                        Several small ducts open  from  it upon the
                        upper eyelid, through which the tears run down
                        upon the conjunctiva.

                          The Lachrymal Canals begin near the inter-
                        nal angle of the  eye, by two small tear points,
                        which communicate with the sac at the upper
                        part of  the nasal duct.

                          The Nasal Duct is a canal about three quar-
                        ters of  an inch long, which runs  down to the
                        inferior  channel of the nose.
                          Figure  57  shows these  organs: 1, being
                        the lachrymal gland;  2,  the  ducts leading
                        to  the  upper eyelid ; 3, 3, the  tear  points
   (puncta lachrymalis); 4, the  nasal sac; 5, the termination  of the
   nasal  duct.
 
ANATOMY.
51
The  Organs of  Hearing.
  The External Ear is composed of the pavilion of the ear (the pinna),
and the auditory canal (the meatus auditorius externus).
  The  Pinna surrounds the entrance to the auditory canal.  It stands
out from the head, and is in common language called the ear.
  The  Meatus Auditorius is a canal about an inch long, partly bony
              Fig. 5S.                and  partly  cartilaginous,  which
                                  goes from the pavilion of the ear
                                  to the drum of the ear.

                                    The Bruin of the Ear  (mem-
                                  bra na tympani) is an oval-shaped
                                  thin  membrane, inserted  into  a
                                  groove around the auditory ca-
                                  nal.
                                    The Tympanum  is  a  cavity
                                  within the temporal bone.

                                    The Eustachian Tube is a chan-
                                  nel of communication between the
                                  tympanum, and the upper part of
                                  the pharynx.  The object  of this
                                  is to  convey air to the  drum of
the ear, as without air, no sound can be produced.
  The  Labyrinth  is a  series
of  chambers through  the
petrous  bone,— embracing
the vestibule a three-cornered
cavity within the tympanum;
the semi-circular canals, com-
municating with  the  vesti-
bule,  and the cochlea, which
makes two and a half turns
around  an axis,  called the
modiolus.
  In  Figure 58,  a,  is the
pavilion  of  the  ear; c, the
auditory canal; g, the mein-
brana tympani;  k, the tym-
panum ;  e, the bones of the
ear; b, the semicircular ca-
nals ;  /, the cochlea ; //, the'
vestibule ; i, the eustachian tube ; d, the auditory nerve.
  In  Figure  59,  we have a view of the  labyrinth laid open, and
highly magnified: 1, 1, being the cochlea; 2,3,  the  channels that
wind around the central point (5); 7, 7, the vestibule ; 8, the foramen
rotundum ; 9, the fenestra ovalis ; 4, 6, 10, the semicircular canals.
Fig. 59.
 
PHYSIOLOGICAL LAWS OF LIFE AND HEALTH....HYGIENE.
                  Life,  the  Infancy  of Being.

     It may be stated as a general truth that man has but just learned
  to live when he is ready to die.   We expend a large portion of our
  lives in searching out our mistakes, and in striving to  undo the mis-
  chiefs they have occasioned.   This is true in reference both to our
  moral and our physical life;  and I draw from it the conclusion that
  the present must be only the infancy of our being, and that our blun-
  ders and  consequent sufferings here, will cause us, in  the great here-
  after, to place a higher value upon knowledge, and to struggle  with
  new fortitude to rid ourselves of every bondage.
     A life which has just begun to take  shape and symmetry, cannot
  be permitted, I think, under the rule of a benevolent  Creator, to be-
  come extinct.   We shall certainly be permitted to take up the broken
  thread of  life, and, in the clearer light of the future, with the warning
  experience of the past, and surrounded by better guards,  to try again.
  In the mean time,  while here, the sooner we become acquainted with
  the laws of life, and the better we obey them, the more we shall en-
  joy-

                     The Nervous System.

    Man is  brought  into connection with the outward  world  through
  the senses of feeling, seeing, hearing, etc.   These communicate with
  the brain and mind through the nerves of sensation.
    The nervous system is  divided  into two  great  central portions,
  the brain  and the  spinal cord; and these together are called, by the
  learned, the cerebrospinal centre.   There are  numerous  pulpy white
  cords, called nerves, which at  one end  are connected  with this great
  axis  or centre,  and from thence  run to all parts of the system.  A
  portion of these nerves start from the  base of the brain and run to
|  the eye, the ear, the tongue, etc. (Fig. 48.) ;  while  another, and  a
  larger part spring  from the cord  which runs through the back-bone,
|  and are distributed over the body, and the lower extremities.  (Flo's.
  50 and 60.)  One  portion  of these cords  produce  feeling; another
  part, motion.   The former we  call sensitive ; the latter, motor.  Both
  kinds are  widely distributed  over the body.   Those which sprin"
  from the spinal cord have two roots, one uniting with  the back, the 
HYGIENE.                          53
other with the front part of the cord.  Cut off the back root, and the
part to which it is distributed loses  its feeling.   As we say in com*
                    FlQ.flo.                   mon  language,  it  be-
                                           comes  numb,  though it
                                           may  move  as well  as
                                           before.   Cut  the front
                                           root, which  is  motion-
                                           producing, and the part
                                           to  which it goes cannot
                                           move.    It  is  palsied,
                                           though it may still  feel
                                           acutely.   The numerous
                                           nerves that spring  from
                                           the  spinal  column  are
                                           pretty  well  represented
                                           in  cut 60.
                                              If the  cranial nerves
                                           of motion which go to
                                           the face  be cut, no emo-
                                           tion or passion  can  be
                                           expressed.   The features
                                           will all  be  immovable,
                                           like statuary.   To smile,
                                           l to  laugh,- to frown, to
                                           give  expression  to  the
                                           feeling  of pity,  or  an-
                                           guish,  or  love, is alike
                                           impossible.   And yet a
                                           breath of  air  upon the
                                           face will be felt as readi-
                                           ly as before.   Paralysis,
                                           or  palsy, as it is called,
                                           partial or general, is the
                                           result of injury upon few
                                           or many of these motion-
                                           producing nerves.  Neu-
                                           ralgia,  tic   douloureux,
                                           etc., arise from some dis-
                                           ease, perhaps inflamma-
                                           tion,  of  the  nerves of
                                           sensation.
   How the Mind Gets Knowledge. — Everything the mind knows of
 the external  world, it learns through the organs of  sense, which com-
 municate with it through these nerves.   Thus, the nerves are acted
 on  by external agents, and then they act on the brain and cause sen-
 sations.  When the hand is burned, the nerves of sensation run with
 the intelligence  to  the brain, which, quick as  thought, through the
 nerves  of  motion,  despatches orders  to the  muscles to  repel the
 injury.
   Comparison. — The arrangement and operation of  the nervous sys-
 
54
HYGIENE.
   tem are like those of the electric fire-alarm system of Boston.  The
   brain is the intelligent centre, like the central office at City Hall.  The
   nerves  of sensation  which carry to the brain, with electric speed, in-
   telligence of what is going on outside, are like the wires which run
   to the City Hall from the several station-boxes.  The quick carrying
   to the  brain of any information of injury done to  some part of the
   body, is like sending to  the City Hall  from a  station-box  the intelli-
   gence of fire in one of the districts.  The rapid transmission of orders
   from the mind to the muscles, is like flashing the alarm over the wires
   to every part of  the city.   And, finally, the powerful action of the
   muscles in warding off danger, is like the dashing of firemen over the
   pavements, and the energetic plying of the engines.


                            Sensations.

     An effect, produced on the mind through a nerve, is called a sensa-
   tion.  Hunger is a sensation.  It is an effect produced upon the mind
   through a certain nerve by the  condition  of  the  stomach.   Thirst,
   pain, heat, cold, are sensations in a similar sense.  Nausea is a sensa-
   tion produced by some injurious substance  acting upon the coats of
   the stomach.

     Strength of Sensation. — Some  sensations are much stranger than
   others;  some are very intense.   A very strong sensation  is  called a
   feeling.  It is common to say, «I feel cold," or, " I  feel hot."  We
   simply  mean by this, that the temperature of the  weather makes a
   very powerful impression upon us.

     Kinds of Sensation. — Sensations are either  pleasurable or painful.
   Pleasurable sensations arise from the proper exercise of some healthy
   part of the  body; and they are  a suitable  reward for  any care the
   mind may take of the corporeal organs.
     The sensations arising from a proper amount of exercise are pleas-
   urable.   The muscles  find a sort of enjoyment in  action.  He who
   leads a sedentary life, either from choice or necessity, loses much enjoy-
   ment.   Hence  there is  pleasure  in labor; and the working man,
   though  often pitied by the wealthy, is generally the happiest of men.
   The eye and the  ear, when directed to agreeable sights and sounds,
   derive the  most agreeable  sensations  from exercise.   The  air of a
   beautiful spring morning gives impressions which none can describe,
   but which all know to  be delightful.   These impressions are well
   fitted to reward us  for taking at that season, in the open air, the ex-
   ercise we so much need.

     Moral Uses of Sensations. — How little we reflect upon the amount
   of happiness it is in our power to create by making agreeable  impres-
|   sions  upon  others.   A civil and  polite address makes a pleasant im-
j   pression.  A kind word, fitly spoken, makes the heart  glad.   Heads
   of families might do much to increase  the happiness of their  domes-
   tics in the kitchen by meeting them with a pleasant countenance, and
   dropping in their ear, now and then, a word of  approval.  Such little 
HYGIENE.                          5q
acts  of benevolence are easily performed, and they make the most
agreeable and lasting impressions upon persons in the lower stations
of life, — creating attachments, in  fact, which  end only with death,
and  which in hours of future sorrow, which come to all, may refresh
us like springs of water in the desert.

                  Full many a shaft at random sent,
                  Finds mark the archer little meant;
                  Full many a word at random spoken,
                  May heal a wounded heart that's broken.
                                            Walter Scott.

   In aiming to make agreeable impressions upon domestics, we should
be governed by the simple desire to create happiness.   Their sources
of happiness are comparatively few.   They spend their days below-
stairs, — shut out from a portion of the light  of day, and  from the
refining influences of the drawing-room, — having little time for  rest
or for recreation.  How unfeeling to treat such persons with harshness,
to wear a frowning face  in  their presence, and thus  wither the  few
flowers of  happiness which bloom around them !
   Every human being is  endowed with the beautiful  nervous organ-
ism  of which I have spoken,  and is daily receiving impressions, pleas-
urable or painful, from thousands of sources.   In all the relations of
life,  it should be our aim to  touch delicately this sensitive structure.
Wives may add much to the happiness, and I may say, to  the affec-
tion of  their  husbands, by always wearing a pleasant face; and the
heart of the wife may be made light and glad  by gentle words from
the  husband.   We cannot but love those who make pleasurable  im-
pressions upon us, and we necessarily dislike such as impress us pain-
fully.   Most of the coldness  and alienations which grow up between
the  heads  of families, spring from  the  habit, of one of the parties, of
saying, or doing, or looking something  which painfully impresses the
other.  A  woman  who  habitually wears a " sour" face, cannot be
loved either by her husband or her children.   The man or the woman
who desires to be  loved, must cultivate a manner, a look, a  speech, a
life, the whole scope of which is fitted to make  pleasurable impres-
sions upon  others.   It is  against nature to love  what gives us pain.

   Agreeable Sensations, a Source of Health. — Pleasurable sensations
not  only beget love, and  increase  happiness, but they add  much to
health.  They exhilarate the spirits  and  drive  away melancholy.
 Travelling  promotes health  and  prolongs  life, by the number  and
variety of  the pleasing impressions it makes upon the mind.

   Care  of the Sick. — If the above  statements be correct,  how im-
portant, that the sick should be so dealt with as to have  none but
agreeable  sensations made upon them.  Many a life has been sacri-
ficed to the peevish temper of a  nurse.   When the nerves are weak
from disease, even  slight causes  make powerful  impressions; and if
these  impressions are of  a painful kind, the results are most deplora-
ble.   To treat harshly the sick, especially those  whose nervous system
is broken, implies either great thoughtlessness, or  extreme cruelty. A 
56                          HYGIENE.
single harsh word, which would scarcely move one when well, may
send  the same person, when sick, almost to distraction.  Every word
spoken to persons in sickness  should, therefore, be gentle and sooth-
ing.   Every feature of  the  face should express either  cheerfulness,
or tenderness and pity.
   As the painful impressions,  which disease  is making, tends to  de-
press the spirits and create melancholy, it is not expected that persons
when  sick will exhibit as amiable tempers as when well; and  for
this, all due allowance must be made.

  Effect upon the Disposition. — This  leads me to say that pleasura-
ble sensations improve the temper and disposition.  This is a fact of
very great importance, and parents should  never  lose sight of it in
dealing with their children.   There are few children but would grow
up  amiable and  useful members of society, were  they dealt with in
the gentle and tender  manner which  their young and impressible
natures require.  From the  moment the young mind wakes to intel-
ligence, it will  be occupied with something.   Parents  and guardians
should aim, therefore, to turn it to all those things  which will impress
it pleasantly, and at the same time do it no harm.  Exercise, songs,
playthings, flowers, — to the   and  other entertainments it should  be
led by gentle hands.  No thoughtful parent will ever pain a child by
harsh threats and denunciations, or  shock it by an oath.
  Bad Effect of  Unpleasant  Sensations. — If pleasurable sensations
improve the health and  temper, unpleasant ones do just the opposite.
They break down the health,  and spoil the disposition.
  They are  intended  to give  us  a warning of  impending injury.
Thus, we have  painful sensations when we have overworked the body
or mind.  The  sensation of weariness tells us that  the muscles have
worked as long as their good requires, and that they need rest.  Were
this sensation unheeded, exhaustion and entire prostration would be
the result.
  When fatigue  begins to be felt, either of body or mind, the sensa-
tion may be dissipated by strong tea, or intoxicating drink, or opium;
but to drive it away in this manner, for the purpose of working longer,
is wrong, and leads, in the end, to disease  or exhaustion.  It is said
tnat one of the most  brilliant advocates of  our  time is dependent
upon  opium for  the stimulus to carry him through his extraordinary
flights of eloquence; but his  restless motion and nervous face remind
us that he has bent his bow very nearly to the snapping point, and
that a sudden  collapse of his  vital powers, at  no distant day, may
be feared as the result of such tension.
  Persons in affliction, whose  spirits are depressed and broken  by
sorrow, should  have  their thoughts turned away from all sombre  ob-
jects and contemplations.  They should be taken into  the open sun-
light,  and be diverted by the beautiful things of nature.   They should
visit cheerful society, and open their  hearts  to pleasurable impres-
sions.
  When we permit any part of the body to remain idle, neglecting
to use it as much as we ought, unpleasant  sensations remind us of 
HYGIENE.                          57
our fault.  The muscles, when unused, waste away and become feeble.
This is sure to produce  an uneasy, nervous state of feeling, which
says to us as plainly as a sensation can, that the muscles are  hungry.
for exercise, and that it is injurious to let them rest longer.

  Need of a Healthy Brain. — In order that we may get correct ideas
of the  external world, it is  necessary that the brain, the nerves, and
the organs  of sense through which sensations are made upon the
mind,  should be in a healthy condition.   It is evident that if the in-
struments of  sensation be  diseased, the sensation cannot be natural,
and will make a false report to the mind.   It is of the highest impor-
tance,  therefore, that the brain should be sound.

   Improper Intermarriages. — This organ, like every other, may in-
herit disease  from parents.   Insanity, which springs from a diseased
brain,  is often hereditary.   When both parents are diseased, the off-
spring are of course more liable to partake of their defects.  Among
the wealthy, and  particularly among the  royal families in  Europe,
nervous  diseases  and sterility are very  common.  This arises,  in a
great part, from intermarriages among  blood relations, — a practice
under  which  any people will degenerate, and  finally perish.   The
wisdom of the Old Testament prohibition of marriage within certain
degrees of consanguinity, has been established by  the observations of
philosophers, and  the experience of mankind.  When a man  commits
the folly of  marrying his first cousin, he generally  either has no issue,
or his children are  afflicted with deafness, or some shocking form of
nervous disease.   Let those who will  transmit to their descendants a
sound mind in a  sound body, observe the laws of life, and  avoid all
marriages with blood relations.
   Need of a Good Supply of Blood. — For a proper performance of
its duties, the  brain  requires and receives a larger supply of blood
than any other part of  the system.   One tenth of  all the blood  goes
to this important organ.   If the quantity or  quality be  materially
lessened or  changed, great disturbance of the brain follows.  A large
loss of blood  occasions  dizziness and fainting.  If  an atmosphere
charged with too much  carbonic acid  gas be breathed, as in a  deep
well, the blood is  not vitalized in the lungs, so as to sustain the brain,
and unconsciousness soon follows.  If the  air be vitiated in any way,
or have its oxygen extracted, as in  large  assemblies, where  it is
breathed over several times, it becomes unfit to support the brain, and
the  result is languid feelings, inability to  apply the mind, headache,
fainting, hysterics, and other nervous manifestations.   •

   Ventilation. — This shows the  great necessity of having dwellings,
churches, and school-houses well ventilated.
   Were a  good  system of ventilation adopted in all our churches,
ministers would  seldom preach to sleeping audiences.  A congrega-
tion sitting in one of our places of public worship, where the air in  a
single afternoon is as many times used over as the minister's sermons
are in  a lifetime, can neither hear with attention, nor comprehend with
clearness. 
58
HYGIENE.
  In our school-houses, the ventilation is quite as bad, and the conse-
quences worse, because they are occupied six hours in the day instead
of three, and six days in the week in place of one.  In the small school-
houses which our children  filled to overflowing in former years, in
which  there was no ventilation, unless they happened to be  blessed
with an  old-fashioned chimney and fire-place, the  effects  upon the
nervous system of the children was  deplorable.   Many  of the dis-
eases which afflict the present generation of men and  women, had
their origin in the bad air of those crowded nurseries of education.
  Our dwellings were partly ventilated in olden time, when the open
fire-place received the "  back-log,"  the " top-stick,"  the  " fore-stick,"
and other sticks to match; but since  we have been  warmed by the
stove and the furnace, we have known little of the luxury of pure air
at the domestic hearth.

  Need of Exercise for the Brain. — Health requires that the  brain
should be properly occupied with vigorous thought.   The same rea-
sons may be given for this  as  for the  exercise of the  muscles.  It is
governed by the same  laws  which apply  to other parts of the system.
Use  improves  its  strength and vigor, — idleness causes it to  grow
feeble.   Of course the labor it is put to  should be only reasonable in
amount,  and  should  not be too long continued at  any one  time.
With the weakening of the brain, the  whole bodily forces, and indeed
the whole mental and moral character, fall into feebleness and decay.
It is a great mistake to suppose that the cultivation and even vigorous
use of  the mind, impairs  health and shortens life.  Just the opposite
is true.  Many of the most eminently  intellectual men, who  have
worked their brains hard all their  lives, have been distinguished for
long life.

  Bad Effects  of Change in Circumstances. — No  class  of persons
suffer more from nervous diseases and general ill health, than  those
who, having worked hard in early life, with little  or no cultivation of
the  mind, are  suddenly  raised to wealth, and  immediately drop  all
exercise, and fall into  habits of indolence and luxury.  The condition
of such persons would be much less pitiable, did they take up books
when they lay by the hoe  or the broom.   But they seldom do this.
Many  a  woman, in early life, has  felt the  glow of  health in  every
limb, and a thrill of pleasure, too, while  scrubbing the floor upon her
hands  and knees,  who has, in subsequent years, reclined in misery
upon her damask-covered lounge, and wondered that she could not
have the heajth of other days.  Let her  cultivate her brain, live tem-
perately, and exercise in  the open air, and  life may again have real
pleasures for her.

  Discretion in Exercising the Brain. — In exercising the  brain we
must use discretion.   We must not sit down in the morning, and ply
it with work  during  the whole day, without rest.   This would soon
bring upon it disease, or  premature  decay.   It should be worked only
until it begins to show symptoms of fatigue.  Then it should be per-
mitted to rest; or, what is better, be turned to  some new sabjeet, of 
HYGIENE.
59
a lighter, or a different character.  This often rests  the  brain better
than to entirely suspend its action.
  Overworking the Brain in Childhood. — Great care should be used
not to exercise the brain too much in early life.  Like other parts of
the system, it is tender in  childhood, and will not bear prolonged ex-
ertion.  As a general  thing, children are put to school too  early, and
made to work their brains too hard.   Great mischief arises from this
source. Children are born  with larger brains now than formerly; and
it  is no uncommon thing to see upon a child of ten years, a  head
equal  in size to that of an adult.  Children run to brain.   Precocity
in development of brain and  mind is common.  The results of stim-
ulating and hastening the unfolding of such minds are deplorable.
In  such children, the  brain should be the last thing to be cultivated.
We need not urge its  growth.   It will come forward fast enough in
spite of us.   Our chief aim should be to harden and fortify the general
constitution, so that the noble  brain  which it is required to bear up
and sustain, may long be its crown and glory.
   Yet parents are proud of their precocious children, and often reverse
this rule.   They do it thoughtlessly, and would be  terribly startled,
could  they suddenly look  into the future, and see the results of  their
folly.  Could they do so, they would see inflammation and softening of
the brain, epilepsy, insanity, paralysis, apoplexy, with all the horrors
of undescribed and indescribable nervous  affections, which, though
without a name, have  a terrible reality.
  Old People's Brains. — Persons in advanced life should be particu-
larly  careful not to overwork the brain.  In  middle life it recovers
easily from great fatigue.   In the decline of life, its powers of recov-
ery are feeble.  A single exhaustion may cause its fatal collapse.  Old
age should be distinguished for gentleness  and  moderation.   The
journey of the down-hill of life should be made by short  and  easy
stages, through regions of  diversified beauty.
   A Supply of Blood. — Every part of the system, when hard at work,
needs and must  have a very large supply of pure  blood.   Without
this, it is  torpid and  inactive.  To cause the blood  to  flow to any
particular  part, it must be exercised.  The lumberman, when in the
forest in  extreme  cold  weather, stamps his  feet violently upon the
ground, or beats them against a log, and whips his hands around his
body; and in this way makes them red and warm with a new supply
of  blood.   The stomach, when it has received a supply of food, be-
gins earnestly to turn  it over; and by this  exercise, and the stimulus
which the food supplies,  it invites large  quantities  of  blood to  its
vessels, and thus increases its power to work.  But just in proportion
that it draws  the vital  current to itself, and  augments  its own  vital
force,  it diminishes the blood in other organs, and, for the time being,
unfits them for work.  The  same may be said of the  brain and  all
other working organs.                        ,
   From this it follows that only one  organ, or set of organs, can work
effectively at the same time, and that it is improper to put  the brain
to hard work immediately after a full meal, because the stomach then 
60
HYGIENE.
 wants the blood to enable it to digest the food ;  and if the blood be
 "called off to the brain, digestion will stop.  Nor should the stomach
 be loaded with food directly after  long  and hard thinking; for the
 brain will yield up the blood to it only after its own excitement has
 had time to subside.


               Sympathetic Nervous System.

   The object of this system seems to be to bind all parts of the body
 together, and to combine and harmonize their  actions.   It takes care
 that no  part of the system acts in such a way  as to  injure any other
 part.  It exerts a controlling influence over digestion, nutrition, ab-
 sorption, the  circulation, etc.   These  are natural processes which
 need to go on while the brain is asleep  and cannot  attend to them.
 The nervous  system, of which  I speak, presides over all  those func-
 tions which are called  involuntary, — so called  because no act of the
 will is needed for their performance.  Secretion, absorption, digestion,
 and the  circulation of  the blood, all have, to go on while we sleep, as
 well as while we wake.  Were an act of the will necessary to their
 performance, as in walking, eating,  conversing,  etc., then they would
 have to cease the moment the brain fell asleep, and death would be
 the result.
   The sympathetic nerves  apprize  each part  of the system  of the
 condition and  wants of every  other part.   When the  lungs  are in-
 flamed, the stomach seems to be aware-of it, and will  receive no food,
 because this would aggravate the disease of the neighboring  organs.
 Well would it  be if human beings would exercise a like forbearance,
 and abstain from those acts of self-gratification which they know will
 injure their neighbors.

  Effects of Nervous Diseases. — Before closing these observations, I
 wish to add a few words respecting the terrible" effects of nervous dis-
 eases which characterize the present time.
  That they are far more  numerous and  afflictive  than in  former
 years, must be apparent  to the most  careless observer.  They  are
 nothing more nor less than the price we pay for a high civilization,
 and especially for our republicanism.  Among us, every man feels his
 individuality,  and  has  a motive  for thinking  and  doing his best.
 Thought and action are here unfettered ; and  if  the race is not to
 the swift, nor the  battle to the strong, every man  acts as  though he
 thought it was.  The great excitement which the struggle  for  wealth
 kindles and inflames, deranges and  shatters the nervous system  to a
 shocking degree.
  And wealth, when obtained, does its full share to weaken  the nerves.
 It brings with it high living, indolence, loss of energy, dissipation, and
 a weakening of the whole moral and physical  powers.  It need not
do this; but, in most eases, it does.
  The  result is, that, at least, every other  person  has some nervous
disease, which makes life a misery rather than a blessing.   The brain
and nerves are  too much developed in comparison with the develop- 
HYGIENE.                          61
  ment of the muscles.   Half our boys  and girls have heads as large
  as men and women.  It is common to see a boy or a girl at ten talk-
  ing and acting like a man or woman.   I do not mean by this, that
  they imperfectly imitate the actions of older persons.  It seems to be
  natural to them.   Their brains are prematurely developed, and their
  acts and thoughts have the maturity of adult life.
     What is Coming? — What will be the result of this state of things,
  no man can predict.  I  sometimes think the  race will break down;
  that that which was intended to be its ornament and strength, will be
  its destruction.  I hope not.   Yet there is danger of it.  Nothing  can
  save us but the wisdom to adopt such means as will develop all parts
  of the system alike.  No race of men can stand for many generations
  such a strain upon the nervous system, unless better means are adopted
  to counterbalance  its evil effects than are now used in the United
   States.   We have got to pause in our swift career, and look after  our
  health, or we shall become a nation of  maniacs.   No proof is needed
  of what  is here said.   There is scarce a man or a woman but  has
   in their, own person the foreshadowing  evidence of  our impending
  doom.
     Hopeful  Considerations. — It is  proper to  say the considerations.
  here presented, terrible  as they are, are  mitigated in some measure by
  others of a more hopeful character.
     Physiology and the laws of life are now better understood than at
  any former  period.  These subjects  are  getting into our common
  schools, and are  engaging the attention of  our youth.   Declining
   health  has  already made us  think  more of the  means of preserving
  it, — such as diet, exercise, bathing, travelling, and amusement   To
   encourage and intensify this hopeful direction of the public mind, I
   propose to devote a few pages to these subjects.


                       Food and  Digestion.

     From the earliest dawn of existence  to the last moment of life,  our
J   bodies are constantly changing.  Old particles of matter, when they
i   are worn out, leave their places and are thrown out of the  system.
   Were  this the whole  of the matter, our bodies would soon waste
i   away, and that would be the end of us.  But as fast as the old. mate-
I   rials are  thrown away, new ones take their places;  and it is solely
   out of our food that these new materials are formed.
i     In order that the food may be well digested, it must first be broken
11   into small particles in the mouth. The act of chewing it, is called mas-
!  tication.   During this act, if it be well performed, a large quantity of
   spittle, called  saliva, flows out of a number of glands, called salivary
  glands, and mixes with the food, forming with it  a soft mass.  In  this
I  condition, it is thrown backward into the 'top of the throat, called  the
|  pharynx.  Here, a little cartilage, called  the epiglottis, drops down
  upon  the opening into the top of the  windpipe, and prevents its en-
  trance into the breath passage; and it is pushed along into the gullet,
|  a tube which runs down behind the windpipe and lungs, and  which 
62                          HYGIENE.
  physicians call the oesophagus.  Here a succession of muscular bands,
  in circular  shape,  contract upon it, one after another, and  force  it
  down into the stomach.
    It is important that two things should be secured while the food  is
  in the mouth, namely, that it should be reduced to a good degree of
  fineness by chewing, and  that a  proper  amount of saliva  should be
  mixed with it.  If the  chewing were  not necessary, teeth would not
  have been given us; and the salivary glands would certainly not have
  been put in the vicinity of the mouth, if the mixing of water with our
  food would serve the purposes of  digestion as well.

    Eating t#«  Rapidly.— The Americans have fallen into a pernicious
  error in eating their food too rapidly.   Time is not given to chew it
  sufficiently to excite a full  flow of saliva; and  as it cannot be  swal-
  lowed in a dry state, it is not uncommon to see persons taking a sip
  of water after every second mouthful to enable them to force it into
  the stomach.   It is a habit we Americans have of cheating ourselves
  both of the pleasures and the benefits of  eating; for the only real
  pleasure of  eating arises from the flavor of  food while retained in the
  mouth, and the only benefit we can derive, comes  in consequence of
 .its proper digestion.
    The food when received into the stomach is in  the  same  condition
  as when taken into the  mouth, except that it is, or should be, ground
  fine  by the teeth, and well  mixed with saliva.
    The Gastric Juice.— The  stomach, like the  mouth, the windpipe,
  and  the gullet, is lined by a mucous membrane.  The chief office of
  this  membrane  is to secrete, or take out of the blood, a fluid which
  we call gastric juice, which means stomach juice ; for the Greek name
  of stomach  is yaarrjp (gaster).   This fluid has  not much smell or
  taste, and looks like spring water.   It has a powerful effect upon  food,
  which,  when  mixed with  it, soon undergoes an important change,
  which is apparent  to the  taste, the smell, and the sight.   What the
  nature of the gastric juice is, or how it produces its effect  upon  food,
  is not certainly known.

    Too Much Cold Water at Meals. —There  are some interesting facts
  connected with the formation of  this  fluid, of which it is important
. that  every person should be apprized.
    Its quantity and quality  depend on the amount  and healthfulness
  of the blood which flows  to the  stomach during the first stage of
  digestion.  It  is, therefore,  injurious to drink large quantities of very
  cold  water with, or immediately after; our  meals;  as this  will  chill
  the stomach, and repel the blood  from its vessels, so that but little of
  the juice can  be formed.   Digestion, in such case, must be imperfect.

    This Fluid not Secreted  Without Limit. — This fluid does not flow
  into  the stomach continuously, but only when we swallow food, and
  then, not as  long as we  please to eat, but merely till  we have taken
  what the system requires.   If, in the amount we  take, we go bevond
  the wants of nature, there will not be fluid enough formed to dissolve
  it, and the whole will be imperfectly digested, and  be a source of in- 
HYGIENE.                          63
jury rather than benefit.  This should teach us to be careful that our
food be only reasonable in arrfbunt.

  Not Secreted in Sickness. — When we are sick, the gastric juice is
either not formed at all, or only in small quantities.  Whatever  may
be our  feelings of lassitude, and however much we may appear  to
need food, at such times, it is useless to take  it, for it cannot  be di-
gested,  and will  only  aggravate* our disease.  If the illness be  only
slight, the fluid will be formed to some extent, and food may be taken
in proportion.
  Its Secretion Favored by Cheerfulness. — A cheerful disposition, and
a happy, lively "frame of mind, are highly favorable to the production
of the  gastric juice ;  while melancholy, and anger, and grief,  and
intense thought of business  at the hqur of meals, greatly hinder its
natural flow.
  This should teach us to go to  our meals with light hearts,  and  to
make the family board a place of cheerful conversation, and of  a  light
and  joyous  play  upon  the  mirthful feelings of all  present.   Should
any of the family circle be  in the habit of using vinegar as a condi-
ment, we  should never be  guilty of compelling them to extract it from
our faces. A vinegar face is not  easily excused  anywhere ;  at the
table it is unpardonable.   A single  countenance of this description
will throw a gloom over a tableful of naturally cheerful persons;  and
if habitually present at the board, may finally spoil the digestion of
half  a dozen, and entail dyspepsia upon them for life.
  The stomachs of the sick  pour out but very little of this fluid, and
they can take but a small  amount of food.  It is cruel to deprive them
of the power  of  digesting that little by treating them  harshly,  and
filling them with  gloomy and desponding feelings.  I, therefore, repeat
the substance of the advice given on a  previous page :  Deal  gently
with the sick.
  How  all this is Known. — As the stomach is wholly concealed from
view, the  reader will very  naturally ask how it is known that the  gas-
tric juice is poured into it in certain  states of the mind, etc., and with-
held in  others.  It certainly could not have been so  accurately known,
had it not been for an accident which opened  the living and  working
stomach to the inspection of Dr. Beaumont, a  United States Surgeon.
A- young  man by the name of Alexis  St.  Martin, a Canadian by birth,
but then in the State of Michigan, had a large part of his side torn away,
and  a hole of considerable size made into his stomach, by the acci-
dental discharge of a gun.   To the surprise of his surgeon, St. Martin
recovered; and the edges of the wound in the  stomach refused  to
grow together, preferring rather to fasten themselves to the borders of
the breach in the  side, thus leaving the passage open.  A kind  of cur-
tain  grew down over this, which prevented the food from falling  out.
Dr. Beaumont, taking  advantage of this state of things, instituted a
series of  valuable  experiments,  by lifting the curtain, and inserting
various articles of food, and witnessing the process of digestion.

  Movement of the Stomach. — The presence of food in the  stomach 
64
HYGIENE.
    causes  its muscular coat to contract and throw it about from side  to
    side, mixing it thoroughly with the gasfric juice, and reducing it to a
    pulpy mass, called chyme.  This, as fast as it is properly prepared,
    passes through the pylorus into the upper bowel, or duodenum, called
    also the second stomach.
      Chyme. — A certain witty professor of anatomy and physiology, is
    in the habit of asking his  class  if they ever  saw  any chyme; and
    when they  answer no, as they often  do, he calls their attention  to
    what they occasionally see in the morning, upon the'sidewalks, where
    drunken men have held  themselves up by lamp-posts, and left the
    contents of their stomachs.
      The pylorus, or opening into the bowel, has a very singular and
    wise instinct, which is worthy  of remark.   When a piece of food,
    which has not been digested, attempts to  pass into  the  bowel, the
    moment it  touches* the inner surface  of this  orifice,  it is instantly
    thrown back by an energetic contraction ;  though a portion of well-
    prepared  chyme  touching the  same opening immediately after,  is
    allowed to  pass  on unchallenged.

      Chyle. — The chyme, when it reaches the duodenum, seems to cause
    the liver to secrete bile, and the pancreas to produce  the  pancreatic
    juice.  These two fluids  are conveyed  into the upper portion of the
    second stomach, and are there mixed with the chyme, and cause it to
    separate into a delicate, white  fluid, called  chyle, and a  residuum,
    which, being worthless, is pushed onward, and thrown out of the
    body.

     Bile ill the Stomach.— Most persons suppose that bile is generally
    found in the stomach; but this is a mistake.  It is  thrown up by
    vomiting", because in that act, the action  both of the first and the
    second stomach is reversed, and the bile is forced up from the duode-
    num,— taking a  direction the opposite of its usual course.

     Destination *>f  the Chyle. — The chyle being separated  from the
j   dregs, is pushed onward in its course
|   by the worm-like motion of the in-
|   testine ; and as it passes along, it is
   gradually  sucked  up  by  thousands
   of very small vessels, whose mouths
   open upon the inner  surface of the
   bowel  These little vessels are called
   lacteals, from the  Latin  word lac,
   which  means  milk,   because  they
   drink this white,  milky fluid.  Fig-
   ure 61 shows a section of the small
   bowel, turned inside out, and covered
   with the villi, or  root-like filaments,
   closely set upori  its surface,  for ab-
   sorbing the  chyle, and at the bottom
   of which, the lacieals take their rise.
     In these lacteals, and in the mesenteric glands, the chyle is gradu-  |
 
HYGIENE.
65
Fig. 62.
ally changed,  so  as to  approach  nearer  and nearer to the  nature
                            of the blood;  but precisely what the
                            change is, or how it is effected, is not
                            known.   Several men have  published
                            their  theories  upon these points, and
                            the writer has  opinions  upon  them;
                            but it is  not  worth  while to trouble
                            the reader with them.  It is sufficient
                            to say that  the fluid is carried  by the
                            lacteals to the  thoracic  duct, through
                            which it is  conveyed into a large vein
                            at the lower part of the neck, where it
                            is poured into  the blood, and becomes,
                            after  going through the lungs and ex-
                            periencing another  and a vital change,
                            the material out of which our  bodies
                            are daily and hourly new-created.
                               Figure  62 gives a  general idea of
                            the stomach, bowels, etc.:  9, being the
                            stomach ;  10, 10, the  liver; 1, the gall
                            bladder ; 2, the duct which conveys the
                            bile to 4, which is the duodenum ; 3, is
                            the pancreas;  5,  the  oesophagus; A,
                            the duodenum; B, the bowels;  C, the
                            junction of the  small  intestines with
                            the colon;  D,  the  appendix vermifor-
                            mis;  E, the coecum;  F, the  ascending
                            colon ; G, the transverse colon ;  H, the
descending colon ; I, the sigmoid flexure ;  J, the rectum.
Nature and  Destination of Food.
  The food which  man requires for his support and development is
of two kinds, the inorganic, and the organic.  The first of these  em-
braces certain mineral substances, as common salt, sulphur, phospho-
rus, iron, and lime, either in combination or separate.
  These are  not generally reckoned as aliments, and yet no  human
being can live without them.   In their absence,  the body decays, dis-
integrates, and perishes.  Common salt is composed of muriatic acid
and  soda.  The first  is an important ingredient in the gastric juice,
and  the  latter promotes the  secretion of bile.   Sulphur is found in
several of the tissues, particularly  in the muscles.  Phosphorus united
to fatty matter, is highly honored in forming a portion of the brain
and  nerves, and is also combined with oxygen and lime to make the
earthy or hard part of bones.

  Found in Food. — These articles it is not necessary often to intro-
duce, into the system in a separate state.   They  are  contained, in
larger or smaller proportions, in most articles of food; and man always
sutlers, as all animals  do, from their absence.  Common salt is found
                              9 
66                          HYGIENE.
in the flesh of animals, in milk, and in eggs.  It is not very abundant
in plants; and we all know how eagerly domestic animals devour it
when it is given to them, and how constantly wild cattle resort to the
salt  springs,  which,  in  the great West,  are  called "buffalo licks."
Lime exists in nearly all animal and vegetable substances.  In wheat
flour we get it in combination with phosphoric acid, that is, as phos-
phate of lime.  Lime exists, too, in the state of carbonate and sul-
phate, in all  hard water.   Iron is found in the yolk of eggs, in milk,
in animal flesh, in potatoes, pears, cabbages, mustard, and other arti-
cles.  Sulphur  we get in flesh, eggs, and  milk; and, as sulphate of
lime, in spring and river water.  Phosphorus is derived from eggs and
milk; and  flesh, bread,  fruits,  and husks  of grain, commonly called
bran, contain even a  larger proportion than we need in our diet.

  Organic Food.— The  organic elements of man's food, which in bulk
embrace almost the  whole of it, remain  to be considered.   In  the
animal economy they serve two great purposes.   A part of the arti-
cles  which compose  them are blood-formers, out of which all  the
tissues  are made, — the other  part produce fat, which serves to warm
the body by being burned with oxygen.   These articles are derived
partly from the vegetable and partly from  the animal kingdom.
Fig. 63.
  Divided into Four Groups. — For convenience, these articles may
be divided into four groups.  For the first,
sugar stands as a type.   We therefore call
it the saccharine group.  It embraces starch,
gum, and the fibre of wood.  These arti-
cles may all be converted into sugar by a
simple chemical process.  Figure 63 gives a
microscopic view of the granules of starch.
  The second group we call the oleaginous.
It is  composed of oily substances,  from
whatever  source derived, whether the  ani-
mal or the vegetable world.
  The third group is the albuminous.  A
good type of it is the white of egg.
  The J'ourth is the gelatinous, or jelly group.

  First and  Second Groups,  Supporters of Respiration.—The articles
composing the first and  second groups are analogous in composition,
all containing oxygen, hydrogen, and carbon.   They are what  Liebig
calls supporters of respiration ;  the  meaning of which is, in more
comprehensible terms, that they are supporters of combustion.   They
are the fuel which warms us.  They keep the fires going, from which
arises all the heat we have in our bodies.  But they are  destitute  of
nitrogen, and, on this account, they are not blood-formers, and cannot
be worked into flesh.  Hence, man cannot live on them.
  The food articles embraced in the  third  and  fourth  groups, also
contain oxygen, hydrogen, and carbon ; and to these they add  nitro-
gen.  This fourth component part, which  forms only a small portion
of them, gives  them, for some reason never explained, the peculiar 
HYGIENE.
67
quality of producing blood and flesh.  They are the raw materials,
out of which our bodies are reconstructed from day to day.
   Feed a man ever so largely upon  sugar, starch, gum, and oils, and
he will starve as certainly as if  he were allowed nothing but water.

   Names of  Two Great  Divisions of Food. — The possession or non-
possession of nitrogen,  then, is what distinguishes from  each other
the two  great classes of food-articles.  Those which contain nitrogen
have been called nitrogenized, and  those which are destitute of it,
non-nitrogenized compounds.   As nitrogen is often  called azote, the
former class  are more  frequently named azotized;  the  latter, non-
azotized.
   Let the reader now fix it in his mind that the azotized articles  of
food produce blood and flesh; the  non-azotized, heat; and he will
have the key to understand much of what is to  be said, and likewise
to unlock many of the mysteries of diet.

   Nutrition Table. — Taking  human milk as the  standard, and ex-
pressing the  amount of nitrogen it contains by 100, the following
table shows  the relative amount of nitrogen in the principal flesh-
producing  articles  of food, and consequently their power  of forming
the tissues:

                            VEGETABLE.

Rice,.....81 Potatoes,    -----   84
Rye,   -    -    -    -  .  -   -  106 Turnips,.....106
Corn,.....125 Carrots,    -     -   -    -   ' -  150
Barley,......125 Peas,                          239
Oats,.....138 Beans,......320
Wheat,......144

                              ANIMAL.
Human Milk,     -   -    -   -  100 White of Egg,    -   -    -    -  845
Cows' Milk,    ....    237 Herring,.....910
Oyster,.....305 Haddock,.....816
Yolk of Eggs,  ----    305 Pigeon,.....756
Cheese,    ....  331-447 Lamb,......833
Eel,......428 Mutton,.....852
Pork-Ham,  -    - ' -    -   -  807 Veal,......911
Salmon,.....610 Beef,.....942

   Other Standards  of Value. — We must not infer that those articles
which have most nitrogen are  necessarily best adapted  for human
diet because  they are the most effective blood-producers.  In deciding
the value of  an  article for food, other things are to be looked  at be-
side its  nutritive qualities.   Those  which are poor  in nitrogen, are
rich in carbon and  hydrogen,  and are well fitted to serve the double
purpose  of nourishing and warming the body at the same time.  The
fitness of an  article for diet, depends  very much  upon the ease  or
difficulty with which  it is digested  and  assimilated.  If an article,
having a great  deal of nitrogen, and being very nutritive, is with
great difficulty  reduced in the  stomach  by the digestive  process, it 
68                           HYGIENE.
may be much less desirable for food than one which is digested  and
assimilated easily, but is much poorer in nutritive qualities.

  Heat-generating Food Articles. — The reader  has before him the
principal blood and tissue-forming food  articles.  Those which we
reckon as fuel, or heat-generators, are chiefly oils, sugar, starch, farina,
sago, arrow-root, tapioca, gums, etc. These are less essential than the
others ; for the blood-forming articles have within them the elements,
out of  which fat is formed in the  process of assimilation;  for  many
of them contain starch ; and this, in the human organism, is changed
into fat.  The amount of starch  in  some of these  articles is as fol-
lows :
     Wheat flour, good quality, 100, contains 65 to 66 parts in 100 pure starch.
Wheat,	- 108	u	53	4 56
Barley meal, Barley,	119 - 130	it	64 ' 37 '	' 65 ' 37
Rye, Buckwheat, -	111 - 108	u	44 ' 43 '	' 47 i 44
Indian Corn,	138	it	65 '	' 66
Rice, -	- 171	d	85 '	1 86
Peas, White Beans,	69 - 59	i<	38 < 37 '	' 39 ' 38
  In the Nutritive  Food Articles, there is a fixed relation existing be-
tween  the  elements of the  tissue-formers and the heat-producers,
which  they contain.  Out of a few of them Baron Liebig  has con-
structed the following table:

  For every ten parts of blood and tissue-formers there are, —
In Wheat flour,	10	46	In Barley, 10	57
In Rye meal,	10 -	- 57	In Rice, ' 10 -	- 123
In Oatmeal,	10	50	In White potatoes, 10	86
In Buckwheat,	10 -	- 130	In Blue potatoes, 10	- 130
  Diet a Complex Subject.— From the facts and tables now presented,
it appears that the question of diet is  one of complexity;  and that
the determination of its several points, require that a number of things
should be taken into the account.  First, in deciding the usefulness
of any article, we may inquire respecting

  Its Digestibility.— If an article be not digestible, it is of little con-
sequence how much or how little albumen, starch, or nitrogen it may
contain.   The  first  and most important inquiry respecting  it is, is it
digestible?   If not, it is to be rejected; for, whatever other  qualities
it may have, it can only injure the stomach, and embarrass the whole
system.
  The following table will be  useful to the reader, though I do not
set it down as reliable in all cases.  There is often  a great difference
in  the ease with which different stomachs will digest the same food.
Many stomachs are afflicted with what is called an  idiosyncrasy, — a
habit, peculiar  to itself, of rejecting, or  refusing to  digest, some one,
or more, articles  which  are  acceptable to  all other stomachs.  This 
HYGIENE.
69
table shows the, length of time required for digesting the several arti-
cles in the stomach of St. Martin, as shown by the experiments  of
Dr. Beaumont:
Articles.
Rice. . .............
Pig's feet, soused'. . . .
Tripe, soused.......
Trout, salmon, fresh. .
   u    u      <i
Apples, sweet, mellow
Venison, steak......
Sago.............
Apples, sour, mellow
Cabbage, with vinegar
Codfish, cured, dry.
Eggs, fresh.......
Liver, beef's fresh..
Milk..........;
Tapioca........."
Milk.............
Turkey, wild.....
    "    domesticated
 Potatoes, Irish......
 Parsnips..........
 Pig, sucking.......
 Meat  hashed . with )
   vegetables......)
 Lamb, fresh.......
 Goose...........
 Cake, sponge . .
 Cabbage-head......
 Beans, pod........
 Custard.........y
 Chicken, full-growjj .
 Apples, sour, hard . .
 Oysters, fresh!.....
 Bass, striped, fresh. .
 Beef, fresh, lean, rare
✓  "  steak........
 Corn cake........
 Dumpling, apple.. . .
 Eggs, fresh........
 Mutton, fresh......
Preparations.
Time.
 Boiled .
 Boiled .
 Boiled .
 Boiled .
 Fried. .
 Raw. . .
 Broiled.
 Boiled .
 Raw. . .
 Raw- • •
 Boiled .
 Raw...
 Broiled.
*fB«iled .
 Boiled .
4Raw. . .
 Roasted
 Boiled .
 Roasted
 Baked .
 Boiled .
 Roasted
Warmed.
 Broiled.
 Roasted
.{Baked .
 Raw...
 Boiled *
 Baked .
 Fricasseed
 Raw. . .
 Raw. . .
 Broiled.
 Roasted
 Broiled.
 Baked  .
 Boiled .
 Boiled soft
 Broiled
 Boiled
 h. m.
 1  .—
 1  —
 1  —
 1  30
 JV30
 1  30
 1  35
 1'45
 2  —
 2  —
 2  —
 2  —
 2  —
 2  —
 2  -
 2
 2
2
 2
 2
 2
 2
  15
  18
  25
  30
  30
  30
  30
2 30
30
30-
30
30
30
45
45
50
55
2


2
2
2
2
2
2
3 —
3 —
3 —
3 —
3^
3 —
3 —
3 —
Articles.
Pork, recently salted
Soup, chicken.....
Oysters, fresh.....
Pork, recently salted
Pork steak........
Corn bread ..*....
Mutton, fresh......
Carrot, orange . . . r.
Sausage, fresh.....
Begf, ?resh, lean, dry
Breaa wheat, fresh. .
Butter. ..........
Cheese, otd, strong. .
Eggs, fresh........
  11  * u
Flounder, fresh. . . ..
0ysters, fresh......
Pofetoes, Irish ...'..
Soup, mutton......
  "  oyster.......
Turnip, flat...*#..
Beets............
Corn, green, and beans
Beef, fresh, lean. ...
Fowls, domoetic
  u      ii
Veal, fresh. .'......,
Soup, beef,  vegeta-)
  bles,  and bread . . )
Salmon, salted.....
Heart, animal.....'.
Beef, old, hard, salted
Pork, recently salted
Cabbage, -with vinegar
Ducks,  wild.......
Pork, recently salted
Suet, mutton......
Veal, fresh........
Pork, fat and lean . .
Suet, beef, fresh....
Tendon ..........
Preparations.
ried- •
ried. .
Raw. . .
Boiled .
Roasted
Broiled.
Broiled.
Baked .
Roasted
Boiled .
Broiled.
Roasted
Baked .
Melted.
Raw.* .
Hard boiled
 frie
 rie
Stewed. ,4
Boiled . .
Boiled . .
Boiled . .
Boiled . .
Boiled . .
Boiled . .
Fried. . .
Boiled . .
Roasted .
Broiled. .
Boil|d . .
Boiled . .
Fried. . .
Boiled . .
Fried. . .
Boiled . .
Roasted .
Boiled . .
Boiled . .
Fried. . .
Roasted .
Boiled . .
Boiled ..
Time.
Ii. m.
3 —
3 —
3
3
3
3
3
3
3
3
3
  15
  15
  15
  15
  15
  15
  20
  30
  30
3 30
3 30
 3
 3
 3
 3
 3
 3
 3
 3
 3
 3
 4
 4
1/4
 4
30
30
30
30
30
30
30
30
45
45
4 —
4/—
4 15
15
30
30
30
30
30
15
30
30
   This  table may be considered as giving a general idea of the rela-
tive digestibility of the  food-articles contained  in it.   If  not found
exactly  right in each individual case, it can be rectified  by experience.
The experience of no other individual's stomach will  ever  be found
precisely like that of St. Martin's, — though in its general features, it
may be sufficiently similar to make his valuable.   The  general  prin-
ciples of conduct  may be learned from the experience of others.  The
particular application must come from our own experience and reason.
   Digestibility Influenced by Amount.—The rapidity with  which any 
70
HYGIENE.
article is digested will  vary with the amount taken. •  A larger qtmn-
tity than is called  for by the wants of the system, will  be digested
more  slowly than the proper amount; while, on the  other hand, an
insufficient supply begets an inability to reduce in the stomach even
the small quantity taken.   We  may err  in  taking  too little food as
well as in taking too much;  though the former error is much less
likely to occur than the latter.

  Choosing  Food  in  111  Health. — But  in  deciding the  kind and
amount of food, we must be guided  not only by its digestibility, but
by the state of the health. .
  If we find the stomach apparently in good working condition, capa-
ble  of dissolving properly whatever is submitted to  its  action, and
yet we are for some cause losing  flesh and strength, we should resort
not only to the most  nutritious of  the albuminous group of the azo-
tized articles, but likewise to the oleaginous group of the non-azotized.
We want a great amount of nutriment, and we need oils to make fat.
This is the kind of food generally wanted in constitutional  consump-
tion.
  In fevers, but little food can be  disposed of at best;  and that little
must  be chosen with reference to its mildness and its unstimulating
qualities.  Generally the farinaceous or starchy articles are most suit-
able, because they have no  stimulating and  irritating qualities, and
especially because they furnish fuel to be burned with  oxygen, and
thus take the place of the  animal  tissues, which are being rapidly
consumed with this devouring element.  In fever, oxygen is literally
burning up  the  body.   In this state of the system, this  element ac-
quires, by some means, a singular  affinity for the  tissues;  and, uniting
with them  rapidly, forms a true  combustion.  The physician who
throws to trfls devouring agent some of the mild, non-azotized articles  .
which offer it stronger affinities than it finds in the tissues, is as wise
as he who  tosses his dog to a hungry lion to avoid being devoured
himself.

  Exercise to be Considered. — In deciding the  diet, the  amount of
exercise is not less important to be  considered than the health.  The
farmer, who works in the open air,  and uses his  muscles a great deal,
wants considerably more nutritive,  as well as more combustive, food
than one who leads a sedentary life.  Of course there is a great deal
more  waste of  the  tissues, and he requires more of the flesh-forming
articles; and as he breathes deeper, and takes  in more oxygen, he
needs more of the supporters of respiration, — the sugars, oils, and
starchy aliments.

  Beans. — By turning  to the table  which shows the  amount of nitro-
gen in the different food-articles, the reader  will see  that  beans are
rich in this element.   They  are, therefore, excellent food for working
men,  who  are  obliged to make  great use  of  their  muscles.  Our
fathers, who broke and subdued the rocky  soil of New England,
showed wisdom even in their  instincts in taking so large a portion of
their aliment from the bean, — especially as they oiled it with the fat 
HYGIENE.                          71
  of pork.  But for the  hard-working student, who daily makes heavy
  drafts upon his brain and nervous system, beans an/1 peas are an im-
  proper diet.   They contain no, phosphorus, in the shape of phosphate
  of lime;  and no brain can work hard without a due supply of phos-
  phorus, which forms a  part of its substance.

    Unbolted Wheat Flour. — For the man who uses his brain a great
  deal, there is no other one article of food equal  to bread  made from
  unbolted wheat  flour.   Fine wheat flour is little better for him than
  beans, because the  miller has robbed it of  much of the phosphorus,
  which is  found chiefly  in the  hull or bran.
    I mention only two or three articles of food as specimens.  By
  looking over the tables furnished, and reasoning upon the whole in
  the  way  I have done upon these few, the reader can give every article
  something like its proper value in most circumstances.

    Climate. — If health and exercise should influence us in choosing
  the  kind  and the amount of food, climate must do so quite* as much.
    In  the frigid climate of high latitudes, it is necessary that a great
  deal of heat be produced in the body, in order to avoid perishing with
  cold.   There is no mystery now, as there once was, about the produc-
  tion of this heat.   It comes from the burning of carbon and other sub-
  stances in the body, where they unite with oxygen, and make just as
  real a fire as that which warms our houses.   Oils, sugar, starch, gums,
  etc., are largely composed of carbon, and readily unite with  oxygen
  in the body.  This is  the reason why they are reckoned as fuel, and
  are  called supporters of combustion.  And for  this reason, they require to
" be largely consumed in very cold climates.  The instincts of men seem
  to lead to the same conclusion,  for the dwellers in all high latitudes,
  consume great quantities of  oils and fats.   The amount of train oil,
  tallow, the fat of seals and other animals, devoured by the Laplanders,
  Kamtschatkians, and other northern people,  is truly wonderful.
    In hot countries,  the fundamental rule for preserving the health, is
  to keep the body cool.  Without observing this rule, the strongest will
  often fall victims to the climate in low latitudes.  But to keep cool,
  of course all the heat-producing articles of  food should be avoided.
  Particularly  all  alcoholic drinks, which are powerful supporters of
  combustion, should be  rejected.  Rice, and the various fruits form the
  most suitable articles of diet.
    The great sacrifice of life  which we have witnessed the last  few
  years  among the emigrants to  California, has  been the result chiefly
  of  using ardent spirits and heat-producing  food while crossing the
  Isthmus, which, to a northern  constitution, is much  like a vast oven,
  heated to a temperature suitable  for baking bread.  There are  few
  persons,  with tolerable health and strength, but would safely endure
  the  ordeal of the Isthmian passage, if they would live light for a few
  days before  starting; and during the passage, take only an abstemious
  vegetable and fruit diet.

    Bayard Taylor's Opinion. —  The distinguished  traveller, Bayard
  Taylor, reports that while spending a few  days in  a heated  part of
• 
72
HYGIENE.
 Africa, he lived, as the inhabitants did, pretty much entirely upon the
 flesh of well-fatted sheep ; and that  he enjoyed, meantime, excellent
 health and  strength.   From this he  concludes that animal food is as
 suitable in hot climates as in cold.
   It is a pity a  man of  such  excellent parts as Mr. Taylor, should
 allow himself to rear so tall a structure upon so narrow a foundation.
 That he could live on flesh in so hot a region, and  not be made sick,
 only proves that he has a fine constitution, and that his health is not
 easily disturbed ; and when he attempts from his limited experience
 of a few days, to reason against the established facts of science, and
 against the Well-attested  laws of life, he does it  evidently without
 reflecting that he is in a  field of thought which he has never had oc-
 casion to cultivate.
   The  great Jewish Lawgiver doubtless had a reason for prohibiting
 pork to the Jews.   Whatever that reason  was, the prohibition had a
 wise bearing  upon the health of the  people.  Palestine has  a  hot
 climate, in which pork-fat is an improper diet.

  More Fat in Winter. — It follows from  what has been said, that a
 more fatty as well as  stimulating diet is needed  in winter than in
 summer.  But the change should be made gradually.   When cold
 weather approaches, the  food should  become  more nutritious and
 warming  by little  and little.  The  exercise  should likewise  be in-
 creased.
  Even the lower  animals act upon this  plan.  In the fall, squirrels
 eat nuts, which are full of oil, and grow fat upon them.
  The instincts of men move in the  same direction.  It is in the fall
 that the hog,  the ox, and  the poultry are  killed; and in the  winter
 that they are largely feasted upon  and enjoyed.  Upon such food,
 combined with various sorts of starch, man fattens ; and a good sup-
 ply of  fat, deposited in  the cells, is equal, in  keeping out cold, to a
 layer of cotton batting, — to say nothing of the  fire kept up  within
 the body by the burning of such fuel.   As hot weather comes on, we
 gradually lay aside these fattening articles (or ought to), and return to
 the watery vegetables and fruits, such as squash, string beans, straw-
 berries, currants, etc.
  Few of us,  I apprehend, would suffer from heat in summer, if we
 could persuade ourselves  to abandon stimulating and fire-producin<*
food, and  confine ourselves pretty much to a cooling and succulent
diet.  Diarrhoeas  in summer are not induced by eating wholesome
vegetables, but by combining them with large quantities of  animal
food.

  The  State of the  Mind. — This should by no means be overlooked
in choosing the  kind  and the  amount of food.   If we have lost
friends, or heard  desponding news, or experienced  calamities  of any
kind, we must during the first hours of  the shock, or even durin«- the
first days, if the affliction be heavy,  partake  very sparingly of Ibod.
 The stomach is in no condition to receive it.  The brain lies prostrate
under the stroke, and the stomach, in sympathy with it, asks for a day
of sorrow and fasting.   Disturb it not. 
HYGIENE.                          73
   Heat-producing Food  Incompatible with Excitement. — It is folly
to take heat-producing aliment when laboring for. days  under high
excitements.  During  political campaigns, when the blood of poli-
ticians is at the boiling point, the diet should be unstimulating,—
containing very little animal flesh, and not  much combustive  food.
Many a man has died of apoplexy, or of heart disease, by putting on
the steam when his blood was up.  Whenever  we have a day of un-
common excitement to pass through, we  should always begin and
end it with  an unusual degree of abstinence  as to  the  amount of
food taken, and with special care that the articles be of the lightest
kind.

   Anger Demands Abstinence. — Anger is a passion which especially
unfits the stomach for doing much -work.  If it occur often, or be
protracted, but little food should be  taken.  Those who indulge it,
have  a double cause for abstinence.  Both their folly and their  stom-
achs call for a fast.

   Food Adapted to Different Periods  of Life.— Food must vary in
different periods of life.  The infant needs  a fattening diet; and this
has been supplied in  the milk of the mother, which contains  more
butter (the fattening portion) than the milk of any other animal.   But
as the infant has much less exercise than the young of animals, its flesh
is not wasted, and it does not require  so much  azotized food, that is,
the reader will remember, food with nitrogen in it.  Accordingly, it
will be seen by looking at the table on page 67, that human milk has
much less of this element than that of the cow.  As the child grows
up, and begins to take  active exercise, indoors and out, it wants more
solid food, and teeth make their appearance to masticate or chew it.

   In  Youth  and Manhood, the great amount of exercise usually taken,
calls  for larger supplies of azotized aliment, — beef, mutton, pork,
fowl,  fish, wheat  flour, corn-meal,  rye-meal, potatoes, turnips,  peas,
beans, etc.   This is the  working part of life, when  the  tissues are
rapidly wasted by action, and the flesh-forming aliments are wanted
to keep them good.

   In  Old Age, the exercise is  diminished, the blood  circulates  more
slowly, and the body grows cold.   Now is the time to resort to non~
azotized food, — oils, fats, the various kinds of starch, sugar, and the
like.  These will furnish fuel to  warm  the sluggish  blood, and wall
invest the body with fat, which will serve the purpose both of a cush-
ion and a garment.  Wine, beer,  porter, and distilled spirits are  never
needed by young persons in health; but the aged  are frequently bene-
fited  by  them, if taken in small  quantities.  They are chiefly  com-
posed of oxygen, hydrogen and carbon, and are properly ranked with
the supporters of combustion.   They  are likewise stimulant, and add
to the comfort of the old by quickening  their circulation.   Like tea
and coffee, they diminish  the  waste of the body, and thereby lessen
the demand for food.
   The smallest amount of aliment upon which a healthy adult person
ever lived for any length of time, was twelve  ounces a day.   Upon 
74                          HYGIENE.
this  small daily  allowance, Lewis Cornaro, a  noble  Venetian, sub-
sisted  in  perfect  health, during  the  protracted  period of fifty-eight
years.   This he  was  able to do only by adding daily to  his  food
about twelve ounces of light wines.   I shall have occasion to refer to
this case again.

                        Cost  of Food.

   One other consideration.must ever influence the  great majority of
men in selecting their food.  I mean its cost.  It is a matter of great
importance to the poor, to know what  kinds of food they can subsist
upon with least expense. For the last few years provisions have been
so high, that persons in poor circumstances greatly need advice in
this  matter.  Let me  endeavor to furnish some information which
shall be of service to the reader.
  Milk is supplied by nature to be our first food, and  is a good type
of all  alimentary substances.   It contains          fig. 64.
curd, which  has nitrogen, and is equivalent
to albumen  and fibrine, and represents the
blood-formers.   It has  butter  and  sugar.
These  represent  the heat-formers.  It has
salts, which  contain  potash, soda, phospho-
rus, etc.   Figure  64 is a microscopic view
of good milk ; Figure 65, of poor milk; and
Figure 66, of milk adulterated with calf's
brains.
  Food will be valuable in proportion as
it combines, in due proportion, the articles
contained in the  four groups, represented by albumen, fat, sugar, and
salts.
            Fig. 65.                             Fig. 66.
  Albuminous Group—Albumen, fibrine, casein, gluten,  and lugu-
min, all enter into the substance of animal and vegetable bodies, and
are all composed of the same elements, namely, 48 parts carbon; 36
of hydrogen; 14 of oxygen;  and 6 of nitrogen.  In containing nitro-
gen they all  differ from the  other three groups.  Albumen being a
good type  of them, they are called  albuminous compounds.  Albu-
 
HYGIENE.                          75
   men forms a large portion of the serum, or colorless part of the blood.
   It is the leading principle in alimentation.   It is worked up into the
   tissues of our bodies.  It forms our muscles, our membranes, a por-
   tion of our nerves, etc.  It is the bricks of which  the house we live
   in  is made.   All the  articles, therefore, which are chemically consti-
   tuted like it, may well be termed albuminous.
     These bodies, consisting of the four organic elements named above,
   have been called quaternary  compounds.   Beside  these elements, they
   have a minute  portion of sulphur and  phosphorus.  It  has been as-
   sumed that these compounds contain a common principle called pro-
   teine ;  and hence they have been called protemaceous compounds.  It
   is doubtful whether such a principle can be obtained.
      Albumen  is a very  unstable compound, — tending strongly to de-
   composition.   This is owing to the complexity of its composition,
   and to its union with the fickle element, nitrogen, which forms chemi-
   cal compacts reluctantly, and breaks them without remorse.  Sub-
   stances which coagulate or  fix albumen in an insoluble compound,
   or preserve the tissues  of the  body, which are  made from it, from
   decomposition or putrefaction, are called antiseptics.

     Fatty Group. — The next group, represented by fat, performs very
   important offices in the system, — the most important of which, is a
   union with albumen in the formation of cells.  All animal and  vege-
   table life begins with the cell, — the tiny cup, with which nature dips
   all the  streams of life  out of the great fountain  of inorganic matter.
   No cell is formed without a minute particle of oil.   The portion not
   used in forming  cells, is either burned as fuel, to keep us warm, by
   uniting with oxygen, or it is stored away in the cellular tissues, adding
   to  the  bulk of  the  person.  If, then, the  very beginnings of life are
   dependent upon fat, it is of great importance as an article of diet.  So
   necessary is it  in the economy of life, that when not taken in the
   food, it is formed out of  albumen in the processes of assimilation.

     The* Starch and Sugar  Group, composed of several kinds of sugar,
   gum, etc., is never used in forming the tissues, but they perform im-
   portant offices in the changes going on within the human organism.
   Thus, sugar of  milk is  decomposed, and forms  lactic acid, so called
   from being found in  sour milk.  This  acid plays a very important
   part in the process of nutrition.
     Pure starch is a snow-white powder, having a glistening aspect.  It
   is composed of  grains from ^^ to g^Tx of an inch in diameter in the
   different grains ; being largest in the potato, and  smallest in wheat.
,  •When  examined with the  microscope, they appear  as in Figure  63.

     The  Salts Group are sufficiently spoken of in another place.
     A wise philosopher in ancient time said, " I do not live to eat .and
   drink ;  I eat and drink to live."   If we intend to eat to live, we must
   combine, in our food, the four  groups above  explained; and if we
   would live at as small expense as possible, we must take those articles
   which are low in price, and rich in nutritive matter.  The following
   table will help the reader make his selections: 
76
HYGIENE.
Table of the relative value of articles of food arranged according to their proportions of
    nutrient matter in each of the four groups of elements concerned in vital changes.
In 100 pounds of
Grains.
  Wheat.............
  Barley.............
  Oats..............
  Rye...............
  Indian Corn.........
  Buckwheat..........
  Rice...............
Pod Plants.
  Beans..............
  Peas...............
Roots.
  Potato.............!
  Turnip.............
  Carrot.............
  Beet (mangold wurtzel).
    Long red........
    Short red.........
    Sugar beet.........
  Parsnip.............
Leaf.
  Cabbage............
Meal.
  Wheat flour
Rye meal
Barley meal
Oat meal. . .
Wheat bran
 a g
02
15
15
16
12
14
15
13

14
14

75
88
85
85
85
85
85
80
10.33
14.50

14
14
13.1
M
W 8
  15
  15
  20
10 to 20
   6
  25
   3

 8 to 11
   9

   4
   2
   3
   2
  3.03
  3.31
   2
   li
4.63
55
 .  to


g-f.S
   3 </J
COS *jj
1-1 <J CO
10 to 19
12 to 15
14 to 19
10 to 15
  12
24 to 28
  24

  2.0
  1.5
  1.5
  2
  0.48
  0.26
2.5
30 to 35
9.70
8.97

14
18
19.3
s  .
2to4
2 to 3
5 to 7
3 to 4
5 to 9
 0.4
 0.7

2 to 3
 2.1

 0.3
 0.3
 0.4
0.35
6
4.7

55
60
60
60
70
50
75

40
50

18
 9
10
11
10.36
12.46
13
16
68 Starch
5.85 Sugar
4.12 Gum
66.54  Stch
2.56 Sugar
9.40 Gum
    68
    62
      .6

   2
   3
   4
   2
   li
   4
   04

   3
   3

ItolJ
4 to 4-5
1$ to 2
 1 to 1
   li
  .75
2

2

7.3
   The  following  tables  have an admirably practical  bearing upon
economy in food:
100 lbs.
B'arley,......
Beans,.......
Beets,........
Buckwheat,
Carrots,......,
Corn,........
Oats,........
Peas,.........
Potatoes,.....
Turnips (field),.
Do. (Swedish),.
Wheat  Flour, .
Wheat Bran, . .
Cheese,*.....
Cheese,f.....
* Whole milk.
t Skim-milk
Muscle-forming
  Elements,
    in lbs.
14
26
 2
 8
 14
12
17
24
 2
 14
 24
11
18
28
45
Fat-forming
 Elements,
   in lbs.
Relative Propor-
  tion of each,
    in lbs.
64
42
12
54
10
77
66
52
19
 9
12
79
 6
27
 6
1 to 44
1 to \\
1 to 6
 Husky, or
Woody fibre,
   in lbs.
 to 61
 to 6?
 to 64
 to 4
 to 2£
 to 94
 to 6
 to 54
 to 7
 toi
1 to 1
1 toi
15
10
(?)
25
 3
 6
20
 8
 4
 2
 2

55 
         Articles.

Barley,........
Beans,........
Corn, .........
Oats,.........
Peas,..........
►Potatoes,......
Turnips,......
Flour (fine),
Flour (unbolted),
HYGIENE				77
		Muscle-producing	Cost of Muscle-produc-	
		Elements.	ing Elements.	
$1 50	per bu.	8.4 lbs.	18c.	per lb.
2 50	a	16.6 "	15c.	<(
1 10	u	6.7 "	16|c	<i
68	ii	5.2 "	13c.	u
2 00	it	14.3 "	14c.	u
1 50	u	1.6 "	94c.	u
50	it	1.2 "	41c.	u
12 00	per bbl.	22.0 "	54c.	u
11 00	tt	24.8 "	44c.	u
  These tables  will well repay study, for their practical use will save
many dollars to the poor.   Let it be remembered that producing
muscle  is  the  same thing  as producing strength,  or labor power.
Bearing this in mind, the following table will be very interesting:

           One pound of labor-power from Potatoes costs 94c. per lb.
Fine Flour	, 54c. "
Uunbolted do. 44c. "	
Turnips,	41c. "
Barley,	18c. "
Corn,	17c. "
Beans,	15c. "
Peas,	14c. "
Oats,	13c. "
  Meats are omitted in  the table.   So far as their nutritive  qualities
are concerned, it is of little consequence which are taken.  Some are
more digestible  than others, and this consideration  should influence
those with weak  stomachs in  selecting.   Every person,  of course,
knows their relative cheapness.
  Among the vegetables given in the table, there is a wider range for
choice.  Let us consider them in course.

  Wheat. — In this, the four groups are represented  in  excellent pro-
portion.   When not deprived of the bran, it is perhaps the very best
supporter of  animal life.   So high have been the  regards of men for
it, and so generously have they  awarded to it their acknowledgments,
that its product, bread, has been everywhere called " the staff of life."
It is unfortunately held at a high price.  My hope is that the  immense
prairies at the West, adapted to its culture, will yet  furnish it in such
profusion as to bring it within the  means of all.

   Barley. — This  has the  four groups represented in nearly  the same
proportions as wheat.  It is, therefore, nearly as valuable an alimen-
tary grain.   Unfortunately it is not  so toothsome as wheat, and can
never  be  so  popular an article of diet.  The Scotch, however, feed
upon it with apparent relish, and  doubtless  think it strange  that for-
eign palates are not better pleased with it.

  Oats. — This  grain, strange to say, has  more albuminous, or nutri-
tive matter, more fat, more  starch, and more salts  than wheat.   In
uniting a large  quantity of the four alimentary groups, it surpasses
every other vegetable substance.   In albumen, it is not quite as rich 
78                          HYGIENE.
as peas and beans, and in starch it falls a trifle below fine  wheat
flour; but in fat it is  exceeded only by Indian corn.   This grain  is
likewise consumed largely by the Scotch, — a people whose claims  to
shrewd common sense  are well supported  by, as their hardy consti-
tutions vindicate, the choice.   This grain might well be permitted  to
take the  place  of rice.   It affords  several times as much nutriment,«
while it costs only about one-fifth as much.  There is  good reason
why the  horse  should  thrive upon oats.  Most stable-keepers think
their horses will do  more work upon corn-meal, but this must be a
mistake.   In using oats for horse-feeding, a large portion of the nu-
triment is lost by not grinding them.

  Rye. — This  is also  a grain of considerable nutritive  value.   It  is
much cheaper  than wheat; and rye meal  has long been a standard
article of diet  in New England, — particularly  in connection with
Indian meal, as " brown bread."  It is useful for relieving costiveness,
in the form of " hasty-pudding," with molasses.

  Indian Corn. — This  staple  article of American produce needs no
praise from me.  It is comparatively cheap, nutritive, and wholesome.
It abounds  in  fat  and starch,  and has a  fair amount of albumen,
though not as much as the oat, the barley, or the  wheat.   In salts,  it
is rather deficient.  Indian corn is strictly an American plant,  and  is
perhaps the  most popular grain in the country.  It has  emphatically ,
a national  reputation,  and is  perhaps worked  up into  more savory
dishes than any other.   At the South it.is an institution.  It is there
made into hoe cake, corn cake, batter cakes, batter bread, muffins, corn
pone, etc.  At  the North, we have jonny cake, Indian  and pumpkin
cake, baked Indian pudding, boiled  Indian  pudding, beside the well-
known rye  and Indian bread, and  other  preparations.   Give  an in-
genious Southern or Northern  housewife a few simple adjuncts, such
as lard, milk,  sugar, eggs, cream of tartar, and soda, and she  will
make a pretty respectable larder from this single  grain.   If molasses
be substituted  for sugar, and a little stewed pumpkin  be thrown  in
by way  of garniture,  we may  have several preparations which are
very nourishing as well as cheap.

  Buckwheat. — Poor  in nutritive matter, fat, starch, and sugar, but
tolerably well  supplied with salts.  It will do very well for  batter
cakes in winter.  When brought smoking upon the table, and  served
with sugar or molasses and butter, these cakes  are a luxury, in which
the rich may indulge if they choose ; but for the poor, the amount of
nourishment they afford is too small for their cost.

  Rice. — Much like buckwheat, except that it has more fat, sugar,
and  starch,  and less salts.  As an article of diet, it has had too high
a reputation.  Those who would live on small means cannot afford  it.
Boiled in plain water, it is excellent for a relaxed state of the bowels ;
and  this is about all the commendation to which  it is entitled.

  Beans. — The richest in nutritive matter of  all vegetable substan-
ces, except cabbage and oats.   They have more albumen than  wheat, 
HYGIENE.                         79
or corn, or barley, or oats;  but in fat and starch, they are lower in
the scale.  Add to them salt pork, and the highest of all nutrient
compounds is obtained.  Daring not less than four generations, pork
and beans, as the principal diet, nourished an iron-sided race of men
in New England.   Bean-porridge was like  honey upon the tongue of
the founders of New  England  institutions.   They ate it morning,
noon, and night; and thanked God for it every time.   And well they
might thank Him; for, with Indian corn, it  furnished  them with a
diet  better adapted to their condition than any other.
   Peas. — Not quite as rich as beans in albumen, but more rich in
starch; of about the same value on the whole.  The Canadian French
in Lower Canada, feed on peas to about the same extent that the
New Englanders  did  on beans.  Pea-soup, as prepared  by the best
cooks among them, is a dish  of  great nutritive excellence; and, in
my judgment, more palatable than bean-soup.

   The Potato. — Three-quarters of this root is water, and it is poor
in all the elements of nutrition.  It  is a palatable article, and most
persons are much attached to it.  As bulk is of some consequence in
food, the potato is not without value; but should the disease with
which it has  been  tormented for sevtraf years, finally exterminate it,
the loss  to the world  would not be so great as many suppose.   Men*
do not often  live entirely upon potatoes,—not even in Ireland.  Milk,
butter-milk, and especially cabbage, are united with them.

   Turnips, Carrots, Beets, Parsnips. — These are much alike, — being
all poor in nutritive qualities.   They serve to please  the  palate  by  '
furnishing a variety; but in our city markets, they are expensive, and
do not furnish an edbnomical diet.
   Cabbag'e. — It is interesting  to  observe  how the instincts of men
have in  all ages led them to select those articles of diet which their
circumstances have demanded.   The poverty of  the  Irish  has led
them to subsist largely upon the  potato, — a root which  the soil  of
their country yields profusely.   But as this root has but little nutritive
matter, necessity required that it should  be united . with some other
vegetable.   The natural instinct selected the cabbage; and  when
chemical science came, at length, to pass judgment upon the  correct-
ness  of this  instinct, it turns  out that  the cabbage is the richest in
albumen of any known vegetable.   The cabbage, then, is the natural
complement  of the  potato; and the Irish  had the sagacity, without
science, to bring the two together.   It is  said  the Irish have a dish
named " kohl-cannon," consisting of boiled and mashed potatoes and
cabbage, seasoned  with pork  fat, pepper, and salt, and that it is a
truly savory dish.   It certainly is a nourishing, and a cheap one.  The
ambassador who was sent to tamper with the patriotism of a Roman
who  had dined on  beans, was  asked if  he was silly enough to think
gold and silver could bribe a man, who was satisfied with so plain a
fare, and desired no other.  We come  to  the conclusion, then, that
bean porridge, pea soup, suet pudding, sweetened with molasses, oat
meal, and barley bread, with " kohl-cannon " for those who can digest 
80
HYGIENE.
it, will furnish, for hard-working men, the most substantial diet, at the
smallest  possible expense.   To  render these dishes savory,  and to
make the table  on which they are spread an inviting board, the deft
housewife must employ her  best  skill in serving them.  With the
thousand " fixings," with which a New England matron knows how to
garnish them  (or would know how if they came within her culinary
operations),  they are  well  fitted to  leave savory impressions  upon
tongues which would  praise them to the end of life.   I speak of these
articles as furnishing a cheap diet  for working  men.   The indolent,
the sedentary, and the effeminate from various causes,  could not
digest them.

               The  Amount  of Food Taken.

  We have  already explained that this should be governed, in part,
by the amount of exercise taken,  by the  condition of  the health, by
the state of  the mind, by the climate, by the  season, etc.  It remains
to add a few words, in a general wTay, respecting the absolute amount
required by an adult man.
  It is plain enough that most men eat too much.  We come very
near, in this  country, being a nation of gormands.  A principal reason
of our over-eating is, that we eat so fast.  When the food is well and
slowly masticated and swallowed, the gastric juice  has time  to mix
with it;  and at the proper moment, the  appetite ceases.   But when
our food is bolted  rapidly,  nature,  finding her laws disregarded, and
all her purposes frustrated,  stands  back, and lets us learn to stop, too
late, alas! from a sense  of fulness in a stretched and abused stomach.
  It  has already been  stated, that Lewis Cornaro  lived fifty-eight
years, namely, from the age of forty-two  to  one hundred, on twelve
ounces of solid  food  a  day, with  about  the same amount of light
wines.  At  the  age of eighty-four,  he wrote a  book, in which  he
praises " divine temperance " in terms which are  sometimes eloquent,
and often enthusiastic.  Indeed it is very rare that a man at that age
retains such clearness of intellect, and especially such freshness of
feeling as he evinces in his  book.  Probably but few could live on the
amount of food which he found sufficient.  Yet it is said the distin-
guished John Wesley lived  on sixteen ounces a day, which, as he took
no wine,  and had to derive  the combustive materials for warming the
body from the food, was  quite as scanty a fare  as  that of Cornaro.
Considering that he led a most extraordinarily active life, both of body
and mind, being half his waking hours in the saddle, and preaching
almost daily, this is probably the  most remarkable case of abstemi-
ousness on record.  Jonathan  Edwards did not, I think, exceed the
same  amount of food, but he was not so active a man.
  Putting aside such exceptional cases as these, we may say in round
numbers, that a laboring man requires, to keep him in  health, about
two to two and a  half pounds of solid food per day.   For ministers,
lawyers,  doctors, authors, and merchants, one pound  and a half is
amply sufficient.   The  amount should be increased a little by a se-
lection from some of the fuel-formers, if no  fermented or alcoholic 
HYGIENE.                          81
drinks be taken, and slightly diminished if they are used.   The reason
is, that these drinks furnish fuel to be burned  in breathing, which has
to be drawn from the food, when they are not employed.   This fur-
nishes  no motive for using ardent spirits ; for there is fuel enough to
be had in the oils, starches, and sugars.
   Dyspeptics. — It is said that dyspeptics eat more than  persons in
health; and, in  many  cases, the  remark  may be true.  The appetite
of a person suffering from this disease is almost  always morbid, and
the information  it gives respecting the real wants of the system, can
seldom be trusted.  If we allow a diseased stomach to dictate to us
when, and what, and  how much we  shall eat and drink,  our misery
for life is a foregone question.  A sick stomach is like a spoiled child;
it cries for  what it should not have.   If the dyspeptic will live, and
enjoy any amount of peace and comfort, he must follow  this simple
rule :  To eat no more than can be digested, even  though the amount be^
only an ounce a  day.

                Animal and  Vegetable  Food.

   It has generally been, supposed that it was intended man should
subsist on a mixed diet, consisting of both animal and vegetable sub-
stances.   Within the  last twenty-five  years, however, a  school of
physiologists  have  appeared in this country, who affirm that» a  vege-
table diet is alone consistent with the laws of health.  They declare
that animal food is not adapted to man's organization, — that it un-
duly stimulates  the blood,  predisposes to fevers, consumptions, diar-
rhoeas, choleras, apoplexy, and numerous other diseases, and of course
shortens life.  That such a school should have come into existence in
this country, where animal food is  more largely consumed than in
any other part  of the world, in proportion to the number of people,
is  not  surprising.  We  do,  undoubtedly, eat too much  flesh.   So
enormous is the consumption, that notwithstanding the vast herds of
cattle raised in all our agricultural states, the supply is not equal to
the demand;  and beef, for two years, has been selling in Boston mar-
ket at twenty cents  per pound, — at least twice  its  full value as a
blood-former.
   Facts show that man may live upon flesh alone, upon vegetables
 alone, or upon  flesh and vegetables  combined.  Is it best  he should
subsist upon vegetables only, or upon  a niixed diet ?   A mere affirm-
 ation upon these points is of little consequence.   To cite facts avails
nothing.  Men  have a way of making their own affirmations, and of
looking  at facts with  eyes which sometimes see clearly  enough on
both sides of them, but totally ignore their existence.
   Man's Structure Settles the Question. — To settle this matter, we
must appeal  to  man's organization.   His structure will tell us some-
thing  we need not mistake.  All the  works of God show design.
Everything he  has  made  has  a use, and is so contrived as  to be
adapted to  that use.   Lions, tigers, and other animals for example,
which feed on  flesh  alone, have a short second stomach, — it  being
                                11 
82                          HYGIENE.
 only about  three times the length of the animal's body.   Animals
 which eat no flesh, have a long second stomach, — that of  the  sheep
 being from thirty to thirty-five times the  length of its body.  A very
 remarkable difference of anatomical structure !
   This is the meaning of the difference :  Vegetable food has a great
 deal of waste matter in it.   Woody fibre makes  quite an item  in its
 composition. This waste portion must all be carefully separated from
 the nutritive part, and this must all be done in the  second stomach.
 It takes time to do it.  It must not be done in a hurry.  The nutritive
 materials are destined to build a living structure, whose duration, like
 that of all other fabrics, will depend on the care with which the  mate-
 rials are  selected and put together.  The second stomach of the  sheep
 is long, that there may be ample time for the  mixed mass of chyme
 when it  passes out of the  first stomach, to be changed to  chyle, and
 then to be carefully separated into the two parts, the useful and the
•useless.  Animal food is in its composition just like our own flesh,—
 there is little waste matter, and not much time is required for its sep-
 aration ;  hence, the second stomach of flesh-eating animals is  short.
 Nearly the whole alimentary mass is quickly taken up by the lacteals,
 and there is no occasion for its  travelling through a long second
 stomach.                           •
   Man's second stomach is in length midway between that of the
 flesh-eating  and the vegetable-eating animals.  If there be design in
 the works of the Creator, and if that design in  the structure of the
 flesh and vegetable-consuming animals has now been correctly inter-
 preted, it is  plain that man is best nourished when he eats both kinds
 of food.   The structure of his  teeth, and the motions of his jaws
 (see p. 30), confirms the same conclusion.

   Americans Eat too Much Meat. — Yet, as I have  said, there  is no
 doubt the Americans eat too much meat.   Sedentary persons require
 but very little.  Less is wanted in summer than in winter, — in  warm
 climates  than in cold.  People  of wealth, whose  circumstances  im-
 pose no  bodily  hardships,  need less  than  the poor, who  are  much
 exposed, and work hard; whereas, they consume more.  Those who
 do  not labor with their  hands, should never taste  meat more than
 once a day.
   It is  painfully-amusing  (if such a compound  word  is admissible)
 to hear a nervous female, whose sole exercise consists in going from
 the parlor to the kitchen once or twice a day, and in making a brief
 shopping excursion once a week, complain  that she  cannot maintain
 her strength unless she eats freely twice a day of meat, and takes her
 free potations of strong coffee and wine.
   A like opinion prevails  generally among the feeble who are not
 obliged to labor.  The  child  in its  nurse's arms, must daily, it is
 thought, suck  a piece of  chicken or beef steak in order to thrive.
 Children thus fed, have their blood constantly inflamed, and stand a
 poor chance when attacked by scarlet fever.  The little  master or
 miss who attends school,  complains of  headache,  and grows pale,
 feeble, and  nervous.  The  books are blamed and thrown aside for 
HYGIENE.                          83
 what the dishes have done.   The doctor is called in, and assured that
 the dear child can eat nothing but  a little fat broth, a custard, or
 cake; and if  he prescribe a diet of plain bread and  milk, he is be-
 lieved to be heartless, and his prescription is not followed.

   The Majority of Mankind Eat no Flesh. —All such  misguided per-
 sons should be apprized that the great majority of mankind eat no flesh,
 because they  cannot afford it.  And they do not appear to suffer from
 its loss.  Millions of Irish do not taste of flesh or fish from one month's
 end to another.  Potatoes, oat meal, and cabbage constitute their chief
 diet.   Rice, poor as it is in nourishment, sustains, when  combined with
 vegetable oil, millions of people  in  Asia.  The  Lazaroni of  Naples,
 with  active and finely moulded  forms, live on bread and potatoes.
 These facts do not afford ground for altogether rejecting animal food,
 any more than Bayard Taylor's statement respecting  whole tribes in
 Africa who live upon flesh, furnishes a reason for excluding vegetable
 aliment.  Man may live  and enjoy health upon either, but his organ-
 ization implies the use of both.


      Proportions of  Animal and  Vegetable Food.

   Upon this  subject, it is impossible to fix any absolute rules.  This
 is a point which must be determined by the temperament, the state
 of the  health, the constitution, etc.  •Persons of a scrofulous  habit
 should eat freely of animal food.   But an inflamed stomach  should
 never be tormented with flesh.  Meat is stimulating,  and will be al-
 most  sure to do mischief when there is heat and tenderness  at the pit
 of the stomach.   There  are cases of inflammation of this  organ, in
 which it may  be necessary to live on bread and milk, with articles of
 the starch group, for months, and even for years.
   On the other hand, when the system has  run low from  some ex-
 hausting disease, which excites no feverish action, it may be necessary
 at times, to  take a diet almost exclusively animal.
   It is absurd to talk of the same diet as adapted to all persons, even
 when in health.  As well might we expect one shoe to fit every foot,
 or one coat every back, or one color every eye, or one  doctrine every
 mind.

   Temperance the Main  Thing. — After all, the great thing to be
 aimed at is temperance.  It is not so necessary to reject one article
 and  use another, as to partake of all  with moderation.  " I  do not
 live to eat  and drink ; I  eat and drink to live," said a wise philoso-
 pher of the c4den time.   One would think the moderns had reversed
 this rule. A modern table has the appearance of being spread for the
 purpose  of inducing men to eat all their stomachs will hold.   A man
 who can dine daily, for half a dozen  years, at one of  our first  class
 hotels, and then find himself free of dyspepsia, and all  other diseases,
 must  have a fine constitution, as well as most admirable control over
his appetite.   Mr. Addison said, « When I behold a full table set out
in all  its magnificence, I fancy I see gout, cholic, fevers, and lethargies 
84                          HYGIENE.
lying in ambuscade among the dishes;" to which he adds, with much
truth, in another place. " Abstinence starves a growing distemper."

  Good Results of Temperance. — A temperate diet has always been
attended with excellent results, and always will be.   There are times
of great anxiety, when abstinence  should be  pushed to the extreme
verge of endurance.   During the siege of Gibraltar, Lord Heath-
field, its gallant defender, lived  eight days on four ounces of rice per
day.  Dr. Franklin, when a journeyman printer, liv°d two weeks on
bread and water, at the rate of ten pounds of bread a week, and was
stout and hearty.   Dr. Jackson, an eminent physician in  the British
army, says, " I have wandered a good deal about the world, and never
followed any prescribed rule  in anything; my health  has been tried
in all  ways; and by the aids of temperance and  hard work,  I have
worn out two armies, in two wars, and probably could wear out an-
other before my period of old age arrives."
  Lord Bacon was  right in the opinion that intemperance of some
kind or other destroys the bulk of mankind, and that life may be sus-
tained by a very scanty portion of nourishment.  Cornaro, whom I
have before mentioned as  having lived fifty-eight  years on twelve
ounces of solid food a day, wrote as follows respecting himself in his
eighty-fifth year: " I now enjoy a vigorous state of body and of mind.
I mount my horse from the level ground; I climb steep ascents with
ease; and have wrote a comedy full of innocent mirth and raillery.
When I return home, either from private business or from the senate,
I have eleven grand-children, with whose education, amusement and
songs, I am greatly delighted; and I frequently sing with them, for
my voice is clearer  and stronger now, than ever it was in my youth.
In short, I am in all respects happy, and quite a stranger to the dole-
ful, morose, dying life of lame, deaf,'and blind old age, worn out with
intemperance."   Howard,  the philanthropist, fasted one day  in the
week ; and Napoleon, when he felt his system unstrung, suspended his
meals, and took exercise on horseback.
  Nothing can be plainer than the duty of fasting, when the stomach,
having been overworked, is disinclined to  receive food.   Brutes in-
variably follow this suggestion of nature; they never eat when sick,
— probably because they have no silly nurses  to coax  them to swal-
low  stimulating  aliments.  The habit of putting high-seasoned food
into the stomach when it is inflamed  and feverish, is about as wise
as directing streams of blue, violet, or red light into the eye when it is
red  and swollen with inflammation.


                      Tea and Coffee.

  It is proper before closing  this chapter upon diet, that something
should be said respecting the  beverages of tea and coffee.
  Some twenty  years ago, more  or  less, a meeting was held by the
leading physicians of  a city in the old world, in which  the merits of
tea  and coffee were  discussed.   In  this discussion each man first
stated  his  experience  in the use  of  these  articles, and then con- 
HYGIENE.                          85
structed his argument according to that experience.  The amount of
what the reader could learn from the discussion was, that Dr. A. had
used tea all  his life, and been benefited by it, while coffee  had uni-
formly injured him; and that he thought  tea should  be used, while
coffee should be rejected; — that Dr. B. had taken coffee  at breakfast,
and found it  an excellent support to the stomach and nervous system,
while tea had disturbed his digestion and his mind; and that the former
was  a beverage of excellent qualities, while the latter was detestable ;
—that Dr. C. had always drank both tea and coffee, and recommended
them to everybody;—and that Dr. D. had himself never been able
to indulge either tea or coffee, and  would have them both expelled
from every household.
  The discussion  was not creditable to the learned and really able
men who participated in it.  The arguments were all based upon the
miserably narrow  basis of  single individual experiences.   They were
no more valid than that of the man who  should hold up a shoe, de-
claring it fitted his foot the best of any he ever had, and  recommend-
ing all men to have their shoes made upon  the same last.
  The truth is, there is but one thing which can be affirmed universally
of the effect of tea  and  coffee.  They both, when taken, tend to prevent
waste in the body, and, consequently, less food is required when they
are used.  This may be affirmed of them  in their applicability to  all
persons, but nothing further.   The truth is, some can  drink  tea but
not coffee, and some coffee  but not tea ; some can use both, and some
neither.  Every man's  susceptibility to the  effects of these beverages
is his own, as much as his susceptibility to  the effects of light, or heat,
or atmospheric changes;  and  these  effects, each person must learn
from experience.   Coffee often produces, and generally aggravates, a
bilious habit, — an effect which cannot, I believe, be traced to the use
of tea.

                             Water.

  There is one universal  beverage; it is water.  All  men  are fond
of it.  In sickness and in health, in joy and sorrow, in summer and
winter, in cold climates and in hot, man loves and drinks  water.  The
stomach, abused and made sick  by stimulating food and drinks, and
repelling everything else, still gratefully opens itself to water.   Wher-
ever man exists, therefore, or wherever he should exist, water is found,
either in the form of  springs, or running brooks, or rivers, or ponds,
or lakes ; and even where it is not found in some of these forms, it is
periodically dropped down from the  clouds.  As there is no element
in nature more necessary for man's existence than water, so there is
none more universally  diffused.

  Pure Water Essential to Health.—But water varies very materially,
both in its physical qualities, and in its adaptation to its purposes.
Pure water is as essential to health as pure air.   When either of these
fluids  is rendered impure  by mixture with foreign matters, disease
will  be a frequent result   The  ancients must have been influenced
by this fact,  or they would not have incurred such heavy expenses in 
86
HYGIENE.
procuring pure water from great distances.   The strong aqueducts
through which, for many miles, large streams of water are at this day
poured into fallen  Rome, attest the freeness of the expenditures she
made for this purpose in the day of her renown.   We may pity the
ancient Romans for being governed in their military operations by the
opinions of augurs and  soothsayers, and certainly these  things  were
silly enough; but in other things, at first view equally superstitious,
they showed practical wisdom.  Vetruvius reports that in selecting the
sites of their cities, they inspected the livers and spleens of animals to
learn the salubrity of the waters and the alimentary productions of the
region.   The size and condition of these organs  do in  fact indicate
the nature of the pasturage and the qualities of the water with which
animals are supplied.   No people can  enjoy good health, when sub-
jected to the double influence of bad water and impure air.
  Division of Water.—The simplest division of water is into two kinds,
soft  and hard.  Rain, river, pond, and snow water is soft;  well  and
spring water is generally hard.  Soft water contains but little impu-
rities, and when used for washing, forms  a good lather with soap.
Hard water contains at least one of the salts of lime,  often more;
mixed with soap, it curdles and  turns white.  The reason of this is,
that the oily acids of the soap unite with  the lime, and  form a com-
pound which the water will not dissolve.  Such water is not suitable
for domestic purposes.
  Chemical Nature of Water. — Water  contains,  reckoning  the  ele-
ments of which it is composed in volumes, one volume of hydrogen,
and  half a  volume of  oxygen.   These two  gases, the  unlearned
reader.will please to remember, are highly subtle bodies, not visible to
the eye; and yet, when chemically united, they form a  liquid which
covers two-thirds the entire surface of the globe, — floating upon its
bosom  the navies and merchant ships  of all nations, and, by its un-
measured depths, and vast breadths, and sublime movements, fills the
thoughtful mind with conceptions of creative  Power, which words
never attempt to  express.  Should the two  gases which  compose
this  vast  body of water cease to  love  each other, and  fall asunder,
the first lighted taper would set the  world on fire, and not a living
being upon its surface could escape destruction.
  Impurities in Water.—It is not surprising that a fluid with as great
a solvent power as water, should often dissolve  and hold  in solu-
tion a great  many impurities.   In passing along through  the earth,
before it comes up in springs and wells,  it is filtered through various
mineral earths, and becomes contaminated accordingly.   In running
through beds  of limestone, it takes up a little  carbonate of lime.
Salt beds impart to it common salt (muriate of soda), while sulphur
and  other ores tinge it with salts of various kinds.
  Water  from the wells of Boston, formerly used by the inhabitants,
was largely impregnated with common salt, and other mineral substan-
ces.  So marked was the saline taste, from this cause, that the New-
Yorkers and Philadelphians used to say the Bostonians, when visiting
their cities, had to  salt their water. 
HYGIENE.
87
  Cochituate Water. — These wells, which so long yielded up brack-
ish water to offend the palates of strangers, are now abandoned, and
Boston is  blessed by a copious stream of pure soft  water,  drawn
through a fine aqueduct from Cochituate Lake, twenty miles distant.
This water is distributed to about every house  and shop in the city.
  The result is, that the health of the  citizens  has  been materially
improved.  Fevers, particularly those of the typhoid type, have dimin-
ished, both in prevalence and  fatality.   The decaying vegetable and
animal matter, so much of which  gets into the common sewers, and
which, in former years,  sent up poisonous gases to attack the  life  of
the citizens,  are now washed away by the soft water, which is daily
and hourly dropping through the  sinks of all the dwellings  of the
city.

  Schuylkill  and  Croton Waters. — The Schuylkill water, introduced
into Philadelphia, and the Croton, brought from quite a distance  to
New York, are both good waters;  though  neither, as chemical analy-
sis  has shown, is quite as pure as the Cochituate, of Boston.

  Lead Pipes. — In  each t>f  these three  cities, water  is  conveyed
through the  dwellings in leaden pipes, — a practice fraught with a
danger to which the inhabitants should not expose themselves.   That
lead does often become  oxidized and impart its poisonous properties
to water when long in  contact with it, is a well-known fact.  Let a
number of  persons drink every morning from  the  first water drawn
from  the pipes, and a portion of  them  will be attacked with some
form of lead  disease.  The  pipes should be emptied every morning,
before using the  water  for domestic  purposes;  and then, it is true,
there  is little danger.   But where the work in  the kitchen is done by
hired persons, who have  no appreciation of th* danger, how is it  to
be  known  whether this  act of safety is always carefully performed ?
Water pipes  should certainly be made of some other  material..

  Physical and Other Properties of Water. — Good water is without
smell, is perfectly clear, and in the mouth, has a soft and lively feel.
When poured  from one vessel to another, it should give  out  air-
bubbles.  Boiled  and distilled waters have a vapid, flat taste.   This
is owing to their containing no carbonic  acid gas or atmospheric air,
— these being driven off in the act of  boiling and distilling.  A hun-
dred cubic  inches of good river water  contains about 2£ of carbonic
acid, and 1£ of common air.
  Carbonic acid  is  what gives  to  mineral, or  soda water,  its brisk,
and even pungent taste.  Without a portion of this acid and atmos-
pheric air,  water  is  perfectly insipid, and not fit to be used as a bev-
erage.  Hence, if it be boiled or distilled to clear it of earthy matters,
we must expose a large surface of  it to the air, and shake it, that  it
may re-absorb from the atmosphere, what it has lost, and thus recover
its taste.

  Rain AVater is the Result of  Distillation on a large scale, and would
be insipid,  like other distilled water, only that, after being distilled off 
88
HYGIENE.
 from the waters  upon the surface of the earth, it recovers, while  as-
 cending as vapor, the carbonic acid and atmospheric air.
   Fishes breathe air as well as land animals, and hence, lakes upon
 the tops of high  mountains, where but little oxygen can  be absorbed
 into the water from the air, are not inhabited by the finny tribes.

   The Saltness of the Ocean is simply the accumulation  of the saline
 substances washed out of the bowels of the earth.
   The  water which for thousands of years has been distilling off as
 vapor, from the  surface of the  ocean, is nearly pure.   Being  carried
 by the  winds to  the continents, it falls  as rain, sinks into the earth, is
 filtered through mineral substances, comes to the  surfaces in springs,
 is collected into rivers, and,  with all  its  freight of mineral salts, is
 borne back to the* ocean.  Everything that water can dissolve, and
 carry down from  the continents, finds a  great depository in the  ocean;
 and as this has no outlet, the accumulation must go on without limit.
 Rivers which flow into the ocean, contain  from ten to fifty grains  of
 salts to the gallon, — composed chiefly  of common salt, sulphate and
 carbonate  of lime, magnesia, soda, potash and iron ; and these are
 the constituents of sea-water.   The time %must come, in the history
 of our globe, when  these salts  will render the water of the ocean  so
 dense that a man can no more sink in it than a cork can sink in fresh
 water.

  Cleansing of Impure Water—Impure waters  should  be  cleansed
 before being used  for domestic purposes.   Distillation is  the most
 perfect  method of  purification.  Filtration through  sand is a good
 method.   It removes all suspended vegetable or animal  matter, and
 all living animals.   Boiling likewise kills all animals, and throws  to
 the bottom carbonate of lime.   It is this which constitutes the crust
 which lines tea-kettles'in all regions where limestone exists.
  Settlers  in a new country, should make it  a prime object to  find
 good  water.  This  is of great moment.  Their  own health, and the
 health of their posterity is dependent upon it.  Any soil, good or bad,
is not worth half  price, if it yield impure water.

  Reasons  for  Prizing* Water—Finally, we ought all to  prize  water
very highly, for it composes nearly eight-tenths of our entire bodies, in-
 cluding our flesh, blood, and other  fluids.  Nay, we owe to it the very
softness, delicacy, and smoothness of our persons.  Our muscles, nerves,
blood-vessels, glands, cartilages, etc., all play smoothly upon each other
 in consequence of water.  Take all the water out of us, and we should
 be dry sticks indeed.  All  our comeliness would  be gone.   Nobody
would or could love us.  We should  be walking reeds,  shaken and
 sported with by every wind.  Let  us never forget how much we are
indebted to water.
                           Exercise.

  Animal life is conditioned upon exercise.   Without it health can-
not exist, or life itself be continued for any great length of  time. 
HYGIENE.
89
   Proper  exercise communicates  motion to every part susceptible of
 it.  It expands the breast, contracts and relaxes the muscles, quickens
 the motion of the blood, moves afresh all the other fluids, and stirs to
 the centre the whole frame.  More  easy and  perfect digestion, the
 nutrition of every part, and the  proper performance of all the secre-
 tions  and excretions, are the results of such exercise.
   A distinguished physician said : " I know not which is most neces-
 sary to the support of the human frame, food or motion." Some of the
 finest talents in the world are  probably lost for the want of  exercise ;
 for without it the mind loses its  keen perception, and its  bounding
 energy; its power of application  and  its general scope.   If men of
 great talents would give attention to  exercise,  the world  would  reap
 a larger harvest from their written thoughts.
   The arrangements of modern society have very much abridged the
 facilities for taking exercise ; but if Trenck in  his damp prison,  with
 fetters of  seventy pounds weight upon him, could preserve his health
 by leaping about like a lion, most persons could do as much with the
 fetters of  modern society upon their limbs.

   Must be Regular. — Exercise, to be of much service, must be regu-
 lar,— not taken by fits and starts, — a good deal to-day and none to-
 morrow ;  but in  reasonable measure every day.  Occasional efforts,
 with intervening inactivity, only does mischief.
   Must be Pleasurable. — It should be connected, too, if possible,  with
 some  pleasing occupation or  pursuit.  The movement of the limbs
 should carry us towards  some place or end in  which  the mind  feels
 an interest; exercise will then do us most  good.   Hence, botanical
 pursuits, the cultivation of a garden, and the like, are often preferable
 to a solitary and aimless walk.

   Must not be Excessive. — Exercise should never be carried  so far as
 to produce great fatigue.  Extremes are injurious ; and too much ex-
 ercise, especially by a sick or feeble person, may be as injurious as too
 little.
   No clothing should be thrown off after exercise, nor should  one  cool
 off by sitting in a draft of air.  Very serious consequences often fol-
 low this practice.

   Not to  be Taken After Meals. —It is not best to take exercise im-
 mediately after meals.   The reasons  for this caution have been ex-
 plained.   It is true many laboring  men  go at once to their work after
 eating, without apparent injury.  Yet  they  are strong, and can endure
 what those who use their brains chiefly could not.  And even they do
 not labor as easily and cheerfully immediately after dinner.
   Active and  Passive---Exercise is properly divided into active  and
 passive.  Walking, running, leaping, dancing, gardening, various sports,
 etc., are active. While sailing, swinging, and riding in carriages, are
passive.   Riding  on  horse-back is of a mixed nature, — being  both
active  and passive.
   A few  remarks upon these  several kinds  of exercise, will have a
practical value to  some of the readers of these pages. 
90                          HYGIENE.
  Walking is  one of the most gentle, easy, and generally one of the
most useful of the active exercises.   It is within the reach of all who
have the use of their limbs, and is indulged at the expense only of a
little shoe  leather.  To make it agreeable, the face is only to be
turned to some  favorite locality, and the mind put in communion
with the voices of nature.
  1*0 walk with  the best advantage, the body should be kept upright,
the shoulders thrown back, the breast projected a little forward, so as
to give the lungs full  play, and the air an opportunity to descend to
the bottom of them.   This attitude places all the organs of the body
in the  most  natural position, and  relieves them from  all  restraint.
Walking then becomes a source of pleasure.   The artist who bends
over his pallet, and gets into a cramped position, is  by this kind of
walking relieved, and his body kept  upright.   Females, particularly
of the  wealthier class, are much more apt to  neglect this species of
exercise than males.
  It is not  so in  England.  There it is no uncommon thing for ladies
of high rank to walk ten miles a day; and they do it in shoes of suffi-
cient thickness to protect their feet from all dampness, and in clothes
large enough to  give their muscles full play.  As a consequence, they
enjoy excellent health, and in many cases, even retain their  freshness
and beauty to old age.
  A master of one of the vessels of our navy  who spent some time,
lately,  in the British Channel, was several times invited to spend the
evening at  Lord Hardwick's, where he made the acquaintance of two
daughters of  his lordship, who, in the drawing room, he thought the
most accomplished ladies he ever saw.  Yet those young women, on
two occasions, in company with other friends, walked miles to visit
his  vessel, once on a rainy day, clad in thick, coarse cloth cloaks which
no  rain could penetrate, and caring as little for wet weather as a
couple of ducks.
  Good for the Studious. — For the studious, walking is a most capi-
tal exercise.  It  varies the scenes so constantly, and brings the mind
in contact  with  so many objects, that the monotony of  in-door life is
admirably broken.  It was  a maxim of Plato, that " he is truly a crip-
ple, who, cultivating his mind alone,  suffers his body to languish."
  Good in  Cold  Weather. — Walking is valuable in cold weather, be-
cause it exposes  one to the cold atmosphere, and hardens the person
against frosty weather, — a consideration of great consequence in
countries which  are subject to extremes of cold.
  Running and  Leaping are forms  of exercise  which should  be  in-
dulged with prudence even by the young and healthy.  For the feeble
and the aged, they are entirely inadmissible.   Used cautiously, in a
system of regular training, they may  help raise  the bodily powers to
a high  degree of agility and endurance.  The North American Indian,
who is bred to the chase, runs with surprising swiftness, and for en-
durance is scarcely excelled by his faithful dog.  What training does
for  the Indian, it may do for the white man, who may chance to in-
herit as good a constitution. 
HYGIENE.
91
   The Game of Ball  requires very active running, and for the young,
it is an exceedingly healthful amusement.   It fills  the  whole frame
with  a bounding spirit, and sets  the  currents of  life  running like
swollen brooks after heavy rains.
   Gymnastics. — The more active  species of exercise  have generally
been  included under the term gymnastics.  Among the Greeks and
Romans, feats of strength  and endurance  were  supposed to  confer
honor.   For this reason, and because war was a laborious calling, re-
quiring bodily endurance  and strength, their youth were trained  in
the most active exercises.  Gymnastic games were with them at once
the school of health, and the military academy.
   In England, during the  middle ages, acts of parliament and royal
proclamations were  employed  to  regulate and  foster  those  manly
sports  and exercises, which  fitted the people for the activity required
on the  field of battle.
   Those  preparations for brutal wars would be unsuited to the pres-
ent state of the world; but the capacity for endurance which these
trainings produced, could be most usefully employed in the laborious
and scientific researches which modern advancement requires.   Very
few of  our scientific  men  have sufficient hardness  of frame to  sus-
tain them in their laborious studies.
   The  heart diseases  which prevail so extensively are the result, many
of them, of violent exercise, taken, perhaps, from necessity, and prov-
ing injurious because not a matter of every-day practice.  Violent
exercise, more  than any other kind, must be regular in order to be
borne.
   Needed by Young Women. — Gymnastic exercises, and calisthenics,
are particularly needed by our young women, to give them something
of the  robustness of our  mothers, two generations back.   For the
want of them, they are  dwindling away, and becoming almost worth-
less for all the purposes for which they were made.
   In view of this want, I  cannot but express my gratification here,
that a high school for young ladies is now open in this city, under the
care of the Rev. George Gannett and his lady, in which a large and suit-
able room is set apart for the daily practice of calisthenic and gym-
nastic exercises, suited  to  the age  and strength of each pupil, under
the instruction of an experienced teacher of their own sex.  I cannot
but look  upon this school, offering, as it does, the  highest advantages
for a complete education in science and morals also, as the beginning
of better things.

   Modems Physically Inferior to the Ancients.  Reason for it___It is
evident that the moderns are inferior in  bodily strength to the ancient
Greeks and Romans.   Before the  introduction of Christianity, men
knew very little about the future, and  therefore strove to make the
most of the present.   Hence, they took measures to ensure health and
long life.  It is true  that a due regard to the welfare of the future,
need  not, and  should not,  prevent  a care for the  present; but from
various causes, to be referred to on a subsequent page, such has been
the practice, to the manifest physical injury of the  race. • 
92
HYGIENE.
   Dancing, when hedged about with  proper  restrictions and limita-
tions, has great advantages as a physical trainer of the young.  There
are very few forms of exercise which give so free a play to all the
muscles, and at the same time so agreeably interest the mind. Begun
in early life, and pursued systematically, dancing imparts a grace and
ease of motion which nothing else can give.   For this reason alone,
it should be cultivated as an art.
   Everyman and woman is often placed in circumstances in life where
the possession of an  easy carriage of body,  and an  unembarrassed
manner, would be prized above gold.   One's personal influence in the
world is greatly increased by an easy, graceful manner.  We all know
how a polite manner wins, while a rough and  uncouth one repels us.

   Warning Against Excess. — While dancing has many things to re-
commend it, there are also several considerations which  should warn
us against using it to excess, particularly in the ball saloons of fash-
ionable life.   So many  muscles  are called into play, the breathing
is so much quickened, and  the  air breathed is often  so  impure, that
the circulation of the  blood is hastened almost to fever excitement.
And when to this  we add the use of wines  and cordials, alternated
with ices and iced drinks, and the exposure, on returning home  from
balls, to the chill night air, under the miserable protection of insuffi-
cient clothing, we have draw-backs enough to abridge, if not to anni-
hilate the benefits derived from this otherwise healthful  and elegant
exercise.
   But  then it will be said, and truly enough, that these are the abuses,
not the uses of dancing.   To these abuses, no parent should permit
the health of a child 1;o be exposed.   In the  parlor at home, in con-
nection with a few  young friends  gathered in to spend  an  evening;
or, in a well-ventilated  hall, under  the instruction of  a master of
known character and refinement, dancing is of high utility, and much
may be said in its favor.   An amusement for which there is so gen-
eral a  fondness, one may say, passion, must be fitted to meet some
want of the animal economy, and perhaps of man's higher nature.
   Grace of  motion gratifies  our sense  of the beautiful, and in its
nature is allied to poetry.  Turning away from the abuses of dancing,
let the  reader thankfully use it as one of the very best physical, social,
and aesthetical educators  of youth.
  But  if dancing is salutary, it is only when every limb and muscle
is allowed to participate naturally and without restraint in the general
motion.  When performed in a dress so tight as to restrain  all free-
dom, not only is every grace  destroyed, but injury of  a  serious char-
acter may be the result.

  The  Cultivation of a Garden is  also  a species  of  exercise highly
conducive to health.  To the poor it should have a double attraction.
It is not only a healthful exercise, but it yields, in its season, many
wholesome vegetables, the price of which,  when they have to be pur-
chased, frequently  puts them beyond  the reach of the poor.  It is
pleasant to  know that in the  towns  of Massachusetts,  where shoes
are largely manufactured, most of the workmen own small  pieces of 
HYGIENE.                          93
ground which they cultivate as gardens, — deriving health both from
the labor, and from  the  vegetables raised.   This is one of the kinds
of exercise which are more beneficial from  having an end  in view.
The man who  works in his garden  derives pleasure from the im-
provement he is making  upon his ground, and from the prospect of
advantage to himself and family.

  Other Active Exercises.— To the  exercises already spoken of may
be  added those which are mostly taken indoors, — the dumb-bells,
jumping the  rope, the  battle-door,  etc.  They  may  be resorted to
when  the weather is  stormy, or when any other cause may prevent
one from going into the  open air.   Nevertheless,  as  promoters of
health, they are  inferior to those exercises which take  one out under
the open sky.  They are too mechanical in their nature, and have too
little aim, to be  allowed  to take the place of  the preceding.

                      Passive Exercises.

  Sailing. — This, to many persons, is among the most pleasurable
and exciting of the  passive exercises.  But the excitement arising
from the motions of a  boat,  sometimes, in case  of  timid  persons,
degenerates into fear, which is injurious.   Young gentlemen who
manage the boat  upon  sailing excursions, should  never put on too
much  sail in a brisk  wind, and torment the ladies by exciting their
fears, as their own amusement may be  in this way purchased' at the
cost of others' health, — a result far enough from  their thoughts or
intentions, but not the less real.

  Swinging. — The sick may sometimes indulge in this exercise, when
capable of enduring no other.   To swing gently has a soothing effect,
and often allays nervous  irritability in a wa^  which nothing else can.
It is like the lullaby motion of the cradle.  It calms and soothes.
  Nervous children  and grown persons in  feeble  health,  are  some-
times, by roguish boys, swung too high, and very much excited and
alarmed.  This  is wrong.   It  may do great  injury.  Very few boys
would do it if they knew the evil consequences.   Boys  and girls are
generally kind hearted; and though  they may like to hector others,
they will seldom knowingly injure them for their  own amusement.

  Carriage-Riding.—The advantages to be derived from this species
of exercise are probably rated too high.  For feeble persons, just re-
covering from illness, who cannot endure walking or riding on  horse-
back it is valuable, particularly if taken in an open carriage.  But for
those who have more strength, it is less desirable than many other ex-
ercises.  True, it is  generally an agreeable mode of locomotion, and
for  this reason, it is generally more serviceable than the small amount
of exercise afforded by it would lead one to suppose.
  Carriages are luxuries, and like all other luxuries, they are apt to
bring on debility, and perhaps  shorten life.   A  man is apt to order
his carriage  to the door at the time when increasing wealth enables
him to retire from the active pursuits of life,—the very moment when 
94                          HYGIENE.
 he is most in need of some exertion to take the place of that to which
 he has been accustomed.   Yet so it is, luxury comes to enfeeble, at
 the time when we need something to harden us.
   Could rich men be persuaded to let their luxuries consist, in part,
 in doing good, and like Howard, find pleasure in travelling on foot to
 visit those who are sick and in prison, they would be surprised to see
 how their happiness would be increased.
   Close carriages are generally used by the wealthy.  They at best
 contain but little air, which is breathed over and over, and becomes
 unfit for respiration.   The windows of such carriages should  always
 be open,  except in  rainy weather, when  the latticed windows only
 should be used.

   Riding in Sleighs  furnishes an agreeable excitement, and may be
 indulged to some extent with advantage.   Yet it can be had  only in
 cold weather, and persons who partake of its  pleasures, should be
 careful to  wear clothing  enough to protect themselves against the
 frost.  This is the more necessary, as very little  motion is communi-
 cated to their bodies by the sleigh.

   Horse-Back Riding. — This form of exercise may fairly rank next
 to walking; in some states of the system, it is preferable.  It justly
 holds a high rank as an  exercise for consumptive persons.  Many a
 man, and woman too, has been benefited by it  when suffering from
 lung  disease.   For those  who have hernia, or falling of the bowel, it
 is not proper, as the  most serious consequences may result from its
 use.

  The Horse should  be Owned.— A'feeble man who rides  on  horse-
 back should, if possible, own his horse ; fop, becoming attached to him,
 as he generally does, he will be able to ride farther than upon an ani-
 mal in which he feels less  interest.  A horse is a noble creature, and a
 man who loves him, will sometimes acquire a passion, almost, for
 being upon his back, and witnessing his splendid performances.

  Pleasurable Exercises Most Beneficial___Finally, those exercises are
 most beneficial, and can  be longest endured, in which we feel the
 greatest interest  Place before even a feeble man some desirable ob-
 ject, and he will endure a great deal to reach it; or engage  the  mind
 of a very tired person in something  which greatly interests  it, and
 considerably more exertion will be easily borne.   This is  well  illus-
 trated by the story told by  Miss  Edge worth of  a certain father, who
 had taken a long walk with  his little son, and found the boy appar-
 ently unable to walk further, some time before reaching home. " Here,"
 said the shrewd-minded father, "ride on my gold-headed cane."   Im-
 mediately the little fellow  was astride the cane, which carried  him as
 safely home as the freshest horse.

  Mental Co-operation is  of the highest importance in all exercise.
 Men who are paid by the  job, work with far  more  spirit than those
who are paid by the day.  One would dig in the earth with  very little
spirit, if he had no motive for doing it; but if he expected with every 
HYGIENE.
95
shovelful of earth to bring up gold-dust, he would not only work with
a will, but would endure a great deal more labor.  From these consid-
erations wre may infer that those farmers and manufacturers, who pay
their men the highest wages, make the most money on their work.

  The  best time for  taking exercise is that in which it does us most
good.  For most persons, the morning hours may be considered most
favorable.  But there are many who cannot take exercise in the early
morning, without suffering from it through the whole day.  Some are
able to walk miles in the afternoon, who would be made sick by sim-
ilar exertions immediately after rising.
   Persons often injure friends who  have  this peculiarity of constitu-
tion, by  urging them  out in  the morning.   They do it from good
motives, but are, nevertheless," blameworthy for attempting to  advise
in matters which they do not understand.

                       Rest  and Sleep.

   Our bodies are like clocks ;  they run down and are wound up once
every  twenty-four hours.  Were they obliged to work on uninter-
ruptedly, they would  wear out in a few days.  It is a merciful pro-
vision  that periods of repose  are allotted to us.   Everything  has its
proper place.   Rest  is not less a luxury after  exercise, than exercise
is after rest.  They both confer happiness at the same time that  they
promote  our well-being.

   Sleeping Rooms. — The largest part of our  rest is  taken in sleep.
Of course the kind of room in which we sleep is worthy of considera-
tion.   Hufeland says: " It must not be forgotten that we spend a
considerable portion of our lfves in the bed-chamber, and consequently
that its healthiness or unhealthiness,  cannot fail  to have a very im-
portant influence upon our physical well-being."   It should at least
be large.   That is of prime  importance, because, during the several
hours that we are in bed, we need to  breathe a great deal of air, and
our health is injured when we are obliged to breathe it several times
over.   We should at least pay as much  attention to  the size, situa-
tion, temperature, and cleanliness of the  room we occupy during the
hours  of  repose, as to the  parlors, or drawing-room, or any other
apartment.  And yet how different  from  this is the general practice
of families.  The smallest room in the house  is commonly set apart
for the bed and 'its nightly occupants.
   The sleeping-room should  have a good location, so as to be dry.
It should be kept clean, and  neither  be  too hot nor too cold.   And
more important still, it should be well  ventilated.
   One bed, occupied  by two  persons, is as much as should ever be
allowed in a  single  room ; though, of course, two beds  in a large
room, are no more than one in a small one.  Both are objectionable.

  Fire  in Sleeping Rooms. —As to having  fire in a  sleeping room,
that  is a  matter to  be determined by the  health  of  the  occupant.
Persons who have poor circulation, and are feeble, had better have a 
96                          HYGIENE.
 little fire in the bed-chamber, in cold weather.  For  those  in  good
 health, a cold room is preferable.

   Open  Windows in  Sleeping Rooms. — In the hot weather  of  sum-
 mer, it is better to keep the windows open to some extent, through
 the night, but not on  opposite sides of the room so as to make a  draft
t across the bed.
   There is  a difference of opinion as to the safety of this practice;
 but the experience of those who have used it prudently and persever-
 ingly,  has generally sanctioned its employment.   It is  presumed that
 night-air is  made to be breathed; and if we breathe it habitually, there
 is no good reason why it should be considered  hurtful.  At all events,
 we have got .to do one of three things, — either breathe it, or be poi-
 soned by air which is breathed several"times over, or  use very large
 sleeping rooms, and thus lay in a stock to last over night.

   An Open Fireplace  in a bed chamber will do  much towards its  puri-
 fication.   It carries off foul air.  But many persons  board up this
 outlet as if  bad air wTere a friend, with whom they could not think of
 parting.   At the same time, they wjll carefully close all windows and
 doors, as if  fresh air were an enemy not to'be let in.

   Beds. — It is a pleasant  thought that while  so  many things which
 injure health are coming into fashion, some which have a like effect
 are going out.   Among the injurious things which are silently with-
 drawing, are feather beds.
   In earlier times, a bed made of eider-down was thought  to  be  a
 great luxury, to be carefully preserved, and handed down from mother
 to daughter.  Beds  made of hens' feathers, and other  coarser kii ds,
 were thought to be only fit for children.  With due deference to these
 earlier judgments, it must be said that feather beds, whether downy
 or coarse, are not even  fit for children.  They are composed of ani-
 mal matter, and by a slow process of decay, are always, when stirred,
 sending  up  an exhalation which it is not healthful to  breathe.
   By their softness, too, they increase the general tendency to effemi-
 nacy.  In warm weather, they are too heating.   To  sink "down  into
 them, and lie nearly buried all night, is to insure a feeling of lassitude
 and  debility in the morning.  Only the strongest persons can endure
 it without being made conscious of the evil effects.

   Beds must not  be  too Hard. — On the other  hand, it is  almost
 equally  unwise to choose a bed of absolutely unyielding hardness.
 When very tired, we may rest  even upon a board; but sleep will
 generally be more sound as well as refreshing, if the  bed be some-
 what yielding.  The  hair mattress is the very best bed yet used.  It
 is healthful  and easy.   No person  once accustomed to it, will  ever
 return to feathers.  In summer, it is  a luxury; in winter, it is suffi-
 ciently warm,  though  a little more  covering is needed  than  with
 feathers.

   Bedding. — In hot weather, linen  sheets  are preferable to cotton,
 and  of course will be used by those  who have ample means.  But 
HYGIENE.                    .      97
cotton ones are good  enough, and in winter are decidedly the more
desirable of the t\*o.   Cotton is best, too, for those who suffer  with
rheumatic  affections.  For  external covering, comfortables are objec-
tionable, because they  do not let the  insensible  perspiration pass off
as freely as  it should.   They  are  light,  however, and so are rose
blankets, which have  the additional good quality of being porous.
We  should sleep under as few clothes as possible, consistently with
comfort.
  Night Dress.— The  flannel,  cotton, linen, or  silk,  worn  next the
skin through  the  day, should always be replaced, on retiring, by  a
suitable night-dress.   This  should be of the same material with that
which is taken off.   If we wear flannel through  the day, we need  it
quite as much at night.

  Do not Cover the Face. — The practice of sleeping with the face
entirely covered with the bed  clothes, is  very injurious.  It compels
one to breathe the air over several times.

  Natural  Position for  Sleep. — The most natural position in which
to sleep is  upon the right side.   This affords the easiest play to the
internal organs.   It is best, however, to  learn  to sleep in different
positions, and to change occasionally from  side  to side.   Upon the.
back  is not so easy a position.  To lie in this way obstructs the cir-
culation of the  blood, by the pressure of the stomach, bowels, etc.,
upon the large blood vessels which pass down and up in front of the
back bone.  It is very tiresome  and injurious to  lie  with  the hands
above the head.
  Amount  of  Sleep.— The  average  amount of sleep required by per-
sons in health, is from seven to eight hours.  Occasionally we find
persons who get along very well with six, or even five  hours ; while
some, even in health, require nine.  There is no absolute standard for
all persons, in the amount of sleep, any more than in that of food.   It
depends on the temperament, the constitution, the amount of exercise,
and the exhausting nature of the mental application.
  The object  of sleep is to repair the energies ;  the extent to which
they are wasted, and the recuperative power possessed, will measure
the amount required.
  Late Suppers.— These are a bar to all sound and  healthful sleep.
The last meal should always be taken at least three hours before re-
tiring, and should be light  During sleep, the stomach should  have a
chance to  rest.   It will work  the better on the morrow.  Some per-
sons  boast that they can sleep  perfectly well after a heavy supper.
Perhaps they can; but,  as  Franklin  has  wisely  suggested, they may
by and by " have a fit  of apoplexy, and sleep till  dooms day."   This
will  be sleeping too well!

  Preparation for  Sleep. —Dr. Franklin left behind the record of a
wise  life, as well as many excellent moral and  philosophical direc-
tions.   A  good conscience  was his  prescription  for quiet  sleep and
pleasant dreams, — a  most excellent direction.   Sleep is promoted, 
98                          HYGIENE.
 too, by withdrawing the mind, a short time before retiring, from all
 hard study, and exciting themes  of conversation; and turning it to
 calmer subjects of reflection, such as the moral attributes of  God,—
 particularly his love and paternal character.


                     Objects of  Clothing.

   The clothes we wear are intended, or should be intended, to secure
 three  objects, — warmth in winter, coolness in summer, and health at
 all times.
   It has already been shown  that  our bodies are warmed by their
 own internal fires.   In the lungs, in the skin, and indeed in all parts
 of the body, oxygen unites  with  carbon and other combustible mat-
 ters, producing heat in the same way that it is produced in  a grate
 where anthracite coal is  burned;  and as our temperature  always
 needs to be kept up to about 98° of Farenheit, it follows that this
 combustion must always be  going on.
   Now, the atmosphere which surrounds us is always receiving into
 itself  the heat which comes to the  surface of our bodies, and thus
 robbing us of our  warmth.   In summer, the atmosphere, full of the
 rays of a burning  sun, may impart heat, instead of taking it away;
* while in winter, it  takes more than it  gives, and would cause us to
 perish with the  cold, were it not for the protection afforded  by our
 clothing.
   Clothes, of course, have no power to manufacture or impart heat.
 They only retain, and keep in contact with our bodies, that which is
 generated within us.  If we have on a single garment which is made
 tight at the bottom and  top, so that no current can pass up or down,
 there will be a layer of air between it and the body, which, becoming
 immediately heated, and being retained there, helps keep us warm, or
 rather, prevents us  from being cold.   With every additional garment
 put over this, there is another layer of heated air, adding still more
 impenetrable guards against either the intrusion of  cold, or the escape
 of internal heat.
   Bad Conductors  of Heat. — But, that our clothes may thus retain
 our warmth, and prevent  its dispersion, they must be bad conductors
 of heat, — that is, they must not readily take up the heat and convey
 it away from  the  body.   They must slowly absorb the caloric  into
 their own substance, and then retain it tenaciously.
   Linen, which is so universally popular in temperate  climates, as an
 article to be worn next the skin, is unfortunately a  good conductor of
 heat.   It does not afford a warm garment.  It conducts heat rapidly
                     away from the body. Hence it always feels cool
                     to the touch.   It is really no colder in itself than
                     other kinds of cloth, but it is  solely the rapidity
                     with  which  it conducts heat  away from the
                     body, that gives it the feeling  of coldness.   It
                     has other qualities  which compensate, in some
 measure, for  this  defect.  The fibres  of which it is  composed, are
 
HYGIENE.
99
Fig.
round and  pliable, which make linen cloth  smooth and soft, and the
sensations produced by it, upon the skin, altogether agreeable.  Figure
67 represents a fibre of linen, as it appears under a microscope which
magnifies it 155 times.

  Cotton is warmer than linen, because  it is a worse conductor of
heat.   The perfection to which its manufacture  has been carried,
makes it almost a rival of linen in  softness and pliability.  It does
not absorb as much moisture  as linen, and therefore better retains
its powers as a non-conductor.
  But then the fibres of cotton are  not round and  smooth, like those
                    of linen,  but flat and spiral, with sharp  edges.
                    Figure 68.represents two of its fibres, magnified
                    155 times. This renders cotton irritable to some
                    very delicate skins.  This is the reason why linen
                    is better  than  cotton  for binding up  wounds,
                    where there is  tenderness of the surface.

  Silk has a round fibre, like  linen, which is even softer and smaller.
It absorbs  less moisture than  cotton, and in  its power of communi-
cating warmth,  it is superior to both the preceding.  It forms  the
most desirable fabric for clothing that we  have ; but its cost makes it
inaccessible to the great-body of the  people, except as a holiday
dress  for the ladies.  Its  culture in our own country, if  once  exten-
sively established, would be a source of national wealth.

  The Fibre of Wool is quite rough, almost scaly, and highly irritative
to delicate  skins.  Figure 69 shows  fibres magni-
fied 310  times.   It is  not possible for some per-
sons to wear it  next the skin.  But where this
cannot be done it may be worn outside the  linen
or cotton; and being a good non-conductor, it will
in this way  preserve the warmth of the body,
without either irritating the  skin,  or disturbing
its electricity.
  Wool, in cold  climates, is one of the very best
materials of which clothes can be made.  In New
England, and, indeed, in all cold and temperate regions, it should be
worn  by delicate persons, in  the form of  thick or thin garments, all
the year round.   It does not readily absorb moisture, and is  a dry,
warm, and wholesome  material for clothing.

  Hair. — Though not precisely in the line of these remarks, hair may
as well be introduced here.  Wool is in fact hair.   Every part of the
skin, with the exception of that upon the soles of the feet, and the
palms of the hands, is intended to produce hairs.   On most parts of
the body, they are short and  fine,  hardly rising above the surface.
Upon the head and the face, they grow to considerable length.
  Hair, like wool, is a  bad conductor of heat; and, as growing upon
the head  and face, is doubtless intended for some  useful purpose.
That  it was designed as a warm covering, can  hardly be doubted.
The beard, when permitted to grow, is a natural respirator, guarding
Fig.
 
100                         HYGIENE.
the lungs against cold and dust.   Mr. Chadwick noticed that black-
smiths who allowed their beards to grow, had their mustachioa discol-
ored by iron  dust, which  lodged among the hairs, and very justly in-
ferred that the dust must have found its way into the lungs, and done
mischief, had it not been arrested by this natural respirator.
  That the beard, when long, does ward off a great many colds and
throat ails, is too well  known to be denied.  It has required moral
courage on the part of those who have broken away from the univer-
sal  practice of shaving, for which they should  be hon-    FlG 70
ored rather than ridiculed.  For those who do not suffer pj^S%$5^|g
from throat or lung complaints, especially  if they are |jl^||j f^f$g|
getting advanced in life, it may not be thought worth r^J^Vj  |||H
while to abandon the razor.   Yet the change would not jjjggggBgSgggil
be regretted.   Figure 70 is a human hair, magnified 250 times, show-
ing its scaly surface.

  The  Color of our Clothing is a matter of some moment.   The dark
colors absorb the light, the sun's rays, and heat, much  more than the
lighter ones; and as those bodies which absorb heat well, are like-
wise good radiators,  the dark colors have the highest radiating power.
White reflects heat, and rays of light, and is a bad absorber and bad
radiator.  In summer it prevents the sun's rays from passing inward
to heat the body, and in winter, interrupts the heat of the body in its
passage out.   In summer, it makes the coolest garment;  in winter,
the warmest one.  These facts can be very simply illustrated, by lay-
ing, side by side, upon  the snow, when the sun shines, two pieces of
cloth, the one black, the other white.   Lifting them up, after a time,
the snow will be found considerably melted under  the  black cloth, but
not under the while.
  It is now seen that the object of clothing is not to impart  heat to
the body, but to prevent  its  loss ; that it is not to create it, but to
furnish the occasion  for increasing its degree. ' It appears further, that
clothing protects the body against the evil effects of changes of tem-
perature, and that white garments, by reflecting, instead of absorbing
heat, guard it against the heat of summer.

  Clothing should be Porous.— All articles used for garments, should
be porous, and permit the  free passage of insensible perspiration.  The
skin receives  oxygen through its pores, and gives back carbonic acid.
It performs a sort of subordinate respiration.   India rubber garments
worn next to it, interrupts this, and must do mischief.  Shoes made
of this material, soon cause the feet to become damp and cold.   The
dampness is occasioned by the insensible perspiration, which cannot
escape  through  the rubber.   Such shoes worn in the open air, should
be immediately  taken oft'on entering the house.

   Thin Shoes. — The defective way in which American females pro-
tect their feet from cold and wet, is a sore evil; and he who persuades
them to adopt a wiser fashion, and cover their feet with better guards
against colds and consumptions, will deserve the •gratitude of the
nation.  We arc in many things too fond of copying foreign  fashions: 
HYGIENE.
101
but if our ladies would, in this matter, follow the excellent  example
of English women, they would live longer, and leave a hardier pos-
terity behind them.
   The shoes worn  by our females, high and low, rich and poor, are
not  thick enough to wTalk with  safety upon a painted  floor, hardly
upon a carpet in an unwarmed room ;  and yet  they, walk with them
upon cold brick  side-walks, upon damp and frozen ground, and even
in mud.
   The result is, that they suffer from  colds, sore throats, pleurisies,
lung fevers, suppressions, inflammations of the womb, and many other
ailments, which in early life, rob them of their freshness and beauty,
of their  health and comfort, of their usefulness to their household and
the world, and leave them helpless  in the arms  of their friends, with
a patrimony of suffering for themselves while they live, and  a legacy
of disease to hand down to their children.  Would that they were wise
in season!  Some, to their honor be it said, have already adopted a
safer course.  It is hoped the evil will be gradually corrected.

   Never  attempt  to mould the Form by Dress. — Parents  commit a
great error when  they attempt to mould  the forms of their  children,
particularly their daughters, by their  dress.   This  cannot be done.
It is the work of  nature,'and she wants no assistance in  it.  The
great object of dress  in childhood  as  well as in adult life, is to pro-
mote health.  With this, there is not much difficulty in preserving the
symmetry ; without it,  deformity is almost a matter of course.
   The fact cannot be too  often repeated, nor too seriously urged upon
parents, that'while  the foundation of all graceful and just prop^-tion
of the different parts of the body must be laid in infancy, it cannot
be done by tight bands, and ligatures upon the  chest, and loins^and
legs,  and arms.   Upon all these points,  the garments of  children
should set easy,  leaving  the  muscles  at  liberty to  assume  the fine
swell and development which nothing short of unconstrained exercise
can give.  Could infants tell all the horrors  they suffer from the re-
straints put upon them by tight dresses, it woukl make many a moth-
er's heart bleed.
   In these brief remarks, the principles are given which should guide
us in the selection of our clothing.  The intelligent reader will  be
able very easily to fill up the outline.


                  Bathing and Cleanliness.

   Aristotle calls cleanliness one of the  half virtues; and Addison,
in the Spectator, recommends it as a mark of politeness, and as analo-
gous to purity of mind.  Both in the Jewish and Mohammedan law, it
is enforced as a part of religious duty.   Its requirement as a prerequi-
site to christian communion, would be wiser than the demands some-
times made.  A dirty Christian may perhaps be  found, but not among
those who mean to be  intelligent.
  The importance  of  keeping the skin clean is not  generally appre-
ciated.   The motive for cleanliness is often a lower  and meaner one 
102                         HYGIENE.
than should be allowed  to  have place in  the  mind.  Many persons
would be mortified to have their hands, or face, or neck dirty, who do
not wash their whole body once a year.  That  they may appear well
in the eyes of others, is the only motive with such for keeping clean.

  Offices of the Skin. — If we  look a little  at  the offices of the skin,
we shall better understand the need of keeping it clean.
  The skin is not merely a covering to protect  us from the weather.
It is a living structure, curiously wrought, with a large extent of sur-
face, and having important duties to perform in the animal economy.
Its structure is more particularly explained under the head of " Anat-
omy " and " Skin Diseases."  It has been  already said, that it helps
the lungs in breathing.   It does many other things on  which the
health is dependent.

  Number of Perspiratory Tubes.— The skin performs several kinds
of secretion, — that is, it separates several things from the blood,—
one of which  is the perspiration, or sweat,  The sweat is formed in
small glands, situated just under the skin, and is brought to the surface
in small ducts, or tubes, like the hose through which firemen  throw
water.   These little tubes are spiral,  as seen in cut 44, and run  up
through the two skins.                  •
   These spiral canals are very numerous, covering every part of the
human frame, — there being about 2800 of  them upon every square
inch throughout the body;  and as a man of ordinary size, has about
2500 square inches of surface, the number of tubes in the skin of one
marwis seven millions.
   Tne mouths of these tubes are called the pores of the skin.  Each
one^of these tubes is extended just below the skin ; and there, among
the cells where the fat is  deposited, it, or rather the two branches into
which it is divided, are wound into a  coil, called the sudoriferous, or
sweat gland.  These ducts are each  about a quarter of an inch  in
length, which makes an aggregate length of tubing in the human skin
of  about twenty-eighty miles.

   Insensible Perspiration.— Through each of these seven million of
quarter inch hose, there  is  poured out, day and  night, as long as a
man lives, a stream of sweat  in the  form of  vapor.   When this  is
thrown  off very rapidly, as happens when active exercise is taken, it
accumulates in drops, and is  called  sweat.  Ordinarily  it does not
thus accumulate ; it is then  called insensible perspiration, — not being
recognized by the .senses.
   This  transpiration  may be proved very beautifully by inserting the
naked arm  into a long glass jar, and closing up the space around it
at  the mouth so that no air can get in.   The inside of the glass will
soon be covered with a vapor, which will  grow more and more dense
until it is  converted  into drops.  Boerhaave says: " If the  piercing
chill of winter  could be introduced into a summer  assembly,  the
insensible perspiration being suddenly condensed, would give to each
person  the  appearance of a heathen  deity, wrapped in his own sepa-
rate cloud." 
HYGIENE.
103
  Now, this continual exudation of sweat through these millions of
tubes is for a wise and necessary purpose.   It is to take out of the
blood and other fluids various  salts,  which would do mischief if
allowed to remain longer, and  particularly carbonic acid, which is
poisonous,—the  same matters, in fact, which are thrown out by the
lungs.   The skin, in truth, is a  kind of helper of the lungs; and a
lady, by covering herself with garments which  have no pores, and
will neither admit air nor let off insensible perspiration, may be stran-
gled almost as certainly as by  putting a cord around her neck, and
closing her windpipe.  Almost twice as much fluid passes off through
the skin as through the lungs.
  Keep the Pores Open. — It is obvious from what has now been said,
that the pores of the skin should  be  kept open to preserve  health.
When bathing is neglected, and the under garments are not changed
sufficiently often, the insensible perspiration accumulates%nd dries up
upon the skin, mingling with the oily matter secreted by the oil glands,
and with the shreds of the  scarf  skin, and forming a tenacious gluey
matter, which  closes up the pores. By this misfortune, that large quan-
tity of worn-out matter which usually goes off with the fluid through
the pores, is retained to poison and embarrass the living current of
blood, or #eek an outlet through lungs or kidneys which are already
burdened with quite as much as they are able to do.   How  impor- .
tant, then,  that these channels through which the body is  purified,'
should be  kept  open! that the  skin should j^e  kept healthy  and in
working order!
  The  Bath, the Great Purifier. — But  this can only be done by, daily
washing.   The bath is the great  purifier of the human skin.
  The antiquity of bathing is very great.   The practice  is supposed
to reach back to the infancy of the race, or certainly to a very early
period.  The inhabitants of middle Asia are said to have been  the
first to use the bath for the specific  purposes of purification and
health.   Domestic baths  are. represented  as  having been  used by
Diomed and Ulysses.   Andromache prepared warm water for  Hector
on  his return  from battle.   Penelope banished sorrow  by  unguents
and baths.
  The  Baths of the Medes, the Persians, and the Assyrians were much
celebrated.  Alexander, though  familiar with the voluptuous baths
of Greece and Macedon, was astonished at the magnificence of those
of Darius.
  Roman Baths. — As luxury and refinement advanced, the means of
luxurious bathing were multiplied, until establishments were built by
the  Romans, the very remains of which excite wonder at this day.
Among these are the  Thermae  of  Agrippa, of Nero, of Vespasian,
of Titus, etc.   One of the halls of the  building constructed for baths
by Diocletian, forms at this day the church of the Carthusians, one
of the  most magnificent temples  in Rome.
  Number  and Character. —According to Pliny,  baths  were intro-
duced into Rome about the time  of Pompey; their first erection Dion 
104                         HYGIENE.
  attributes  to Maecenas.   Agrippa increased their  number to one
  hundred and seventy;  and within two hundred years they were mul-
  tiplied to about eight  hundred.  These establishments were so vast
  that one writer compares them to provinces.  They were paved either
  with crystal, or mosaic, or plaster, and were adorned by sculpture and
  painting to the very highest degree.   They added not merely to the
  health and  luxury of the  people, but  contributed to their culture  in
  the highest departments of art and taste.

    Names of Baths. — To  the  apartment of their dwelling in wThich
  they washed their bodies in warm or hot water, the Romans gave the
  name of balneum, or bath; to the public establishments, that of balnea,
  or baths.  The apartment which held the vessels was called vasarium.
  In this were the three immense vessels which contained the cold, warm,
  and hot water.   There were instruments of bone, ivory, and metal,
  for scraping*the  skin, with a groove in  the  edge, through which the
  impurities of the skin might run off.
    On the north front  of the thermae  was a reservoir  of cold water
  large enough for swimming, called  by Pliny  the younger, baplisteium.
  In the centre was a spacious vestibule, and on each side, warm, cold,
  and vapor  baths, with  apartments for cooling, dressing, and  refresh-
  ments.  There was the frigidaium, a  vaulted room,  a cooiing room
>9 midway between the warmer and the open air ; the tepidarium, with
  a temperature widway  between the above and the hot  bath;  and the
  colidarium, or the vapq^bath.
    Then there was the room where the body was rubbed over with a
  great number of ointments and essences of the most  precious kinds;
  and another in which it was sprinkled over with powder ; and also a
  room which held the  clothes, in which trfe bathers undressed and
  dressed at pleasure.
   All these apartments were double,  the two wings being appropri-
  ated to the sexes.

   Open to all. — These baths, thus  numerous and  magnificent, were
  open to all classes of the people, and contributed largely to the gen-
  eral health and physical endurance for which the Romans were con-
  spicuous.

   The  Bath Neglected under the Christian System. — When Jesus of
  Nazareth came into the world, he found man's nature cultivated in a
  most defective way.   The moral element had sunk down to the low-
  est place, while the physical had risen to  the highest,—just the reverse
  of the  true  order of things.  This Divine Teacher came, not to re-
  commend a neglect of  the body, but a new cure for the imperishable
  part.  Mankind were for the first time systematically taught to forgive
  injuries.  Prostrate  liberty, and degraded woman,  became the wards
  of Christianity.
    Unfortunately, under the new order of things, the lower element
  of man, which had been exalted and worshipped, was cast down and
  abused.  What the  Pagan had  pampered, the Christian persecuted.
  The body, which had  been bathed, and scrubbed, and anointed, and 
HYGIENE.
105
perfumed, was thenceforward, in  consequence of the improper inter-
pretation of certain texts, scourged, and fasted, and clothed in rags.
Thousands believed, and thousands do to this  day, that to torment
the body is to please God.  Under this feeling, the public and private
baths were  neglected; and to this day, no christian nation has fully
appreciated the necessity of cleanliness, and of  sanitary measures for
the maintenance of the public health.  To a considerable extent, the
body is still under disabilities; still the subject of persecution; and
where this is not the case, it is too often  regarded only as a loose out-
side garment, to#)e thrown over the traveller to the celestial city, and
is expected to be well  soiled with mud and  dust.   The teachings of
the Great Master will by and by cease  to be  perverted, and will be
applied to raise  up man's body, as they have raised his mental and
moral nature, and will make a well-developed and  harmonious being.
   In the mean time, it is the duty and the privilege of the physician
to urge a return,  not to  the magnificence of the ancient regimen for
training the body, but  to its real efficiency in a simpler form.

   Cold  Bathing. — Water applied to the skin at a temperature below
75° of Farenheit, is called a cold bath.  If applied to a person with
sufficient  constitutional  energy to bear  it, it is a decided and very
powerful tonic.   By this is meant that it promotes the solidity, com-
pactness, and strength  of the body.
   The first effect of the application of  cold water to the skin, is the
sudden  contraction of all its vessels, and the  retreat  of the blood
towards the internal organs.   The nervous system, feeling the shock,
causes the heart to contract with more  energy, and throw the»blood
back with new force to the surface.
   This  rushing of the blood back to the skin, is called a reaction;
and when it occurs with  some energy, it is an evidence that  the  sys-
tem is in a condition to be much benefited by the cold bath.  When
this does not take place, but the skin  looks shrunken, and covered
with " goose flesh," and  a chilliness is  felt for a longer or shorter time
after bathing, then the inference should be,  either that the water  has
been used too profusely,  or that the bather has  too little reactionary
power for  this form of the bath.   The latter conclusion must not be
accepted until cold water has been tried with all possible guards, —
such as beginning with  tepid water, and gradually lowering the tem-
perature ; bathing for  a time, at least, in  a warm room; beginning
the practice in warm weather ; and applying the water at firft with a
sponge, out of which most of it has been pressed by the hand.  With
some or all of these precautions, most persons  may learn to use  the
cold bath.  It is always to be followed by brisk rubbing with a coarse
towel or flesh-brush.

   The Sponge Bath. — A wet sponge  is  the  simplest, as well as  the
best mode  of  applying water to the surface  of the  body.  With
persons who are feeble, a part only of the  body should be exposed
at a time, — which part, having been  quickly sponged  and wiped
dry, should be covered,  and another  part exposed, and treated in a
like manner.  In this way, all parts of the body may  successively be 
106
HYGIENE.
 subjected to  the bracing influence of water and friction, with  little
 risk, even to the most delicate, of an injurious shock.  The only fur-
 niture  required for carrying out this simple plan of bathing,  is  a
 sponge, a basin, and a towel.  There is no form of bathing so uni-
 versally applicable as this, or so generally conducive to health.

   The  Shower Bath requires a brief notice.  The  shock to the nervous
 system  produced by it, is much  greater than  that from  sponging.
 Beside the sudden  application of coldness, there is  a concussion of
 the skin by the fall of the water.   This form of theJaath is  excellent
 for those who are strong and full of vitality, but is fraught with some
 danger for the feeble and delicate.  This,  however,  depends on the
 judgment with which it is  used.   In the form of  a  delicate shower,
 and with tepid water, the frailest body might bear its shock.

   The Warm Bath. — A temperate bath ranges  from  75° to 85°; a
 tepid bath, from 85° to 95°;  a warm bath, from  95° to 98°; a hot
 bath, from 98° to  105°.  A warm bath is  of the same temperature
 with the surface of the body.   Of course it produces no shock.  To
 those who are past the meridian of life, and have  dry  skins, and begin
 to be emaciated, the warm  bath, for half an  hour, twice a week, is
 eminently serviceable in retarding the advances of age.
   It is a mistake to suppose  the  warm bath is enfeebling.   It has a
'soothing and tranquillizing effect.   It renders the  pulse a little slower,
 and the breathing  more even.   If the bath  be above 98°, it becomes
 a hot one, and the pulse is quickened.
   The, temperature of the warm bath, as of the cold;  should  be made
 to range up and down according to the vigor of frame, and the circu-
 lation of the individual.   The aged and the infirm,  whose hands  and
 feet are Imbitually cold, require it to be well up  towards the point of
 blood heat.  The pulse should not be made to beat  faster  by it, nor
 should  sensations of heat or fulness be induced about the temples
 and face.

   The Vapor Bath. —This differs from the warm  bath in being ap-
 plied to the interior as well as to the exterior of the body.   The
 warmth is inhaled into the  air tubes at the same time that it envel-
 ops  the  external person.   The first sensation of the vapor  bath is
 oppression, and causes some difficulty of breathing;  but this passes
 off' as soon as  the  perspiration  begins  to  flow.    From the steam-
 chamber* the bather  should step into a tepid bath, and after remain-
 ing a short time in this, wipe himself thoroughly  with dry towels.

   Cold  Affusion immediately after either the warm  or the vapor bath,
 is excellent.  In Russia it is common, after  the  vapor bath, to pour
 upon the head  of the bather, a bucket of warm water, then one of
 tepid, and lastly one  of cold; and  to finish  with giving him a good
 towelling.  It is even  said that the natives leave the steam and the hot
 bath, and roll themselves in the snow.
   No danger need be feared from cold affusion when the skin is red
 and excited by the warm bath, provided the nervous frame is not in
 a depressed condition. If the body is chilled, and the nerves pros- 
HYGIENE.                         107
trated by disease or fatigue, the application of cold water to the skin
may do great mischief, and  should in no case  be hazarded.  Cold
water applied to a hot skin, cannot do  harm ; to a cold skin, it can do
nothing but harm.   Hence, the  cold bath may be used with advan-
tage on rising in the morning, while the body is warm.  Another good
time  is at ten or eleven  o'clock in the forenoon, when the nervous
power is advancing towards its height for the day.

   Reaction Necessary. — As  a  means  for promoting cleanliness, the
importance of the  bath can hardly be overstated.  For the  support
and improvement of health, it is equally important.   But for the pro-
motion ©f the latter, one prerequisite is essential, — the reaction of
the skin.
   Various means are resorted to, to secure this.   The Hindoos secure
it by  a kind of shampooing, thus described by a writer: " One of the
attendants on the bath extends you upon a bench, sprinkles  you with
warm water, and presses  the whole body  in an  admirable manner.
He cracks the joints  of the fingers, and of  all the extremities.  He
then  places you  upon the stomach,  pinches you over the  kidneys,
seizes you by the shoulders, and cracks the spine  by agitating all the
vertebrae,  strikes some powerful blows over  the  fleshy and muscular
parte, then rubs the body with  a hair-glove  until he perspires, etc."
" This process," says the  writer, "continues  for  three-quarters of an
hour,  after which a man scarcely knows  himself;  he feels like a new
being."  Sir John  Sinclair speaks thus of the luxury of the process :
" If life be nothing  but a brief succession of our ideas, the rapidity
with which they now pass over the mind would induce one to believe
that, in the few short minutes he has spent in the bath, he has lived a
number of years."

   The Coarse  Towel, the horsehair glove, and the  flesh-brush  are the
appliances commonly used for stimulating the skin, and causing reac-
tion.   For tender skins, the  towel is  sufficiently rough.  With this
the bather should rub himself, unless he is weak and the exertion pro-
duces palpitation.   The muscular exertion necessary for this will help
the reaction.

   Restoration of  the  Bath desirable. — It is greatly to be wished that
the bath might be restored to something like the  importance  it held
among ancient nations.   It  is  a  luxury, a  means of health, and a
source of purity  both of  body and of mind; for the morals of any
people will rise where the use of the  bath  is  regular and  habitual.
The attempt to cure all diseases by what is called the " water-cure,"
has a bit of fanaticism about it, which will cure  itself in  time.   But
that water, used  judiciously in  the form of  baths, is a potent moral
and physical renovator of the race, is not to be  doubted ; and  this
should commend  it to all sensible people, even though it should some-
times be abused by excess, as all good  things are.
   A people with clean hands, and clean bodies, and clean health, will
very naturally come to like clean streets and clean cities, and  finally,
clean  consciences.   A  fondness  for cleanliness in one form,  almost 
108                         HYGIENE.
necessarily runs  into  a  like fondness for it in  other forms, until the
purifying desire pervades the whole nature, moral as well as physical.

                    Air  and Ventilation.   #

  Water and air are fluids.   Water covers two-thirds the surface of
the globe, having a depth, in some places, of five miles or more.   Air
covers not merely the remaining third of the earth, but the water as
well.   It embraces  the  entire  globe, pressing  alike upon land and
water, and having a depth of about forty-five miles.  This is a sea of
such magnitude, that the Atlantic or Pacific shrinks to a very small
lake in the comparison.
  Man has his  residence, and walks about at  the bottom  of this
ocean.  He has no means of navigating it, and, therefore, never rises
to its surface ; but, with his natural eyes, and with telescopes, he dis-
covers objects which lie millions and billions of miles beyond it, and
even acquires much exact and useful information  respecting them.
  This vast ocean of air  we  call an atmosphere, from two Greek
words signifying vapor, and a sphere, — it  being  an immense fluid-
sphere, or globe.
  Pressure  of the Atmosphere. — This atmosphere presses upon man
and upon  every object on the surface of the earth, with a force equal
to fifteen pounds to every square  inch ; and as a man of average size
has a surface of about 2500 square inches, the air in which he lives,
presses upon him with a  weight of eighteen  tons.  This would of
course crush every bone in his body, but  for the fluids within him
which establish an equilibrium, and leave him unoppressed.
  The Philosophy of Breathing cannot be fully explained in the brief
space  allotted to this subject; it  is enough  to say, that, upon the  at-
tempt being made  to draw in the breath, the muscles of the breast
draw up the ribs, the diaphragm  or midriff at the same time contract-
ing, — the whole movement being such as to  create a vacuum in the
lungs.  The air, pressing upon every part of the surface, as mentioned
above, instantly rushes in and fills the vacuum.   The lungs being
filled, the  contraction of the  muscles  of  the  belly causes the  dia-
phragm, which has  sunk down towards a plane, to rise up into the
form of an umbrella, and squeeze the air out of the lungs.
   This is about all that need  to be said of the method of getting the
air into and out of  the lungs.  The whole process is under the con-
trol of that part of the nervous system  called  the medulla  oblongata,
or top of the spinal cord.
   Objects  of Breathing.— There  are at least  three objects to be ac-
 complished by breathing; the renewal of the blood and the taking of
 impurities  out of it; the warming of the  body ; and the finishing  up
 of the process of digestion,  and the change  of  chyle into nutritive
 blood.
    There is no good reason for attempting  here to explain the last of
 these objects.   To  give  any idea of the  first two, it is  necessary to
 furnish a very brief explanation of the circulation of the  blood. 
HYGIENE.                          109
   The heart  is double.  There  are  in fact two hearts, a right and a
 left, joined together.   The right heart receives the blood from the
 veins, and forces it up  into the lungs, whence it  is brought  back to
 the  left heart, and  by this is driven through the arteries into ever*
 part of the body.  When received into the lungs, the blood is of a
 dark purple color, and is loaded with carbonic acid and some other
 impurities.  It has also been deprived, during its  circulation  through
 the  body, of most of its  oxygen.  The small, delicate vessels which
 convey this dark and  impure blood through the lungs, pass directly
 over the air cells; and  at this  moment the carbonic acid and water
 pass through the blood vessels  and air cells, and are borne from the
                       bod^ on the outgoing breath;  while  the  oxy-
                       gen enters the blood through the walls of the
                       same vessels ; and this exchange, which takes
                       place with every breath, alters the blood from
                       a  dark  purple to  a scarlet  red.  Figure 71
                       shows at 1, a bronchial tube divided into three
                       branches;  2,  2,.2, are air-cells; 3, branches of
                       the pulmonary artery winding  around the air-
                       ceils with  the dark blood to be reddened.
   That carbonic acid and water are  borne out of the lungs with every
 breath, may be easily proved.  If we breathe into lime-water, it will
 become white.   This  is  owing  to  the carbonic  acid  in the breath
 uniting with the lime, and producing carbonate of lime.   Then, if we
 breathe upon a piece of glass, it becomes wet, showing that there is
 watery vapor in the breath.   That the blood receives oxygen from
 the air.we breathe is proved by the fact that the ingoing breath has
 one-fourth more oxygen in it than the outgoing.
   The  lungs, then, take out of all the air we breathe, one-fourth of
 its oxygen. If we breathe it over a second, a third, and a fourth time,
 it not only has less oxygen each  time, and is less useful for the  pur-
 poses of respiration, but it becomes positively more hurtful by reason
 of the poisonous carbonic acid which, at every outgoing breath, it
 carries with it from the  lungs.

   Effect of Sleeping in  a  Small Room. — Now,  consider the effect of
 sleeping in a small room,  seven feet by nine, not furnished  with the
 means of ventilation.   A pair  of lungs, of onlinary -size, take in, at
 each breath, about a pint of air.  Out of this air  one-fourth of its oxy-
 gen  is extracted ; and when it is returned from the lungs, there comes
 along with it about eight  or nine  per cent, of carbonic acid.    As it is
 not safe to breathe air containing  more than three or four per cent.
 of this  gas, the  pint which the lungs take in and throw out  at each
 breath, is  not only spoiled, but it spoils something mtfre than  another
 pint with  which it mingles; and as the breath is drawn in and  thrown
 out  about eighteen times per minute, not less than four cubic feet of
 air is spoiled in that time  by one  pair of lungs.   This is two hundred
and  forty  feet an hour;  and in eight hours, the  usual time spent in
the sleeping room, it amounts to one thousand  nine  hundred  and
twenty cubic feet.  During the hours of sleep, therefore, one pair of
 
110
HYGIENE.
  lungs so spoil one thousand nine  hundred and twenty cubic feet of
  air that it is positively dangerous to breathe it.
     In a room seven feet by ten,  and eight feet high, there are five hun-
  ted and sixty cubic feet of air, a little  more  than one-quarter  the
  amount  spoiled by  one  pair of lungs  during sleeping hours.  In a
  room of this  size, there  is not air enough to last  one person  three
  hours ; and yet two persons often remain in such rooms eight or nine
  hours.
     Why then do they not perish ?  Simply because no room is entirely
  air tight.   Fortunately, all our  rooms are  so made that some foul air
  will get out, and a little that is  pure will find its way in.  Were it  not
  so, no man who closed the  door behind him, for the night, in a small bad-
  room, would ever see a return of day.
     Suppose fifty children  are confined in an unventilated school-room,
•  twenty feet by thirty, and ten  feet high.   These  children will  spoil
  about one  hundred  and  fifty feet of air in one minute, or nine thou-
  sand feet per hour, or twenty-seven thousand feet in three hours, — a
  usual half  day's session.   But the room holds only six thousand cubic
  feet of air, — the whole  of which these  children would spoil in forty
  'minutes.
     These simple facts show the absolute  necessity of  ventilation.  Yet
  how poorly it is provided for in  our sleeping rooms, our sitting rooms,
  our school houses, our churches, our court houses, our halls of legis-
  lation, and even in our anatomical and medical-lecture rooms!
    In sick-rooms, ventilation should  receive special attention.—Every
  disease is aggravated by  the breathing of  bad air.  Yet it is common
  to close all the doors and windows of rooms where  sick persons are
  confined, lest the patients should take  cold.   This is a bad practice.
  The  sick should  have a plenty of fresh air.  Their comfort  is pro-
  moted  by it, and their recovery hastened.
    It is strange that human beings should  be afraid of pure air.  It is
  their friend and not their  enemy.  Impure  air only should be shunned.
    The supply  of good air ample. — There is no  necessity for breath-
  ing air which has lost a part of  its oxygen, and acquired a portion  of
  carbonic  acid.  The supply of good air  is ample.  An ocean of it
  forty-five miles deep, covering  the whole  globe, seems a pretty plain
  intimation  that it is not to  be sparingly used.  When men retire
  within  their dwellings, and attempt to shut out this great sea of air,
  they show about  as much wisdom as would be exhibited  by fishes
  which should build water-tight huts around themselves at the bottom
  of the ocean,  and swim  about continually in the unchanged water
  within.   Fishes can only live  in  glass  globes when the  water is
  changed  every day;  and  if the water be changed  half a dozen times
  a day,  they cannot  be as  healthy  as when swimming in the great
  ocean.

    Cultivating Trees— In most of our cities there is almost a criminal
  neglect of the cultivation of trees ; yet they add  greatly to the health,
  and prolong the lives of the citizens.
    The leaves of a tree are the lungs with  which it breathes ; but  in- 
HYGIENE.
Ill
stead of extracting oxygen from  the  air, and giving back carbonic
acid, like  man, it takes only the poisonous  carbonic acid, and gives
back oxygen.
  Were there no animals on the globe, the vegetables would consume
all the  carbonic acid, and die for want of breathing material; on the*
other hand, were there no trees or other vegetables, the animals would
in time so far exhaust the oxygen as to perish for lack of it.  The two
together keep the air healthy for each.
  The relation of plants and animals, in all that  relates to their pecu-
liar actions and effects, is a complete antagonism.  Their movements
are in contrary directions, and by hostile  forces.  Their  opposing ac-
tions may be illustrated thus:
  The vegetable  produces the non-
nitipgenized substances, sugar, starch, and
gum.
  The  vegetable  decomposes car-
bonic acid, water, and ammoniacal salts.
  The vegetable disengages oxygen.
  The vegetable  absorbs heat and
electricity.
  The vegetable is a de-oxidizer.
  The vegetable is stationary.
  The  animal consumes the non-ni-
trogenized substances, sugar, starch, and
gum.
  The animal produces carbonic acid,
water, and ammoniacal salts.
  The animal absorbs oxygen.
  The animal produces heat and el-
ectricity.
  The animal is an oxidizer.
  The animal is locomotive.
  We learn from the facts of  Geology that the  time was in the his-
tory of our  globe, when lunged animals could not breathe its atmos-
phere ; it was too much loaded with  carbonic acid. . The trees then
grew  with a rapidity almost inconceivable, decomposing the  poison-
ous gas, taking to themselves  the carbon and setting the oxygen free,
and lifting up their brawny arms to heaven in acts of thankfulness
for the great feast.                                            •  >
  At  length the noxious gas was exhausted; and then, pale and sickly,
they feebly held up their  hands for help;  and  God sent numberless
tribes of warm-blooded animals, full  of life and energy, that sported
in the exhilarating air, and destroyed vast forests, thereby reproducing
carbonic acid.
  These simple facts  should  teach man the sanitary importance of
trees  and bushes; and wherever he has a rod, I had almost said a foot
of ground to  spare, a  tree should be planted  and carefully nursed.
This  is particularly necessary in  large cities.   Every  narrow street
even in Boston, should be lined with trees.   For their absence, thou-
sands of men, women, and children have died sooner than they other-
wise would.   We want them stretching up their arms to all our win-
dows to give us oxygen, and to take to themselves the carbonic acid
we  exhale.

  Tight Dresses. —The  health may be injured by not breathing air
enough, as well as  by inhaling that which is impure.  It is therefore
improper to compress the lungs by wearing tight dresses.  If the ribs
are  held down by the dress, but little air can get into the lungs, and
only a small  amount  of carbonic acid can be  carried out.  In this
event, the health is injured in two ways; the blood is not vitalized by
oxygen received, and it is poisoned by carbonic  acid retained. 
112                         HYGIENE.
  Tight lacing has in a measure gone out of fashion ;  yet too much
of it for the best development of female health is yet retained.   As a
knowledge of physiology and the laws of life, and a better judgment
of the true symmetry of the female form prevail, this barbarous cus-
tom will pass out of use, and the substantial  health, and real  beauty
of the American woman will together rise to  a higher standard.

  Fill  the lungs well. — Persons who take but little exercise are apt
to acquire the habit of drawing the air very little  into the lower part
of the lungs.  This  should  be counteracted  by taking  Jong and full
inspirations for a short time, every day, while in the open  air.   This
practice would get the  lungs in the  habit of  opening to the air quite
down to their base, and would make the breathing much more natural
as well as effectual  at all  times.  In the case of young persons, it
would enlarge the capacity of the chest, and add to the brief years
of life.
                          Travelling.

  It is true  that many persons who dwell in one spot, and hardly
move from it all their lives, live to old age.  Yet change of location
for  a short time, or permanently, does promote health, and protract
life.  The mind tires of contemplating one set of objects for a great
length  of time;  and  in the  absence  of all stimulation, it sinks into
apathy, and  imparts  no  energy to the body.  The physical  frame,
partaking of the ennui of the mind, droops. This is doubly true when
one is suffering from illness.
  Travelling  is eminently fitted to draw the thoughts  of the nervous
and feeble from themselves, and to  turn them with interest to outward
objects.  This is of  great importance.  It is better than stimulants
and tonics.
  The nervous  system has great power over the health ;  and  the
pleasurable sensations, excited by visiting new places and scenes, and
conveyed to the  mind through the nerves, often awaken in the consti-
tution, energies which are essential to recovery.
  Travelling  places  a man  in entirely new  circumstances.   It sur-
rounds him with novelties, every one of which makes a demand upon
his attention.   It breaks up his old  trains of thought, which have been
monotonous so long that they have grown oppressive.   It causes  the
world to touch him at a thousand new points, and surprises him every
day, perhaps  every hour, with a view of the false relations he  has
sustained to it   It opens to  him new depths  in his own nature, and
causes him to wonder that  they, never attracted his attention before.
It opens to him one door after another, leading him into new apart-
ments of knowledge ; and as the world grows, he finds himself grow-
ing with it, until his whole nature dilates and beats with new life.

  Means of Travelling Increased. — The  last twenty-five years have
greatly increased the  facilities for  travelling.  Many of the sick may
now seek health in distant lands, who, had their circumstances been 
HYGIENE.                         H3
similar twenty years ago, would  have been  compelled to pine at
home.  The cars give  an easy journey to thousands who could not
have borne a ride in the old stage coach.

  One thing more wanted. — But one thing is wanted to bring the
means of travelling, for the  sick, very nearly to perfection ; it is a
method of propelling carriages upon common roads, by some cheap
power, which can never be exhausted, and which shall be easily man-
aged by the traveller or his companion.  This is a prominent want of
the present hour; a giant discovery, which, at a single stride, would
carry the world forward a hundred years, and which, we may hope, is
in the womb of the near future.  The  power, it is believed,  will be
electro-magnetism.   The mode  of applying it, when discovered, will
be simple, yet wonderful; and the results to the  sick, beneficent be-
yond expression.   The human mind cannot conceive the  advantages
which invalids would derive from such a mode of conveyance.  Jour-
neys might be long or short;  might be made with any rate of speed
which  the strength  permitted.  The morning  or  afternoon  stages
might be discontinued when fatigue demanded, and resumed at pleas-
ure.   Over uninviting  regions the traveller  might glide swiftly, and
linger where nature spreads her feasts for the mind.

  The best Seasons for Travelling are spring and autumn.   Winter
is too  cold.  A pleasurable  excursion may sometimes  be made in
summer;  but in general the season is too hot for comfort.  In chang-
ing climate, food, water, etc., in the sultry season, there is danger of
contracting very troublesome  bowel complaints.

  Means  of Travelling  for the Poor. — There is one painful thought
connected  with travelling as a means of health.  It cannot be en-
joyed  by the poor.   When sick they  generally have the  careful
attention  of humane physicians; they receive from kind neighbors
little delicacies of food and drink; they are watched with by night,
and  visited by day; but though suffering from the hard routine of a
laborious  life, and  needing diversion and recreation  more than  all
else, they  cannot  travel.   They have not the means, and nobody
thinks of  supplying them for such a purpose.
   This is  a channel into which charity ought to pour some of its
benevolent streams.  In large cities there is a  class of poor females,
who sit in their small  rooms and ply the needle diligently through
the whole year, and who run  down every  summer very near to con-
finement in bed. . Two or three weeks, in the hot season, spent in
travelling in the mountains and elsewhere, would bring back the color
to the pale cheeks of such persons, and save them many years both
from the grave and from the almshouse.  No millionnaire could make
a better use of his property than to set it apart, at his death, for the
specific purpose of enabling the poor to travel.   And if this sugges-
tion should induce one rich man to consecrate his wealth to the God-
like work of bestowing health, happiness, and intelligence upon the
poor, the great labor of preparing this book will not  have been en-
dured in vain.
                                15 
114                     .   HYGIENE.
                        Amusements.

  That which engages the mind, and at the ^ame time  impresses it
with  pleasurable sensations, is a sufficiently accurate definition of
amusement.  Whatever  occupies  the  thoughts and senses in  an
agreeable  way, and  employs them with  some degree  of intensity,
comes under the same head.
  This broad  and general definition allows us to regard our daily
employments as amusements when  they engage our  deep attention,
and at the same time give us pleasure.
  The term amusements, however, in the more popular sense, is re-
stricted to those sports, games, plays, exhibitions, entertainments, etc.,
which involve a suspension of our daily labors, and are properly called
diversions.
  When nature is tired and worn with those severe  and exhausting
toils by which we earn our bread, amusements turn us aside, divert
us, engage other powers, and allow our tired faculties to rest  They
are, therefore,  of very great importance.   Even the most  trifling
amusements may have the highest value.   Their very nature and ob-
ject imply that they will  be  valuable just in proportion as they divert
and rest us.  And just in proportion as they  do these  things, they
give us health.
  One other thing amusements do for us, which must not be forgot-
ten ; they preserve in us, in middle life, and even in old age, the warm
simplicity  of childhood.   They keep us young in our dispositions and
feelings.   They keep us  in  harmony with nature, and  consequently
artless and truthful.   They  prevent the formalities of conventional
life from stiffening us into cold and repulsive hypocrites.
  Selection of Amusements. — Of course the same amusements  are
not adapted to all persons.   The farmer who has worked his muscles
all day, would  not be  benefited by a game  of ball in the  evening;
yet there are few games more suitable for the student who  has bent
for many hours over his books.  Care should always  be taken, there-
fore, that amusements or sports do not bear upon those limbs or fac-
ulties which are wearied by work.
  Amusements improve various  faculties. — To one  who has a taste
for art; who is fond of works of genius and poetry,  theatrical enter-
tainments  will always be  agreeable, and a source of gratification and
health.  I  know these exhibitions are objected to by many as immoral
and hurtful, but more, I think, from habit and fashion, than upon any
solid  grounds of reason or religion.   They certainly appeal to a high
order  of faculties  in the human mind; and to those who are fitted to
receive them, teach lessons of great moment.  Even the lower exhi-
bitions of comedy, though not particularly improving to the mind, are
yet, rfrom their  power to provoke laughter, among the most  powerful
up-builders of health.
  The Games of Wliist, Euchre,  etc., engage the minds of the players
in a sort of mental contest, which is exciting, agreeable, and health- 
HYGIENE                         H5
imparting.  These  games make us skilful in calculating chances, and
judging how men  ought to act under  certain contingencies.  They
make us sharp to detect and turn aside  the unseen forces, which tend
to oppose and destroy our success in life.
   I  hardly need  say that money or other property should  never  be
staked upon a game of cards, or upon any other game.  Gambling is
one  of the meanest as well as most destructive  things in which men
can  engage.   It raises the healthful excitement of these  innocent
amusements, — innocent when properly pursued, — into raging pas-
sions, which, when defeat comes, as come it will, sink into  remorse
and bitterness  as terrible as the mind  can conceive.  I warn young
men as they would escape the  pangs of a hell on earth, and  the loss
of character, happiness,  and probably health  for life, to avoid any
such abuse of cards.

   Chess, Chequers, etc., appeal likewise to the fondness of competi-
tion, which is common to all men. But they cultivate in us a little
more of the mathematical element.   As they require very close appli-
cation of the mind, they are not suitable for persons of sedentary em-
ployments, or whose daily avocations' require a constant use of the
mind.   Such persons should choose lighter and more active amuse-
ments.
   Lighter Amusements.— Beside these  higher amusements, there are
a great number of lighter and more childish ones, which should not
be overlooked.
   Some of these are merely physical, involving a trial  of  strength,
fleetness,  action,  etc., as  the games of ball, cricket, etc.  Others are
domestic  in their nature, involving mirth, and  various other of the
lighter excitements, as blind-man's buff, puss in the corner, hole in the
wall, fox and geese, hunt the slipper, hurly-burly, roll the platter, etc.
   In fashionable American households, these simple  domestic plays
have in a great measure, gone out of use, — being deemed vulgar, and
below the dignity of ladies and gentlemen. I  am  sorry to say this ;
for the vulgarity, in my judgment, is in those who reject them, and
not in the plays.
   The officer of our navy, whose visit to the mansion of Lord Hard-
wick I have spoken of on page 90, reports that on the evening of one
of his  visits, the play of blind-man's buff was engaged in by the
whole  party; and that  his Lordship in attempting to make a short
turn during the play, fell upon  his back, when  one of his daughters,
who was blinded, caught him by the heels, and  being  assisted by
others, drew him stern-foremost half the length of the hall, amid the
shouts of the whole party.  This would have been deemed very vul-
gar by fashionable people in  this country. But to me, who am no
believer in any nobility which Lord Hardwick can receive from kings
or queens, this  simple  narrative raised  him at once to a peerage  in
nature's realm.   Without doubt, he is one of nature's noblemen.   A
man in his station, and with his wealth and temptations to snobbery,
who can  preserve such simplicity of character, must have a warm  as
well as  a noble heart in his breast. 
116                         HYGIENE.
  Value of Domestic Amusements. — I remark  here, that in all our
amusements, we should as far  as  possible, seek those of a domestic
character.  They are more simple  and childlike in their nature, and
preserve  in us, even to old age, the freshness of feeling, and truthful
simplicity, which spread so beautiful a greenness over the autumn of
life.
  Simple domestic amusements, too, are always gotten up on a cheap
scale; they do not encourage costly extravagance, and can be indulged
in by the poor as well as the rich.
  But more, and better than all, they keep young men and old men,
and young women and old women, at home, by making  the domestic
circle the centre of attraction.  They draw the seekers of  pleasure
around the hearth-stone, instead of outward into the world.  They
incline young  and old to look to the family circle as the  centre of the
most pure, because  the most simple and natural, enjoyments.  They
teach us to look to home as the  centre of life, and to all outshie as
only its appendages.
  It has been  said that homes are found only in England; that in
other countries, life wanders, houseless  and  shelterless,  abroad, seek-
ing happiness, it knows not where, while in England it nestles warmly
in the bosom of home.  To whatever extent this is true, — and I be-
lieve there is truth in it, — it is owing to the simple household amuse-
ments of England.
  An American Want. — One of the  great wants ol* this country is a
more liberal provision  for amusements.  We attach here too much
value to wealth; and  we pursue  it  with an intensity altogether in-
compatible with health. We cannot take time for recreation because
we  are in so great a hurry to be rich.
  If we would save ourselves from a total wreck of health, we must
take broader and better views of life.   We must value it for its solid
comforts, rather than for its glitter and show.
  We need quite an increase in the number of our holidays, — days
on  which the  people can  give  themselves up to sportive recreations.
Some progress has been made in this direction of late.  Washing-
ton's  birth day has very nearly fixed itself among us  as a holiday;
the claim of Lafayette's to a similar  observance is beginning to be
acknowledged.  Quite a number  more, scattered through the year,
are much wanted.   They  would  save  hundreds of our population
annually from insanity.
  Contrary to the  general belief, insanity is very prevalent among
seamen and farmers.   The former lead a life of dreary solitude upon
the ocean ; the latter, one, if not of equal, certainly of very objection-
able solitude upon the land.  The sailor who does business  upon the
great sea,  should provide himself with great numbers  of games  to
amuse him in his wanderings.  The farmers of our land should culti-
vate more of the sociabilities of life.  Let them meet together in the
fine summer evenings, like the peasants of France, and dance gayly
upon the green lawns before their cottages.  They will till their lands
more cheerfully for it; enjoy  better  spirits and health; and live  to
greater age. 
HYGIENE.                        117
  Completeness of Life.— Amusements are necessary in order to give
a completeness to life.  The faculties of the human mind are numer-
ous.   It is only when they are all exercised, in their due proportion,
that there is a harmonious beauty in our lives.  The customs of soci-
ety twist us all out  of shape, — perverting us mentally, morally, and
physically,  and robbing  us of every manly and  healthful quality.
Getting out of the ruts of fashionable Ufe, we must come back to the
simple paths of nature. 
TEMPERAMENTS, CONSTITUTION,  AND  SYMPTOMS.
   Man has thinking, warming, nourishing, and moving powers.  Foi
the performance of each of these great  functions, he has  organs  of
the best possible construction.

   For  Thinking, he has a brain.  If this be large in proportion to his
other organs, it gives a character, a cast, a peculiarity  to  his whole
organization.   Everything about him is  subordinate  to  his brain.
We recognize  him, at once, as a thinking and a feeling being.   He
has an intellectual look.   There  is a delicacy, a refinement, a sensi-
tiveness, a studious habit, an air of thoughtfulness about him, which
determine his traits, his tone, his temper,  his whole character.  Hence
it is proper to say  he has a cephalic or thinking temperament.

   The Limgs and  Heart, devoted to renewing  and circulating  the
blood, are  placed in the  chest or thorax.   If these be large in man in
proportion to other organs, he is characterized  by great activity of cir-
culation, by a large supply of red blood, and by the general indica-
tions of a full, warm, and bounding life.   This activity gives him his
tone and temper, and shows that his is  the thoracic or calorific temper-
ament.

   In the Great Cavity  of the Abdomen is done the work of receiving,
digesting, and  disposing of the materials  which nourish  the body.
If the  organs  which do this work be large in proportion to  others, the
body  is fed to repletion, and the whole organization speaks of the
table.  The habit, the  look, the temper, are all sluggish.   This is the
abdominal or alimentary temperament.

   The Bones and Muscles are instruments by which the movements
of the body are performed.  If these be the largest,  in proportion, of
any in the body, then  the locomotive powers are in higher perfection
than any others.  There is largeness of person, energy of movement,
and greatness of endurance.   The whole cast of the person partakes
of the strength and coarseness of bone  and muscle.   This is the mus-
cular or locomotive temperament.
   This gives us four temperaments, as  follows :

   I.  The Cephalic Temperament, denoted  by large brain, activity of
mind, and general  delicacy of organization. 
TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS.      119
  II.  The Thoracic Temperament, indicated by a large chest, force
of circulation, redness of skin, great activity, warmth of temper, and
fulness of life.

  III.  The Abdominal  Temperament, denoted  by a large develop-
ment of the stomach, liver, bowels, and lymphatics;  by a  fulness of
belly, fondness of high living, and a disposition to  float  sluggishly
upon the current of the world, rather than to struggle against it

  IV.  The Muscular Temperament, indicated by largeness of frame
and limbs, coarseness  of structure, and  great power of locomotion
and endurance.                                 ,
   There  are some reasons for reckoning but three temperaments in-
stead of four, by reducing the thoracic and abdominal to one, after
the manner of the phrenological  Fowlers, — especially as the organs
in the chest, and their appendages, take an important part in the pro-
cess of nutrition.  But as the heart and lungs are placed in one cavity,
and the stomach, liver, etc., in another; and as one set of these organs
may be largely developed, and the other defectively, I have  thought it
most convenient, on the whole, and  quite as philosophical, to retain
the four temperaments.
  These  temperaments seldom or never appear single and pure.  They
mix and cross with each other in all possible ways.


              Medication  and Temperaments.

  The object of speaking of temperaments  in this work, is to make
the reader acquainted with the principles  upon which remedies are to
be adapted to their development  The  philosophical-minded physi-
cian will, in prescribing, always keep the  temperament in view.

  Persons of a Cephalic Temperament cannot bear  powerful medi-
cines,— particularly drastic purges.  Their fine, delicate and sensitive
organizations would be torn all to pieces by doses which would hardly
be sufficient in a fully-developed muscular temperament  This should
always be borne in  mind in prescribing for persons of a large brain
and delicate organization.
   In this temperament, too, fevers, instead of  running a high and
fiery course, take the low typhoid type,  the patient  becoming pale,
and showing a constant tendency to sink.  Such patients  would  be
killed by purging, leeching, cupping, sweating, and starving.   They
want tonics, stimulants, and every kind of support  which the case
will possibly permit.

  Persons of a Thoracic Temperament, having a rapid circulation, and
a fulness of blood, are  most liable to inflammatory diseases.  When
fever attacks them, they have what is called a " high fever."  If rheu-
matism comes, it is acute rheumatism.  Disease takes  hold of them
smartly.  As they do everything with emphasis and energy when well,
so, when ill, they make a business of it,  and are sick with all their
might. 
120      TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS.
  Stimulants and tonics generally make  such persons worse.  They
want sedatives,  and diaphoretics, and sweats, and purgatives, and
leeches, and cups, and low diet, and  cold  bathing, and whatever else
will slacken the ferocious swiftness of their circulation.
  Those of the Abdominal Temperament are not particularly subject
either to very high fevers, or  to those typhoid forms which  produce
sinking.   As in the two temperaments  noticed above, their com-
plaints chiefly attack the  organs  most largely developed.   Their dis-
eases affect the stomach, the liver, the spleen, and the bowels.  These
are the largest organs in their bodies, and  are most used ; and, being
overworked, they^fall into  disease.
  As these  persons are slothful in all their  habits, so their  diseases
run a sluggish  course.  They are not so liable to sudden death  as
persons of either of the  preceding  temperaments.   They have  all
sorts of chronic  diseases  which linger a great while, and are  cured
with much difficulty.
  These persons will bear larger doses  of  medicine than either  of
the preceding.   Neither do their  constitutions respond as readily to
medicine.    A physician  will  be  disappointed if he expects to see
them recovering as fast under its use.
  Those of a Muscular Temperament, having little fondness  for any-
thing but a hardy, active life, are much exposed to the elements.
Though strong and long-enduring, the hardship  of their lives often
breaks them down, and when felled by  disease,  they are oftentimes
shockingly racked and torn by it.
  These persons bear large doses of medicine, and when sick, need
to be treated with an energy proportioned  to the  strength of their
constitution. Rheumatism,  which affects the joints, the ligaments,
and the tendons, is an affection from  which they suffer severely.


                     The  Constitution.

  In prescribing for disease, it is of very great  importance to take
notice of the constitution.  This  is a different, matter from the tem-
peraments.  Persons of the same temperament are often quite unlike
in the strength of their constitution.   And those having good natural
constitutions, frequently abuse them by  improper habits and indul-
gences, and at length come to have  broken and very feeble constitu-
tions.
  Some persons' muscles and other tissues are put together as if they
were intended never to come apart.  Like some of the woods of the
forest, — the lignum vitae for example, — they are fine-grained and
tough.  A real smart boy  will wear out an iron rocking-horse sooner
than one of these persons can exhaust their constitution by hard work.
Others, to outward appearance equally  well made, have very little
endurance, break down  easily under hard work,  and lose their flesh
from trifling causes.
  The state of the constitution, therefore,'should  always be learned
before much medicine is given ; for what a person of a strong consti- 
TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS.      121
tntion will need, may greatly injure a feeble person, even of the same
temperament.
  Habits. — These must likewise be attended  to.   Persons  using
stimulants require larger doses of medicine to affect them than other
persons.
  Climate. — Medicines  act  differently on the same persons in sum-
mer and winter.  Narcotics act more powerfully in hot weather and
climates than in cold, and must be given in smaller doses.

  Idiosyncrasy.— Medicines  of only ordinary activity, act very power-
fully, and even  violently on  some persons.  This is owing to a pecu-
liarity of stomach, or constitution, called idiosyncrasy.   It  makes the
person, in this  particular, an exception to the general  rule.  And no
physician can know beforehand  in what  particulars this  exceptional
disposition will show itself.   Persons, however, learn  their own idio-
syncrasies, and should make  them known to those who prescribe for
them for the  first time.
  The Sex. — The peculiarities of each sex should never be forgotten
in prescribing for the sick.
  Males are  not so sensitive  as females.   They will bear more medi-
cine, and their nervous system is  not so readily excited by it.
  Influence of Age. — Human life is divided  into infancy, childhood,
youth, manhood, and old age.   Each of these periods has peculiarities
which modify disease.
  The First Period, extending from birth to  the age of seven  years,
is marked by tenderness and excitability, and is alive to every irrita-
tion.   Teething and other disturbances occur  at this period, and need
careful management
  The Second Period extends from seven to fourteen, and is quite
subject to disease, including  the second dentition.  During*these two
periods, there is no great difference between the sexes; both are ten-
der, and need careful watching.
  During the Third Period, the changes occur which mark and sepa-
rate the  sexes.   This  is a  developing  period, when the  functions
become  established,  and the frame  acquires form, proportion, and
strength.
   At this time, hereditary tendencies to disease, latent till now, begin
to show themselves, and call  for every possible endeavor to break them
up, and fortify the constitution.
  The Fourth Period embraces  the vigorous  maturity of life, w,ben
the powers of body and mind, in both sexes, are at the summit of
their  excellence.  The  functions are now well established.  It is dur-
ing this period that the female is subject to most of the harassing
ailments peculiar to her sex.   So numerous are these complaints, and
so large and valued the class of persons affected by them, that he who
treats  them with the greatest skill, and with the  delicacy which their
nature demands, may be said to be at the head of his  profession. '
                      • 
122
TEMPERAMENTS,  CONSTITUTION, AND SYMPTOMS.
  The Fifth Period  is that of old age, when the functions are declin-
ing, and the  frame is  bending under  the  weight of years.   Old age
begins  earlier with  females  than with males.   Many ailments  are
common  to  this period, which require peculiar management, both
medicinal  and hygienic.

  Proper Frequency of Dose. — Each succeeding dose should be given
before the effect of the preceding is gone.  If this rule is not attended
to, the cure does not advance.   What is gained by each  dose is lost
by the  rallying of the  disease in the  interval.   Care must be taken,
however, not to apply this rule too strictly with very active medicines.


                 How  to  Examine  a  Patient.

  When  a patient is presented for examination, having observed the
temperament, constitution, sex, and age,
  1. Learn the  causes of the disease, whether local, specific, or gen-
eral, and also its history.
  2. Search out  its nature and character, whether febrile or  other-
wise.
  3. Take notice of the  whole  train of symptoms, — embracing the
pulse, the  condition of the mouth, tongue, and  digestive  organs, the
breathing, the urine, the fecal discharges,  the  condition of the brain
and nervous system, the state  of the skin,  etc.


         Brief Table  Explanatory  of  Symptoms.

                 general appearance of patient.
  1. Tonic spasm of the trunk.
  2. Distorted  features, altered position,
and impaired motion of limbs.
  3. Irregular and perpetual motion.
  4. Entire and absolute immobility.
  5. Great and unnatural boldness.
  6. Great and unusual languor.

  7. Ability to lie only upon the back.
8. Lying upon the face.
9. Lying upon one side.
10. Maintaining the sitting posture only.

11. The head thrown back.

12. Restlessness and tossings.

13. General enlargement of body.
  1. Locked jaws.
  2. Paralysis of one side.

  3. St. Vitus's dance.
  4. Catalepsy.
  5. Insanity or delirium.
  6. The beginning of an acute disease,
or the progress of a chronic one.
  7. Apoplexy.   Organic disease of the
brain or spinal marrow.  Acute inflamma-
tion of the lining of the abdomen.  Rheu-
matism of the joints.
  8. Several kinds of cholics.
  9. Pleurisy, or inflammation of the lungs.
When one iung only is affected in con-
sumption, the patient generally lies on the
diseased side.
  10. Disease of the heart or lungs, which
interferes with breathing.
  11. Severe diseases of the  larynx and
windpipe.
  12. The  beginning of acute inflamma-
tion. Fevers^ Delirium, and acute mania.
  13.  Cell-dropsy.  Emphysema from a
wound of the chest- 
TEMPERAMENTS, CONSTITUTION, AND  SYMPTOMS.
123
Head, Face, and  Neck.
1.  Head bent to one side.
   2.  Head increased in size.

   3.  Swollen scalp.
   4.  Dull expression of face.
   5.  Full, red face, with blood vessels of
eyes injected.
   6.  Pinched, contracted countenance.

   7.  Pinched  nose, sunken eyes, hollow
temples,  skin of forehead tense  and dry,
complexion livid.
   8.  Wrinkles across the forehead.
   9.  Wrinkles from forehead, vertically,
to root of nose.
   10.  A  white  line from  inner  angle  of
the eye to just below the cheek bone.

   11.  White line from the upper border
of the wing of the nose (ala nasi), curved
to the outer margin of the orb of the eye.
  12. The white line in children from an-
gle of mouth to lower part of face.
  13. A white line  external to  the  last
two, in a semicircular direction towards the
chin.
  14. Swelling of face and eyelids.
  U5. Transient redness or flushing of face.

  16. Hectic flush.
  17. Paleness of face.
18.  Dingy, white, or greenish face.
19.  Yellow tint.
20.  A citron tint.
21.  A bluish tint.

22.  Perpetual motion of eyelids.
23.  Forcible closure of eyelids.
24.  Eyelids remaining open.

25.  Palsy of the upper lid.
26.  Flowing of tears over the cheek.
27.  Nostrils dilating forcibly and rapidly.
28.  Itching of nostrils in children
Erysipelas.  Small pox.
Typhoid fever.'
Swelling of heart.   Congestion of
   1. Convulsions.   Paralysis of one-half
the body.  Dislocation of bones of neck.
Swelling of elands of neck.
   2. Chronic  hydropholus.    Enlarged
brain.
   3.
   4.
   5.
brain.
   6. Acute  inflammation of peritoneum.
Exposure to  severe  cold.
   7. Chronic disease just before death.
   8. Excessive pain arising externally.
   9. Distress, anxiety, and severe inter-
nal pain.
  10. In children, a brain  or nervous  af-
fection ; in adults, abuse of the generative
organs.
  11. In consumption  and wasting of flesh.
The  lower part of the line indicates  dis-
ease of stomach; the upper part, some affec-
tion of upper part of bowel.   When united
with the white line named above, and with
a drawing in of the cheek, fixed eyes, and
a wan complexion, it implies worms..
  12. An affection of  the chest, with diffi-
culty of breathing.
  13. Chronic and obstinate disease* in the
chest or belly.

  14. Albumen in the urine.
  15. Suffering from  the monthly irregu-
larity.
  16. Consumption.   Chronic affections.
  17. Cold stage of fever.  Acute  inflam-
mation.    Chronic  diseases,   especially
Bright's  disease,  during  recovery.
  18. A low and deficient state of blood.
  19. Jaundice.
  20. Cancerous disease.
  21. Poor circulation in the veins. Chol-
era.   Typhus fever.  Blue disease.
  22. Mania and idiocy.
  23. Intolerance or dread  of light.
  24. Orbicularis palpebrarum.  Paralysis
of the muscle which closes the eye.
  25. Injury of the third pair of nerves.
  26. Obstruction of the lachrymal duct.
  27. Difficulty of breathing.
  28. Worms in the bowels.
The  Tongue.
  1. Surface of  tongue covered  with  a
layer of whitish, soft, mucous  substance,
which may partially be taken  off with a
scraper, — also, clammy mouth.
  1. Derangement of stomach, or bowels,
or both. 
124
TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS.
  2. State of tongue as above, with clammy
mouth, bitter taste, and fetid breath.
  3. Great load on tongue as above, which
peek off, leaving the  tongue smooth, red,
and tender.
  4. Tongue slightly white from small white
points, and sometimes covered with fur,
like the fibres of coarse velvet.
  5. Tongue pale, tumid, clean, and very
smooth.
  6. Tongue furred and dry.

  7. Tongue white and loaded, with much
thirst.
  8. As above at first, — afterwards clean,
red, and dry.
  9. Tongue white  and loaded, with dry-
ness.
 10. Tongue dry, parched, tender, and
dark brown or black.  Pushed out  with
great difficulty and trembling.
 11. Tongue loaded with white,  through
which  numerous elongated, very red pap-
illae protrude their points.
  2. Acute dyspepsia.  Asthma.

  3. Severe cases of acute dyspepsia.


  4. Chronic dyspepsia.   Some affection
of the liver, if the fur be yellow.

  5. Chlorosis or green sickness.

  6. Violent local inflammation.   Irrita-
tion in bowels.
  7. Inflammatory fever.

  8. Protracted inflammatory fever.

  9. Mild typhus fever.

 10. Severer forms of typhus fever.


 11. Scarlet fever.
The  Throat.
1. Throat enlarged.
2. Violent pulsation of carotid arteries.
  3.  Pulsation  of the  nameless  artery
(arteria  innominata)  above the  breast
bone, and to the right of the windpipe.
  4.  Circumscribed swelling about throat
  1.  The approach of puberty in females.
  2.  Acute mania. Inflammation of brain.
Enlargement of heart, and dilation of right
ventricle.   Anemia.
  3.  Regurgitation from aorta.
4.  Enlargement of glands.
The  Chest.
  1. General enlargement of one side of
chest.
  2. Bulging at the base of a lung.

  3. Bulging at front upper part of chest.
  4. Bulging right  hypocfyondrium (See
Fig. 95).
  5. Bulging in region of heart.

  6. Tumor where the third rib  joins the
breast bone.
  7. Tumor between the base of the shoul-
der blade and the spine.
  8. Depression or retraction of one side
of chest.
  9. Breathing increased in rapidity. Gen-
erally, in health, about twenty breaths are
taken in a minute.
 10- Breathing diminished in rapidity.
  1. Large effusion of water from pleurisy.

  2. Water from pleurisy settling to the
bottom.
  3. Emphysema.
  4. Enlargement of liver.

  5. Water ia heart-case.   Enlargement
of heart.
  6. Aneurism of the ascending aorta.

  7. Aneurism of the descending aorta.

  8. Consumption.   Absorption of fluid,
effused by pleurisy.
  9. Spasmodic asthma.
 10. Pleurisy.   Paralysis of respiratory
muscles.  Inflammation of lungs.  Emphy-
sema.  Pneumothorax.  Consumption. 
TEMPERAMENTS,  CONSTITUTION, AND  SYMPTOMS.       125
11. Jerking respiration.

12. Breathing with muscles of ribs only.
1. Increased size of belly.
2. Enlargement in epigastrium.  Fig. 93.
3. Enlargement in hypogastrium. Fig. 95.

4. Belly diminished in size.
1.  The limbs immovable.
2.  Limbs contracted and rigid.
3.  General swelling of limbs.
4.  Swelling of joints.

5.  Limbs diminished in size.
1. Morbidly increased sensation.

2. Tensive pain.
3. Dull, heavy pain.
   4. Smarting pain.
   5. Shooting, tearing pains.
   6. Boring pains.

   7. Contusive pains.
   8. Itching.   Sensation as of ants creep-
ing over the skin.
   9. Exaltation of vision.

  10. Black flecks floating before the eyes.

  11. Painfully acute hearing.
  12. Dull hearing.
  13. Increase of strength.

  14. Debility.
  11.  Spasmodic asthma.  Obstruction in
larynx and windpipe.
  12.  Abdominal  inflammation.  Inflam-
mation of diaphragm.
  1.  Dropsy.   Wind in bowels.  Inflam-
mation of peritoneum.   Obstruction  in
bowels.  Hysteria.
  2.  Hysteria.  Cancer of stomach.
  3.  Distension of bladder.  Ovarian tu-
mors.  Accumulation of feces in bowels.
  4.  Chronic  dysentery.  Lead colic. Also
in most chronic diseases.
  1.  Paralysis.
  2.  Softening of the brain.
  3.  Defective circulation of blood.
  4.  Rheumatism.   Water  in the joints.
White swelling.
  5.  Paralysis.
    1. Acute  inflammation  of  brain  and
spinal marrow.   Fevers.  Hysteria.
    2. Phlegmonous inflammation.
    3. Enlarged internal organs.  Internal
tumor.   Effusion  of  water into  cavities
lined with serous membranes.  Felt in the
loins previous to discharge from menstrua-
tion, and from piles.
    4. Scarf skin removed.
    5. Neuralgia.  Cancer.
    6. Constitutional syphilis. Rheumatism.
Gout.  Inflammation of periosteum.
    7. Bruises.   Acute diseases.
    8. Several diseases of the skin.

    9. Ophthalmia.  Inflammation of brain.
Some nervous diseases.
   10. Affections of the brain  and optic
nerve.  Dyspepsia.
   11. Inflammation of brain.  Hysteria.
   12. Typhus fever.
   13. Delirium.  Inflammation of brain.
Mania.
I   14. Most diseases.
The  Belly.
                         Privat

1. Enlarged penis in children.
2. Drawing up of testicles.
3. Enlargement t»f scrotum.
The
Organs.

  1. Stone in bladder.  Masturbation.
  2. Stone in kidneys.
  3. Hydrocele.  Hematocele.  Sarcocele.
Limbs.
The  Nervous  System. 
126       TEMPERAMENTS, CONSTITUTION, AND  SYMPTOMS.
15.  Trembling.
 16. Rigidity of upper extremities.

'17. Cramp.

 18. Temporary spasm.

 19. Pain at extremity of penis.
 20. Pain in right shoulder.
 21. Pain in left shoulder.
 22. Exaltation of affections.
 23. Loss of moral sensibility.

 24. Exaltation of intellect.
1.  Stiffness of chest.

2.  Pressure upon parts.
3.  Obstruction of air-tubes.
4.  Compression of lungs.
5.  Pain in parts moved in breathing.

6.  Paralysis of muscles of chest.
7.  Spasm of muscles of chest.
8.  Deficiency of red blood.
  1. Hollow and barking cough.

  2. Sharp, ringing cough.
  3. Hoarse cough.
  4. Wheezing cough.
  5. Belching cough.
  6. Cough in paroxysms.
  7. Cough sounding harsh and concen-
trated when listening with the stethoscope.

  8. Cough sounding hollow, when listen-
ing with the stethoscope, as though it came
from a cavern.
  9. Cough having a metalic or ringing
sound when listening with the stethoscope.
1.  Scanty expectoration.

2.  Copious expectoration.
    15.  Cold stage of fever.  Nervous affec-
  tions.  Old age.  Action on the system of
  lead,  mercury,  strong  coffee, alcoholic
  drink, tobacco, opium.
    16.  Softening of the brain.   Infiltration
  of blood into the brain.  Hysteria.
    17. Pregnancy.   Hysteria.   Painters'
  colic.
    18. In convulsions  of children.   Some
  affections of the brain.
    19.  Stone in bladder.
    20. Congestion of liver.
    21. Disordered stomach.
    22. Hypochondriasis.
    23. Mania.   Typhus fever.   Masturba-
  tion.
    24. Melancholy.   Sometimes indicates
I  close of life.
  1. Cartilages turned  to  bone.   Pleura
hardened.  Distortiomfrom rickets.
  2. Tumors.  Dropsy of belly.
  3. Spasm of glottis.  Spasm near the
small ends of bronchial tubes.  Mucus,
etc., thrown out upon the inner surface.
  4. Effusions in   pleurisy.   Water in
chest.  Air in substance of lungs.   Aneu-
rism and other tumors.
  5. Pleurisy.  Inflammation  of  perito-
neum.
  6. Injury of spinal marrow.
  7. Locked jaw.   Spasmodic asthma.
  8. Anaemia. Chlorosis or green sickness.
  1. Last stage of consumption.  Chronic
bronchitis.   Some nervous affections.
  2. Croup.
  3. Beginning of cold. Chronic laryngitis.
  4. Asthma.
  5. Some diseases of larynx.
  6. Hooping cough.  Hysteria.
  7. Consumption.   Inflammation  of the
lungs.  Pleurisy.   Enlargement of bron-
chial tubes.
  8. Tuberculous cavity.   Enlarged bron-
chial tubes.

  9. Large tuberculous cavity.
  1. First stage of acute  diseases of the
lungs.
  2. Decline of acute diseases of air pas-
sages and lungs.
The  Breathing.
The  Cough.
The  Expectoration. 
TEMPERAMENTS, CONSTITUTION, AND  SYMPTOMS.
127
   3. Watery expectoration.

   4. Mucous expectoration.
   5. Expectoration of pus.

   6. Expectorated matter shaped  like
coin  (nummular).
   7. Muco-purulent, floculent expectora-
tion.
   8. Tubular expectoration.
   9. Whitish or greenish  expectoration,
that  clings to the vessel.
  10. Yellow expectoration.

  11. Rusty expectoration.
  12. Putrid smell of expectoration.
  13. Faint and sweetish smell of expec-
toration.
  14. Expectoration smelling like garlics.
   3. Beginning  of bronchitis.   Conges-
tion of lungs.  Vesicular emphysema.
   4. Bronchitis.   Inflammation of lungs.
   5. Consumption.   Third stage of in-
flammation of lungs.
   6. Tubercular consumption.  Bronchi-
tis of measles.
   7. Consumption far advanced.

   8. Plastic bronchitis.  Pneumonia.
   9. Acute  affections of lungs, particu-
larly bronchitis.
  10. Chronic bronchitis.   Other chronic
affections of the lungs and throat.
  11. Inflammation of the lungs.
  12. Gangrene of the lungs.
  13. Bronchitis.   First stage of consump-
tion.
  14. Broncho-pleural fistula.
  1. Dull, heavy, aching pain at the base
of the chest.
  2. Soreness about the breast bone, and
between the shoulders.
  3. Sharp, sudden, tearing pain below
the nipple.
  4.t Pain darting from front part of chest
to between  shoulder blades.
  5. Constant pain between the shoulders.
Pain.

       1. Acute bronchitis.

       2. Acute bronchitis.

       3. Pleurisy.

       4. Consumption.
  5. Consumption. Green sickness. Othev
chronic diseases.
The  Pulse.
  1. Strong pulse,  resisting  compression
by the finger.

  2. Weak pulse, easily pressed down.
  3. Full pulse, as if the artery were in-
creased in size.
  4  Small pulse, opposite of full.
  5. Hard, sharp, contracted pulse, — vi-
brating like a cord under the finger.
  6. Soft pulse, yielding readily  to pres-
sure.
  7. Frequent pulse.
  8. Slow pulse.
   1. Inflammatory   affections,  especially
 of the  substance of large organs,  as  the
 liver, etc.
   2. Prostration  from disease.   Nervous
 and chronic affections.   Fear.   Diseases
.of women and children, and old  persons.
   3. Congestion  of  brain.    Apoplexy.
 Disease of heart.
   4. Inflammations  of stomach, bowels,
 bladder, etc.' Hysteria, and other nervous
 affections.
   5. Inflammation of membranes.  Active
 bleedings.   Lead colic, etc.
   6. Affections characterized by debility.

   7. Inflammatory diseases. Hemorrhages.
   8. Apoplexy.   Sometimes in disease of
 heart.
  1. Tongue trembling and  dry, and di
minished in size.
  2. Voracious appetite.
Relating  to  Digestion.

                    1. Typhoid and other low fevers.

                                                Insanity.
  2.  Pregnancy.    Hysteria.
Sometimes in dyspepsia. 
128       TEMPERAMENTS, CONSTITUTION, AND  SYMPTOMS.
  3. Diminished appetite.
  4. Increased thirst.

  5. Thirst gone.
  6. Vomiting.

  7. Pain increased by pressure.
  8. Pain relieved by pressure.

  9. Urgent desire 4;o go to stool.
 10. Watery stools.
 11. Mucous stools, like white of egg.
 12. Hard and lumpy stools.

 13. Clay-colored stools.
 14. Yellow or dark-brown stools.
 15. Dark-green stools.

 16. Stools red, and streaked with  blood.
 17. Pitchy black stools.
 18. Stools pure blood, with no colic.
 19. Stools like rice-water.
. 20. Black stools.
 21. Shreds  of false membrane in stools.
 22. Fat with stools.
 23. Fetid stools.
  1 Diminished secretion of urine.

  2. Retention of urine in the bladder.
  3. Urine increased in amount.

  4. Red  or yellow sand deposits in urine
(uric acid).

  5. White  sediment  in urine  (earthy
phosphates).
  6. Oxalate of lime deposits in urine.
  7. Blood in urine.
  8. Albumen in urine.
  9. Mucus in urine.

 10. Sugar in urine.
1.  Profuse perspiration.
2.  Diminished perspiration.

3.  Night sweats.
4.  Sour smelling sweats.
5.  Fetid smelling sweat.
6.  Sweat with mouldy odor.
7.  Smelling like  ammonia.
8.  Sweat having the odor of mice.
9.  Sweat smelling like rotten-stone.
   3. In most acute diseases.
   4. Acute affections of  stomach  and
bowels.
   5. Cerebral disease, with coma.
   6. Early pregnancy.  Colic. Disease of
brain.  Inflammation of stomach.  Hernia.
   7. Inflammation of internal organs.
   8. Over-distention of bowels.  Neural-
gia.  Colic.
   9. Dysentery.  Sometimes in diarrhoea.
  10. Diarrhoea.   Cholera.
  11. Chronic inflammation of colon.
  12. Constipation.   Colic.   Cancer  of
stomach.
  13. Deficiency of bile.
  14. Too much bile.
  15. Bile from children  after taking cal- '
omel.
  16. Dysentery.
  17. Melaena.
  18. Bleeding piles.
  19. Asiatic cholera.
  20. Iron taken in medicine.
  21. Dysentery.  Diarrhoea.   Worms.
  22. Diabetes. Consumption.
  23. Diseases attended by debility.
  1. Dropsy.   Inflammatory  and febrile
diseases.
  2. Paralysis.  Typhoid fever.  Hysteria.
  3. Diabetes.    Cold  stage of  fevers.
Hysteria.   Various passions of the mind.
  4. Fevers.  Acute rheumatism.   Con-
sumption.   Dyspepsia. ' Great indulgence
in animal food.
  5. Depressed state of  the  nervous sys-
tem, of serious import.
  6. Derangement of digestion.
  7. Bleeding of kidneys, etc.
  8. Bright's disease.
  9. Inflamed mucous membrane  of ure-
thra, bladder, etc.
 10. Diabetes.
  1. Acute rheumatism.  Decline of acute
inflammations and  fevers, being sometimes
critical.
  2. Early stage of acute disease.  Dropsy.
Diabetes.
  3. Consumption.
  4. Rheumatism.   Gout.
  5. Some debilitating fevers.
  6. Measles.   Scarlet fever.
  7. Typhoid fever sometimes.
  8. Insanity.
  9. Miliary.
The  Urine.
The Perspiration. 
TEMPERAMENTS, CONSTITUTION, AND  SYMPTOMS.       129
                        The  Temperature.

  1. General heat of surface.
  2. External local heat
  3. Hot forehead.
  4. Hot scalp.
  5. Skin of chest hot.
  6. Hands and feet hot.
  7. Acrid  heat, burning the hand when
applied.
  8. Chills.                             8. Beginning of fever.
  9. Low temperature.                    9. Poor circulation.
 10. Cold hands and feet                10. Nervous diseases.  Dyspepsia.  Low
                                     state of the blood.
                                   17
1. Fevers.
2. Inflammation.
3. Headache.*
4. Disease of brain.
5. Inflammation in chest.
6. Consumption.
7. Typhus fever. 
SKIN   DISEASES.
  The skin is the soft and pliant membrane which covers  the entire
surface of the body.  The interior, like the exterior, is likewise covered
by a  skin, which, from its  always being moist, is called  a  mucous
membrane.  At the various openings of the body, the outer  and the
inner  skins are united, — forming one continuous skin, — like the
same  piece of silk turned over the border, and covering both the out-
side and inside of a bonnet.                                    *
  From this continuity or oneness of the skin and mucous membrane,
springs an important medical law, namely, that a disease of the  skin
may spread to the mucous membrane, and a disease  of the  mucous
membrane may spread to the skin.  We  see  this illustrated by the
breaking out around the lips which follows colds, and the  itching of
the nose of children when the mucous membrane of the bowel is irri-
tated  by worms.

  The Skin is Composed of Two Layers. — These are separated from
each  other by the action  of a blister.  The thin portion which is
raised up  by the  fluid  of a blister is called the scarf skin, the cuticle,
or the epidermis ; that which remains in connection with the body is
the sensitive  skin, the cutis, the derma, or the true skin.  The two
skins  have very different offices to perform.   The scarf-skin is horny
and insensible, and serves  as a sheath  to protect the more sensitive
skin under it.   Were  the  scarf-skin  taken off, we could not bear to
have anything touch us.
  The derma,  or true skin, and its glands, etc., are the seat of all the
cutaneous diseases.   These may be separated into four great divis-
ions, — namely, diseases  of  the true skin, diseases of the sweat glands
and tubes, diseases of the  oil glands and  tubes,  and diseases of the
hairs  and  hair glands.
  Then the diseases of the true skin are divided  into
  Inflammation of the true skin;
  Enlargement of the papillce of the true skin;
  Disorders of the vessels of the true skin;
  Disorders of the sensibility of the true skin;
  Disorders of the color-producing function of the true skin.
  The inflammation of the  true skin is conveniently divided into two
groups, — namely, 
 
P-,
pi
H








o
CD
CO



CO
 
132                      SKIN DISEASES.
 erates the fever, and adds to the comfort of the patient.   If the fever
 runs  high, take half an ounce of rochelle  salt, and use recipe 51.
 Should the eruption " strike in," apply leeches or cups, over the inter-
 nal organ affected, if any, and recall the rash by a mustard bath.
   Those who have  been exposed to the contagion, and are liable to
 have  the  disease, should  avoid all unnecessary exposure to wet or
 cold, — keeping the feet warm and'dry, and the whole body well clad.
 With these precautions, and a mild, unstimulating diet, much of the
 force  of the disease may be broken.
   During the first stages of the disease, bathing the feet once or twice
 a  day with hot water, and freely  using warm, sweating drinks,  as
 saffron, summer-savory, pennyroyal, balm, and mullein  tea, and put-
 ting mustard drafts to the feet, will hasten the coming out  of  the
 eruption.
   Should the breaking out be delayed  by excessive fever, give full
 doses of tincture of veratrum  viride, or nauseating doses of ipecac,
 antimony, lobelia, or hive-syrup, and teaspoonful doses of compound
 tincture of Virginia snake-root.
   Beside the milder forms of the disease, cases occur, chiefly in broken-
 down  constitutions, in  which  the rash delays its coming out till the
 seventh day, and is then mingled with  dark and  livid spots, which
 remain, often, for ten or twelve days.   The fever is of a low, typhoid
 kind,  and the patient is  extremely weak and languid.
   In this condition of things, the patient must be supported by tonics
 (49), and  stimulants (134), and expectoration promoted by some ap-
 propriate remedy (106), (124).
   If at any stage of the disease, there  should be fixed pain in any
 part of the chest, which is made worse by coughing, or by taking a full
 breath, we may  conclude  there is some inflammation  of the  chest;
 and it must be treated as directed for  pneumonia.


                 Scarlet Fever. —Scarlatina.

   This is likewise  an acute inflammation of the entire covering of
 the body, both external and internal, connected with fever which is
 infectious and contagious.

   Symptoms. — The  fever comes on somewhere between the second
 and tenth day after  exposure.  On the  second day of the fever, the
 eruption  comes  out  in  the  form  of very small  points  and pimples,
 which appear either in patches, or constitute a general redness, of a
 bright scarlet color.   In Plate I, Fig. 2, the  artist has  given  a fine
 picture of the disease.
   The disease begins with languor, pains in the head, back, and limbs,
with drowsiness, nausea, and chills; and these are  followed  by heat,
thirst,  etc.   When the redness appears,  the  pulse is quick,  and the
patient is anxious, restless,  and sometimes  delirious.  The eyes are
red, the face swollen, the  tongue covered in  the middle with  white
mucus, and  is  studded with  elevated  points  of  extreme  redness.
 The tonsils are swelled,  and the throat red.  The greatest degree of 
SKIN DISEASES.                       133
redness is  reached on the evening of the third or fourth day from its
beginning,  when a gentle moisture  appears, the  disease  begins  to
decline, with itching, and the scarf-skin falls off in branny scales.
   A swelling or putfiness of the flesh, which spreads out the fingers
in a singular manner, seems to be peculiar to scarlet fever.
   In the first stage of the complaint, the tongue, as stated above, is
covered with a fur; but as it advances, the tongue  often becomes
suddenly clean, and  presents a glossy,  fiery-red  surface, which  is
sometimes, with the whole lining of the mouth, raw and tender.
   It is peculiar in this complaint, that the inflammation of  the throat
almost always runs into  a state of ulceration.  As far as can be seen,
on pressing  down the tongue, the throat is swollen and of a  deep,
florid red;  and on the tonsils may be  seen white or gray ulcers.  This
makes swallowing very difficult, and  aggravates the sufferings of the
patient.  The  great amount  of mucus in these  parts causes also a
continual rattling in the  throat.
   The eustachian tube,  which extends up to the ear, is apt to get
involved in  the inflammation, and cause" swelling and pain  in that
                       region.  The glands under the ear and jaw
                       sometimes  inflame, and after a time, they oc-
                       casionally break.  Abscesses  formed in the
                       ear, frequently produce some deafness which
                       is not easily cured.
                         In the cell-dropsy, which sometimes appears
                       after  scarlet  fever, the  crystals of urate of
                       ammonia  may  often be  found in  the  urine
                       with the'microscope (Fig. 72).
                         This disease resembles measles; but may
                       be distinguished  from it by the absence of
                       cough ; by the eruption  being finer, and of a
more scarlet color (see plate); by the rash  coming out on the second
day instead of the fourth;  and by the ulceration  in the throat.

   Treatment. — In ordinary cases, the  treatment should be very simple.
The apartment should be kept cool, and the bed-covering  light.  The
whole  body should be sponged with qool water as  often as it is hot and
dry, and the patient be permitted to take cooling drinks.  Beside this,
in many cases, very little is needed, except to give a few drops of the
tincture of belladonna, night and morning.
   In some cases where  there is a good deal of fever and soreness of
throat, give tincture of veratrum (124) often enough to keep  down the
pulse.   It  would be well  also to begin the treatment of such  cases
with an emetic, (1) (4)  (2).   In addition to this, the feet and hands
should be  soaked in  hot water, with a little ground mustard, or pul-
verized cayenne, stirred  in.  This bath should be  continued twenty
minutes, twice a day, for two  or three days.
   The cold stage having passed, and the fever set in, warm water may
be used without the mustard,  etc.   If the head be affected, put mus-
tard drafts  upon the feet.  Should the bowels be costive, they may be
gently opened by some.very mild physic.
 
134
SKIN DISEASES.
  No solid  food should be allowed;  but after the first shock of the
disease is passed, drinks, in reasonable quantities, will be advisable,—
such  as  cold water, lemonade, barberry and  tamarind water, rice
water, balm or flax-seed tea, and some thin wTater gruel.
  To promote the action of the skin, the spirits of nitre, with other
articles (125), adapting the dose to a child, will be found useful.   The
nitrate of potash is useful, given in one to three-grain doses, dissolved
in water, every three or four hours.
  The muriatic acid, forty-five  drops  in a tumbler  filled with water,
and  sweetened,  and given to a child in  teaspoonful doses, is a good
remedy.
  In very violent attacks, the system sometimes  inclines  to  sink im-
mediately ; typhoid symptoms show themselves ; there is great pros-
tration ;  the  eruption  strikes in; the  skin changes to  a purple or
mahogany color; the tongue is of a deep red, or  has a dark-brown
fur upon it, and the ulcers in the throat become putrid.  This is called
scarlatina maligna; but it is  only a severer form of the same disease.
  The treatment of this  form  must be  different  from that recom-
mended above.  It must be tonic.  Quinia (65) must be freely given.
Wine whey, mixed with toast water, will be  useful.   Tincture of
cayenne, in  sweetened water, may  be given  often in  small doses.
Ammonia (135) may likewise be given as a stimulus.  Gargles (245)
(244) (243) are also required.
  A dropsical affection is one of the  most frequent results of scarlet
fever.  It is believed that this seldom occurs,  if the warm bath is
daily used, as soon as the skin begins  to  peel off.   After the dropsy
has set in, give the warm bath twice a week, and encourage  perspira-
tion  by the  compound tincture of Virginia snake-root, and similar
articles.   The child should have a generous diet, at the same time, to
bring up its  strength.


                     Small-Pox.— Variola.

  This is another disease characterized by acute inflammation of the
entire skin, both external and internal, connected with infectious and
contagious fever.  The eruption has the form of red points, which
soon become  pimples, then vesicles, then  flattened and  scooped-out
vesicles, then  pustules, and finally hard brown scabs.  These last fall
off from  the eleventh to the twenty-fifth day, and leave behind them
small pits and scars.  The fever is remittent, and  precedes the erup-
tion  some three  or four days, — ceasing when  the  eruption  is devel-
oped, and returning when it has  reached its height.   The  period
between  exposure and the attack of the  disease, called incubation, is
from five or six to twenty days,—being short in the severe cases, and
longer in the milder ones.

  Symptoms. — The disease  begins with  languor and lassitude, with
shivering, and pains in the head and loins; with hot skin, and quick-
ened pulse  and breathing; with thirst,  loss of  appetite, and furred
tongue;  with nausea, vomiting, constipation, restlessness,  and uni- 
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SKIN DISEASES.                      135
versal prostration.  To these symptoms sometimes succeed, difficult
breathing, cough,  drowsiness, and even insensibility.  The tongue,
white at first, soon becomes red at the point, and over the  whole
surface.  The fever is highest during the night.   The  constitutional
symptoms are more violent just before the eruption, but immediately
subside, and soon  disappear, when  the  breaking  out is  established.
The eruption is at first in the shape of small red points, which are
hard to the touch, and shaped like a cone, and are proportionate in
number to the subsequent pustules.   In  Plate II, the artist has well
exhibited the developed disease, as well as the progress of the erup-
tion from day to day.

  Treatment. — Like  the two preceding diseases, the  ordinary, un-
complicated  form of this  requires only the  most simple treatment.
Not much is wanted, except confinement in  bed, cooling  drinks, cool
and even temperature, frequent  change of linen, and  sponging the
body with cool water.  But when what is called the fever of invasion
is past, and the eruption is fully developed, and has  brought along with
it the secondary fever, then some recipe, as  131, (124)  (125) will be
in place, and some  gentle laxative to keep the bowels open (8), — also
gentle injections, (249)  and opiates to relieve  sleeplessness and ner-
vous symptoms.
  Should the system, at this period, appear to  be sinking, a more
generous diet, and a little wine may be allowed.   If the brain sutlers,
apply leeches to the mucous membrane of the nose, or behind the ears,
and put the feet in a mustard bath (242). If the breaking out appear
with difficulty, put the patient into a warm bath, and tartrate of anti-
mony, (104) or Dover's powders may be employed.  Gargles will
frequently be needed  for the inflammation, and dryness  of the mouth
and throat (243).   Cold sponging may be considered as highly bene-
ficial, in both the primary and secondary fever.  The belladonna like-
wise is a useful remedy, used in the same  way  as in scarlet fever.
The plaster 288, applied to the face, will, it is said, arrest  the formation
of  matter, and prevent the unsightly scars which  so often  cover the
face of  persons who have suffered from small-pox.


                     Varioloid.—Varicella.

   Varioloid, or modified small-pox, begins  with symptoms  similar
to those of small-pox, but  much  milder in degree.  These symptoms
are feverishness, nausea, vomiting, pains in the loins and  head, and a
quickened pulse.   The eruption  comes out on the third  or fourth day,
and looks  like that of small-pox.  It reaches its height the fourth or
fifth day, and then declines without any secondary fever.   The pus-
tules  dry up and form  brown scabs which fall off in a few days, and
leave slight pits, and  a few red or purple spots.
   Varicella appears under a variety of forms, called " hives," " swine-
pox," "chicken-pox," "horn-pox," etc.   But  they all have a family
likeness, and need not be described.  The treatment of all  these forms
must be conducted on the same  principles with small-pox.  Sponging 
136                      SKIN DISEASES.
the skin in all these inflammatory conditions has  the  happiest effect,
and should seldom be omitted.

                     Cow-Pox.—Vaccina.

   This disease exists to some extent among lower  animals, and is
identical with small-pox in man.   The  immortal Jenner taught  the
world that the pus, taken from the cow having this disease, and intro-
duced  under the  skin of man, would produce an eruption similar to
that of small-pox, and that this would protect the  system from  the
latter disease.  This was an immensely important discovery, and will
render  the name of Jenner famous through all time.
   It is  a question of great importance how far vaccination, or inocu-
lation with the matter of cow-pox, does, in  fact,  protect the system
from small-pox.  That it is a protection, to a certain extent, is doubted
by none,  'jhat in some instances it protects through  life, is likewise
generally admitted.   Is it a protection in  all cases, and through  the
whole  life ?  Perhaps not,  though this  is a disputed  point.  Proba-
bly the mild form of the vaccine disease does not  impress the system
powerfully enough to last more than a certain number of years. Most
thinking physicians  now believe it is wise to revaccinate occasionally,
to make sure of the protection.  It is done with little trouble,  and
may save a terrible  infliction.  Plate  II, Fig. 4, gives a good idea
of the  appearance and progress of the eruption.
   The  Second Group of diseases,  characterized by  inflammation of
the true skin, without constitutional symptoms  of  a  specific kind,  are
Erysipelas, Nettle-Rash, False-Measles, and Inflammatory Blush.

              Erysipelas.—St. Anthony's Fire.

   Erysipelas is a diffused  inflammation of the skin, affecting only a
part of the surface of the body, and is accompanied by a fever, which
is generally thought to be infectious  and contagious.   The local in-
flammation  is disposed to  spread; it extends deep, and  is attended
by swelling, a tingling, burning, and pungent heat, and by a redness,
which  disappears when  the skin is pressed by the finger, and returns
on remitting the pressure.
   Symptoms.— The  constitutional symptoms are chilliness and shak-
ing, succeeded  by heat; lowness of spirits, lassitude, pains in  the
back and limbs, pains in the head, quick and hard pulse, thirst, loss
of appetite, white and coated tongue, bitterness of mouth,  nausea,
vomiting, pain in stomach,  and costiveness.
   These symptoms  go before the local inflammation several days;
they increase with  the redness of the skin, and  disappear upon its
decline.   The nervous  system is sometimes severely affected,  and
indicated by low, muttering delirium.  At  the  close  of the inflam-
mation there is  generally a relaxation of the  bowels, and the scarf-
skin peels  off.  Sometimes matter forms under  the skin, and occa-
sionally mortification occurs.  The face is the most frequent seat of 
ERYSIPELAS
PI.S

Fig.l
■
■
Fig.Z. 
* 
SKIN DISEASES.                      137
the disease.   It commonly begins on one side of the nose, and soon
spreads over one side of  the face, closing up the eye, and changing
the features in a shocking manner.  See Plate III, Fig. 1.
   Somewhere about the third, fourth, or fifth day, very minute blisters
appear on the inflamed parts, filled with water, which increases until
the blisters break and let it out.   The disease comes to a head on the
eighth or ninth day, when the blistered  parts dry, and the skin begins
to peel off.
   Treatment. — In the treatment two things are to be done, — to sub-
due the fever, and the local inflammation.   The fever is assuaged  by
rest, mild diet, gentle laxatives, (26) (21), etc.;  and by  the use  of
tincture of veratrum.   For the local inflammation, various things have
been advised, but nitrate of silver, on the whole, has the preference.
First wash  the inflamed part with  soap and water to remove any
oily substance,  and wipe the skin dry.   Then  moisten the inflamed
and surrounding skin, and pass  over it a stick  of  nitrate of  silver,
touching not only the inflamed  part, but. going even an inch beyond
it on all sides.  Or, a solution of nitrate of silver and nitric acid, (214)
will in many cases, according to Dr. Higginbottom, do even better.
A solution of coperas  (215) is a  good application.   So is 303.
   In  mild cases, flour may be dusted on the inflamed  part from the
dredging-box.  Warm fomentations are also useful, and cloths wet
with water,  and laid on.  A solution of per. chloride of iron, applied
to the inflamed skin, is much used now.
   In  erysipelas the  powers of the system are generally reduced, and
tonics, such as quinine, wine, etc., are generally required.  Dr. Robert
Williams, — high authority in these matters, — says he puts his pa-
tients upon  milk diet, gently opens the* bowels, and gives them, daily,
from four to six ounces of port wine, together with sago, and that he
seldom has  to change this course, whatever the symptoms.
   For the inflamed skin, a tea  made  of buckwheat meal, is a good
wash.  Alcohol and water, or new rum, may be  used  for the same
purpose.

                   Nettie-Rash.—Urticaria.

   Nettle-rash begins with fever,, which  lasts  two or  three days,
when  wheals of various  shapes, round, oval, and oblong, appear in
the midst of red, slightly elevated patches, attended by great itching
and tingling, as if the common nettle  had been applied to the skin.
The wheals go off during the  day, and come  again at night.  The
eruption is  often a symptom of other diseases, or of mental  anxiety.
Sometimes it is the effect of articles of  diet.  Children have  it occa-
sionally while cutting teeth.  A lighter form of the disease exists, in
which the wheals appear  and disappear at  short intervals, according
to the heat  of the weather, the exercise, diet, etc.
   Treatment.— The treatment varies according  to  the cause of the
disease.  If this be anything offending the stomach, especially if it be
putrid fish, an  emetic (2)  (4)  will be required, followed by brisk 
138                      SKIN DISEASES.
physic (29). After which take a few doses of quinine (67).  For exter-
nal application, the  lotion (216) or common vinegar and water (215)
will be useful.  Dr. Wilson recommends corrosive sublimate, etc. (217)
as the very best lotion to apply outwardly.
   The diet should be simple and cooling, all stimulating food  and
condiments being avoided.

           Rose  Rash.—Roseola.—False  Measles.

   Symptoms. — The  summer rose rash appears first on the arms, face,
and neck, thence it spreads over the whole body, producing tingling
and itching.   It is usually preceded by the symptoms of fever-chills,
succeeded  by  flushes of heat, languor, pains  in the  head, back, and
limbs, restlessness, quick pulse, and thirst.  The rash appears in small
irregular patches, paler than those of  measles, and of a more roseate
hue.   There is some hoarseness from inflammation of the throat.  The
rash  never continues more than five days, unless it be merely partial,
in which <;ase it sometimes comes  and goes  at intervals for weeks.
If it " strike in," it  generally produces disturbance of the stomach,
headache, and faintness, which are relieved by its reappearance.
   The autumnal rose rash is  in more distinct patches than the  for-
mer, of a circular figure, slightly elevated, and of a dark damask-rose
hue.   Seldom any fever, or itching and tingling.
   Treatment. — For  the "first-described form of the disease, light diet,
acid  drinks, and gentle laxatives ; for the second, recipe 59, or 51, ac-
cording to convenience.

              Inflammatory Blush.—Erythema.

   What  is called marginated inflammatory blush, is a mottled, red,
smooth fulness of the skin, occurring on the extremities and  loins, in
irregular patches, bounded on one side by a hard, elevated, red border.
This  species of the  disease attacks old people,  and indicates some
internal disorder, which is dangerous.
   Another form of the complaint  appears on  the  arms, neck, and
breast, in  extensive,  bright-red, irregular  patches, slightly elevated.
The  redness, at its height, is  very vivid, and  continues about a fort-
night, when it assumes a purplish hue in the centre.
   Treatment. — Light diet, gentle purgatives (21),  opiates  (218) to
allay the tingling  and secure  sleep, and the mineral acids (63), with
bitter tonics, comprise all that is required, except sponging with water,
and friction.

                       Watery Pimples.

   We now come to  a class of diseases characterized by watery pim-
ples.   Wilson  says they are distinguished by  " effusive inflammation
of the derma," which means  that there is inflammation of the true-
skin, which causes water to be poured out on top of the derma,  and 
SKIN DISEASES.                       139
underneath the scarf-skin, causing the latter to be lifted up in the form
of small or large blisters, or vesicles.   At first the fluid in these pim-
ples  is transparent, but in a short time becomes milky.  Sometimes
this  fluid absorbs; at other times, it dries  up, and with the cuticle,
scales off as scurf.

                  Humid Tetter.—Eczema.

   An eruption of minute, round pimples, about the size of a pin's
head, filled with a  colorless fluid, and terminating in scurf.  It is gen-
erally a  symptom of  a feverish state, and is preceded  by languor,
faintness, perspiration, and a pricking and tingling of the skin.
   Another species of this disease is called sun heat, which is an erup-
tion  of vesicles without any  redness, of a  white or brownish color.
These  vesicles generally terminate in brownish-yellow scabs.  It oc-
curs only in summer, and affects those parts which are uncovered.
   In still another species, the eruption is attended with pain, heat,
itching, intense smarting, and a swelling of  the affected part.   When
the blisters break, the water which runs out  irritates and inflames the
skin, which becomes red, rough, and thickened, — covered sometimes
with a thick crust.

   Treatment. — Low diet, cooling drinks,  gentle  purgatives, warm
baths.   In old chronic cases, apply externally either lime  water, or
corrosive sublimate (212)  in solution.  In the second and third forms
of the affection, apply externally, a solution of nitrate of  silver (219).


                 Tetter—Shingles.—Herpes.

   After a slight feverish  attack, lasting two or three  days, clusters
'of small, transparent pimples, filled sometimes with a colorless, some-
times with a  brownish lymph, appear on the cheeks or  forehead, or
on the extremities, — and at times on the body.  The pimples are a
little larger than in eczema, — about the size of  a pea.   After a few
days, the vesicles break, paur out their fluid,  and form brown or yellow
crusts, which  fall off about the tenth day, leaving the surface red and
irritable.  The eruption is attended wnth heat, itching, tingling, fever,
and restlessness, especially at night.  Ringworm  is a curious  form of
herpes, in which the inflamed patches assume the form of a ring.

   Treatment. — Light  diet, gentle laxatives.  If the patient be  ad-
vanced in life, and feeble, a tonic (64) will be desirable.   For external
application, white vitriol  (220), or  an ointment of sulphuret of lime
(174), or elder-flower ointment, etc. (175).

                         Itcfc.—Scabies.

   To this disease all classes are liable, though it is much  less com-
mon than in  former years.  It is found  frequently among the poor,
whose condition in  life does not give them the means to guard at all 
140                      SKIN DISEASES.
points, against it;  but it is most common among such as neglect per-
sonal cleanliness.
  Symptoms. —  An eruption of distinct, cone-like, watery pimples,
which are transparent at the summits, and  are accompanied by an
excessive  itching,  which is made worse by high-seasoned  food, by
drinking liquor, and by the heat of the bed.   When these pimples are
scratched and torn, a  sticky, watery fluid is poured out, which forms
small scabs; and, in time, if the disease is not cured, these scabs being
often torn off, extensive sores are made.
  Cause. — It  will excite  the wonder of many readers  to state  that
animals of so  small a size as scarcely to be seen with the naked eye
exist in the skin  of man.  Yet such is the fact; and it is the presence
of these minute creatures, or the effect of their presence, which  con-
stitutes the  disease called itch.  The little creature (acarus scabiei,
by name), a species of mite, is one seventy-seventh part  of an inch in
length; and when  closely inspected under the  microscope, is really a
beautiful, I may  say an elegant, animal.  Here are a front, a side, and
a back view of him, well done by the  artist.

           Fig. 73.               Fig. 74.              Fig. 75.
  His Method of Attack. — When  placed upon the skin,  the  little
fellow, like the squirrel and other ground animals, sets himself to make
a hole through the scarf-skin with  his head and fore feet.  Into this
he pushes his whole body.   He then begins to burrow himself in the
derma or true skin — making a channel many times  his own length,
at the end excavating a chamber where he sleeps, and whence he goes
out to do his day's work at mining, or boring for food.   When tired
of this sleeping apartment, he digs onward and scoops out another.
   This travelling, and boring, and turning about in an organ as sensi-
tive as the true skin, must, of course, occasion a tickling and itching;
and from this circumstance the  disease took its  name of itch.   But
this itching is not painful.  James the First is said to have  remarked
that the itch was fitted only for kings — so exquisite is the enjoyment
of scratching.   Probably it is a royal luxury.   Be that as it may, most
persons would consent to have it  all done by royal fingers.  They
have been used for meaner purposes.
 
SKIN DISEASES.                       141
  Treatment. — Whatever will kill  the little animal described  above,
will cure the itch. Various agents have been employed for this purpose,
but none have been found equal to sulphur.  The  compound sulphur
ointment is a sovereign remedy for the disease.   Four ounces of this
should be well rubbed into the skin, before the fire, morning and even-
ing, for three or four days.   This will put an end to the whole colony
of these sovereign squatters upon forbidden soil.
   Two ounces  of sulphuret of potash, and the same amount of soft
soap, dissolved in a pint of water, and  applied well to the skin,  is
used in many cases with good effect.
   Caustic  potash, one part to twelve parts of water, applied in  a sim-
ilar way, is said to be a pretty sure remedy.
   A solution of the chloride of lime, used as a wash, will often effect
a cure.
   The ointment of the American hellebore sometimes does well.
   Before applying any of these preparations, let the skin be washed
with warm water and soap,  and well dried.


                             Rupia.

   This is from a Greek word which means dirt, from the dirt-colored
crusts which are formed after the breaking of the large watery pim-
ples.   The vesicles are like  those of eczema and  herpes, except that
they are larger.  This is distinguished from all other skin diseases by
the formation  of unhealthy,  foul, and burrowing  sores, which pour out
a reddish matter in such quantities that it collects  and  dries upon the
sore, and forms a crust  of  great thickness, — sometimes of the size
of an  oyster-shell.  Rupia  has  its  origin in a weakly and  debilitated
constitution, and cannot be cured without renovating the  whole sys-
tem.

   Treatment. — Warm baths once or twice a  week, with generous
and nutritious diet.  Tonic  medicines (63) (51)  (67) (61) (65) will be
required.   For external treatment, dust the surface of the ulcers with
cream of tartar, or  apply nitrate of silver (214)  (219)  (220),  white
vitriol, etc.

                   Pemphigus.—Pompholix.

   The first of these terms is from the Greek, and means a bubble; the
second, pomphoiix, is from  the  same language, and means a water-
bubble.  This is still more  applicable to the disease in hand,  which
consists, in fact, in  the raising up of the scarf-skin in  the shape of
bubbles, containing a watery fluid.   These bubbles are just like com-
mon  blisters.   They vary from the size of a split pea, to that of a
lien's egg.   They rise up very rapidly, and break in two or three days,
leaving a raw surface which soon becomes covered by a thin crust.

   Treatment. — Similar to that for Rupia, with the addition of  iodide
of potassium (140), and applying the  stick nitrate of silver to the 
142                       SKIN DISEASES.
whole surface of the ulcer, and a short distance beyond it on all sides,
or the ointment (176).

                      Mattery Pimples.

   Another natural group of skin diseases are distinguished by an
eruption of pimples, filled, not with water, like  those  just described,
but with matter.  The pimples of this  class are  not  transparent, or
whitish, but opaque and yellow from the first.  The matter is poured
out upon the true skin, and raises up the scarf-skin, in the same way
as the watery pimples.  As in the preceding  diseases,  too,  the drying
up of the matter forms crusts.  But these pimples are  never so small
as those of eczema, nor so large as those of pemphigus.

                 Crusted  Tetter.—Impetigo.

   This  eruption consists at first of slightly-elevated pustules or pim-
ples, closely congregated, with an  inflamed border.   These  break, and
the surface becomes red, excoriated, shining, and full of pores, through
which a thin, unhealthy fluid is poured out, which gradually hardens
into dark, yellowish-green scabs.   These scabs sometimes  look like a
dab  of  honey dried upon the skin.   This has given impetigo  the
name of " honey disease," or  honey scab.  This  honeyed look is well
represented in the crusts which form on the lips  and ears of children.
Sometimes these scabs cover  nearly the whole face, and are called the
milk crust.   This  is putting the  agreeable  words milk and honey to
rather questionable uses !  When this crusted tetter invades the head
or scalp, it  causes the hair to fall, and  becomes what is called a scall.

  Treatment. — The vapor bath, and water dressing.   The following
ointments  are  useful:  oxide of  zinc, white precipitate,  or diluted
nitrate of mercury (178).  Hydrocyanic acid (221), applied  externally,
has a fine effect.  The crusts  should first be removed  by a weak lye
made from hard-wood ashes, or potash; then, after applying one of
the ointments above, or the lotion, cover  the  part with  oil-skin.   If
the crusts are on the head, the hair should be cropped off  before the
remedies are  applied.

                 Papulous Scall.—Ecthyma.

   The  mattery pimple called ecthyma is developed on a highly in-
flamed  skin.   The bladders are about  the size of a split pea, and are
surrounded by a broad ring of redness.   They are  generally separate,
not clustered  like impetigo.   They are scattered  over various parts of
the body, and are followed either by a hard black  crust, or by a sore.
The disease  is either acute  or chronic.   The latter attacks weakly
children, and persons reduced by sickness or low living.

  Treatment. — For  the  acute form, low diet, gentle  laxatives, with
ointment (176), and the cold sponge bath on the sound  parts.  For the 
SKIN DISEASES.
143
chronic form, (140)  (65)  (63)  (61)  (48)  to be taken internally, and
(17$) (175) (214) (211) for external application.

                       Scaly Eruptions.

  The  scaly eruption is called dry tetter.  It is an inflammation of
the true skin, and is distinguished from the rashes and pimples by the
alteration of the scarf-skin.   The diseases forming  this group are
three in number, — lepra, psoriasis, and pityriasis.

                       Leprosy.—Lepra.

  In this  disease,  the eruption makes its appearance  as  a small,
salmon-red spot, raised a little  above  the surrounding skin, and  con-
stituting, in fact, a flat pimple, almost as large  at the top as at the
bottom.  On top  of this pimple, the scarf-skin  becomes rough, and
after a little while, a  thin scale is produced.  New layers are added
to its under surface, and it accordingly grows thicker.   It  has a bright,
silvery lustre.  These scaly spots multiply, and become  the form  of
leprosy called lepra guttata, from the Latin gutta, a  drop, the scales
looking like drops of  water on  the skin.
  But the  eruption more frequently spreads out into circular patches,
of the size of a fifty cent piece. These generally appear below the
elbows  and knees, and on the breast  and shoulders, and  back of the
hands.   Sometimes  the entire hand is covered with scales of a pecu-
liar silvery whiteness.  These patches heal from the centre.

                           Psoriasis.

  This differs from lepra in the eruption being more  irregular.   The
spots sometimes come out in thick clusters, and blend in various ways.
Instead  of appearing in distinct circular  forms, as in  leprosy, the
patches  are irregular, and of every size.  Instead of one  well-formed
and thick scale,  there are many small and thin ones.   And instead  of
a depressed centre with rising edges, the surface is level.   While lep-
rosy is a circular dry tetter, this is an irregular dry tetter.

                          Pityriasis.

  This is  much like the two preceding, except that it gives rise to a
copious production of very small bran-like  scales.  Indeed, its name
is from the Greek, and means chaff or bran.  It is  a branny tetter.
It may  occur on any  part of  the body.
  Treatment. — When the skin is highly inflamed, and stiff with heat,
pain, and itching, the diet should be light, and the drinks  of a cooling
and unexciting kind.   The. warm bath, and gentle friction of the skin
are  useful.   Laxatives or tonics, may be employed, according to the
indications, — frequently laxatives first, and tonics afterwards.   The
specific remedies for curing the disease are,  corrosive sublimate (139), 
144                       SKIN DISEASES.
 iodide  of potassium (140), arseniate of iron (68), Fowler's solution,
 in two-drop doses, three times a day; or Donovan's solution, in  five-
 drop doses, three times a day.  For external application, use a hap-
 thaline ointment (177),  zinc  ointment, white precipitate  ointment,
 diluted nitrate of mercury ointment, or solution of corrosive subli-
 mate (212).

                          Dry Pimples.

   These are distinguished by the high degree of irritation of the skin
 which they create.  They are exceedingly troublesome, not only from
 the distress and itching they occasion, but because they are likely, in
 consequence of this to be torn into painful and obstinate sores.
   When  appearing in  children, they are called red gum,  and tooth-
 rash.  In grown persons, one form is named lichen, and another, dis-
 tinguished by excessive itching, prurigo.
   In this form of pimples, the fluid is not poured out upon the  sur-
 face of the true skin, — as in several of the preceding diseases, — but
 is collected within the tissue of this organ, and the pimples feel hard
 under the finger.
   The tooth rash of infants is  always accompanied with some fever-
 ishness, caused generally  by irritation of gums from growing teeth,—
 occasionally by flannel worn next the skin.
  Lichen  has  a variety of forms.   In one case the pimples are of a
 bright red, in  another, bluish or livid.  In one case  they  appear in
 circular groups, in another, they produce great disorganization of the
 skin, and occasion terrible suffering.
  Prurigo is a still more cruel disease than lichen.  The pimples are
 not very manifest, but the skin is thickened or swollen, and condensed.
 The suffering from it is terrible.  It gives one no sleep, night or day.
 That form of it called ant-bite prurigo, gives the sensation of millions
 of ants eating the flesh, or as many red-hot needles piercing it.  This
 renders the existence of many elderly persons a terrible burden.
  Treatment. — Careful diet, and gentle cathartics  or tonics, accord-
ing to the condition of the system.   Externally, the  cold  salt-water
sponge  bath, and glycerine, applied with a soft sponge, vinegar and
water, corrosive sublimate (222), creosote ointment, the diluted nitrate
of mercury ointment, laudanum and sulphur (179), prussic acid, etc.
 (171).   For relieving the terrible itching of the private parts, which
females sometimes suffer, I have found morphine (223), for external
use, very effectual.

                             Lupus.

  This makes its appearance in the form of one  or more  circular
elevations, of a dull red  or salmon-color, and  partially transparent.
When pressed under the finger, these elevations are found to be soft,
and when the  finger is  removed, they are flat and whitened.   They
generally appear on the face, and particularly the nose. 
SKIN DISEASES.                      .145
   In another and worse form of the disease, the tubercles are harder;
and after a time, they become covered with thin brown scabs, which
                           are scratched off, and followed by others,
           TTrn 7fi                       *           •        *
                           and these by others, until ulcers appear,
                           which are  sometimes  slow and some-
                           times rapid in their progress. The whole
                           nose  has  been destroyed by them in a
                           month.  (See Fig. 76.)   This is one of
                           the  diseases  which  Erasmus   Wilson
                           thinks, and, in my  judgment,  correctly,
                           to  be,  like scrofula,  the  result of the
                           syphilitic   poison, filtered  through the
                           blood of several  generations.  (See col-
                           ored  Plate IV.)   The artist has here
                           given a beautiful likeness of the disease.

                              Treatment. — The internal  remedies
                           are iodide of arsenic (141), and iodide of
                           potassium (140); the external, vinegar of
                           Spanish flies; and to promote  the  heal-
ing of the ulcers, a weak solution of  nitrate  of silver (211) (214)  is
adapted.

      Warts  and Corns.—Verruca — Tylosis — Clovus.

   In  the derma or true-skin, there are a great many small  arteries,
veins, and nerves, united together, and formed into loops (see cut 43),
resembling, in shape, the peaks of  miniature mountains. These are
called papilla;.   These loops, frequently, without any apparent cause,
take on a disposition to grow, and by extending themselves  upward,
they  carry the  scarf-skin along with them, which is thickened: and
together they form what is called warts.  Corns are formed  by a
somewhat similar growth of the papillae, brought about by the pres-
sure and friction of tight boots and shoes.

   Treatment. — For warts,  take a piece  of diachylon plaster, cut a
hole in the centre  the size of the wart, and stick it on, the wart pro-
jecting through.  Then  touch it daily with aqua fortis.  Nitrate of
silver sometimes answers well for  touching it.   They may be taken
off very neatly, sometimes, by tying  a string  tight around them.
Corns should be  shaved down  close,  after being soaked in warm
water and  soap, and then  covered with a piece of wash-leather, or
buckskin, on which lead plaster is spread, a  hole being cut in the
leather  the  size of the corn.    They may be  softened, so as to be
easily scooped out, by rubbing glycerine on them.  Manganic acid de-
stroys warts .and corns rapidly.  Bunions, which affect the joint of the
great toe, must be treated with fomentations, and sugar of lead water
(224), when there is considerable inflammation, with rest and a hori-
zontal position.   But the best cure for corns  and bunions, is to put
away tight shoes.
                                   19
 
146                      SKIN DISEASES.
                    Mother's Marks. — Nevus,

     The small vessels of the skin, called capillaries, suffer certain alter-
   ations of structure which pass  under the name of mother's marks.
   These  marks  are  simply a great dilatation of  these minute blood
   vessels.   These marks vary in size from a mere point to a patch of
   several inches  square*.
     The smallest of all is the spider  mark.  It is a  small red point,
   from which several little  straggling vessels spread  out on all sides.
   Sometimes this is of the size and appearance of a red  currant; at
   other times, of a strawberry or raspberry; and  occasionally it is even
   much  larger, and is compared to a lobster.
     When the circulation is active through them, or  the individual is
   excited by exercise, or by moral causes, these  marks are of a bright
   red color.   Some  are naturally livid and dark-colored, and look  like
   blackberries, and black currants.  The  blueness  of these is owing to
   the vessels being still more  stretched and dilated, and to the  conse-
■".  quent slower  passage of.the blood through them, which gives more
   time for its change from the arterial red to the venous blue.
     Treatment — If  the mark is not making progress, it had better be
   let alone, or only subjected to gentle pressure by putting a piece of
   soap plaster over it.   When its course is threatening mischief, it is
   sometimes cured  by- pencilling  a  small portion  of  its surface, from
   time to time, with nitric acid.

        Disordered  State  of the Nerves  of  the  Skin.

     Itching1,, — Pruritus.   This is supposed  to be dependent  on  an
   altered condition of  the nerves of the skin, and  consists  in a painful
   sensation of itching.  There is no perceptible  alteration in the ap-
   pearance or structure of the skin.  This itching is thought, generally,
   to be  a result  of sympathy, through the  nerves, with some diseased
   and excited condition of a distant part.  The itching is brought on
   by the most trifling causes, and  for hours may deprive the sufferer of
   every  particle of  repose.  It more frequently affects the fundament,
   or the private  parts, particularly the scrotum.
     Treatment. — As this disease is only a symptom  of several others,
   the constitutional  treatment belongs under the  heads of these other
   diseases.  The local applications for relieving the itching are, a solu-
   tion of sugar of lead* (224), of white vitriol (220), of corrosive subli-
   mate  (212), diluted nitrate of mercury ointment, and poppy fomenta-
   tions.   Also (223).

       * Disorders Affecting the Color  of the Skin.

      Colored Patches. — Macules.   The depth of color in the skin depends
   on the amount of a certain coloring matter, called  pigment, incorpo-
   rated  with the deeper and  softer portion of the scarf-skin.   In  the 
JJl.Buflorcte LWi- Boston. 
 
LUPUS NON EXEEENS.                   PI 4.

JJt.Buflfcrttz LUh. Boston. 
 
SKIN DISEASES.
147
 scarf-skin of the  inhabitants of northern latitudes, there is but  little
 of this  pigment;  in  that of the dwellers in Africa, there is a great
 deal; among the inhabitants of Southern  Europe, the quantity is
 intermediate between the two.
    The depth of color in the skin, depends on the energy of its action.
 In the  tropics, where light and heat are in  excess, the skin is stimu-
 lated to great action'just as vegetation'is, and the color is increased
 and  intensified.   This  is illustrated every year before our eyes.   In
 summer under the heat of the sun and the flood of light, the pigmi  ,-
 forming power is increased, and the fairest skin is  browned; while
 the withdrawal of these forces, leaves the winter's scarf without pig-
 ment, and blanched.
    What the sun  and light do, under natural circumstances, diseased
 action may effect.   Hence  we  occasionally  meet with alterations of
 color in the skin, from a disordered state of the system.   We witness
 the formation of  patches of dark color and irregular shape on various
 parts of the body.  Sometimes they are raised above the level of the
 skin, and  are called moles.   At other times, they have no elevation,
 and  spread over the whole body.
    Occasionally, from some peculiarity of constitution, the pigment is
 diminished, and white  patches  appear  all over the body.  At other
 times, a black person will become completely white.  Such are called
 albinos.
   In  many cases the coloring pf the skin  has  varieties of  tint, as
 when persons of light complexion, are, in the summer season, covered
 with  yellow spots, like  stains.  These spots are known by the name
 of freckles, or, in  learned language, lentigo.

   Treatment. — It is generally best not to meddle with a mole.  If it
 be very  unsightly, let it be removed by two  incisions, taking  out an
 elliptical portion of skin, and closing the wound with  sticking  plaster.
 In the case of bleached places, apply the shower bath, tonics, and a
 stimulating liniment (163) to the faded spots.  For the change of color
 called sun-burn, a liniment  (191) of lime water, etc., is the best pre-
 paration.  For freckles, use lime water (191), or, perhaps, still better
 (222).

              Disorders  oT the  Sweat  .Glands.

   The perspiration is sometimes greatly increased above nature's de-
 sign.  This  is, technically, idrosis.    In other instances there is  too
 little  sweating. This  is called anidrosis.  Sometimes the  perspiration
 is so  altered in its  physical qualities as to have some  peculiar  smell.
 This  is  osmidrosis.   In  some rare instances, according to old writers^
 she sweat was changed in color.  This was chromidrosis.   And now
 and then a case  occurs of  bloody  perspiration, of which, the most
 memorable case on record, is  that of the  Redeemer of men, who  in
 the garden, sweat great drops of blood.  Several cases  of' this  are
 recorded in medical books.   It is called hcemidrosis.
   The proper  action of the skin being so vitally important-to health,
these  changes often involve very serious consequences. 
148
SKIN DISEASES.
   Treatment. — Either too much or too little  sweating can generally
 be corrected by  the cold or warm bath, friction, tonics, and proper
 clothing.

         Disorders of the Oil-Glands  and  Tubes.

   That the skin may be limber, healthy, and fit for use, it is neces-
 sary to have it  oiled every day.  For this object, the Creator  has
 wisely provided,  by placing in the true skin a large number of very
 small glands and tubes, whose office it is to prepare and pour  out
 upon the  surface  the  proper  amount of oil.  The gland, regular
 little oil-pot, is in the true skin; and  from it a piece of hose  or tube
 runs up through  the scarf-skin, through which the oily fluid is poured
 out.  Some of these tubes are spiral, others are straight.   On some
 parts these vessels do not exist; on others they are quite abundant,—
 as on the face, nose, ears, head, eye-lids, etc.   They produce the wax
 of the ears; and on the head, they open into  the sheath of the hair,
 and furnish it with a hair-oil or pomatum better than the chemist  can
 make.
   These,little vessels are always  at work, when  the  skin is healthy;
 and no persons need be afraid to wash all over every  day, lest, as the
 Boston Medical Journal taught, the skin will be injured by having the
 oil  removed from it.  You  might as well be  afraid to eat a  meal of
• victuals, lest the  saliva should all be swallowed with it, and none be
 left for future use.   There is oil  enough where that upon the skin
 comes from, and the vessels which  produce it are not injured by work,
 any more than the muscles of the legs are by walking.
   Grubs or Worms. — But, unfortunately, the  skin  is not well  taken
 care of in all cases, as in cities and towns where sedentary habits pre-
 vail.  Here, the actions of the skin, instead of  being regular and com-
 plete, are often sluggish and imperfect; and  the  contents of the oil-
 cells and tubes, instead of flowing easily, become hard and impacted,
 and the vessels.are not emptied.   When this  matter becomes station-
 ary, dry, and hard, it distends the tube, and fills it to the surface; and
 then coming in  contact with the dust
 and smoke of the atmosphere, the ends
 become black, and look like the heads of
 worms.  These  spots  are common  on
 the nose and face of persons who  have
 a sluggish skin.  They may be squeezed
 out by pressing the nails on each side of
 them.   These   are  called  grubs and
 worms, or, technically, comedones. When
 this matter produces inflammation of the
 tube, there  is then  a black  spot in the
 middle of a  red pimple, and  the disease
 is called spotted acne.  Now and then
 the oily matter becomes very hard, pro-
 ducing spine-like growths, and even horns (Fig. 77); and again, it col-
 lects and forms soft tumors, as  wens,  etc.   These  are  technically
 
SKIN DISEASES.
149
called encysted tumors.   Sometimes the action  of the glands is  too
great, and oil is poured out so profusely that the face shines with it.
At other times there is so little  that the skin is dry and harsh.   In
the  hardened, oily matter, which constitutes grubs,  are  found small
animals, which Dr. Wilson calls the " animal of the oily product of
the  skin."  Here are three views of him.
Fig. 78.
Fig. 79
Fig.!
   Treatment. — For roughness and harshness of skin, wash with soap
 and water every night, and rub well into the skin after  the bath, and
 in  the morning, the ointment (180), and take a dose of sulphur, etc.
 (23), twice a week.  Or, rub the skin every  morning  with  a damp
 sponge,  dipped in fine  oat-meal, and  after drying the surface, the
 liniment  (164) may be  applied.   The spinous variety, or porcupine
 disease, requires washing with a quart of warm water, having a large
 teaspoonfui  of saleratus dissolved in it, and the use of the ointment
 (181) twice a day.  For grubs, stimulate the skin, by washing it with
 strong soap suds, twice a day, and rubbing briskly with a coarse towel;
 and by using the corrosive sublimate (225) as a lotion.
   A spare diet will do  much towards improving the skin in many
 cases.

         Barbers' Itch—Jackson's  Itch.—Sycosis.

   This is very much like orae,- only differing  from it in its location.
 It appears chiefly  on the hairy parts of the face, —the chin, the upper
 lip,  the region of the  whiskers, the eyebrows, and the nape of the
 neck.  It consists in little conical elevations, which maturate at the
 top, and  have the  shaft of a hair passing through them.   These pim-
ples are of a pale yellowish color.  In a few days they burst,  and the
matter running out, forms into hard, brownish  crusts.   These  crusts
fall off in one or two weeks, leaving purplish, sluggish pimples behind,
which disappear very slowly.
• 
250                       SKIN DISEASES.
  The eruption is preceded by a painful sensation of  heat, and tight-
ness of the skin.
  The disease is  supposed to be brought on frequently by using a
dull razor in shaving.  It is very obstinate, — often lasting for many
months, and even  for years.
  Treatment. — The  most important part of the treatment is the re-
moval of the cause.   The beard must not be pulled with a dull razor;
the shaving had better be discontinued altogether, and the beard be
merely cropped off with  scissors instead.   All intemperance in eating
and drinking, and  exposure of the face to heat, must  be avoided.  A
light, cool diet will do much towards curing the disease.
  The nitrate  of mercury ointment,  and a solution of oxalic acid, are
the best applications.  If one does not succeed, try the other.

         Disorders of the Hair  and Hair Tubes.

  The hair is an appendage to the scarf-skin, and is intended to be
both useful and ornamental.
  It is subject to several disorders.  It may grow too  long, or too
thick, or it may appear in an  improper place.   This last  happens in
the case  of those  little spots and patches, which  disfigure the  face,
and are called moles.  The hair may be defective in its growth, or
may fall off prematurely from various causes, or in the natural course
of things  from old age.  This last is called calvities.  It  may change
its  color, too, under  a great variety  of circumstances, and at nearly
every age.   It  is not very uncommon to find a single lock varying in
color from that which surrounds it.   Old age, the winter, of life, nat-
urally brings the frosted locks ; but they frequently appear also upon
the heads  of younger persons.  Strong mental  emotions, such as fear,
grief, or sorrow, may bring a bleaching of the  hair in a brief period,
or even suddenly.   Byron,  in his " Prisoner of  Chillon," beautifully
refers to this fact:
                  " My hair is gray, but not with years,
                         Nor grew it  white
                         In a single night,
                   As men's have grown from sudden fears."

  Porrigo.— There is a troublesome  disease of the hair and hair tubes
called porrigo.  It begins with the formation of a thin layer of scurf
either around single  hairs, or in patches which encloses several.  These
patches frequently have  a circular form, which give to the affection
the character  of a ringworm.  The hair tubes are generally a  little
elevated, in the shape of  papilla?, which gives to the diseased scalp the
appearance of " goose-flesh."   These hairs, losing  their proper nour-
ishment and healthiness, break off at unequal distances from the skin,
leaving their  rough  ends, twisted, and  bent, and  matted  into thick
grayish and yellow  crusts.    Upon  the surface  of these crusts  may
generally be seen  the ends  of a few hairs, looking like the fibres of
hemp or tow.   The  scratching causes inflammation of the skin after
a time, and  matter is poured out, which still  further mats the  hair, 
SKIN DISEASES.
151
and thickens the crusts.   There are several varieties of this disease,
differing slightly from  each other;  but this general description  will
answer all practical purposes for this work.
   The reader will often notice a disease of the hair-glands, character-
ized by a yellowish and dirty-looking powder, covering the scalp and
hairs.   This matter is collected at the mouths of the follicles,  and
considerable of it is strung upon the hairs like beads.  Pull out a hair,
and the root will be  found thin, dry, and starved in its appearance.
In this disease, it is difficult to keep the hair cleansed, or to prevent
its falling off.
   Favus. — Still another disease, called favus, is known by the collec-
tion of a yellow substance, at first, around the  cylinder of the hair.
 This  substance, after a time, spreads  out upon the scarf skin,  and
 dries into yellow crusts, in the form of a cup, around the base of each
 hair.   A number of these cups, collected together, look  like the cells
 of a honey-comb.  This  disease is contagious,  and is communicable
 by contact to any part of the skin.

    Treatment. — For  removing the hair from particular parts of the
 scalp, it is common to resort to depilatories.   Of these, the recipes
 260, 261, 262, are frequently used, and are as  good as  those adver-
 tised ;  indeed,  they are the same.
    To prevent  loss of hair, and to restore  it when lost, the  circulation
 should be stimulated in  the small vessels  of the scalp.  With this
 view, washing the head every morning with cold water, drying it by
 friction with a rough  towel, and brushing it to redness with a stiff
 hair-brush, are excellent.  To these should be added some stimulating
 ointment (183), or liniment (257) (258) (259).   These last are about
 the best known preparations for causing the growth of the hair.

   Ringworm of the scalp requires attention to the diet, and such rem-
 edies as will improve the general health, with stimulating applications
 externally (257) (258)  (259).
   To color  the hair, several preparations  are  used.  Of these, 263 is
 about the best.  It produces a beautiful black.   A preparation of sul-
phur and sugar of lead (264) is the famous compound recommended
by General  Twiggs,  and extensively used.  Preparations of nitrate
 of silver (265) (266) (311) are much in use in some quarters.  They
perhaps give a finer black to the hair, but they render it dry and crisp,
 and they will stain the skin, if care is not used in applying them.

   Ill Favus, the two great objects to be gained are, to remove all local
 causes of irritation, and to excite the diseased hair  glands  to healthy
 action.  The first object is effected by cutting off the hair with the scis-
 sors, and removing the crusts by washing the scalp with castile soap
 and water.  It may be well first to wet the crusts through with corro-
 sive sublimate (212), in weak solution.  The washing with soap and
water should be repeated every day, and be followed by rubbing into
the scalp a stimulating ointment (183).  A very weak solution of the
 acid nitrate of mercury (226), applied every other day, with a camel's
.hair brush, sometimes produces excellent effects. 
DISEASES  OF  THE BRAIN  AND  NERVES.
  The brain and  spinal cord are the great centres of the nervous
system.
  The brain produces sensation, thought, and voluntary motion.  When
this organ is diseased, therefore, we may expect one of these functions
to be either disturbed or destroyed.
                                                  9
  Of Sensation  there  are various  disturbances, perversions, ana sus-
pensions, caused by disease of the brain and nerves ;  such as nausea,
giddiness, specks floating before the eyes, ringing in the ears, decep-
tive tastes and smells, intolerable itching, neuralgic pains, boisterously
high spirits, depression without apparent cause, anxiety, and dread.

  Thought, in like manner, is disturbed and perverted in many ways.
There is high delirium, dulness and confusion, loss of memory, Weak-
ened judgment, and every degree of stupor, down to entire loss of
consciousness.

  Voluntary  Motion is perverted and destroyed in muscular twitch-
ings, trembling of the limbs, spasmodic stiffness, involuntary jerkings,
convulsions,  muscular debility, and palsy.
  The brain is composed of three parts, — the cerebrum, the cerebel-
lum, and the medulla oblongata. These are all contained within the
skull bones, and are immediately covered by three membranes, called
the  dura mater, the arachnoid, and the pia mater.  The dura mater is
a strong, fibrous membrane lying next to the skull-bones.   The arach-
noid is a serous membrane, lying next below, and the pia mater, which
means pious mother, is a vascular membrane, lying next to the brain,
dipping into it in places, and containing the  vessels which bring to it
all its nutrient materials.  Hence its name.
  These  membranes  are all liable to  be inflamed, — and  so is the
brain.

            Inflammation  of the Dura Mater.
                                    9
  The inflammation of this membrane does  not often occur sponta-
neously ;  but it happens  frequently from external  injuries, as blows
upon the  head.
  After a blow upon the head which stuns him, a man may recover
himself, and  for some days remain in perfect health.  Then he has. 
DISEASES OF THE BRAIN AND NERVES.           153
pain in the head, is restless, cannot sleep, has a flushed face, red eyes,
hot skin, hard pulse, rigor, nausea, vomiting, — ending with convul-
sions and delirium.
 * This disease is  often caused by what is called otitis, or inflamma-
tion of the internal ear.  In such cases, inflammation will arise within
the tympanum, causing intesse earache; matter comes at length from
the external ear, but  the  pain does not stop; the  patient  shivers, be-
comes drowsy, perhaps delirious, and  finally sinks into stupor.  The
dura mater is inflamed.                                        •
  Treatment. — When the disease arises from inflammation in the
ear, leeches are to be applied behind  the ear, and blisters and other
irritants  afterwards.   Other modes of treatment will be  mentioned
after the next two forms of disease.

     Inflammation  of the  Arachnoid and Pia Mater.
                           Arachnitis.

   These two membranes are  generally inflamed  together.   They
are  so intimately connected that  each involves the other in its own
troubles.
   Generally this is divided into  three stages :
  The Irritative, characterized by wakefulness, irritable temper, re-
pugnance to strong fight, and contraction of the pupils.
  The Inflammatory  stage, known by transient  pains in the head,
alternating with similar ones in the bowels, increased restlessness and
irritability, a quick and  tense pulse, an  expression of discontent  on
the  face, the eye-brows knit and frowning, the  eye-lids half closed,
retching and vomiting, deep sighing, and  torpid bowels.
  The Depressing  Stage,  in  which the delirium is more  continuous,
the  countenance  has  a look of surprise and  stupor, the  pupils are
contracted or  dilated, the white of the eyes injected and  red, the
pupils rolled up during sleep, constant sleepiness, inattention to sur-
rounding objects,  torpidity of mind, gradually increasing  until  com-
plete coma closes all the  senses.
   The disease does not  always exhibit all these symptoms, or  come
on in the regular  way described.  Sometimes the  first thing noticed is
a long-continued paroxysm of general convulsions.  Again these con-
vulsions  will come on after violent pains in  the head, and  are  at-
tended with screaming.

     Inflammation  of the  Brain. —Brain Fever.
                     Encephalitis. — Phrenitis.

   Acute and general inflammation of the brain  and its membranes
has  two  stages.
  The Stage of Excitement, in which there is intense and deep-seated
pain in the head, extending over a large  part of it, a feeling of  tight-
ness across the forehead, throbbing of the temporal arteries, a flushed 
154           DISEASES OF THE BRAIN AND NERVES.
face, injected eyes, looking wild and brilliant, contraction of the pupils,
great shrinking from light and sound, violent delirium, want of sleep,
general convulsions, a parched and dry skin, a quick and  hard pulse,
a white tongue, thirst, nausea and vomiting, and constipation of the
bowels.
  The  Stage of Collapse, in which there are indistinct mutterings, dull
and perverted  hearing and vision, double vision, the pupil  from being
contracted expands  largely and becomes motionless, twitchings of the
muscles, tremors  and palsy of some of the limbs, a ghastly  and ca-
daverous countenance, cold sweats, profound coma, and death.
  The disease will not show all these symptoms in any one case.  It
runs a rapid course, causing  death, sometimes, in  twelve  or  twenty-
four hours; or it may run two or three weeks.
  Treatment. — This  should  be  energetic  and administered  early.
The measures  usually employed are blood-letting, purging,  and the
application of cold to the head.
  General Blood-letting. — This is much approved  by many;  for my-
self, I do not like it.  Wet cups and leeching are about the extent to
which  I would ever carry the abstraction of blood in these diseases.
These  may sometimes be applied with advantage to the neck, and
behind the ears.
  Cold Applications. — These, applied  to the  head, are of great im-
portance.  First,  shave the head, and  put  on cloths wetted in water
as cold as it can be made, changing them often;  or, put powdered
ice in a flexible bladder, and lay it upon the head, — taking care not
to make it too heavy.
  Purging. —  This, while the inflammation is  in  the active stage,
should be thorough and energetic.  To effect it, many use  calomel
and other forms  of mercury.  They are not  needed.   Croton oil is
one of the best articles (31), or calacynth, gamboge, etc. (32),  without
the oil, or the compound powder of jalap.
  In the stage of collapse, if there is pallor of the  countenance, a
feeble  and  flying pulse,  great debility  and tremors, coldness of the
extremities, etc., give wine and other stimulants.
  See  that the bladder is emptied every day.
  The feet,  in  the  early stage of the complaint, should be bathed in
warm water, or mustard and water (242).  Mustard draughts  must
also be put upon  the feet.
  The tincture of veratrum,  given  in  full  doses, to bring down the
pulse, and produce sweating,  must not be omitted.

         Softening of the Brain.—Ramollissement.

  Inflammation  of the brain, wheij it has run its course, sometimes
leaves  this organ,  or portions of it, in a softened condition.  The
same mischief may happen to the brain from the blood-vessels which
run to it being diseased, so as not to  be able to  carry blood for  its
proper nourishment. 
DISEASES OF THE BRAIN AND NERVES.          155
 $ Symptoms. — The  most remarkable symptom of this disease is the
rigid contraction of the muscles which draw up the limbs; the hand
may be clenched and pressed against the shoulder, or the heel carried
up to the hip.
  The other symptoms are various, — tingling and numbness in the
ends of the fingers; perverted vision, and sometimes blindness ; paral-
ysis of one limb, or half the body; difficulty of answering questions;
forgetfulness, making it difficult, at times, for the patient to remember
his own name.

         Suppuration  and Abscess  of  the Brain.

   When a diseased  brain is examined after death, sometimes matter
 is found mixed in  with the softened portion.  This shows that suppu-
 ration took place.   At other times, the matter is found in a cavity,
 which shows that an abscess had formed during life.
   The  symptoms  of these mischiefs  are  convulsions in the  earlier
 stages, and palsy in the latter.

                  Induration of the  Brain.

   Instead of  softening the brain, inflammation sometimes  does the
very opposite, — it hardens it, — producing a change something like
that which happens to white of egg when dipped in hot water.
   Convulsions appear as the result of this change, as in  suppuration
and abscess ; palsy much more seldom.

                    Tumors of the Brain.

  Tumors infect the brain, occasionally, — growing around it, on all
sides, pressing themselves into its substance, and causing many dis-
turbances.   Cancers  and hydatids are found  there.  The  signs which
these irritating bodies produce, are like those of other diseases of the
brain, and therefore cannot be distinguished during life.

       Delirium Tremens.—Drunkards' Delirium.
                          Mania a Potu.

  This  is often  mistaken for brain fever; but it is quite a different
disease.  It is not the  result of inflammation of the brain, but of
irritation.  It  is  important to distinguish  it from inflammation, be-
cause the remedies which are employed for that would be injurious
if used for this.

  The Symptoms are  incessant talking, fidgeting with the hands, trem-
bling of the limbs, a rapid pulse, profuse sweating, utter sleeplessness,
and a mingling of the real with the imaginary in the busy talk.   The
patient is apt to think some one  is about to  do him a great injury,
yet is unwilling to  be alone.  His face is pale and sallow (sometimes
red  and  flushed), his eye is rolling, quick and  expressive, his speech 
156           DISEASES OF THE BRAIN AND NERVES.
stuttering and inarticulate,— bodily and mentally, he is busy day and
night, and can with difficulty be confined to his bed or room.  As the
disease  advances, and he has been long without sleep, he imagines
vermin  to be crawling upon his scalp and body;  troops of rats run
across his bed, or look at him out of the wall; giant  boxers confront
him, and  he  squares off for a round at fisticuffs; animals, figures of
all  shapes, and horrible monsters, frighten his  imagination;  devils
laugh at him, and dance before him.  In long and sleepless hours, he
talks and chatters with these  spectral phantoms, — now beckoning
them, now shrinking  from  them, till he wears out and sinks from ex-
haustion.   This is a  disease of drunkards and  opium eaters.   The
attack generally occurs in consequence of the withdrawal for three or
four days  of  the accustomed stimulus.

  Treatment.— Opium and its preparations are the  sovereign remedy.
Give  one-third of a  grain of  morphia; if this  does not  quiet the
patient, give  thirty drops of laudanum every two hours, till sleep is
produced.  Sleep will cure him, and nothing else will.  A draught or
two of his accustomed drink, brandy, gin, or whatever it may be, will
also generally dispose him to sleep.
  Recently, a very effectual remedy  has been found in  the use of
tepid  baths,  prolonged from four to ten  hours, in connection  with
cold applications to the head.  In  connection with this, small doses
of opium  are required; but the treatment may  yet prove to be very
valuable by enabling us to dispense with excessive doses of opium.

        Enlargement  of the  Brain.—Hypertrophy.

  This  is chiefly a disease of childhood.  It consists  in an unnatural
growth  of the brain.   Sometimes the skull grows with it, and there
may not be any, or only slight, symptoms of disease.
  The  complaint is  sometimes congenital, — the  child being  born
with a  head  far above the  natural standard of  size.   Sometimes  a
child's head, from this disease, will reach the size  of an adult's, by the
time it  is five  or six years old.   This is  not  necessarily a disease,
though  children that suffer  from it are very apt to die finally of some
affection of the brain.

  Symptoms.  — Dulness of intellect, indifference to external objects,
great  irritability of temper,  inordinate appetite, giddiness, and an ha-
bitual headache, which at times is very severe.   In addition to these,
there are,  at times, convulsions, epileptic fits, and idiocy.   There is a
peculiar projection of the parietal bones, which serves well to distin-
guish this disease from acute hydrocephalus.

  Treatment.—As far as possible, suspend  and repress all exercise of
the mind.   Take the  child  from school as soon  as the disease is dis-
covered, and  put it to the most active muscular  exercise in the  open
air.  The  moment there is any excitement of the brain, or heat on
the top  of the head, apply cold water, ice, or cold evaporating lotions.
If, t*< the child grows  up, the signs of mischief increase, the  diet must 
DISEASES OF THE BRAIN AND NERVES.           157
be simple, and carefully regulated.   Bread and milk only is  some-
times advisable.


            Shrinking of the  Brain.—Atrophy.

   This is a disease in which the volume of the brain is diminished.
There are two forms of it; one is congenital, the brain  not being
properly developed at birth; the other occurs in consequence of dis-
ease either in the membranes or the arteries.   The  symptoms are not
distinguishable during life from those of other brain affections, and
therefore it can only be treated according to general principles.


         Water in the Head.—Acute Hydrocephalus.

   This, like enlargement of the brain, is  likewise a disease of child-
 hood, and often attacks scrofulous children.
   Being an inflammatory disease, it is important to have early notice
 of its  existence, and, if possible, to be aware of its approach;  Which
 we may be, frequently, by observing the following premonitory

   Symptoms; namely, a  disturbance of the disgestive functions, indi-
cated by a capricious appetite, — the  food at one time being  disliked,
at another devoured greedily; a foul tongue, offensive  breath,  enlarged
and sometimes tender belly, torpid bowels, stools  light-colored from
having no bile, or  dark  from vitiated bile, fetid, sour-smelling, slimy
and lumpy.  The child  loses its healthy look, and grows paler and
thinner.   Its customary spirit and activity are gone ;  it is heavy, lan-
guid, dejected; it  is fretful, irritable, uneasy; and  sometimes  is a
little tottering in its gait.
   After  these  warning symptoms, the disease may begin in one of
three ways :
   The pains in the head become more severe and frequent, and are
sharp and shooting, causing the little patient to wake and shriek out.
As the drowsy state advances, the shrieking  gives  place to moaning.
Beside these  symptoms, there are  stiffness in the  back of the neck,
pain in  the limbs, great tenderness  of the  scalp,  vomiting, sighing,
intolerance of light, knitting of the  brows, increased disturbance of
stomach and bowels.   This stage may last ten to fourteen days, the
child growing more weak and  peevish.
   Another form of attack  is marked by acute pain in the head and
high fever, convulsions, flushed face, brilliant eyes, intolerance of light
and sound, pain and tenderness in the belly, stupor,  great irritability
of stomach, causing retching and vomiting upon every attempt to sit
up in bed.
   The third mode of attack is very insidious, — the  early symptoms
being  mild and hardly noticeable, or not  even occurring  at all.  In
such case, the convulsions or palsy  come suddenly, without  notice,
bringing swift and unexpected destruction.  This has sometimes been
called water-stroke. 
158           DISEASES OF THE BRAIN AND NERVES.
   The First  Stage  is the period of increased sensibility and excite-
ment, caused by inflammation, in which  the pulse is quick and irreg-
ular.
   The Second Stage is one of diminished  sensibility, or lethargy, dur-
ing which water is  effused upon the brain, and the pulse is  slow.
   The Third Period is  one of palsy and  convulsions, with squinting
of the-eyes, rolling  of the head, stupor, and a rapid, thread-like pulse.
   Treatment. — In  the  first or inflammatory stage, purging is  very
important, and it must be  continued for three or four days.   Scam-
mony and croton oil (33) may be chosen  for this purpose.   Apply
cold water, ice, etc., to the head.
   In  the  second stage, put blisters upon the back of the  neck, and
one upon the bowels if  they are very tender.
   In  the third stage, effusion having taken place, use the warm bath,
or the vapor bath,  — also digitalis, squills, and iodide of potassium,
(144) (128) (302) (130).
   Confine the child to a darkened room, of moderate temperature,—
excluding all noise  and  causes of excitement,  and let him lie upon a
hair mattress, with  his head somewhat elevated.
   Diet.— Gruel only during the stage of excitement, — during  that
of collapse, it should  be nourishing, but mild and easy of  digestion,
as beef tea,  plain chicken or  mutton broth, and animal jellies.   At
the same time, support the patient by the cautious use of the  aro-
matic spirit  of ammonia, ten drops every four hours, valerian, wine
whey, and infusion  of gentian, columbo, or quassia, (64) (66).

       Dropsy of the  Brain.—Chronic  Hydrocephalus.

   Acute  hydrocephalus is an  inflammation;  chronic  hydrocephalus,
now to be considered, is a dropsy.  It often begins before birth.   It con-
sists in the accumulation of enormous quantities of water within  the
brain, sometimes within its ventricles, at other times, upon its  surface.
When it occurs soon after birth, it  advances slowly, and impercepti-
bly,— the enlargement of the head being the first thing noticed.
   The skull being tender in infancy, it separates at the fontanelles, as
the fluid accumulates, and  the head, at  times, attains an  enormous
size,—so great that the child cannot carry it upright, but lets it droop
laterally upon the shoulder, or forward upon the breast.
   As  the disease advances, the senses become blunted,  the  child is
deaf or blind, the intellect is weakened,  perhaps idiocy appears, the
flesh and strength pass away,  convulsions and paralysis come  in their
turn,  and a stupor is apt to occur which ends in death.
  Treatment. — The remedies may be external, or internal, or both.
  Internal  Remedies. — These should be purgatives (33) (31), or di-
uretics and alteratives (302) (145) (144).
  External Remedies. — Apply an  ointment of  the iodide of potas-
sium  to  the  scalp every night  (185).   A  tight bandage apphed over 
DISEASES OF THE BRAIN AND NERVES           159
Fig. 81.
the whole head will sometimes have a favorable effect.   Another ex-
pedient is to puncture the skull and draw off the water.  Tapping
the brain* has effected a cure in many cases, and perhaps promises the
most relief of any remedy we have.

               Diseases of the  Spinal  Cord.

               There are few diseases more  interesting, as a study,
             than those which affect  the nervous  cord  which runs
             through the centre of  the back-bone.  This cord is a
            |||continuation, an appendage or tail of the brain.  (See
             Figure 81.)   It is  the  seat and  centre of certain ner-
             vous functions, called reflex, by which so many move-
             ments take place which are not under the control of the
             will.
               In order that we may feel what  takes place in any
             part of the body or limbs, and that  the will may have
             power to move such part, it is necessary that nervous
             matter should be continuous and unbroken between the
             part in question and the brain.
               If the spinal cord  be cut, broken, or crushed at any
             point, all those parts which receive  nerves  from below
             the  injury,  lose their power of motion  and their feel-
             ing.  When the injury  is in the upper part of the cord,
             the  breathing and the  circulation will stop, and death
             is the immediate consequence.   If  the middle  portion
             of the cord be  the seat of the injury, the bowels and
             other organs may lose their motion  and  feeling; if the
             lower  portion, then  the lower limbs only will be the
             sufferers.
               Disease or injury  in the upper part of the  cord is
             therefore  much more dangerous than the same thing
             the  lower.

            Inflammation of the  Spinal  Cord.
occurring m
   The membranes which surround the cord may be inflamed just as
those are which enclose the brain ; but as the cavity running through
the spine  is quite small, there cannot  very well be inflammation of
the membranes without its involving the  cord at the same time.
  Symptoms. — Pains, often intense, running along the spine, extend-
ing out into the limbs, and made worse by motion.  They are similar,
in some respects,  to rheumatic pains.  There is rigid contraction, and
sometimes violent spasms of the muscles of the back and neck, — so
great, at times, as too bend the body back into the shape of a hoop;
also a feeling of constriction in various parts, as if they were girt by
a tight string ; a sense of suffocation ;  retention of  urine;  a most
obstinate constipation ; and frequent chills or rigors.  The pain which
is felt along the cord is aggravated  by rapping upon  the spine, but
not by pressure. 
160           DISEASES OF THE BRAIN AND NERVES.
  The above symptoms are supposed to be the result of inflammation
predominating in the membranes.  When its seat is more particularly #
in the substance of the  cord, the  symptoms are, — convulsive affec-
tions of the head and face, inarticulate speech, loss of voice, squint-
ing, and difficulty  of swallowing, if the  extreme upper part of the
cord is inflamed; if the disease be slightly lower, difficulty of breath-
ing, irregular action of the heart, and tightness of  the chest; if lower
still, vomiting, pain in the belly, sensation of a cord tied  round the
abdomen, pain and heat in passing water, retention of the urine, ina-
bility  to retain the urine, desire to go to stool, or involuntary stools.
  Spasm  and stiffness, then, are the results of inflammation of the
membranes;  convulsions and  palsy, of the  same  affection of the
cord.
  Treatment. — When the inflammation is acute, apply a few leeches
or wet cups along the  sides of the  spine.  In  chronic inflammation,
powerful friction, or mustard draughts, stimulating liniments (190),
or plasters, will generally answer the purpose.

                           Apoplexy.

  Apoplexy is  that condition in which all  the functions of animal
fife are suddenly stopped, except the pulse and the breathing; — in
which there is neither thought, nor  feeling, nor voluntary motion; in
which the person falls down suddenly, and lies  as if in a deep sleep.
  Modes of Attack. — There  are at  least  three ways  in which this
terrible disease may make its assault.
  The First Form of attack is a sudden falling down  into a state of
insensibility and apparently profound sleep,—the face being generally
flushed, tjie breathing stertorous or snoring, the  pulse  full and not
frequent, with occasional convulsions.
  From this mode of attack some die immediately, others get entirely
well, and  others get off with the exception of paralysis on one side,
or the loss of speech, or some one of the senses.
  The Second mode of attack begins with sudden pain  in  the head.
The patient becomes pale, faint, sick, and vomits, — has a  cold skin
and feeble pulse, and  occasionally some  convulsions.   He may fall
down, or be only a  little confused, but will soon recover  from all the
symptoms, except the headache, — this  will continue, and the patient
will sooner or later become  heavy, forgetful, unable to connect ideas,
and finally sink into insensibility, from which he never rises.
  This  mode  of invasion, though not  appearing  so  frightful as the
first, is of much  more serious import.
  In the Third form of attack there is sudden loss of power on one
side of the body, and also of speech, but not of consciousness.  The
patient retains his  mind, and answers  questions  either by words or
signs.   This  may be called paralytic  apoplexy.   The  patient may
either die  soon,  or get well, or  live for  years, with imperfect speech,
or a leg dragging after him, or an arm hanging useless at his side. 
DISEASES OF THE BRAIN AND NERVES.           161
  The  Persons Attacked are apt to have large heads, red faces, short
and  thick necks, and  a short, stout, square  build, though it  occurs
often among those who are thin, pale, and tall.  The tendency to it
increases in  advanced life.
  The  Forerunners of apoplexy are headache, vertigo, slight attacks
of palsy, double vision or seeing  two objects when there is  but one,
faltering speech, inability to  remember certain  words,  sometimes a
sudden forgetlulness  of one's own name, a frequent losing  of  the
thread  of ideas  attempted to  be pursued, and occasionally an unac-
countable dread, for which no reason can be given.
  Exciting Causes.— Whatever hurries  the circulation of the  blood,
as strong bodily exercise, is an exciting cause.   So are  all those things
which  cause the blood to flow towards the head, as coughing, sneez-
ing, laughing and crying, straining at stool when costive, lifting heavy
weights, singing, and playing on wind instruments.   To  these may
be added, exposure to the sun, the bad air of crowded rooms, holding
the head down, or turning  it around to look backward, tight cravats
worn about  the neck, and exposure to severe cold.
  Treatment. — If the patient have the appearance of suffering from
fulness of blood in the  head, as evinced by redness and turgescence
of the  face,  and throbbing of the temporal arteries, and if the pulse
be full  and hard, feeling like a tense vibrating rope under  the  finger,
place him in a half-recumbent posture, with his  head raised;  loosen
his clothes, particularly  his neck-cloth  and shirt  collar, and whatever
may press upon the neck, and then as quickly as possible  apply cold
wet cloths to his head, changing them often.  Ice is  still better, if it
may be had.  Apply wet cups to the nape of the neck, and mustard
draughts to  the soles of the feet, — at the same  time applying tight
ligatures around the  limbs, to prevent the blood from returning rap-
idly in the veins.  The  ligatures should be gradually removed when
the patient recovers his consciousness.   Also administer a stimulating,
purgative injection (246), and place two drops of croton  oil, rubbed
up with a little pulverized loaf sugar, far back upon the tongue.  Re-
peat the injection every fifteen minutes, till the bowels are  thoroughly
moved.
  If the patient be old, and the pulse  small and  feeble, with no ful-
ness or beating of the  temporal arteries, or swelling of the veins of
the neck and forehead,  the countenance  being pinched,  and  the skin
bloodless  and cool, the cupping, purging, and applying the ligature
must be omitted.   In this  case it will be better to apply warm flan-
nels  and  hot bricks  to the surface, and administer ammonia and
camphor (283) (135) internally.
  To prevent future attacks, gentle tonics should be used, and  the
skin  should  be kept healthy by daily bathing and  friction.  The bow-
els must not  be permitted  to become  costive.   The  diet should be
light, chiefly vegetable,  and almost entirely so in  hot  weather. The
food should be well chewed.   The mind should  be kept cheerful and
hopeful, and free from great excitement.   The sexual  passion  should
be restrained, and very rarely indulged.  Intoxicating drinks should be
                                 21 
162           DISEASES OF THE BRAIN AND NERVES.
  abandoned, if used, and all tight cravats be discarded  from the neck.
  Direct rays of the hot sun in summer should be carefully shunned.
  No food should be taken for three  hours  before retiring, and a mat-
  tress only, of some degree  of hardness, should be slept  upon, — the
  head being always Well elevated.  To these precautions, I would add,
  dipping  the feet every night, before retiring, in cold  water; ang!,  if
  any tendency to cold feet be experienced, dusting pulverized cayenne
  in the bottoms of the stockings.

                   Sunstroke, — Coup De Soleil.

    This is much like apoplexy;  in  fact, it is a kind of apoplexy.   It
,  occurs in warm climates, or in very hot days in temperate regions, by
  exposure  to the sun.
    It  begins  by headache, thirst, dizziness,  and sometimes difficult
  breathing and  bilious vomiting.  The patient  drops down  senseless,
  as  in apoplexy, and unless immediate relief is obtained, soon dies.
    Treatment. — Take the patient immediately into the  shade, and
  employ about the same remedies as  for apoplexy.

                       Palsy.—Paralysis.

    Palsy  is a loss of the power of voluntary motion and  feeling, one
  or  both  coming  on, sometimes gradually, but more often  suddenly,
  and extending at one time to a part, at another  time to the  whole
  body.  It is a kind of station-house on  the way to apoplexy, where
  passengers stop, not merely to stay over night, but to rest  many days,
  or even years.
    A  great injury inflicted upon the  brain, either by pressure, or other
  cause, will induce a complete loss of motion and feeling,  and this ex-
  tending to the whole structure, brings likewise a  loss of conscious-
  ness, which is apoplexy.   A  smaller degree  of pressure,  or  a less
  injury upon the same brain, would occasion a loss of motion only, or,
  if a loss of feeling were  experienced also, it would only  extend to a
  part of the body, and consciousness would remain.  This  would  be
  palsy.  The  disease is like apoplexy in kind, but stops short of it in
  degree.

                          Hemiphlegia.
          *
    When palsy affects an entire half of the body, dividing it through
  the centre of the face, neck, body, etc., from head to foot, it is called
  hemiphlegia.   It  is  more nearly allied  to apoplexy than any  other
  form of the disease, and is generally ushered in by pretty well-marked
  apoplectic symptoms.
    Symptoms.— Sometimes  there are no premonitory symptoms; but
  often before  the  attack  there are flushed  face, swelling of the veins
  about the head  and neck, vertigo, a sense of fulness, weight, and
  sometimes pain in the head, ringing in the ears, drowsiness, indistinct 
DISEASES OF THE BRAIN AND NERVES.           163
 articulation of words, or even loss of speech, confusion of mind, loss
 of memory, and change of disposition, — amiable persons being made
 sullen and peevish, and irritable ones mild and simpering.  After  the
 attack, the countenance generally acquires  a  vague expression;  the
 mouth is drawn to one side;  the lower lip on the palsied side  hangs
 down, and the spittle dribbles away.  The  speech is altered, and the
 mind is generally impaired.
   In some instances, the patient recovers in a longer or shorter time ;
 in others, little or no improvement takes  place, and the patient, a   r
 remaining helpless, often for a long, time, dies  either from  gradual
 exhaustion, or suddenly from  apoplexy.


                          Paraphlegia.

   This form of  palsy divides the body transversely, at  the hips, and
 confines itself to the lower extremities,  and to  the parts about  the
 pelvis.
   Symptoms. — When  it arises from affections of the  brain, it is at-
 tended by pain in the head, giddiness, drowsiness, dimness of sight,
 and  impaired memory.  Numbness is sometimes  felt  in the  upper
 extremities as a forerunner of this form of palsy.  At  first there is  a
 slight stiffness and  awkwardness of the  motions of the legs, which
 continue to  increase till a cane  is  needed to  balance  the body and
 make it steady.   From a paralysis of the neck of the  bladder,  the
 stream of urine grows more feeble, and finally dribbles away involun-
 tarily.   The  bowels are for  a time costive, but when  the  circular
 muscle which closes the fundament becomes  palsied, the feces pass
. without consent of the will.
   When disease of the spinal cord is the cause of the complaint, it
 is apt to come on  gradually; languor and weakness  are felt in  the
 knees, the legs are not easily directed in walking, — being thrown
 across each  other, causing tripping and  stumbling.  By degrees  the
 loss of power increases in the thighs and legs, until  at length  the
 whole lower extremities become palsied and useless.

                          Local Palsy.

   Palsy is called local when it is confined to a single limb, or muscle,
 or locality.   One of these forms is called facial palsy.   It  affects
 one half of the face only, and is a good specimen of these affections.
 It removes all power of expression from one half of  the face, and
 leaves the features  still, blank, and unmeaning.  With  the affected
 side of the face, the patient cannot laugh, or  weep, or frown, or  ex-
 press any feeling or emotion, while the features of the other side are
 in full play.   Among the ignorant, who do not comprehend the extent
 of the evil, the drollness of the expression excites laughter. 
164           DISEASES OF THE BRAIN AND NERVES.
                        Shaking Palsy.

  The nature of this form of palsy is well expressed by its name.

  Symptoms. — The first  symptom of this  complaint  is a weakness
and tremor of the head or hand.  In about a year the  other hand, or
the lower extremities become affected; and  the patient begins to lose
his balance in walking.   Then the trembling becomes  perpetual; no
limb or part remains still.  Reading and writing are no longer possi-
ble, and' the hand cannot  even  carry the food  to the  mouth.  The
balance cannot be maintained in walking; there is a tendency to fall
forwards, and to avoid  it, the  patient is  obliged  to run  or move
quicker, and upon the toes.
  At a later period, the tremor  continues during sleep; there is in-
creased weakness;  the body  is bent  forward,  the  speech becomes
indistinct, swallowing difficult, and the bowels  torpid.  At last, the
urine  and feces  pass involuntarily, and delirium and coma bring life
to a close.

                         Lead Palsy.

  In this disease the muscles of the forearm are palsied, so that the
wrists " drop," as it is said, and the hands hang  down when the  arms
are stretched out.  It is caused' by the  gradual  introduction of lead
into  the system.  It is a  disease,  therefore, peculiar  to painters,—
particularly those who use carbonate of lead, or white lead,  as it is
called.  It is generally the sequel of painter's colic.

  Causes. — Hemiphlegia and paraphlegia, are caused  by pressure
upon the brain, by the effusion upon it of blood  or water, by a tumor,
by mechanical injuries, by the  striking in of eruptions,  and by intem-
perance in eating and drinking.  Paraphlegia  often  results from dis-
ease or injury of the spinal marrow.

  Treatment. — A sudden and  severe  attack of palsy requires the
same treatment  as apoplexy.   When the bowels are obstinately con-
stipated, they  must be purged by scammony and croton oil (31) (32,)
and by injections (246).
  When all the symptoms of determination of blood to  the  head
have disappeared, and the disease has become strictly chronic, ex-
citing remedies must be employed, as frictions, stimulating liniments,
blisters, stimulating baths, cold affusion, and electricity.   Among the
internal remedies, strychnine has the best reputation (85) (86).   The
tincture  of the  poison oak is well recommended (284).   An altera-
tive (145) should likewise be used.
   Apply counter-irritants along the track of  the spine, such  as blis-
ters, the moxa, the compound tar plaster, and the pitch plaster.
   At first the diet should be light; but after  the more active symp-
toms have disappeared, it should be nutritious, and sometimes stimu-
lating.   Flannel under-clothes should always be worn next the skin. 
DISEASES OF THE BRAIN AND NERVES.          165
  For lead palsy, the best remedies are iodide of potassium, or sul-
phuret of potassium.  The dose of either of these is from three to ten
grains, three times a day, dissolved in water, one ounce of the salt to
six ounces of water, and taken in simple syrup.   The affected limb
should also  be soaked  an hour each day in a gallon of water, with
half an ounce of sulphuret of potassium dissolved  in it.

                   Hydrophobia.—Rabies.

  The bite of the  mad dog, or mad wolf, or other hydrophobic ani-
mal, is the most dangerous of all poisoned wounds, because it is apt
to be followed by a disease  for  which there  is no certain remedy.
Fortunately, the human subject is not as susceptible to the effects of
the poison as some of the lower animals ; for only about one-tenth
of those bitten are attacked by hydrophobia.
  Symptoms. — The interval  between the bite and the appearance of
the disease, -varies from twelve days  to two months.   The wound
heals like any other bite of a  similar animal.  After a time, the scar
begins to  have darting, lancinating pains, which, if it be a limb that
was  bitten, run up towards  the body.  Sometimes it feels  cold, or
stiff,  or numb, or  becomes red, swelled, or livid, and  occasionally
breaks open, and  discharges matter.   The  patient  feels  a  strange
anxiety, is depressed in spirit, has an occasional chill, and disturbed
sleep, and spasmodic  twitches.  The pulse is above its natural state,
both in quickness and strength,  and the nervous system is very im-
pressible.   The senses  are all more  acute; trifling  noises produce
agitation, and the  eyes are so disturbed by the light that the patient
sometimes hides himself in a  dark place.  The appetite is lost.  This
is the first stage.
  Thirst now appears, and he attempts  to drink.   But the moment
water approaches his mouth, a spasmodic shudder comes over him;
he pushes it back with horror; the awful fact of  his condition  flashes
upon  him ; and he cries out, " What I have dreaded  has come upon
me."
  Thenceforward he  can swallow no  fluids;  complains  of pain and
stiffness about his  neck ; is thrown into convulsions  by the sight of
water, or even the sound of liquids agitated in a vessel, or by a breath
of air blowing upon  him, by a bright  light, or the glare of a mirror.
His throat is full of a viscid, glairy matter, which he continually tries
to clear away.  Thus,  between convulsions, in which he  struggles,
and sometimes strives  to bite  his attendants, and comparative still-
ness, during  which he  suffers great depression of spirits,  he  passes
three  or four days, and then dies either in a spasm, or from exhaus-
tion.
  Treatment. — Cut off the bitten part, or apply dry cupping, or suc-
tion, at once.  Also the caustic potash.  The  internal remedies here-
tofore employed have  had little success.   Perhaps nothing now known
promises more than  to keep the patient, for a long time, under the
influence of chloroform or ether.  The tincture of  scullcap, in two or 
166           DISEASES OF THE BRAIN AND NERVES.
 three dram doses, will  allay the nervous  agitation,  and is always
 worth using.   It has been  proposed to clear the throat of the tough
 mucus by cauterizing it with a strong solution of nitrate  of silver
 (219), applied with a shower syringe.  The remedy is worthy of a trial.
    Some of the Western physicians declare  the red chick weed, or
 scarlet pimpernell, to be an absolute remedy for this disease, and cite
 some quite remarkable cases of its success.    Four  ounces of this
 plant, in the dried state, are  directed to  be. boiled in two quarts of
 strong beer or ale, until  the liquid is reduced one half.  The liquid ia
 to be pressed out and strained, and two drams of laudanum added to
• it.   The dose  for a grown  person  is a wine-glassful  every morning,
 for three mornings.  A larger  dose  is required if the disease have
 begun, to show itself;  and  if the case be fully developed, the whole
 may be taken in a day.   The wound is to  be bathed  with the same
 decoction.  The medicine, it is said, produces  profuse sweating.  It
 is worth a trial.
    Considerable has been said of late of a remedy used in. some parts
 of  Europe, and said to be effectual.  It is the  "golden  cenotides"
 (cetonia aurata), or common rose beetle, found in large quantities on
 all rose  trees.   A similar insect is said to infest the geranium plant.
 When collected, they are dried and  powdered; and given in  this
 form, relieve excitement (so it is said) of the brain and nerves, and
 throw the patient  into a sound sleep.

  Muscular and Nervous Derangements from  Wounds.

    In some persons, a very small local injury will produce violent dis-
 turbance of the nervous system.  Some will faint and be thrown into
 convulsions and vomiting from causes scarcely greater than the prick
 of  a needle; and, before Morton gave the world  the boon of ether, it
 was  not very uncommon for persons to  die under the knife of the
 surgeon.   One  of the most serious disturbances from wounds, of a
 nervous  and muscular character, is

                     Locked Jaw.— Tetanus.

    This  is spasmodic  contraction,  with rigidity, or  stiffness, of the
 voluntary muscles.  Sometimes this rigidity is partial, at other times,
 universal throughout the system.
    Tetanus is produced by two causes, exposure to cold  (idiopathic),
 and  bodily injuries,  particularly the injury of a nerve  (traumatic
 tetanus).  This last is the most frequent, — perhaps the only form of
 the complaint.

    The Symptoms  are long-continued, violent and painful contraction
 or  cramp  of the voluntary muscles.   At first  there is difficulty and
 uneasiness in  turning  the  head, with inability to  open  the mouth
 easily,—then the jaws close gradually, but with great firmness; swal-
 lowing, now becomes difficult,  and a pain, starting from  the breast-
 bone, pierces through to the back, — probably caused by cramp of the 
DISEASES OF THE BRAIN AND NERVES.           167
diaphragm or midriff.  The cramps now extend to the muscles of the
body, the limbs, the face, the tongue, etc., which continue in a state of
rigid spasm, — being swelled and hard in the centre, — till the disease
yields, or the patient dies.   At times the abdominal muscles  are so
tense as to make the belly as hard as a  board.   Occasionally the
patient is drawn  backward into the shape of a hoop, so as to rest on
his head and heels (episthotonos); at other times he is drawn forward
in the shape of a ball (emprosthotonos).  All the contractions  are at-
tended with  intense pain.  It is the racking of the entire body with
cramps  like those which sometimes attack the calf of the leg.   So
violent are the contractions that the teeth  are,  sometimes broken by
them, and the  tongue is often badly bitten.  In the  mean time, the
appearance of the sufferer is frightful.   The forehead is wrinkled, the
brow knit, the  eye-balls motionless and staring, the  nostrils spread,
the corners of the mouth drawn back, the set teeth exposed, and all
the features fixed in*a ghastly grin.

   Treatment. — The only known remedies for this  disease are chloro-
form and ether,  taken either  into the stomach, or by inhalation, in
quantities sufficient to control  the spasm, and to be pursued  as  long
as they continue to occur.   The costiveness must be removed  by one
or two drops of croton oil, administered in  a spoonful of gruel.

                 Epilepsy.—Epileptic Tits.

   This disease has been sometimes  called the falling sickness, but
generally passes under the more vague title of fits.

   Symptoms. — The disease is characterized by a temporary loss of
consciousness,  strong  spasms, and  intervals between the fits.  The
attack is sudden, generally without warning, and attended with a loud
cry, when the  patient falls down, is senseless  and convulsed, strug-
gles violently, breathes with embarrassment, has a turgid  and  livid
face, foams at the mouth, bites his tongue, has a choking in the wind-
pipe, and appears to be at the point of death.  Presently, in from five
minutes to half an hour, and  by degrees, these symptoms diminish,
and at length cease; and the patient falls into an apparent sleep. In
a short time more he recovers, and is apparently well.  These attacks
come again and again, and at irregular intervals.
   This is the  worst form  of the disease ;  there is another  class of
cases in which the symptoms are  much lighter, — there being no tur-
gescence of the  face,  no foaming at  the mouth, no  cry, no  convul-
sions ; but merely a sudden and brief suspension of consciousness, a
fixed gaze, a feeling of  confusion, or  a totter, from all of which the
recovery is speedy.

   Causes. — These are numerous,— as worms, disturbance from indi-
gestible food in  the stomach and  bowels,  difficult teeth-cutting, ner-
vous irritation, either direct or by sympathy,  sexual excesses and
masturbation,  disease or  injury of  the brain or spinal marrow, gall
stones  in the  excretory duct of  the liver, stone or gravel in  the kid- 
168           DISEASES OF THE BRAIN AND NERVES.
neys and bladder, fright, distress of mind, passion, great loss of blood,
and many others.
  Treatment.— But little can be done during the fit, except to protect
the patient from being injured by the violence of the convulsions.
To do this, place a piece of leather, cork, or other substance not too
hard, between the back teeth to prevent the tongue from being bitten.
Remove the neckcloth, and unbutton the shirt collar.  If the stomach
and bowels are suspected to be overloaded, give an injection (246).
  The treatment during the intervals, must depend on the cause of
the disease.  If worms  be  the cause, expel them ; if the  attacks be
excited by difficult teething, lance  the  gums; if by uterine disturb-
ances,  search out the nature, and give  the treatment recommended
under  the  proper head; if masturbation, command  its entire discon-
tinuance  as the only hope  of relief; if the complaint arise from  in-
digestible food, great attention must be given to the diet and general
health.
  In all  cases, indeed, the  diet  should  be carefully regulated, being
light, nutritious, and easy of digestion.   The sleep  should be taken
at regular  hours, and daily exercise in the open air  be insisted upon.
The  bowels must be kept regular, by the food, if possible; if not, by
mild laxatives.   Apply along  the  spinal  column 195,  once a day,
rubbing it well in ; also, now and then, mustard poultices.
  In addition to these remedies, give pills  of iron and quinine (72),
one after each meal, — also oxide of zinc (270), which is one  of our
very best remedies.  Of the pills, one should be taken three times a
day.
  . We can seldom go amiss in giving medicine  calculated to relieve
nervous irritation, and to build up the general system.  For this pur-
pose, the valerianate of  quinine*, and the extract of black cohosh (79)
are well  adapted.  Citrate of iron and strychnine  (316), is a very
valuable  remedy.
  It is said that a black silk handkerchief thrown  over  the face of a
person in a fit, will immediately bring them out of it.  It is  an ex-
periment easily tried; and having  seen it in a respectable medical
journal, I give it  for what it is worth.

              Catalepsy.—Trance.—Ecstasy.

  Cataleptic fits are simply what is known to all  the world under
the name of trance; and ecstasy is a modification of the same ner-
vous disorder.  It is a state in which the mind  becomes so intensely
absorbed in something  outside of its earthly tenement, that it with-
draws  all control  over the body, and all apparent connection with it,
— leaving  it as if dead.   There is a very light ticking of the heart,
just perceptible to a cultivated ear, but  the breast does not rise and
fall with  breathing, the  features are all inexpressive and still, the eyes
are wide  open and motionless, apparently staring  after  the departed
intellect; and the body and limbs  are  entirely passive, — remaining
unmoved where  they are  placed by others,  however  tiresome  and
uncomfortable the position.  In a word, a person in catalepsy is, in 
DISEASES OF THE BRAIN AND NERVES.           169
 appearance, like  a marble  statue, or  like a  human body suddenly
 turned to stone, or, like Lot's wife, to a pillar of salt.  There  is as
 little feeling, or thought, or consciousness, as if the bowl had been in-
 stantaneously broken at the cistern, and the apparent death were real.
   It is a peculiarity in this disease that the patient, on  recovery from
 a fit, takes up  the thread of conscious life just where  it was broken by
 the attack.  Thus, if she were  lifting a cup of water to the mouth,
 she would  hold it steadily,  with the  mouth open, till  the return of '
 consciousness, and then place it to the lips, as if no interruption had
 occurred; or,  if conversing,  and in the midst of a sentence, the unfin-
 ished words would  be uttered  at the end of the fit, even though it
 should last many days.
   Persons in a cataleptic fit have much the appearance of one in the
 mesmeric state ; and the statue-like position in which an attack fixes
 a  patient, reminds one of the manner in which the psychologists, so,
 called, will arrest a man under their influence, and make him immov-
 able, with one foot raised in the act of stepping.
   The disease attacks females much more often than males.
   The premonitory  symptoms are much like those of epilepsy, and
 the treatment  should be about the same.
                  a

               Saint  Vitus's Dance. — Chorea.

   This disease is chiefly confined  to children and youth between the
 ages of eight  and fourteen.   But few cases occur after puberty.
   Symptoms. — The complaint  affects mostly the  muscles and the
 limbs.   It excites curious antics,— such as we should suppose would
 occur if a part of the muscles  of voluntary motion had  hatched a
 mimic rebellion, broken away from the control of the will, and in
 sheer mischief and wantonness, were tripping their fellow muscles, .
 and  playing tricks with the patient.  A few of the muscles of the
 face or limbs begin their mischievous pranks by slight twitches, which,
 by degrees, become more energetic, and spread to other parts.  The
 face is  twisted into  all kinds  of ridiculous  contortions, as if the
 patient  were making mouths at somebody.  The hands and arms do
 not remain  in one position for a moment. In attempting to carry
 food to the mouth, the hand goes part way, and is jerked back, starts
 again,  and  darts  to  one side, then to  the other,  then mouthward
 again ; and each movement  is so quick, and nervous, and darting, and
 diddling, that  ten to one the food drops into the lap.  If the  attempt
 be made to run out  the tongue, it is snatched back with the quick-
 ness of a serpent's, and the  jaws snap together like a fly-trap.  The
 lower limbs are in a state of perpetual diddle; the feet shuffle  with
 wonderful diligence upon the floor, as if inspired  with a ceaseless
 desire to dance.
   It is supposed by some that the disease consists in a partial palsy
 of a part of the muscles.  The will in that case not being able to
control the  palsied muscles, when it commands the others to move,
their action is  not balanced,  and they twitch the face and limbs into
all the capricious and fantastic shapes we witness. 
170           DISEASES OF THE BRAIN AND NERVES.
   Others, and probably with more truth, hold  that  the  seat of the
 disease is in the cerebellum or little brain.  It is supposed  to be one
 of the functions of this organ to preside over and regulate the loco-
 motion,— that it holds the office of chief engineer, and that its duties
 are to keep  the muscles in subjection to the will.  The combined and
 consenting  action of several muscles is needed  for every movement.
 It is the business of the cerebellum  to  maintain  this oneness of pur-
 pose  and action —to see that no muscle flinches so as to disturb the
 harmony of the movement.  When the cerebellum  is diseased, all is
 confusion,—just as the locomotive runs from the track when the en-
 gineer is smitten with palsy.
   The  disease is  not  dangerous,  but  when it  continues  for many
 years, it is  apt to  weaken  the  mind, and it sometimes very nearly
 destroys it.

   Causes. — Whatever excites and weakens the nervous system, as
 powerful emotions of the mind, overworking the mind, reading excit-
 ing novels, eating too much meat, fright, striking in of eruptions, self-
 pollution, etc.

   Treatment. — In  the  first place, remove all cajises of excitement.
 Take the patient from school, and require some sort of cheerful out-
 door exercise,  daily.  Take  away all books, and  be careful not to do
 anything to occasion  anger, or  fear, or any kind of injurious excite-
 ment.
   In  the second  place, regulate the diet, — making it more animal
 and stimulating if it has been too low,  and more vegetable  and cool-
 ing if it has been too high.
   In the third place, if the above changes have not been sufficient for
 the purpose, open and regulate  the  bowels with some gentle physic
 (30) (34) for a few days.
   In the last place, build up the nervous system with oxide of zinc
 pills (270), three a day; or  iron (73) (80), or black cohosh, scullcap,
 etc. (79), or  the compound  valerian pill (81).  Sulphate of zinc (82)
 will  sometimes succeed, when the  oxide fails;  and where there is
 scrofula, the iodide of zinc is to  be used.
  To these remedies should be added the shower-bath, begining with
tepid water, and making it  a little  colder every day.   If the shower-
 bath frightens the patient,  or is not otherwise well borne, take the
 sponge bath.

                       Chronic  Chorea.

  This can  hardly be said to amount to a disease.  It consists rather
in uncouth  tricks,  arising from some  slight disorder of  particular
muscles, and grown into a fixed habit,  such  as shaking of the head
every three to  twenty seconds, repeated  squinting of the eyes in con-
nection with a peculiar knitting of the eyebrows,  wrinkling of the
nose,  shrugging of the shoulders, lifting the ears up and down, or
even moving the whole scalp back and  forth.   These movements are
commonly made without a consciousness of it; and  generally there 
DISEASES OF THE BRAIN AND NERVES.           171
 is no power to suspend  them without a painful effort which cannot
 be easily continued.
   No medical treatment is of any avail.   These tricks can  only be
 corrected by great watchfulness and effort on the part of  the person
 suffering from them, and in many cases, not even by such means.

                             Cramps.

   Cramp is experienced in the calves of the legs,  the  thighs,  the
 stomach, the breast, the womb, etc.  It is a very painful, sudden, and
 violent contraction of one or more muscles.  The part is  sometimes,
 as the phrase is, " drawn up into knots."  When it attacks the stom-
 ach, it is a very dangerous affection.   Women are subject  to it about
 the third or fourth month of pregnancy.
   Causes. — Drinking cold  water when very hot and perspiring, ex-
 posure to damp night air, debility, indigestible food, and excesses in
 eating and drinking, and particularly overstraining the muscles.
   Treatment.— Moderate the excessive labor and straining of  the
 muscles  which produce the cramps.  When an attack occurs in  the
 legs, tie a cord or handkerchief tight around the leg above the affected
 muscle.  This  will  generally produce instant relief.   Also rub  the
 part with spirits of camphor, or paregoric,.or laudanum.
   When it occurs in the stomach, apply warm fomentations, or what
 is better, a mustard  paste (165).   Then make one grain of morphine
 into four pills, and give one.   If this does not bring relief, repeat it
 in half  an hour.  The bowels, if confined, should be  opened with an
 injection.
   Cramps of the limbs which afflict women in the family way, can
 only be mitigated, not cured, till after confinement.   As a palliative,
 high cranberry bark, scullcap,  etc. (87), will be found useful.

              Pain  of the  Nerves.—Neuralgia.

   This  disease  affects one tissue only, — the nervous; and has  one
 symptom, —pain.
   In apoplexy, the nerves, rendered  powerless and senseless by an
 externa'l  fdrce, are like a man under a bank of earth which has  slid
 down upon him.  In palsy, they are suddenly bereft of feeling  and
 motion by a blasting scourge  within, — as one is smitten down by a
 pervasive charge from a magnetic battery.  In  epilepsy,  the nerves
 are grasped  and for a time held senseless by an unseen power, in
 which they struggle, as a man strives in the folds of the  anaconda.
 In catalepsy, they are suddenly stiffened  into senseless strings,  for
 such automatic use as the bystander may, for.the time, choose to
make of them.  In chorea, they are  set to dancing  by an invisible
exhilaration, as a man is crazed by brandy.
   In neuralgia, the nerves are  neither crushed, nor collapsed,  nor
restrained for a time, nor stiffened,  nor exhilarated.   They  simply
have their sense of feeling intensely exalted; they are filled with pain. 
172           DISEASES OF THE BRAIN AND NERVES.
 The pain is generally of a peculiarly darting, piercing character.  The
 patient sometimes calls it tearing pain.  It comes on in sudden par-
 oxysms, with intervals of freedom between.   The  attacks are some-
 times  like an electric shock, and are so agonizing as to bring a tem-
 porary loss of reason.  Occasionally there is  great tenderness of the
 parts affected, and some fulness of the blood-vessels in the neighbor-
 hood ; but generally the signs  of inflammation are all absent, except
 pain.
   Neuralgic pains occur in almost every part of the system.   One of
 the most familiar forms of the disease is known under the  name of


                       Tic Douloureux.

   It occurs in those branches of the fifth pair of nerves, which go to
 the face.  (See Fig. 82.)  Sometimes one, sometimes all of the three
 branches  are affected, but  more often,            Fig. 82.
 the middle branch only.  When the up-
 per  branch  is the seat of  the  disease,
 the pain  is in  the forehead, the brow,
 the lid, and sometimes the ball of  the
 eye.  The eye  is  generally closed dur-
 ing the pain, and the skin  of the fore-
 head is wrinkled.   When  the  affection
 is in the  middle nerve, the  pain is pre-
 ceded  by a pricking  sensation in  the
 cheek,  and twitching  of the lower eye-
 lid.  Soon it spreads in quick and pierc-
 ing pangs over  the cheek, reaching  the
 lower  eye-lid, the  sides of  the nostrils,
 and the  upper-lip.   If in  the lower
 branch, it sends its lightning shafts to
 the  chin,  the gums,  the tongue,  and
 even up the cheek to the  ear.

  Face-Ache. — There is a species of nervous pain called  face-ache,
which  does not  quite amount to tic douloureux, but is  nevertheless
very afflictive.  It  occurs principally in the jaw, which seems to be
filled with pain.   No one spot  seems  to be more  affected than an-
other.   From the  jaw the  pain often goes to the whole head, but it
 has not the stabbing intensity which generally characterizes neuralgia.
It often proceeds from defective teeth.
                         Hemicrania.

  This is a neuralgic pain, confined to one side of the head, — gen-
erally the brow and forehead.  Sickness of the stomach often attends
it, and in many cases, it is periodical, — coming on at a certain hour
every day, and lasting a given time, and then passing away.
  It may be caused by whatever debilitates the system, as hysterics,
suckling an infant too long, or low diet,   In fever and ague districts, 
DISEASES OF THE BRAIN AND NERVES.           173
it is frequently produced by miasm.  In many instances, the cause
cannot be discovered.

                           Sciatica.

  This is a pain beginning at the hip, and  following  the  course of
the sciatic  nerve.    Occasionally it is  an inflammatory complaint;
sometimes is  connected with  an  affection of the kidney;  but fre-
quently it is a purely neuralgic or.nervous pain ; and I have therefore
thought it best to place it here, with nervous diseases.
  Beside the  various  forms of neuralgia now noticed, the  disease
occurs, — sometimes with great severity, — in the female breast, in
the womb, in the stomach, in  the  bowels, in the thighs, in  the  knee,
and even in the feet.  In many of these cases, the disease is not where
the pain  is felt, but in  the brain or  spinal marrow, and consequently
the true  source of the  complaint  very  often escapes detection.  An
excellent Episcopal  clergyman in northern  New York, the Rev. M.
B----, with whom  I studied Latin  and Greek preparatory to college,
had a neuralgic pain in the knee so intense, persistent and exhaustive,
that the  limb had to be cut off" at the thigh to save his life.

  Treatment. — This must be as  diversified as the causes of  the dis-
ease.
   For tic  douloureux, and some  other forms, give, internally, valeri-
anate of ammonia (88);  also 89, 90, 91, 92, 93, 316.
   For external use  in tic douloureux, and other neuralgic affections,
the prescriptions 188, 196, 197, 198.
   For the face-ache, above mentioned, muriate of ammonia (134), in
half dram doses, is a very valuable remedy.
   When the disease is caused by miasm, and has a periodic  character,
like ague, it must be treated with quinine (67) (79), and if there be a
low state  of  the blood, iron  (72)  (93) must be  given at  the  same
time.
   The shower bath, exercise  in the open air, and whatever else will
build up the general health, must be used according to circumstances.


             Derangement of Mind.—Insanity.

   Most  writers on  this disease have attempted a definition of it.   I
have  never seen  one which suited  me.  Here is mine.   Insanity is a
wrench of maris nature, which sets his intellectual  and moral faculties
awry in their relations  with the external world.
   In a state of mental  and moral  health, he looks straight at the out-
ward world, and sees it as it  is; insanity gives him  an angular con-
nection with it, and  he sees it as it is not; its objects have all changed
their relative places  ; objects at the right in the panorama of life have
moved to the  centre, or gone quite  over to the left; while  things at
the top have gone to the bottom, and those in  the lowest places have
taken  the  highest.   With the thoroughly insane, the vjorld has gone
back to chaos. 
174           DISEASES OF THE BRAIN AND NERVES.
  These persons have  their sensibility very much  altered and  per-
verted.  Errors  of  the  senses  and illusions cheat  them.  In many
cases, they cannot read because the letters are mingled in a confused
mass.   They often  do not recognize their freinds, and regard them as
strangers or enemies.
  They become awkward in the  mechanical use of their hands, and
their touch loses the power to correct the errors of the other senses.
Hence they are cheated in  regard  to the size, form, and thickness of
bodies.
  They are haunted, at times, with smells which have no existence,
and they hear voices distinctly speaking to them from clouds, or from
trees; and these voices have the familiar tones of a friend, relative, or
enemy.
  The insane lose  the  power  of comparing ideas.  They associate
things the most unlike, and often  in a ridiculous way.
  They also lose the control  of themselves,  and  come under the
dominion  of their passions; and then they will do acts  which they
themselves disapprove.   One of strict integrity, of unblemished mor-
als, and of excellent standing, becomes insane, and immediately steals
what he does not want, makes infamous proposals, and indecent ges-
tures, and is in every respect the opposite of his past self.
  The insane  often become averse  to  those  who  were previously
among  the most dear  to them.   For acts of kindness,  they repay
abuse.  They fly from their best friends.  This is the result "of their
fear and jealousy; for they are very cowardly and jealous.  This alien-
ation from friends is almost  a characteristic of insanity, and is one of
its saddest features.   The  moral  affections are always  disordered,
perverted, or annihilated in  insanity.   So much is this a leading fea-
ture of the  disease, that it is only when the insane begin to recover
their moral affections, when they begin  to wish to see their children
and friends, to fold them once more in their arms, and to enter the
family circle and renew its  joys,  that we can count upon  any certain
signs of a cure.
  The insane have a thousand strong  fancies in regard to  themselves.
One thinks himself  inspired of God, and charged with the conversion
of the world; while another, equally sincere, believes the devil  has
entered  into him, and that the  pains of hell are  already taking hold
of him,  and he curses God, himself, and the universe.  Still another
is the " monarch of  all he surveys," and much more ; he governs the
world, and directs the stars.  One has all knowledge, and affects to
teach the wisest.  Another is proud, and withdraws from  his fellows,
bidding them not to come into  his  presence without proper acts of
homage, — calling himself, it may be,  a king.
  There are five kinds of insanity.  I will speak of each of them
briefly.

                 Melancholy.—Lypemania.

  This  is  characterized by moroseness, fear, and prolonged sadness.
The  melancholic person is  lean  and  slender, with  black  hair, and a 
DISEASES OF THE BRAIN AND NERVES. •          175
pale and  sallow  countenance.  His skin is brown or blackish, and
dry and scaly.  His physiognomy has a fixed appearance, the muscles
of the face are drawn tight, the eyes are motionless, and  directed to
one point, the look is askance and suspicious, and the general expres-
sion is one of sadness, fear, and terror.  He desires to pass his days
in solitude and idleness.   He walks as if aiming to shun some dan-
ger.   His eye and ear are on the watch for evil.
   These persons do not sleep much.   They are kept awake by fear,
jealousy, and hallucinations.  If their eyes close, they see phantoms
which terrify them.
   Their secretions are disordered.   The urine is either abundant  and
clear, or scanty and muddy.   They sometimes  retain their  urine for
days.  One patient did not dare to make water lest he should drown
the world, but was finally persuaded to it by the assurance that he
would extinguish a fire which was devouring a city.

          Insanity on One Subject.—Monomania.

   This is a chronic affection of the brain, not attended by fever, and
characterized by a derangement of the intellect, the affections, or the
will, upon one subject only.  The patient seizes upon a false princi-
ple,  and  draws from  it injurious  conclusions, which modify  and
change his whole life and  character.   In  other  cases the intellect is
sound, but the affections and disposition being perverted, their  acts
are strange and inconsistent.  TheSe they attempt to justify by plau-
sible reasoning.

                             Mania.

   This  is also  a chronic affection of the brain, generally without
fever.  The countenance of the maniac is sometimes flushed, at other
times pale.   The hair is crisped ;  the eyes  injected, shining  and hag-
gard.  Maniacs dislike  the light, and certain colors  horrify them.
Their ears are sometimes very red,  and are disturbed  by a tingling,
and a rumbling sound.   Noise excites  and disturbs them.  They suf-
fer from false sensations, illusions  and  hallucinations ; and their ideas
come with great rapidity, and are confused and without order.  Their
affections  are in a state of turmoil, and their judgments are all erro-
neous.
   Unlike  the monomaniac,  their delirium  extends to all  subjects.
Their entire intellect, affections and will, are a chaotic  wreck.

                           Dementia.

   Here is another chronic affection of the  brain, without  fever, in
which the sensibility,  the intellect, and  the will,  are  all weakened.
Demented persons have not the power to concentrate  their  minds on
anything,  and can form  no correct  notions of objects.  Their ideas
float after each other  without connection or meaning.  They speak
without any consciousness of what they are saying. 
176           DISEASES OF THE BRAIN AND NERVES.
   Many of them have lost their memory, or, like old persons, they
remember nothing recent,.—forgetting in a moment what is just said
or done.
   The  demented have neither desires nor aversions; neither hatred
nor love.   To those once most dear to them, they are totally indiffer-
ent.   They meet friends long absent without emotion, and part from
their dearest ones Without a pang.  The events of life passing around
them, awaken in them no interest, because they  can, connect them-
selves  neither with  the past  nor the future; they have no remem-
brances, nor hopes.  Their brain is inactive ; it furnishes no ideas, or
sensations.  They  are no longer active, but passive  beings;  they
determine nothing, but yield themselves to the will of others.
   They have a pale face, a dull eye, moistened with tears, an uncer-
tain  look, and a physiognomy without  expression.  They sleep pro-
foundly, and for a long time, and have a voracious appetite.

                            Idiocy.

   Idiocy is the condition in which the intellectual  faculties have
never been manifested.  We are not to infer disease from it, any more
than we infer it in the lower animals from the  absence of intellect.
   In idiocy there is no mind, because the brain is not  large enough
to be the organ of intelligence.  It always dates back, therefore, to
the beginning of life.  Everything^ about the idiot betrgfys a defective
organization.  The demented person, the monomaniac,  etc., once had
intelligence ; the idiot, never.   They, in  many cases, may  be  cured;
he is hopelessly incurable.   They had  blessings which have been
taken from them; to him, none were ever given.  They were once
the pride and hope of their friends ; he, from his birth, was the smit-
ten and blasted one of his family.   He never reaches an advanced
age, — rarely living beyond thirty years.
   These remarks are sufficient to show the difference between idiocy,
and other forms of mental derangement.  In  the other forms of in-
sanity there are brains  enough, but they are diseased; in this there is
no disease; the smallness of the brain is the primal and fatal defect.
   This  form of mental derangement is caused  by a defective develop-
ment of the brain.  That the other forms are produced  by disease of
the brain, there can be  no doubt.
   Some have  supposed  insanity to be a mental disorder merely, hav-
ing nothing to do with  the body.  They might as well suppose the
delirium of  fever to be a disease of the mind only.
   Insanity  is an unsoundness of the brain and nerves which  proceed
from it, in  every instance.   At first it is probably  only excitement of
the brain ;  but this, long continued, becomes a chronic inflammation.
The brain and nerves of an insane person are undoubtedly sore, and
hence the painful  thoughts  and feelings which afflict them.   When
the soreness is much increased, they are violent and furious; when
it  subsides, they are calm.   In consequence of this  inflammation
and soreness of the brain, an insane person  can  no more think,  or
reason,  or  will,  or  feel  correctly,  than a person  with an inflamed 
DISEASES OF THE BRAIN AND NERVES.           177
stomach can digest food well, or than one with inflamed eyes can
see well.

  Causes of Insanity. — Hereditary predisposition ;  painful subjects
of thought  or  feeling long revolved in the  mind; injured feelings
which  cannot be  resented, mortified pride,  perplexity in  business;
disappointed affection or ambition ; great political, religious, or social
excitements; sudden  and heavy strokes of misfortune in the loss of
property and friends; and in general, whatever worries the mind for
a long time, and creates  a deep distress, may be a cause of  insanity.
  But one of the most prolific causes, and worthy of special mention,
is masturbation, or self-pollution, — a vice  contracted by thousands
of young people, both male and female.
   Beside the above, I may mention several  phy^oal causes, as con-
vulsions of the mother during gestation, epilepsy, monthly disorders
of women, blows upon  the head, fevers, loss of sleep, syphilis, exces-
sive use of mercury, worms in the bowels, and apoplexy.

   Chances of Cure. — Idiotism is never cured.
   Melancholy and monomania are cured when recent, and do not
depend upon organic disease.
   Dementia is sometimes, though seldom, cured.
   Chronic insanity, of long standing, is not easily cured.
   Insanity which has been  produced  by  moral causes, acting sud-
denly, are generally curable ; if the causes have acted  slowly and
long, the cure is more doubtful.
   Excessive study causes insanity which is hard to cure.
   If caused or continued by religious ideas, or by pride, it is not often
cured.
   Insanity  caused and  maintained by  masturbation, is cured  with
great difficulty.

   Treatment.— The treatment of the insane is now almost confined,
as  it should be, to public hospitals.   In these institutions, all the
means  are  provided which humanity has been able to devise, to lift
from  these unfortunate beings  the terrible shadow*which is upon
them.   Here they have safety, comfort, recreation, friendly guardians,
rest, and medicine.
   They have safety  from the annoyances which well-meaning but
mistaken friends at home almost dlways commit in contradicting, and
reasoning with, persuading, and  threatening them;  for only in these
humane institutions has it been well learned that to do so is no wiser
than to persuade, scold, or threaten a neuralgic  pain  in the  face, an
inflammation in the  stomach, or a felon upon the finger.  They are
safe, too, from the impertinent scrutiny  of neighbors, the hootings of
unthinking boys in the  streets, and especially from the causes, what-
ever they ^re, which  have produced the disease.  And so far, this is
just  the treatment they  want, — no  contradiction, no  impertinent
scrutiny from neighbors, no abuse in the streets, and a withdrawal of
the causes which have produced the disease.
   In these institutions, too,  they  have  comforts.   They  have clean
                                 23 
178           DISEASES OF THE BRAIN AND NERVES.
rooms, galleries, lodges, bathing-rooms, yards and gardens for exercise
and walking, safe, quiet, well-aired bed-rooms, and clean and com-
fortable beds;  cheerful  dining rooms, and plain,  wholesome, and
nutritious food.  And this, likewise, is the treatment they require.
  They have  recreation, — dances, cards,  back-gammon,  chequers,
chess, billiards,  nine-pins, walking  parties, riding parties, gardening,
and an indulgence in those  arts of painting,  music, drawing, and
architecture, for which they may have a taste.   And such recreations
are powerful instruments in the cure of all disorders of the nervous
system.
  Here, too, they  have friendly guardians, who have  long studied
their complaints, and have imbued their souls with a sympathy which
goes down into the depths of their sufferings, and allies itself with
all their sorrows i-g- men and women who are willing to act the part
of guardian angels* to be their friends ; who know how to gain their
confidence;  and who use the  influence acquired by love, in leading
them  back towards health and happiness.  And this, too, in curing
the insane, is of great consequence, for none can do them good till
they have their confidence, and this can be gained only by love and
wisdom.
  In  these insane asylums, they find rest.   When the  brain is  hot
from inflammation*, and they are raving from delirium, they are here
withdrawn from the noisy crowd, and shielded  from the  rude shocks
of the world.   If need be, they are ^placed in solitary rooms, where
silence spreads its soothing stillness through the"ir excited brains.  And
it is of the greatest importance that the sore and torn feelings should
rest; for rest allays excitement, and brings sleep; and without a iproper
amount of sleep, recovery is not possible.
  Finally, in these institutions, they receive the best medical treat-
ment.   They have warm and cold bathing, judiciously administered;
they have simple cathartics when the bowels are bound, as salts, cas-
tor oil, and magnesia; tonics for debility, such as quinine, iron, quas-
sia, columbo, and chamomile;  and quieting medicines  for their ex-
citement, such  as opium, morphine, cicuta, hyoscyamus, belladonna,
stramonum, scullcap, and valerian.   Prescription 74 is a combination
much used.  Here, too, broth, gruel, and milk, are administered by
the forcing  pump to  such as take a fancy not to eat, — an expedient
which has saved many lives.   Fruits of all kinds,  as  strawberries,
cherries, currants, plums,  apples,  peaches,  and grapes,  are allowed
freely.  Cold water, sweetened  or  otherwise, is the  drink.  To these
things are added  lively conversation, and  whatever will divert the
mind from reflection,  and internal  imaginings and revery.       *.
   Thus I have indicated, very briefly, the treatment which the insane
receive in public institutions.   That the chances of recovery in these
humane retreats  is much  greater than at home, does not admit of a
doubt.  When it is not convenient  to send an insane person to a
hospital, the treatment should be as near like the one here sketched
as circumstances will permit. 
                 DISEASES OF THE BRAIN AND NERVES.           179


                           Hypochondria.

     The common names of this disease are low spirits, spleen, vapors,
   hypo, and the blues.  It produces constant fear, anxiety, and gloom.
   Business, pleasures, the  acquisition of knowledge, and all the useful
   pursuits of life,  become insipid, tasteless, and even  irksome to the
   hypochondriac.   His mind is full of the belief that something dread-
   ful is about to befall him.  He is either going to be sick, or to die  r
   lose his property or friends.  He has no mind to engage in any busi-
   ness, nor does he wish  to  go  anywhere, or to see  anybody.  Night
   and day his spirits are  down  to zero, and his heart  has  a load too
   heavy to bear.  He is wholly occupied with his troubles, and his feel-
   ings.  He thinks he has various diseases, and wears  out  his friends
   by talking of his sufferings.  He feels of  his  pulse often, looks at his
   tongue in the glass, and several times a day asks a friend if he  does
   not look pale or sick.
     The external senses manifest symptoms of derangement as well as
   the thoughts, feelings, emotions, and passions.  There are roarings in
   the ears, like a waterfall, or the noise of a distant carriage.   Floating
   black specks, or bright sparks, are seen before the eyes..  These indi-
   cate a slight fulness of the bloo.d vessels, and perhaps, in some in-
   stances, sparks of electricity passing to or from the eye, and are in no
   proper sense subjects for the  alarm they cause.  At one time  the
   person will feel as large  as a barrel, at other times not larger than a
   whip-stock;  the  head will  feel light or heavy, large or small.   The
   skin will twitch in  different parts, or feel numb, or have the sensation
   of spiders crawling on it.   The smell  and taste  become  perverted;
   the hypochondriac  will smell odors and flavors, at times, where there
   are none.
     These errors of the senses are all owing to  some slight disorder of
   the organs of sense; and they  are no more wonderful than  that the
   mind should perceive personal  danger, poverty, and death itself, when
   none of these things are impending.
     These persons are subject to  fainting turns,  when the breathing will
   appear to stop, the body  become cold, the face pale; there will be
   distress in the region of the heart, which will apparently stop  beating,
   and the person will feel as if dying.   At the same time the mind will
   remain clear.  These nervous  spells are alarming, but pass off with-
   out danger.
     These persons become changed in their moral dispositions. They
   are jealous, take a  joke  as an affront, and feel the greatest distress at
   any apparent lack of attention or neglect on the part  of friends.
   They put the worst construction upon the actions of  friends. They
   are irritable, fretful, peevish, and fickle.
     The complaint is distressing, but does not appear to shorten human
   life.
     The seat of the disease is in the brain and  nerves.   It is caused by
   anxiety, care, disappointment, working the brain too hard, diseases of


1 
   180           DISEASES OF THE BRAIN AND NERVES.
   ---------—*^----------------------------------------------------
   the liver slid stomach, costiveness, sedentary habits, excessive venereal
   indulgence, and masturbation.
     Treatment. — This disease is more easily prevented than cured.   It
   would be almost entirely prevented in this country if in childhood we
   were  all taught  to be contented  with humble competence, to love
   active labor, and to think it  honorable,  instead of struggling after
   wealth,  and  falling into unhappiness when it does not come.
     Remedies. — Of all the remedies for this complaint, that which is
   most  important  is  active employment  out of doors.   The human
   body  was made for motion.   Without  it the blood cannot be dis-
   tributed to the several organs.  The senses, — the eye, the  ear, the
   touch, — should be much in  communion with nature.  In this way
   they are strengthened.  Nature is their great physician.  Man is a
   creature  of  sensation ;   and if too  much occupied  with  feelings,
   thoughts, and  deep reflections, the nerves will be irritated, and begin
   to give deceptive sensations.  A very nervous man should fly to some
   active occupation, if he would be rid of suffering.
     The open, fresh  air is very important to  restore the system to
   soundness.
     Temperance-, both in eating and drinking,  will  do  much for  this
   class  of patients,  yet they are the very persons who eat largely, and
   they often fly to the excessive use  of stimulants to drive away their
   sorrow.   By so doing, they aggravate the disease.
     Amusements are very important for  hypochondriacs.   Lively com-
   pany,  cheerful  and witty conversation, with mirth and laughter, lively
   songs  and instrumental music, are all desirable ; and so are gunning,
   fishing, riding, billiard-playing, and travelling.
     Never allow these patients to be alone, and to have  time  to brood
   over their misery.   See that they go early to bed, and rise betimes in
   the morning.   The warm  bath, the cold shower, or  sponge bath, with
   brisk friction, are not on any account to be omitted.  The diet should
   be light, nutritious, and generous ;  but fats, acids, liquors, and coffee,
j?  must be forbidden.
     But little medicine will be required.   If there be costiveness, let the
   cracked  wheat be eaten;  if this do not answer, a little rhubarb and
   bicarbonate of potassa (35), or  leptandrin, podophyllin, etc. (36), may
   be given as required by the symptoms.  A teaspoonful of  calcined
   magnesia  once a day, or the infusion of thoroughwort, drank cold,
   will often answer an excellent purpose.   A bowl of warm mother-
   wort tea, with a teaspoonful of spirits of camphor  in it, will do well
   in fits of fainting when there is a sensation of dying.  A teaspoonful
   of sulphuric ether may be given at the same time.  If  there be debil-
   ity,  tonics are sometimes useful (50) (49)  (54)  (55).

                       Hiccough.—Singultus.

     This is a sudden, jerking spasm of the midriff, occurring every few
   moments in bad  cases, causing the air to be driven out of the lungs. 
DISEASES OF THE BRAIN AND NERVES.'          181
with such suddenness as to produce a noise something like the invol-
untary yelp of a puppy.   It  is generally caused by acidity of the
stomach, which irritates the nerves  distributed  to its neighborhood,
and is not difficult to remove ; but when it occurs towards the close
of some acute and grave disease, it  is sometimes a sign that dissolu-
tion is at hand.
  Treatment.— Startle  the  person suffering, by exciting  surprise, or
fear, or anger ; or, let a  few  small  draughts of cold water  be taken in
quick succession ; or, let the breath be held as long as possible.  If
the stomach is sour, take a teaspoonful  of bicarbonate of soda, dis-
solved in  half a tumblerful of cold water.  To expel wind from the
stomach, if it  be  present, take some warm  aromatic-essence of pep-
permint, ether, or compound spirits of  lavender.   But  one  of the
most effectual remedies, is heavy pressure made  upon the collar bones.
It is simple, and very effectual.

                     Fainting.—Syncope.

   Fainting is preceded by a distress about the heart, a swimming of
the head,  sometimes sickness  at the stomach, coldness of the hands
and feet, and a loss of sight, or a sense of things growing  dark.  The
breathing diminishes, the  pulse becomes small, the  face deadly pale,
and the patient wilts down,  and becomes more or less unconscious of
what is passing around.
   Whatever causes debility, particularly of the nervous system, will
predispose to fainting.   Persons  much  weakened by disease,  faint
easily, — especially when they attempt to stand  still.   When on their
feet, such persons should keep moving.   Fainting is sometimes in-
duced by  sudden surprizes and  emotions,  by violent  pains,  by the
sight of human blood, and  by irritation  of the  coats of the stomach
by indigestible food.
   Treatment. — Lay the patient upon the back, with the head  low;
let fresh  air  into  the  room  instantly,  and apply gentle  friction.
Sprinkle a little  cold water upon the face, and hold  spirits  of  cam-
phor, ether, hartshorn, or vinegar to the nose, — rubbing a  little of
the spirits of camphor upon the forehead, and about the nostrils.  As
soon as the patient can  swallow, give  a teaspoonful of compound
spirits of  lavender, with ten drops of water of ammonia in it.
   Persons subject to fainting  should not  go into crowded assemblies
where the air is bad ; neither  should'they wear tight dresses, or allow
themselves to get excited.   Cold bathing, a well-regulated diet, and
vegetable tonics, will do much to break up the habit.

             Dizziness of the He ad.— Vertigo.

   This affection makes objects  which  are  stationary appear  as if
moving, or, as the phrase is, " turning round."   When seized with it,
one  will  have a  sensation  as if falling, and  objects about him will
seem to be in motion. 
182         . DISEASES OF THE BRAIN AND NERVES.
  It is caused by irritation of the nerves of the stomach in dyspepsia,
by long application of the mind, by a weakened nervous system,* by
hysterics, and by a fulness of the blood-vessels of the head.   When it
proceeds from most  of these causes, it is not dangerous; but when
caused by impending apoplexy, it is a symptom of very serious im-
port.
  Treatment. — Find out  the cause and remove that, and  the  dizzi-
ness will disappear.  If it come from dyspepsia, eat lightly; if from
costiveness,  open the bowels  either by coarse  food, by daily  cold
water injections, or by some  gentle physic.    Avoid coffee, ardent
spirits, and  late suppers,  and take  much  exercise.   Keep the feet
warm, and the head cool.

        Disturbed  Sleep.—Nightmare. — Incubus.

  In this complaint the sleep is disturbed generally by some frightful
image.  Whatever of an alarming character is presented to the  mind
in sleep, causes fear, or some other painful emotion, the same as when
awake.  And when the attempt is made to resist, or to flee from the
danger, it is ineffectual, because the muscles are locked fast in sleep.
The fear being increased by the inability to escape, the sleeper makes
all sorts of horrible noises, indicating distress of mind.   The danger
seen is as real to the  sleeper as if he were awake, and he tries  to do
just what he would if awake.  Sometimes the sensation is that some
heavy weight, or perhaps some  horrible monster, is upon the breast,
nearly pressing the breath out of the body.
  At times, the  power of motion  is not absent, and then disturbed
dreams  may cause one to talk, or to rise and walk, or run.   Children
will laugh, or cry, or scream, which  shows that  their minds are agi-
tated by different passions.  Persons who  idulge gloomy and troub-
lous thoughts in their waking  hours, are apt to be disturbed with
sleep-walking, sleep-talking, and frightful dreams, as of falling down
precipices, during the hours for repose.
  There is nothing very wonderful about these disturbances of sleep.
It is  only necessary that there  should be  an unusual  sensitiveness
of the brain, or  that a hearty supper, eaten late, should irritate the
nerves of the stomach, and that distressing thoughts should be dwelt
upon during the day and evening, in order to produce all the walk-
ing, talking,  dreaming of hobgoblins, shipwrecks, fires, and polar bears,
which distress so many unfortunate sleepers.
  In night-walking there is simply a little more wakefulness than in
night-talking, and in this latter, more than when one falls from a high
place, and in this perhaps slightly more than in real incubus, when
one is in the greatest peril, but cannot move at all.

  Treatment. — When sleeping  persons groan,  or make any  noise
indicating nightmare, shake them, and they will come out of it at
once.  As these troubles  are often caused  by  a weakened state of
the nerves, much out-door exercise should be taken.   The diet should
be*simple, and  well  regulated.   The  suppers  should  be light, and 
              DISEASES OF THE BRAIN AND NERVES. #          183

never taken late.  The evening should  be spent in  some pleasant
amusement, which will drive away care ; and the last hours of wake-
fulness be  occupied with pleasant reflections.   One afflicted with
nightmare should not lie upon the back,  nor with the hands over the
head.  Acidity of the  stomach, and  costiveness, if they exist, should
be removed%y the neutralizing mixture.

                         Headaches.

  These are not always caused by disorders of the brain and nerves,
but they frequently are, and this seems the proper place to speak of
them.
  It is unwise ever to neglect headaches.   They are sources of great
suffering, and  often lead to  serious derangements of the health.   In
childhood they have a more serious meaning than in adult life.  They
often indicate the approach of scarlet fever, or measles, or of other
diseases.
  Headaches are more common among the civilized than the uncivil-
ized ; more frequent among females than among males;  among those
of sensitive feeling than among the  more obtuse; among those who
think much than among those who think little ; among the sedentary
than among the active.                            *

  'Causes of Headaches. — They are  dependent on various causes, as
derangement of the circulating system, of the digestive organs, of the
nervous system, etc.   Among those  dependent on*disturbance of the
circulation, are

  Plethoric Headaches. — These are dependent on a general  fulness
of blood   They are of two kinds.   One is occasional, and lasts but
a few hours.  The other lasts for days or weeks.  It  occurs most
often in  the night or morning.  Persons whose occupations  require
stooping have it  most.  A little dizziness  is generally felt on rising
up  from a stooping posture.  It  is  brought  on  by the bad  air of
crowded  rooms, and is attended by costive bowels, short breath, and
a white furred tongue.
  The persistent  headache is accompanied by  a sense of fulness, and
sometimes  of throbbing over the brows and temples, with a sensation
of dizziness, and of mist before the eyes.   The sufferer fears exertion,
and  is constantly looking for a rush of blood to  the head.   Nature
sometimes  relieves this form of headache by a diarrhoea, or by bleed-
ing from the nose.
  There is  another form of plethoric  headache, differing  slightly from
the above, in which  there is too much blood, and it is made too fast,
but it does  not circulate so rapidly.  The muscles  are not very firm,
and the heart  does not propel the blood  with much force.  This form
of headache is connected with congestion.

  Headaches of Indigestion. — These are caused either by taking im-
proper articles of food, or by eating too  much of those which are
proper.   The  sensation in the head  is not always a pain, but some- 
184           DISEASES OF THE BRAIN AND NERVES.
   times only a dull weight, attended by languor  and disinclination for
   exertion;  a tongue white  in the centre, and pale red at the tip and
   edges;  cold  and numb  fingers;  slight nausea;  languid and  feeble
   pulse; dim and indistinct sight; eyes  aching  when  employed; and
   difficulty in fixing the attention.
     Sick Headache. — This has  received its  name  from the constant
   nausea  or sickness at the stomach  which  attends the  pain in  the
   head.
     This  headache is  apt to begin in the morning, on waking from a
   deep sleep, or after sleeping in a close room, and when some irregu-
   larity of diet has been committed on the day before, or for several
   previous days.   At first  there is a distressingly oppressive feeling  in
   the head,  which gradually merges into a severe,  heavy pain in the
   temples, frequently attended by a sense of fulness  and tenderness  in
   one eye, and extending across the forehead.  There is a clammy, un-
   pleasant taste  in  the  mouth,  an  offensive breath, and the tongue
   covered with a  yellowish-white fur.   The  sufferer desires to be  alone,
   and in the dark.   The hands and feet are cold and moist, and the
   pulse feeble.
     Accompanying these symptoms, there is a depressing sickness  at
   the stomach, which is increased by sitting up, or moving about.  After
   a time, vomitiqg comes, and relief is obtained.

     Bilious  Headache.—This is most common in summer and autuntn.
   It afflicts persons of dark complexion, with black hair and melancholy
   dispositions.  There are two kinds ; one is due to an accumulation of
   bile in the system ; the other to a large secretion of bile.
     In the  first variety the skin is dingy and sallow, the spirits de-
   pressed, the bowels costive, and there is wind in the stomach, with a
   dull, aching pain on the right shoulder.   The pain is in the forehead,
.   eyebrows,  and eyelids, and the « white of  the eye " is a little yellow-
   ish.   The tongue has a  brown  fur, and is cracked in the centre.
   There is a bitter taste in the mouth on waking in the morning, after
   restless nights, and frightful dreams.
     In the second variety, which is due to an " overflow of bile," the
   symptoms are much like those of the first kind,  but the pain is not so
   continuous.   In addition to the symptoms  named, there is a throb-
   bing, rending pain in the head, the skin is hot  and the  face  flushed,
   the limbs are sore, and there is a luminous halo or ring around objects
   looked at,  and a feeling of giddiness.

     Nervous Headaches. — These are  more common  among  females
   than  males.  They occur most frequently  among persons of high
   susceptibility, who are easily elevated, and as easily depressed.  They
   are often connected with indigestion.
     The pain is usually acute and darting, and is made worse by light,
   with  a feeling as if the temples were  being " pressed together," and a
   " swimminess "  in the head.  There is sometimes a sense of sinking,
   with a dread of falling, and great despondency and restlessness.  The
   bowels are generally  costive, and the sight dim.'  The pain comes 
DISEASES OF THE BRAIN AND NERVES.           185
 on most commonly in the morning, lasts through the day, and abates
 in the evening.

   Hysteric Headache. — There is a nervous headache dependent on
 the hysterical condition.   It is generally confined  to  one small  spot,
 frequently over the eyebrow, and is sometimes compared to a wedge
 or nail driven into the skull.

   Headache from Exhaustion.— Still another species of nervous head-
 ache arises from extreme exhaustion, produced by great loss of blood,
 by diarrhoea, or by over-suckling.  The pain is generally on  the top
 of the skull, and is often compared  to the beating of a small hammer
 on the head.

   Brow Ague. — This is  intermittent in its character, and is  brought
 on by  exposure to cold and moisture in damp and marshy districts;
 and in this respect is much like ague.

  pMegrims. — This is most frequent among females.  Jfc is often de-
 pendent on the same causes as Brow Ague, and is also produced by
 long and exhausting watching over sick children, distress of mind,
 and indigestion.
   In both the above forms, the pain is intermittent^eldom lasting
 long, but being of a sharp, piercing  character, like thm of tic doulou-
 reux.   The pain of Megrims, usually begins at the inner  angle of the
 eye, and extends towards the nose ;  the parts being red and sore, and
 the eye-ball  tender.  In Brow Ague, pain and great tenderness cover
 an entire half of the head, compared  by the patient, sometimes, to
 "an opening and shutting of the skull."  It begins with a creeping
 sensation over the scalp.
              «
  Rheumatic Headaches. — These generally affect persons who  have
 been subject to rheumatism, and are often brought on by uncovering
 the head when sweating.   The pain is  usually in  the brow, the  tem-
 ples, or the back of the head, and is dull and aching, — rather  an
 intense soreness than a real  pain; and the painful part is exces-
 sively tender upon pressure.   Tne  skin is moist, but not  hotter  than
 natural.

  Treatment. — In considering the treatment, I will take up the same
 order in which I have spoken of the different forms of headache.
  Plethoric Headaches. — Not  much medicine should be taken for
 these, if it can be  avoided.  A diuretic  (131) may be taken  twice a
 day, and an occasional dbse of gentle physic at night, followed by (7)
 in the morning.  This will generally give great relief.
  Meat should be taken  but  once a day, and the  whole  diet should
 be spare, the appetite  never being fully satisfied.  All  spirituous
 drinks, including  distilled  and fermented, should  be let alone, and
 coffee likewise.
  Much exercise should  be taken in the  open air.  The  hair should
be kept short, and the head  elevated during sleep.   Bleeding at the
nose, when it occurs, must not be too suddenly stopped. 
186           DISEASES OF THE BRAIN AND NERVES.
   Congestive Headaches. — The exercise, diet, mode of sleeping, etc.,
 should be the same as in plethoric headaches.   In this complaint, there
 is too much blood in the head, and it inclines  to stagnate.   The feet
 and hands are cold; and gloves and stockings  of wool, and other bad
 conductors of heat from the body, must be worn.
   Occasionally a little gentle  physic (319) is desirable to induce the
 bowels to act every day.  If there is great debility, iron (71)  (74) (75)
 (320) will be required.

   Headache of Indigestion. — If the pain come immediately after a
 meal, and can  be traced to something eaten,  an emetic (2) may  be
 taken, if the person be tolerably strong.  If the  pain come  on some
 hours after eating, take  rhubarb and  magnesia (28) (14), or  fluid
 magnesia.   When  the  system  is debilitated,  take a warm draught
 (322) in  the morning after a  light breakfast, or twice a day, a bitter
 with an  alkali (323).  If the stomach be  very irritable, bismuth, at
 meal times (£24) (326).  When it occurs after a debauch, take recipe
 O/iiO.                                                           ™

   Sick Headache. — When  it results from food taken, a draught  of
 warm chamomile tea, or a little weak brandy-and-water, will generally
 give relief.  If the sickness continue,  soda and water, with a  little
 ginger may doTwell, or  a  mustard poultice upon  the stomach (165)
 may be  required.   As  soon  as it can be kept  on  the stomach, a
 dose of physic (326) must be taken; and if relief does not come after
 the operation of this, give a bitter and an aromatic (327).  The patient
 must have  perfect rest.   If there be great lack of tone in the system,
 the mineral acids (328)  (329) will be excellent.
   The diet must be carefully regulated, as in plethoric and congestive
 headaches.

   Bilious Headaches. — These are generally connected, more or less,
 with some affection of the liver.
   During an attack,  if the suffering be  great, attended by nausea,
 give an emetic (2).   In  milder cases, give recipe (321).  If  there be
 costiveness, give recipe (330) at nigfft, and (7) in the morning.
   A few doses of podophyllin,  leptandrin, etc. (34)  (36) (39), to re-
lieve the  liver when the  bile does not flow fast  enough, will  diminish
the frequency and force of the attack.  The fluid extract of dandelion,
taken for some time, often does good service.
   The diet should  be light, and chiefly vegetable, and exercise in the
open air  must not be omitted.    The daily sponge bath, with friction,
is  excellent.

   Nervous Headaches. — The  first thing to be  done  is to relieve the
pain, and this may generally  be accomplished either by preparation
(331), or (332), or  (333), or (88), or  (93), or two  or three  drops  of
tincture of nux vomica in a spoonful of water, taken three times a
day.
   In simple nervous headache, diet is of the greatest importance ;  in
hysterical cases, exercise; in headaches from exhaustion, tonics (81)
 (79) (63) (73) (64)  (61) (60). 
DISEASES OF THE BRAIN AND NERVES.           187
  Rheumatic Headaches. — Take a light diet, with but little animal
food.   Wear warm  clothing,  and  avoid  exposure to wet feet and
dampness generally, and go to a mild climate, if convenient.
  When the local pain is great, apply hot fomentations, or a stimu-
lating liniment (334), or a mustard poultice, to the back of the neck.
In the beginning of the treatment, a little  physic at night (335) is
useful.
• 
t
DISEASES  OF  THE  THROAT.
     The diseases which seat themselves in the throat, and in the great
  cavity of the chest, have occupied a large share of my attention for
  the last ten years.  My practice in these complaints has been large,—
  being drawn from every part of the United States, and the British
  Provinces.   No class of diseases from which men suffer are more nu-
  merous  than these, and none have so generally baffled the skill of the
  profession.   For this reason, I wish to  present  here a brief, practical,
  and common-sense view of these complaints, which shall be of real
  value to the thousands of families, who, I trust,  will consult these
  pages.

    Increase of Throat Diseases. — A striking increase  in the number
  of throat diseases  has  been witnessed within the  last few years.  A
  person suffering  from any of  them will  find, on speaking of  his com-
  plaint, that a number of his neighbors are afflicted with troubles of a
  similar kind.  I have thought that in some of their forms these dis-
  eases have fastened upon the throats of not less than  half our popu-
  lation.  And when it is considered  that they  are the  natural, and
  if unmolested, the certain  harbingers of lung disease, it is wise to
  make a  note of the above fact.  As I shall describe them in the nasal
  cavities, the pharynx, the fauces, etc., they all have a natural proclivity
• downwards.   From these upper cavities they pass,  by  one short step,
  into the larynx, — the cavity  where the  voice is formed, — and then,
  by another equally short  and easy stage, into the  body of the wind-
  pipe.  It is  a singular fact that their progress is always  from the
  upper breathing  passages downward, and never from the lower pas-
  sages upward.  They afford a parallel to the  order of progression in
  the moral world,  in which evil tendencies are toward a lower depth.

    A Mistake  Corrected.—Before describing the several diseases which
  belong to this family, I wish to correct the mistake which so generally
  classes them all under the term Bronchitis.
    They all consist in a simple inflammation, acute or chronic, either
  of the mucous membrane lining the several cavities to be spoken of,
  or of the small glands or follicles connected with that membrane; and
  each disease takes its  name from its particular location.  Thus, the
  inflammation of  the membrane lining the upper part of the throat, or
  pharynx, is called Pharyngitis.  Inflammation in the top of the wind- 
DISEASES OF THE THROAT.                 189
pipe, or larynx, is Laryngitis.  In the windpipe, or trachea, it is Tra-
chitis.  In  the bronchial  tubes, it  is Bronchitis.  As the bronchial
tubes exist nowhere except in the  lungs, below* the  division of the
windpipe, there can  be no Bronchitis in the throat.   Nevertheless, it
is the same disease with Laryngitis  and Pharyngitis, and differs from
them only in being in a more dangerous place.
  As the windpipe descends into the  chest, it  divides below the top
of the  breast bone into two branches, one going into the right, the
other into the left lung.   These branches divide  and subdivide very
minutely, and send their ramifications into every part of the pulmon-
ary tissue.   Thus situated, Meckel  has compared the windpipe to a

                              Fio. 83.
hollow tree with the top turned downward, — the larynx and trachea
representing the trunk, and theAronchial tubes, with their innumera-
ble subdivisions, the branches and twigs.  (Fig. 82.)
  If the reader will now understand that the trunk and branches of
this bronchial tree  are  hollow*  throughout, and lined with a delicate
and smooth mucous membrane, and that the diseases to be described
are inflammations either, upon this membrane  or  the  small glands
connected  with it,  causing swelling, redness, unhealthy  discharges,
roughness,  etc., he will have a good general idea of them.

                        Nasal Catarrh.

  I take these diseases in the order of their location.  Nasal Catarrh
consists in inflammation, which begins behind and a little above the
veil of the  palate, and extends upward from thence into the nose.  It 
, 190                DISEASES OF THE THROAT.
is an exceedingly troublesome complaint, and afflicts .great  numbers.
It passes under the name of Catarrh in the Head.
  The inflammation.is not confined to the nasal cavities.  It extends
frequently to the air  cavities, called antrums and sinuses, which cover
a considerable portion of the face, and extend to the lower part of the
forehead.  Persons sometimes feel as if their whole face were involved
in the disease, and were almost in a state of  rottenness, — so great is
the amount of matter discharged from the head.  Such free discharges
cannot be wondered  at when we reflect that all the air cavities in the
face are lined with the same mucous membrane which lines  the nose,
and that they all communicate with the nasal cavities.
  The "horn ail," among cattle, is  a similar inflammation  of  the
inner surface of horns; and  the " horse distemper" is an inflamma-
tion of the air cavities in the head  of the  horse, and is much  the
same disease with our catarrh in the head.
  The catarrh often  creates a perpetual desire- to swallow, and gives
the feeling, as patients  express it, " as  if something were sticking in the
upper part of the throat."                «•
  When the inflammation has existed a long  time, and ulceration has
taken place, puriform  matter is secreted, and drops down  into  the
throat, much to the discomfort of the patient.  Indeed, this  is one of
the most distressing features of the complaint,  as this matter often
descends into the stomach in large quantities, causing frequent vom-
iting, and a general derangement of the health.   Many times  the
sufferer can only breathe with the mouth  open.  Upon rising in  the
morning a great effort is required to clear the head and the extreme
upper part of the throat.  There is occasionally a feeling of pressure
and tightness across  the upper part of the nose ;  and the base of  the
brain sometimes suffers in such a way as to induce headache, vertigo,
and confusion.  The smell is  frequently destroyed,  and  sometimes
the  taste.   The  inflammation sometimes gets  into the  eustachian
tubes, the mouths of which are behind and  a little above the veil of
the palate, and extends up the lining  membrane to the drum of  the
ear, causing pain or deafness, and occasionally both.   In addition to
this catalogue of evils, there is often added inflammation  and elon-
gation of the uvula or  soft palate.

  Treatment. — The  following  is a fmr  illustration  of my  mode of
treatment:
  On the 12th of December, 1852, Mr.----,  of this city, came under
treatment for a bad case of catarrh  in  the  head, complicated with
follicular disease of the pharynx, or upper  part  of the  throat.  In
addition to nearly all the symptoms mentioned above, he had a stench
from the nose exceedingly offensive to all about him.   So much had
the  disease worn upon  him that he had  become bilious, sallow, de-
jected, and low in strength and flesh.  When it is said  that to all
this were added  a cough  and loss of appetite, with  insidious  ap-
proaches of  hectic, it will not be surprising that his friends saw  the
most serious results  impending, even though assured by me that the
disease  had not yet  taken firm hold of his  lungs.   The first thing 
DISEASES OF THE THROAT.                 191
done for him was to cut off the uvula.  Five days  after, I began to
bathe the whole nasal cavity, three times a week, with  a shower
syringe, by pushing the smooth bulb up behind the veil of the palate,
and throwing instantaneously a most delicate  shower of medicated
fluid up both sides of the septum.  The upper part of the throat was
likewise  bathed by the use of a shower syringe  made  expressly for
that  part, and the larynx, or place where the voice is  formed, by a
long, bent instrument  made to reach  this part of  the  throat.   The
solution used consisted of half a dram of crystals of nitrate of silver
dissolved in one ounce of soft  water.
  The nitrate of silver powder was inhaled once a day with the powder
inhaler.   In this way the nasaj cavities and throat  were kept cleansed,
and the articles used gradually subdued the inflammation, setting up
a new and healthful action in place of the diseased one.  The stom-
ach was relieved of the offensive matter which had daily and nightly
gone down into it, and the system of the poisonous  effects of its absorp-
tion.  The great danger which threatened the lungs, and which would
soon  have been realized in  their destruction, passed.away.  The skin
gradually assumed its proper color;  the  appetite, flesh, spirits, and
strength came back, and  Mr. B.  has been since in the enjoyment
of good health, pursuing his business cheerfully.
  When the above  treatment fails,  as it does  occasionally, I am in
the habit of changing the solution, using, sometimes, a weak solution
of acid  nitrate of  mercury, twenty drops to an ounce of water.  In
other cases, a solution  of sulphate of zinc serves a good purpose.  A
dilution  of  the  tincture of arnica flowers is a preparation of  some
value in these  cases.  There are other preparations, too numerous to
mention, which I am in the habit  of using.  I will add, that the
nitrate of silver powder, snuffed once a day, a  pinch at a time, is far
more successful than any other snuff ever made.

       Inflammation  of the  Pharynx.—Pharyngitis.

  This  is an inflammation of  the upper and back part of the throat,
or all that part which can be  seen when the mouth is stretched open.
It causes a redness of  the mucous membrane lining the part, which
is deep  in  proportion to the intensity  of the inflammation.   This
complaint is generally connected with the one I am about to describe ;
and  since the treatment is the same, the reader  is referred to what
next follows.

    Clergymen's  Sore Throat.—Follicular Pharyngitis.

  This  disorder made its appearance in this country in 1830, and the
attention of the profession was first  drawn to it,  as a distinct disease,
in 1832.  Some have supposed its origin to have had a hidden con-
nection with the epidemic influenza, which spread over the civilized
world in 1830, and affected all clashes of persons; but this is  only
conjecture.   In  its early developments it attracted notice  chiefly by
its visitations  upon the throats  of  the  clergy.  Hence its  popular 
192
DISEASES OF THE THROAT.
name of Clergymen's Sore Tliroat.  It was  soon found, however, to
attack all classes of persons indiscriminately, whether engaged in any
calling which required a public exercise of the voice or otherwise.  It
was  noticed more by public speakers and singers, on account of the
greater inconvenience it gave them.
  The disease consists in a chronic inflammation of the mucous fol-
licles, or glands  connected with the mucous membrane which  lines
the throat and windpipe.  The office of these little glands is to secrete
a fluid to lubricate the air passages.   When inflamed, they spread an
acrid, irritating fluid over surrounding parts, which excites inflamma-
tion  in them.  Hence a general inflammation of the upper part of the
throat, or pharyngitis, usually attends the follicular disease, and  I
shall speak  of the two  together.  This inflammation of the glands
and  the membrane, being neglected, as it generally is, lingers on  from
month to month, or from year to year, making in some cases  slow
progress, in others more  rapid, — made a little worse and its step
slightly quickened by every  fresh cold, and  finally results in ulcera-
tion.  The expectoration thenceforward becomes puriform, and finally
undistinguishable  from that  of  consumption,  with all  the symp-
toms of which the patient finally dies.   Indeed,  before its nature was
understood by the profession, it was considered the most fatal  form
of consumption, because  it could be  affected only in a very small
degree, if at all, by medicines taken into the general system.


  Inflammation of Mucous  Membrane  and  Glands  of Larynx.

                       Follicular Laryngitis.

  A  few strong and beautifully  formed cartilages unite to form  a
curious and convenient box or cavity at  the  top of the windpipe,
called the larynx.   Across this enclosure are stretched two remark-
able cords, called the vocal ligaments.  They are from half to  three
quarters of an inch in length, and are rendered more or less tense by
the small muscles with which they are  connected.  Just above  these
cords are two cavities, which, with the ligaments, act  an  important
part in the formation of the voice.  Here is produced the sound, which
is modified and articulated by the tongue, the lips, and the nasal cav-
ities.
  When disease reaches this cavity, and the fluid secreted to lubricate
these cords  becomes  acrid, the voice, from this and  other causes, is
made hoarse; and when, at  length,  these ligaments are altered in
structure by inflammation and ulceration, the voice suffers a gradual
extinction.   I have treated  a large number suffering entire loss of
voice, and am happy  to  say it has been generally restored, where the
lungs have  not been involved in  the  disease.   There is often also a
little sensitiveness, or even soreness, in some cases, in the region of
the larynx, which  may be felt fcy pressing" upon that prominence in
front of the throat, called  Adam's  apple. 
DISEASES OF THE THROAT.                193
      Inflammation in  the  Windpipe.— Tracheitis.

  This complaint and the one preceding it differ only in their locality
from those described in the upper cavities ; and they are more alarm-
ing, because two removes nearer the citadel of life.   Happily, we know
that the  seat of these diseases may be easily reached, and we have a
shower syringe, constructed  by me in 1849, so  arranged as to pour
the remedial agent directly upon them, without any lacerating dis-
turbance of  the parts.

  Symptoms. — The approach of these disorders is often so insidious
as hardly to attract notice, — sometimes for months, or even years,
giving no other evidence of their presence  than the annoyance of
something in  the throat to  be swallowed or  hawked up,— an  in-
creased  secretion of mucus,  and a sense of  wearisomeness  and loss
of power in the throat, after public speaking,  singing, or reading
aloud.  At  length, upon the taking of. a severe cold, the  prevalence
of an epidemic influenza, or of an unexplained tendency of disease
to the air passages and lungs, the  throat of the patient suddenly
becomes sore, its secretions  are increased and rendered more viscid,
the voice  grows hoarse, the difficulty of speaking is  aggravated, and
what was only an  annoyance, becomes an affliction, and a source of
alarm and danger.  These diseases  clearly  belong to the family of
consumption, and need early attention.
                                                    •
  Causes. — It is  amusing to reflect upon the theories which writers
were in  the habit of  constructing, a few years since, to account for
the throat affection among the clergy.   It was attributed by some to
speaking  too  often, by others  to  speaking too  loud.   One  class of
writers thought it arose from high, stiff neck-stocks ; another, from a
strain of voice on the Sabbath  to which it  was not accustomed on
other days.
   The cause lies  deeper than any of these trifling things.  As it con-
cerns ministers, it may generally be expressed in two words, — labor,
anxiety.
   The clerical order are placed just where  they feel the force of  the
high-pressure  movements of the  age.   They are  the  only class of
recognized instructors of adult  men, and are obliged to make  great
exertions to meet the wants of their position.   The extremely trying
circumstances  in which they are  often  placed, too, in these exciting
times, by questions which arise and threaten to rupture and destroy
their parishes, weigh  heavily upon their^ spirits, and greatly depress
the vital  powers.  And when we add  to this the fickle state of the
public mind,  and the shifting, fugitive character of a clergyman's
dwelling  place, and the consequent liability to  poverty and want to
which himself and family are  exposed, we  have  a list of depressing
causes  powerfully  predisposing to any form of disease which may
prevail.
   It will be pardoned me, I  think, if I  suggest  here, that  the nature
of a  clergyman's calling is  of so serious a character, that he some- 
194                 DISEASES OF THE THROAT.
   times carries  himself with  too much sedateness, keeps  himself too
   much braced  up, and  does- not allow himself hours enough of that
   cheerful, light-hearted  abandon, which  is essential  to  the  health of
   every sedentary man of mental habits.  The hard-thinking and  hard-
   working minister, who will retain his health, and save his throat, must
   have some moments, at least, when the weighty responsibilities of his
   office are lifted up from  his soul, and he becomes, for the hour, the
   jocund, playful boy of earlier days.   How far he  can consistently
   relax  and let  himself down, or in  my view of the matter, raise him-
   self up to the simplicity and mirth of  childhood, he alone  can be the
   judge.  As  a  physician, I prescribe; as a minister, he must decide
   how far my  prescription can be followed.

     Reading Sermons.— There  is one  practice, which, though it has
   not much to do with inducing this  disease, does frequently aggravate
•  Jt when once established ; I mean the  habit of reading sermons  from
   manuscripts, — especially when it  is  done in a  sort of  mechanical
   way.  Every person who has suffered from throat ail,  has doubtless
   noticed  that to read aloud, for half an hour, from a book, occasions
   more fatigue and irritation in the throat than extemporaneous speak-
   ing, in the same tones, for one or two hours.   The reason is, that in
   the latter case the mind conceives the thought  in season for the
   organs of speech to fall into  a natural  attitude, and utter it with  ease.
   The two work harmoniously together, — the  instruments of articula-
   tion following the mind,  and easily and naturally uttering its concep-
   tions.   Whereas in the  case of reading, the  mind itself is, at  least
   partially, ignorant of what is coming  until  it  is just upon it, so that
   the organs of  speech, being warned of what is to be  done only at
   the moment their service is required, do their work under a perpetual
   surprise and constraint.   The difference is, in some respects, like that
   between walking freely at large, without regard to where the feet are
   put down, and being obliged to step exactly in the footprints of some
   traveller who has  gone before.  In the latter case, the muscles tire
   much sooner, because they work in fetters.
     I have thus spoken particularly of  the clergy, though it is not by
   any means they only, but all classes of people who are  afflicted  with
   this dangerous malady.
     These  diseases often begin with a cold.   But colds are seldom
   taken  except when the nervous system is depressed,  so  that they are,
   in fact, to be traced back  to the same cause which I have assigned to
   catarrhal or throat complaints themselves.

     These Complaints Worse at Mght—It is worthy  of  note, that all
   these complaints, and many.others, are worse  during the night.   This
   is easily explained when  we remember that the atmosphere has the
   least amount of electricity  in it at  three o'clock in  the morning,
   and that the first minimum atmospheric  pressure, which  happens
   twice a day,  occurs not far from the same hour.  From three to four
   in the morning, therefore, the  nerve-power sinks to its  lowest ebb; and
   those diseases  which owe their  existence to anxiety, overwork, etc.,
   suffer, at this time, their  greatest daily aggravation.   Death occurs, 
DISEASES OF THE THROAT.                195
too, more often during these hours, than in any other portion of the
twenty-four.
  Treatment. — Some  years  ago these diseases were thought to be
incurable ;  and by all the appliances of medical art then known, tJley
were so.   But  time has brought a successful method of treatment, as
well as a clearer knowledge of their nature.
  This treatment consists in what is called topical medication, or the
applying of the medicine directly to the diseased  part.  The medici-
nal agent  more extensively used  than any other  is  a  solution of
crystals of  nitrate of silver.   This substance is not, however, adapted
to every  case, — other  articles succeeding  better  in  some  instances.
Modern  chemistry has given us a  variety of agents  from which the
skilful physician may  select a substitute, should the  nitrate of silver
fail.
  The operation of applying this and other substances to the air
passages, is a delicate  one, requiring tact and experience.  Surgeons
had supposed it an anatomical impossibility to introduce an  instiu-
ment  into  the  larynx ; but  this has been practically demonstrated to
be a great mistake.
  Instruments. — The  instrument  devised and used by Dr. Horace
Green is a piece of whalebone, bent at one end, to which is attached
a small, round  piece of sponge.  This, dipped in the solution, is dex-
terously introduced into the laryngeal  cavity, and applied directly to
the diseased part.                                              •
  I formerly used this instrument myself, and am  happy to know,
that notwithstanding  its defects,  it was  generally  successful.  Yet
where the  larynx was highly inflamed, with a swollen and ulcerated
condition of the epiglottis and lips  of the  glottis,  I am sure I some-
times had  the  singular powers of the nitrate of silver put at defiance
by an irritation evidently produced by the sponge  of the  probang.
Upon its introduction, in such cases, £he parts  contract upon and
cling  to  it, and suffer aggravated  irritation, almost  laceration, upon'
its withdrawal, however carefully effected.
  Laryngeal Shower Syringe. — Such defects in the  probang led me
to contrive an instrument, which I  call a Laryngeal  Shower Syringe.
It is in the form of a syringe, the barrel and piston of which are made
of glass, silver, or gold,  as  may be desired.   To this is attached  a
small tube, made of silver or  gold, long enough  to  reach  and enter
the throat, and bent like a probang, with a globe or bulb at the end,
from a quarter to a third of an inch in diameter, pierced with  very
minute  holes, which cover a zone around the centre about one-third
of an inch in breadth.
  This silver bulb I daily introduce into highly inflamed and ulcer-
ated larynges,  generally  without any knowledge of its  presence on
the part of the patient, until the  contained solution is discharged.
The instrument, being charged, is carried to the proper place, when  a
delicately quick pressure upon the piston causes very fine streams to
flow through the holes in the form of a delicate shower, and all sides
of the walls of the larynx are instantaneously bathed. 
196                 DISEASES OF THE THROAT.
  How Introduced. — The introduction  of this instrument  into  the
larynx is  easy.  Upon  the approach  of any foreign substance,  the
epiglottis instinctively drops down upon the entrance to the larynx,
guarding it against improper intrusions.   It has been found, however,
that when the root  of the tongue is  firmly depressed, this cartilage
cannot obey its instinct, but stands erect,  its upper edge generally
rising into view. • Availing himself  of this, the surgeon  has  only to
depress the  tongue with a spatula, bent at right  angles, so  that  the
left hand  holding  it  may drop below the chin out of the way, and as
the epiglottis  rises to view, slip the ball of the instrument over its
upper edge, and then with a quick yet gentle motion, carry it down-
ward and forward, and the entrance  is made.   I have often  admired
the faithfulness of this  epiglottic sentinel,  who, when  overborne by
superior force, stands .bolt upright, and compels us to enter the sacred
temple of speech directly over his head !

  Pharyngeal  Shower Syringe. — For washing the upper part of  the
throat, I construct the  instrument with a  straight tube, with  holes
over the outer end of the  globe, and  extending to the centre.  This
washes instantaneously  the fauces and pharynx, but  does not throw
the solution back upon the tongue.  Its main advantage over  the
probang is, that it bathes  every part of the fauces and  pharynx  in-
stantaneously, and does not  subject the patient to the coughing and
gagging which follow the slower and rougher  process of drawing  the
spdhge from side to side across the cavity of the throat.

  Nasal Shower Syringe.— Inflammations in the back passages to  the
nose, called catarrh in the head, have been almost  inaccessible by any
reliable healing agent,  and  consequently incurable.   The  probang
could only reach a short distance, and  occasioned great suffering.  I
have  had a syringe constructed with  the tube  bent at an angle of
forty-five  degrees,  and the globe, very small, pierced with a few fine
holes at the upper end.   Carrying this  globe up  behind the velum
palati, with a  single injection I wash both passages clear through.  I
have had the pleasure of curing a large- number of bad cases, of many
years' standing, to the surprise and delight of the patients.
  About  nineteen twentieths of the physicians who have examined
these instruments, and so far as my  knowledge  extends, all who have
used them, think them much better than  the probang.  As to patients,
I have  yet to  see one who will allow the sponge to be used after try-
ing both.

  Have Superseded the Probang. — In my own practice the syringes
have  superseded the probang altogether.  My reasons may be briefly
stated.   I have already said there is  less  irritation produced.   A piece
of sponge drawn  over  an inflamed surface, especially when clung to
by the irritated and  quivering parts, must necessarily, in some cases
at least, aggravate the  symptoms of disease.  To this  consideration
add the comfort of the patient during  the operation.  It is so quickly
and delicately done with the syringe, that it is  scarcely known when
the act is performed.   The straight syringe does not touch the throat 
DISEASES OF THE THROAT.
197
 at all.  On touching the probang to the throat, the nitrate of silver
 unites with the mucus upon the surface, instantly covering the sponge
 with an albuminous pellicle, something like that which lines the shell
 of an  egg,  preventing, in a degree,  the further pressing out of the
 solution, and  rendering  its contacts  with other parts of the surface
 comparatively powerless.  For this reason, the  sponge pushed  down
 into an  ulcerated bronchus, as  Dr. Green  recommends, must  be
 utterly valueless as a remedial  agent.   Mopping, .as it does  in  its
 whole course, a larynx and trachea, lined in some cases with puriform
 matter, and generally with  mucus, every inch  of its descent  doubles
 the gravity of this objection.  Let it  be considered, too, that in apply-
 ing the  remedy  to  an  ulcerated larynx,  the  sponge cauterizes the
 healthy parts above, in  its descent,  and thus  unfits itself for  doing
 much  for the diseased part;  whereas the syringe retains its  solution
 till it  reaches the affected place, and then pours a clean shower  di-
 rectly  upon it, and upon no other part.
   Considering these manifest advantages of the syringes, I  am sur-
 prised that any physician should still use the probang, — especially as
 one of these instruments, the Nasal  Syringe, accomplishes an object
 which the  probang  cannot effect at  all, not even in a rough way.   I
 have wondered, too, how any parent  can allow a child, suffering with
 croup, to be tormented  by having a  sponge pushed down its throat,
 when a syringe would give it so much less pain.

  The London Lancet. — It may as  well be mentioned here, that in
 August, 1852, I put a neat set of these Syringes into a package, with
 one of my  Tonsil Instruments, and  sent them as a present to the
 editors of the  London Lancet, accompanied by a brief note, expressed
 in as civil language as I could command, asking them to accept rav
 small  offering to the profession in England, and if they deemed the
 instruments of  any value, to make them known.   Seven  months
 passed, and no private note acknowledged their reception.  In April,
 1853, the Lancet contained an article under the head of " New Inven-
 tions," which began  by describing Dr. Green's Probang, then " Dr. Ira
 Warren's Shower Syringes, three in number, very  neatly made, and
 contained  in  a  neat case," and  lastly, " Mr. Coxeter's  Laryngeal
 Shower Syringe," which they pronounced the most convenient of all.
  From reading  this article in the Lancet, no  one would  infer that
 either of the above  syringes had any claim to paternity of the other.
 Dr. Ira Warren's residence, or even that he was an American,  could
 not be learned from the article.  And yet the facts are, that the editors
 put my syringes into the  hands of  Mr. Coxeter, who employed the
 seven months of  their silence in getting up a miserable imitation  of
 mine, which the  editors  call his invention, — saying nothing about his
 having stolen it from me, or the  manner in which they abused private
 confidence in helping do it.
  The distal  extremity of Mr. Coxeter's instrument is flattened  from
 side to side.  If the globe is retained  and flattened, any mechanic can
see  that  it cannot be as easily insinuated into the larynx as a perfect
sphere.  If the sphere is wholly removed, as  the cut in the  Lancet 
198                 DISEASES OF THE THROAT.

seems  to indicate, then the point is too  sharp, and no prudent physi-
cian would risk  the  chances of wounding the  throat by its  use.  In
any view of the case, there seems to b'e no better reason for the alter-
ation than  the desire to appear to furnish a new instrument, while in
fact it is only mine a little altered for the worse.
  As to the rubber bottle at the  other end, it is wholly unfit for  the
purpose intended.  Its self-acting mode of charging the instrument is
alone sufficient to condemn it.  No sportsman  who intends  to  bring
down  his game, would think of charging his piece by  some self-
acting machine which would  be  liable to draw in twice as much, or
twice as little powder as he desired.
  Men who stand, like the editors  of the  Lancet, at the portals of
professional opinion, should be men of large souls, who are disposed
to give any new thought  or  instrument that comes to  them, clear
papers  of  "safe conduct,"  to travel anywhere, — to fame or to
oblivion, — without  improper  molestation, especially  without a seven
months'1 imprisonment.
  The truth is, that  in the  construction  of ships and boats, locomo-
tives, farming implements, several kinds of machinery, surgical  in-
struments, etc., the Americans are in advance of the English.   While
it is clear that the latter are slow to acknowledge this, I did not sup-
pose any respectable Englishman would  resort to anything deceptive,
with a view to appropriate what belongs  on this side the water.
  Several parties in this country have  got up  imitations of  these
syringes, and  have  made them-
selves  liable for damages under
the patent;  but they are persons         [PatentedDecember6, 1853.]
of little or  no  responsibility, and
I have not as yet  brought the
law to bear upon them.  Those
who purchase and use  these imi-
tations, should bear in mind that
they are also liable for damages.   Figure 84 represents these syringes
as they lie in a case.
              •
  Mode of  Using. —  The glass barrel  and piston  of  my instruments
are delicate, but they need not be broken.  I handle them with  the
same ease that I do  a spoon in feeding myself, and not in  a very dis-
similar way.  The last three fingers are placed on the under side of the
barrel, with  the  thumb on the upper  side,— the  index finger  being
poised over the end of the piston,  ready to drive it home at the proper
instant.  The  motion  of the  piston should be quick, so as to  cause
the streams to leap  out in  jets;  yet  delicate, that they may not  im-
pinge with too much force upon the diseased surfaces.
  They should be rinsed with water immediately after being used.
But  even with this  precaution, a small residuum of the  nitrate re-
mains  and  crystallizes, and after a time partially closes the  holes.
They must then be picked out with the point of a needle.
  When the silver tube becomes detached from the glass, it may be
fastened on with common  sealing wax ; first  melting the wax and
 
DISEASES OF THE THROAT.                 199
  sticking it around the glass;  then heating the silver over a lamp, and
  pressing it on.
    Amount of Solution  to be  Used. — The amount of solution  to  be
  used should be small.   Half a dram is enough.   The piston of the
  syringe need  be drawn up  only from  an eighth to a  third of  an
  inch.   Strangling is not often produced  by these operations ;. but to
  make its prevention still more  sure, let the patient be directed to  fill
  the lungs with a long inspiration while the operator is depressing the
  tongue.
    Strength of Solution. — The strength of the solution  in  ordinary
  cases of chronic folliculitis, etc., should generally be about forty grains
  of the crystals of the  nit-rate of silver to the ounce of water.  But
  in all acute diseases of the  air  passages, it should  be considerably
  stronger, — varying from  one to two drams.  A preparation of this
  strength is powerfully  antiphlogistic and sedative.  In those cases of
  chronic disease, where  the inflammation is of a  low grade, and the
  mucous membrane is  in a relaxed,  atonic condition,  looking  either
  sodden and pale, or of a dark color, like the cut surface of beef, some
  days exposed to the air (as is often the case in throats of literary dys-
  peptics), then  a solution of  fifteen to  thirty  grains  to the  ounce, is
I  sufficient.  This strength acts as a stimulant, and is well  suited to
  throats in  such condition, but would be  injurious in high grades of
  inflammation.   Catarrh in the head generally requires only about this
  strength.   I am sorry to say, the  topical mode of treating throat affec-
  tions has  been in some places injured, in the public estimation, by a
  lack of knowledge and judgment on the part of the operator, in choos-
  ing the strength of his solution.
    To determine the proper frequency of the operation, also requires
  judgment  and experience.   In  an ordinary case of chronic disease,
  the treatment may begin by showering the  throat  once a  day for a
  week.   Then  the  operation should  be repeated  three times a week,
  for a shorter or longer period ; then twice a week, and  at  last once a
  week.
    Attendant Diseases.— Among  the persons I am  treating for diseases
  of the air passages, many are dyspeptic and suffer with depression of
  spirits.  So often does this symptom present itself, that I regard it as
  almost one of the  peculiarities  of throat disease.  Persons  thus  de-
  pressed generally  have the  dark and  dingy look of the  face  which
  indicates functional derangement of  the  liver.  They are often ema-
  ciated, nervous, hypochondriacal, irritable in  temper, and are  ex-
  hausted by an excessive  secretion of urea.   The urine of  such per-
  sons is always acid, and loaded with crystals of oxalate of lime.
    An explanation of this fact has been attempted, by supposing that
  the oxydation of carbon (of which these persons have a superabun-
  dance), imperfectly accomplished  in inflamed  respiratory organs, is
  vicariously effected in 'the capillaries  of the  kidneys, — oxalic acid
  (C2. 02.) instead of carbonic acid (C.  02.) being the result.
    The crystals of oxalate  of lime are  octahedral in  form, and, in the
  field of a good microscope, are beautiful objects for inspection. 
200                DISEASES OF THE THROAT.
   Lawyers,  clergymen,  statesmen, and, in  general, those  who labor
 hard mentally, with but little bodily exercise, and who have a great
 weight of care resting on them, are the persons who suffer most from
 this complication.  Generally, the inflammation in the throat is of a
 low grade, and must nqt be  treated with a very strong solution of
 nitrate of silver.
   Of  course when these attendant  diseases exist, something more is
 needed than  the local treatment.   For the troubles  just described, the
 treatment for hypochondria and dyspepsia will be proper.

                 Elongation of the Uvula.

   The uvula is the small teat-like or pendulous organ which hangs
 down  from the palatine arch, just over the  root of the tongue.  It is
 very apt to get inflamed, and its parts becoming relaxed, it stretches
 out lengthwise, so that its lower extrem-            FlQ ^
 ity sometimes  rests upon  the  tongue.
 (Fig. 85.)  When this happens, it flaps
 about, backward and  forward,  and to
 the right and left, —touching the throat
 at various points, and by  the tickling
 sensation produced, exciting a most  in-
 cessant,  uncontrollable,   and  racking
 cough.   Some  of the  most distressing
 coughs I have  ever heard, have  been
 produced and  kept  up  by this cause
 alone.   Many a fatal consumption has
 begun  in  this  way.   When  long  in-
 flamed, it often gets much out of shape,
 being sometimes bent nearly double.
  Treatment.— In some cases, the uvula,
 thus elongated, may be reduced back to
 its natural size, by an astringent gargle,
 composed of an  infusion of white-oak
 bark, with  a  little alum  dissolved  in it
 (232) ; but it will generally stretch out
 again  and again, upon the  appearance
 of any fresh  cold, and, therefore, the
 only certain cure is to cut it off.
  To do this, take hold of it with a pair
 of common forceps, and having stretched
 it  down  a little, clip it  off above the
 forceps, with a pair  of curved scissors.
 Nearly the whole of it  should  generally be removed.   To take off a
 part only, leaves a stump, which is often more objectionable than the
whole organ.   Its removal never injures the  speech  in  the least.  In
many cases of  nasal catarrh, this organ  is a sort of diseased  centre,
from which the inflammatory  action spreads upward into  the nasal
 cavities, and  no medicine or power  on earth  can effect a cure until
this offending member is  snipped off.
 
DISEASES OF THE THROAT.                201
    Acute Inflammation  of the Tonsils.— Tonsilitis.

  The tonsils are chiefly a collection or mass of small  mucous folli-
cles or glands.  They secrete a portion of the  fluid which keeps the
throat moist.
  There  is a class of persons  who  suffer about every  winter, some-
times oftener, with an attack of acute  inflammation of these  glands,
which  causes  great suffering for several  days.  The trouble begins
with a slight soreness and  swelling in these glands, which gradually
increase until the mouth can scarcely be opened, and the act of swal-
lowing is attended with indescribable suffering.   At length, in from
four to ten days, an abscess forms and breaks in one or both  glands,
which produces immediate relief.
  Treatment. — The  inflammation  may sometimes be cut short by
thrusting a lancet  into the tonsils, and bleeding them freely, and then
steaming  them by the inhalation, by means of an old  teapot, of the
steam of mullein leaves  and hot water.   But the only cure is to be
found by  cutting off  the. tonsils, after the inflammation has subsided.
This will  put an end  to the attacks at once.
  Tonsils which are subject to these periodical attacks of acute inflam-
mation are always more difficult than others to operate upon, as they
are almost invariably bound down very tight to the throat, and cannot
be raised up for convenient excision.

          Chronic  Inflammation of  the Tonsils.

  In many of the fallicular diseases of the throat, these glands are
affected by a chronic  inflammation, and  are found enlarged,  and
sometimes very much hardened.  In such  cases they secrete a thin,
unhealthy,irritating, fluid, which is spread over the throat, increasing
and perpetuating  its  disease.  Much of this secretion, finds its way
into the stomach, and thence into the circulation.
  In the throats  of many young persons and children, these glands
are permanently so large, as nearly to fill the fauces.  The respiration
of many children  thus afflicted, is difficult, and when asleep they can
only breathe with  the mouth open.   The  defective breathing of such
children often occasions contraction  of the  chest, and  thus lays the
foundation for consumption.  From these diseased parts, the  inflam-
mation often spreads upwards, into the  posterior nares, and many
times enters the eustachin  tubes, causing deafness or pain in the ears.
Such children often breathe as though they had a bad cold in the head.
Their health and  safety require an immediate attention to this  state
of things.
  Treatment.— It is customary to attempt to reduce  enlarged tonsils
by astringent gargles, by repeated applications of a solution of nitrate
of silver, and by  other remedies, and  particularly by brushing them
over with the tincture of iodine.  As a general thing, these applica-
tions are useless, ending in disappointment.  As with the elongated 
202                 DISEASES  OF THE THROAT.
uvula, the remedy is found only in excision.  Cut them off.  The
throat seldom  gets well until  they are removed.   The speediness of
the* recovery after the removal is often surprising.

   Improved  Tonsil Instrument. — For the excision of these glands, I
found the same lack of instruments as for making topical applications
to the throat.  The  only one  which had any claims to regard, was
the guillotine instrument.  It had, however, no  facilities  for drawing
the tonsil forward.   Generally, all that could be done with it, was, to
trim the gland, which did little good, for it became again enlarged.
I  have  prepared  an entirely original instrument, with which the extir-
pation of these glands is easy and expeditious.   It has  two cutting
blades in the shape of crescents,               fig. 86.
which,   when  open, leave   a        [Patented January 17, 1854]
proper  space  for drawing  the
tonsil between them.  Two pol-
ished guards which  I formerly
had made of steel, but  now of
German silver, protect the upper
and the under surfaces  of  the
crescentic  blades, and running back, are fastened by the  common
rivet, which holds together the shanks, so that, when open, the  blades
are concealed under the guards.  The tenaculum rests upon the rivet,
as upon  a fulcrum, and, dipping between the blades, takes hold of the
tonsil, and draws it up for excision.   Cutting,,as these  blades do, the
entire circumference of the gland first, and at the  same  instant, and
the central portion last, the operation can never fail.  The entire ton-
sil, even when much hardened, is swept off with a cleanness and ease,
which, at the first trial, surprises the operator not less that the patient.
The pain  of removing these  glands is so trifling, as scarcely to be
thought of; and the pretence that  evil consequences follow  their re-
moval, is the offspring of great ignorance of the whole subject
   To operate easily, take the instrument in the right or left hand, ac-
cording to the side to be  operated upon ;  take the forceps in the other
hand, and running them through the open blades, into the mouth of
the patient, take  firm hold of the tonsil; then  slide the instrument
down over the forceps, and lifting the gland up between the blades,
cut it quickly off.
   I am  aware that a few irregular practitioners, who stand outside
the profession that they may act without responsibility, have declared
that mischievous  results follow this operation upon  the tonsils.  Their
reasons for so  declaring  are manifest.   They have never performed
the operation, and have  not the skill to do it  if they would.  They
expect, too, that those nervous  persons who dread the operation, will,
when told by a physician that  it  is  necessary, strive to  evade it by
seeking  their advice.   Such  practitioners  are shrewd,  but  neither
honest nor wise.  They defeat  their own purpose in the end.  I have
again and again had patients .leave me when this operation was
urged upon  them, and finally  return and submit  to it, after nearly
losing their lives  in the hands of dishonest  quacks.  A few of these
 
DISEASES OF THE THROAT.                203
practitioners  have taken the  same course in regard to the use of ni-
trate of silver, and for similar reasons.
  Curability of Tliroat Diseases. — I have dwelt somewhat  upon  the
preceding forms  of throat disease, not so much  because they have
been a speciality  with me for the last ten years, as because they pre-
vail to a fearful  extent, and  are, in thousands of cases, but the first
stages of fatal disease of the lungs.
  If not connected with lung disease in the beginning, my experience
in treating them enables me to say,  emphatically, they are generally
curable.
  But patients often put the question to me, — " If cured, will I ever
have the complaint again ? "   My answer is, — " Unless I can  plant
in your constitution a better  protection than your Maker put there at
your  creation, ytiu will of course be  liable to a second attack."   But
then,  where the  lungs have  been entirely free from disease, I have
never yet seen a case of simple throat complaint relapse and become
dangerous after proper  treatment with the syringes.   Let not those,
therefore, who have  been benefited, but not.entirely  cured by this
treatment, undervalue what  has been done for them.   Even in such
cases, the advantage  derived to them amounts to just the value they
attach to — the continuance of life.
  Dangers of Delay. — In  closing these  remarks, let  me  warn  the
reader against the dangers of delay.  Many of those who finally seek
my services  in these complaints, first  try all nostrums, and tamper
with  their disease till  the case is either critical  or hopeless.   Too
many wait till they are near enough to the engulfing whirlpool to
hear  it roar, before  they seek in any practicable  way  to escape its
dangers.
   Scarce a day passes but cases come into my hands  which at first
were  only a slight inflammation of the pharynx, and might have been
cured in a few days, but which, from  long neglect, has gradually crept
down the windpipe, spread over the widely distributed mucous lining
of the bronchial  tubes, and thus become curable only in a partial de-
gree,  and after long and tedious treatment.   Hundreds of persons in
this  city, and thousands  in  New England, are now suffering from
slight attacks of this sort, who might be rid of the affliction in a week
or a fortnight, but who will  either carelessly give  it no attention at
all, or resort to useless nostrums, until it has run through its primary
stages and invaded the constitution, and will finally die of some of
the forms of  pulmonary disease.

                        Cases Treated.

   In  July, 1852, Professor  ---- of W----,  Mass., a  distinguished
teacher and  composer  of  music,  called  on me to obtain relief from
laryngitis and tracheitis, from both of which he was suffering, in con-
nection with bronchial and pulmonary irritation.  A year previous to
this  his health had suffered  a  general break-down from these com-
plaints.  He had soreness in the larynx and trachea; a severe cough 
204                 DISEASES OF THE THROAT.
 and large  expectoration; he had  hoarseness, with inability  to  sing;
 night  sweats;  emaciation; general debility and  lowness of spirits;
 in short, the whole catalogue of symptoms which  indicate impending
.bronchial consumption.  By advice of physicians and friends, he went
 to Europe and travelled extensively.  Finding no  relief, he pushed on
 to  Africa.   On reaching Cairo, his  disease showed the first abate-
 ment.   Remaining here a few weeks, he found himself, as he thought,
 about  well.  But on reaching Europe, upon his way home, his cough,
 with all his other bad symptoms,  returned, and  after a year's weary
 search  for health,* he came to the  wharf at Boston in about the same
 condition as when he left.   It was at this moment, that, disheartened,
 and expecting  to  die, he picked up  the Evening  Traveller, the first
 paper  that met his eye, and saw an article on throat diseases, which
 brought him to my office.   Fortunately,  before his  departure for
 Europe, Mr.----had bought a farm in W----.   I gave him an in-
 strument, with the proper medicines to inhale, and directed him to
 work every day on his farm, to *be extent of his physical ability, and
 to  come to  me three times a  ^eek to have  the larynx and windpipe
 showered with a solution of nitrate of silver.  These directions, with
 others relating  to his general  health,  he followed to the letter.   It is
 enough to  say, that  all his bad symptoms  gradually subsided, and
 upon the approach of the following winter he found himself nearly
 recovered.    In  accordance  with my advice, however, he abstained
 from professional labor until the  following spring, since  which time
 he  has pursued his calling diligently.

   In 1853, Mr.----, a merchant  of this  city, came to me with two
 enormously  enlarged and hardened tonsils, with which  he had been
 afflicted for a long time.   One of the glands had been operated on five
 times, the  other eleven times, by  one of our best  surgeons.  But the
 old guillotine instrument used was not large 'enough to permit either
 gland  to be drawn into it, and only small pieces could be shaved off.
 The consequence was, that they were made no smaller  by the opera-
 tions ;  and  being  often cut, they were hardened by it, and had taken
 a very obstinate form of disease, so much so, that  the patient, though
 naturally a strong man, was seriously threatened with pulmonary dis-
 ease.   He had travelled much during the preceding summer, but was
 in no way improved by it.  I had a large instrument made expressly
 for the purpose, through which the glands could b« easily drawn, and
 cut them  both through the centre, or root, removing one  half.  A
 solution of nitrate of silver, fifty grains to the ounce, was applied to
 the throat three times a week, for  about a month, at the end  of which
 time,  the patient was  dismissed  well, and  has remained so to the
 present time.

   In February, 1852, another  merchant of this  city,  Mr. J. A----,
 came  under treatment for a  well-marked case of follicular  disease,
 with nasal catarrh and bronchitis.   Indeed, the  lungs  were on  the
 point of becoming a prey, as a fine rattle was plainly distinguishable
 at the top on both sides, and blood was raised at various times. 
DISEASES OF THE THROAT.                 205
  The uvula first being excised, the wrhole throat  and nasal cavities
were  showered from  two to three times a  week, for two or three
months, every bathing  bringing away, during the first part of the
treatment, enormous  quantities of tenacious, ropy mucus.   To this
treatment, with inhalation, and constitutional remedies, the disease
yielded slowly but surely, and Mr.  A. has a good prospect of pursuing
his profession in comfort to old age.

  In  February, 1857, I was inquired of respecting the prudence  of
undertaking to get a young man to Boston from one of the northern
towns of New Hampshire, who was supposed  to  be  rapidly sinking
in consumption.  After hearing the case described, I  decided it to be
a safe undertaking.  Though  feeble,  he came safely in two days.
He had  the most  incessant, tearing,  and destructive cough, I ever
heard.  The moment I heard its peculiar  sound,  I suspected the
source of the trouble ; and, seating him in a chair, I opened his
mouth, and  found the uvula enlarged to a size,  and stretched down to
a length, which I had never witnessed before.  It was lying down
upon the tongue, as  in cut 85, which is  a good representation" of it.
Without giving him any notice, I  took the  forceps and scissors, and
cut it off, the  whole of it.   I told him to go to his  hotel, and come
to me the next morning.  He  entered  my office the next day, cheer-
ful and laughing, saying he  had not coughed any all night, and had
slept  well, — a thing he had not  done for several months.   In two
weeks, he could  walk three miles, and I sent him home well.  But
for the operation, he would have died within six weeks.
  I would be glad to add a great number of cases to the above ; but
these are all for which I have room.


                     A Cold.—Influenza.

  A slight attack  of the disease  about to be described, affecting only
here  and  there a person, and  lasting  only  for a few days, is called
a cold.  When it affects a large part of the  community at the same
time, lasting many days, or even  weeks, it is then an epidemic, and
passes under the name of influenza.  In this latter form, it sometimes
spreads over a whole country, and has at times, as in 1832, extended
to nearly the whole civilized world.  It often shows marked severity
in its progress, and leaves serious  results behind.

  Symptoms.— A tingling, with   dryness, and a sense of fulness in
the mucous membrane of the nose, are among the first indications of
an attack of this complaint.  Sneezing is a common symptom.  Soon,
pain is felt in the forehead, and breathing through the nose becomes
difficult.  The eyes are red  and watery, the  throat is sore ;  there is a
dry cough, hoarseness, thirst, general lassitude, chills, and a desire to
get near the fire.  The mucous membrane of  the nose, throat, wind-
pipe, and breathing  tubes,  is  inflamed, red, swollen, and sometimes
painful.
  In  a short time, water begins to run from the nose and  eyes, and 
206                 DISEASES OF JHE THROAT.
the cough becomes a  little more moist.   There is also a slight dis-
charge from the throat and tubes, which. gradually increases, and, at
length, as the disease declines, and becomes less acute, the expectora-
tion is thick and yellow.
   Aching of the back and limbs, thirst, loss of appetite, flashes of
heat, and chills whenever the patient is exposed  to  air a little cooler
than he  is accustomed to, are almost constant attendants  upon the
disease.
   Causes. — It is not always easy to say what the causes of this com-
plaint are.   Frequently, it can be traced to an improper exposure to
cold or dampness ; but in a great majority of cases, especially when
it takes  the form of influenza, the causes are not obvious.  They
probably exist  in some peculiar states of the atmosphere, and in  a
depression of  the nervous system.
   The influence upon disease of the different degrees of density in
the air which  surrounds us,-and of other circumstances affecting it,
have not been much studied.   Some valuable facts will be drawn
from this source before many years.  The putting upon the body, or
taking from it, several tons of pressure every time the barometer rises
or falls, must have, of itself, no small influence upon its health.  The
comparatively new science of Physical  Geography, by spreading be-
fore us its interesting  facts in regard to temperature, storms, atmos-
pheric currents, etc., is opening the way for the physician to learn a
great deal more about the causes of disease than he now knows.

   Treatment. — In mild  cases, only the most simple treatment is re-
quired, — such as remaining in the house for a few days, soaking the
feet in warm  water, taking a gentle sweat, drinking warm infusions
of  flax-seed, mullein, slippery  elm,  or  warm lemonade,  and taking
only a spare vegetable diet.  If the bowels be costive, some gentle
physic (34) (41) may be used.  A laxative  drink  (132) will likewise
be useful.
   When the  attack is more severe, sweating must be induced by de-
cisive  measures.  This may be effected by the spirit vapor bath, or
by putting the patient in bed, putting bottles of hot water to the feet
and sides, and administering warm  drinks, and the compound tinc-
ture of Virginia snake root.   Five drops every hour of the tincture
of veratrum viride, will  often  cause very free perspiration, and will
reduce the inflammation upon the mucous surface.
   An  emetic  is sometimes very useful.   To produce vomiting, use
Jhe powder of ipecac, ten to twenty grains, or the compound tincture
of lobelia.
   It soothes the inflamed  mucous  surfaces very much to inhale the
vapor  from half a pint of  hot water, with five drops of tincture of
veratrum viride, or the same amount of the tincture of aconite root.
   If the cough is severe, use  the  preparations recommended under
bronchitis and consumption.
   In  the latter stages of the disease, if there  be  debility, — as there
generally is, — quinia, iron, nux vomica, etc. (75), should be taken ; or,
to support the nervous system, the extracts of scullcap, and boneset, 
DISEASES OF THE THROAT.                207
and the sulphate of quinia (81) will be found useful.  At this stage
of the complaint, the diet should be more liberal and nourishing.
  The patient should riot venture into the open air, until the unpleas-
ant sense of chilliness, peculiar to the disease, ceases to be produced
by exposure.

         Acute Inflammation of the  Epiglottis.

  This is the disease by which our country lost  its most loved and
distinguished citizen, George Washington.  This complaint was not
understood at the time of his death, —the intelligent physicians who
attended him, supposing it to be inflammation of the windpipe.  From
their very clear description of the symptoms, we now know it to have
been an acute inflammation of the epiglottis and glottis.
  From the rapid inflammation of the epiglottis, water is effused into
this cartilage, so as to puff  it up, and prevent it from shutting down
in the act of swallowing.  The lips of the glottis are swollen from the
same  cause, and brought so near to each other that air passes through
to the lungs with great  difficulty, and unless  relief is soon obtained,
the patient is strangled.

  Symptoms. — The disease  begins with a severe chill, accompanied
with  some pain, and a  sense of stricture  or  tightness  in the  upper
and fore  part of the throat.   There is cough,  with difficult and some-
times painful  swallowing.   These symptoms are  soon  followed  by
quick and laborious breathing.  Speaking aloud is from the first diffi-
cult, and soon  becomes impossible.  As the complaint runs its  rapid
course, the breathing grows more difficult,  and  death  soon results
from complete strangulation.                        .

  Treatment. — Apply immediately to the parts,  a strong solution of
nitrate of silver.  The solution should  be of the strength of ninety
to one hundred  and twenty grains to the ounce of soft water.   It
should be applied every hour or two till the feeling of suffocation sub-
sides, and should be done with the laryngeal  shower syringe, though
if this is not at hand, the sponge probang may be used.
  While this local treatment is being employed, liberal doses, from
five to twenty drops of tincture of veratrum viride should be given
every hour, watching the effect, and discontinuing when the  pulse
sinks  too low.
  Hot fomentations applied  externally, and filling the room with
steam, as recommended in cases of croup, would be useful.

                      Mumps.—Parotitis.

  This  disease  appears most often among children; but as it is not
confined to them, I  have not placed it among their complaints.

  Symptoms.— It begins with soreness and stiffness in the side of the
neck.   Soon a swelling of the parotid gland takes place, which  is
painful,  and continues  to increase for four or five days, sometimes 
208                 DISEASES OF THE THROAT.
 becoming very large, and making it difficult to swallow, or open the
 mouth to receive  food.   After the fourth or fifth day  the swelling
 subsides, and disappears in from seven to ten days.
  Both glands generally swell about the same time, but sometimes
 the swelling appears in  one only after it has subsided in  the other,
 and occasionally the swelling is wholly confined to one side.
  When the swelling is great, there is heat, and sometimes fever, with
 dry skin, quick pulse, furred tongue, constipated bowels, and scanty
 and high-colored urine.
  The affection is sometimes translated, as we say; that  is, in fe-
 males, the breasts swell, and in males, the testicles become swollen
 and painful.  This accident generally happens in consequence  of tak-
ing cold from some imprudence.
  The disease  is contagious;  that is, it  is communicated  from one
person to another.
  Treatment. — In mild cases, very little treatment  is required.   Keep-
ing the face and  neck warm, avoiding exposure to cold and damp,
drinking warm infusions  of balm, spearmint, or sage, and taking oc-
casionally, if there be some severity of symptoms, four to six grains
of Dover's  powder; or  the compound powder of jalap, if there be
eostiveness, is  about all  that is required.   The diet should consist of
rye hasty pudding, or brown bread and sweetened water.
  If the case be severe, and other glands  swell, physic must be freely
used,  leeches  must  be   applied,  and  cooling  lotions,  or  poultices.
 Sweating must also be  induced by  the  compound  tincture of Ver-
ginia snake root, or by a  vapor bath. 
DISEASES  OF  THE  CHEST.
                  Consumption.—Phthisis.

   At the head of the diseases of our climate stands Consumption,—
at their head both as it respects prevalence and  fatality.   Small pox,
yellow fever, and cholera, are terrible in their visitations; but what
are all their aggregated slaughters compared with the ceaseless, silent
march of this fell disease, which steals away in their fresh prime the
brightest and the best ?
   Boston, from its population of 160,000, loses by consumption about
fifteen per week, sixty-five  per month, or  about seven hundred  and
eighty per annum.   An  equal mortality from any disease not often
among us, would send our citizens in terror to the country, and cause
the stoutest hearts to feel that " in the midst of life we are in death."
Massachusetts loses  about 6000 per annum;  New England, not  less
than 20,000 ;  and with the  State of New York added, the victims of
this single disease swell to 40,000 a year!   What an army !   Picked
from  the choicest!   All sundered  from life  untimely,  and  leaving
more  blight and sorrow behind than would perhaps twice or thrice
the number wThom any  other pestilence would  have selected.  The
magnitude of the evil places the question of the  remedy before all
others that pertain to the healing art.

   Methods of Examining the Chest. — Before speaking further of con-
sumption, I  propose to do  what has never  been done, namely, to
instruct the general reader, very briefly, in the method of examining
the chest to learn the existence of  disease.   Perhaps this will  be con-
sidered a departure, in some slight degree, from my purpose  to make
this entire book intelligible to the general reader.   If so, my reply is,
that there are many school  teachers, mechanics, masters  of vessels,
and farmers, who have inquiring minds, and sagacity enough to learn
the physical signs of chest disease, and to make them, in many cases,
practically useful; and that even readers of  little reflection cannot
fail to comprehend a portion of my explanations.

  Position of the Patient. — In performing percussion upon the front
of the chest, the patient should be required to  sit in a square position,
with the arms hooked over the corners of the  back of the chair, and
the head thrown a little back.
                                 27 
210
DISEASES OF THE CHEST.
  Instrument with which to Thump. — The index and middle fingers
of the right hand are to be brought together, into a line, and used as
the percussing instrument.  The blow given with these is tp be smart
and quick, rather than heavy.

  Medium to Thump Upon. — Either  the index or  middle finger of
the left hand is to be pressed firmly upon the surface of the chest to
be percussed or struck, and thus used as a pleximiter.

  Auscultation. — Listening for the  purpose of hearing within the
chest the sounds produced by breathing, talking, coughing, etc., is
called auscultation.

  Instruments with which to Listen. — The  naked  ear is  generally
considered  best  for hearing low and delicate sounds ; but for hearing
loud  and rough ones, it  is not so good as the  stethoscope,  repre-
sented by Fig. 8T.  A still better instrument is the  double-eared steth-
oscope, Fig. 88.   It magnifies the sounds  very  much, and  is apt to
confuse an examiner not accustomed  to it; but when the ear is once
familiar with it,  the aid it affords is very valuable.
Fi». 87.
Fig. 88.
A  - I
   The examiner should pass from side to side, continually comparing
the sounds upon one side, with those upon the other.
   The patient must be calm, and the examiner in no hurry.

   Healthy  Sounds.— To become skilful  either in percussion  or aus-
cultation, the examiner's ear must first be trained to healthy  sounds.
   These are best heard in  the. child, in whom they are louder  than in
the adult.
   In  describing the healthy sounds in  the  different regions of the
chest, 1 shall refer the reader constantly to Figs. 89 and 90.

   Clavicular Region. —This, in Fig. 89, is represented by 1,1.   Upon
thumping upon the collar-bones, the sound given out at the  breast-
bone  end should  be very clear; less clear in the middle ;  and dull at
the shoulder end. 
DISEASES OF THE CHEST.                  211
  Subclavian Region. — This is represented by 2, 2, and lies between
the collar-bone and the fourth  rib, on both sides.   It covers a consid-
erable portion of the upper lobe of the lungs.   The sound upon strik-
ing this space should be very clear.
Fig. 89.                            Fig. 90
  The Mammary Region, represented by 3, 3, extends from the fourth
to the seventh rib, on each side.  In the upper part of this region, the
healthy  sound  is  clear; but  at  the bottom  of  it, on  the right, the
sound is deadened by the liver; on the left, by the heart.
  The Infra-Mammary Region, 4, 4, lies between the seventh  rib and
the edge of the cartilages of the false  ribs.   On  the right side, the
liver makes the sound dull; but under the left side  lies  the stomach,
which is hollow, and the sound is generally quite loud.     ,

  In the Sternal Region, 5, 6, 7, which covers  the breast-bone, the
sound is generally clear.
  The Axillary Region, 8, 8, is in the arm-pits.   In this the "sound
should be clear.
  The Lateral Region,  9, 9, is immediately  below the above, and
yields, likewise,  a clear sound.
  The Lower Lateral Region, gives a dull sound on the right side, and
on the left a very hollow one.
  Fig. 90 represents the back  part of the  chest.   In looking at this,
we see the
  Acromial Region, represented by 11, 11.   In this  space the sound
is dull, but.it has not much meaning.
  The  Scapular  Region, 12,12, covers the part occupied by the shoul-
der-blades.  It gives rather a dead sound. 
212                 DISEASES OF THE CHEST.
  The Intra-Scapular Region, 13,13, lies between the shoulder-blades,
on each side of the back bone.  If the patient's arms are crossed, and
the head bent forward, a clear sound will be obtained.
  The Dorsal Region, 14, 14, covers ihe base  of the lungs, and,  in
health, gives a clear sound.
  Observation. — If, now, on thumping upon the chest, we find a dull,
dead sound in any spot where a clear one ought to be yielded, we are
to conclude that underneath there is not the usual quantity of air;
but we cannot tell merely by percussing, whether tubercles are depos-
ited there, or thfe lung has become solid by inflammation, or water
has been poured out into the cavity of the pleura.  This point must
be determined  by auscultation, etc., to be explained gradually as we
go along.
  Auscultation  of Breathing. — On applying the ear or  the stetho-
scope to the chest, two sounds are heard which  immediately succeed
each other, — the louder is produced by the ingoing  breath, or inspira-
tion ; the weaker by the outgoing breath, or expiration.  These sounds
will be further explained as we go along.
  Auscultation  of the Voice and Cough.—The chest of a healthy per-
son speaking, communicates  to  the ear  no  distinct sound, but only
a vibratory sensation, called,  in  technical language, the pectoral fre-
mitus.
   Over the larynx and windpipe, the examiner may hear natural pec-
toriloquy; between  the shoulder blades, in the space corresponding to
the roots of the lungs, natural bronchophony.
  Philosophy of Chest Sounds. — The fulness and clearness of sound
upon percussion, depends upon  the amount of air in the chest.
   The sounds  called breathing murmurs, are caused by the expansion
and contraction of  the air-cells  or vesicles, as the  air passes in and
out; hence they are called vesicular murmurs.
   The friction  of the air against the sides of the windpipe and large
bronchial'tubes, causes the blowing sound heard in  those parts.
   In children a larger amount of air enters the lungs, and the air vesi-
cles are expanded with more force; hence their breathing has a louder
sound, which is called puerile  respiration.   This kind  of breathing,
heard in the grown person, is a sign of disease.
   The lung  tissue  is a bad conductor of sound ; and the voice is ac-
cordingly heard only over those  parts where large bronchial tubes are
near the surface ; heard elsewhere, it indicates disease.
   Division of Consumption. — Consumption may be divided into two
kinds, the tubercular and the bronchial.  The former has a constitu-
tional, the latter a local origin.

        First Stage of Tubercular Consumption.

   Physical Signs. — Dulness of  sound on and under the collar-bones.
   Inspiration shortened; expiration augmented both in duration and
intensity. 
DISEASES OF THE CHEST.                 213
   Occasionally a pulmonary, crumpling sound.  Dry, crackling rat*
ties.
   The resounding of the voice increased at the top of the lungs.
   General Symptoms. — A sense of weariness and languor.
   Occasionally, slight, flying pains about the chest and shoulders.
   A peculiar sensitiveness to the effects of cold.
   Breathlessness  on moving quick, or ascending a hill or stairs.
   In  many cases a blue  lividity of the lips, and roots of the finger
nails, and coldness of the hands and feet.
   Occasionally, in females, even at this early stage, a cessation of the
monthly turns.

   Observations. — The formation  of tubercles  almost always begins
at the top of the  lungs.  Laennec and  others thought they appeared
oftenest  on the right side first; Louis, Andral Watson,  Sir James
Clarke, and others, believed they appeared more often on the left side.
Recent investigations show that they were all mistaken.  Tubercles
appear first about as often upon one side as upon the other.
   The pulmonary crumpling sound is caused  by a mechanical ob-
struction to the  expansion of the lungs.  It is generally heard only
during the  drawing in of the breath.   The sound is like that pro-
duced by blowing upon very fine paper.


                        Second Stage.

   Physical Signs. — Marked dulness of sound on the collar bones, and
extending below them.
   Inspiratory  murmur diminished  in duration  and intensity; expira-
tory murmur augmented in both.
   In upper lobes  of  lungs, moist, crackling rattles, succeeded by mu-
cous rattles.   Also bronchial respiration.
   In lower lobes  of lungs, puerile  respiration.
   Sounds of the  heart heard  under the collar bones.
   Bronchophony  heard in the same parts as bronchial respiration.
   General  Symptoms. — A quickened  pulse;  slight  fever  towards
evening.
   Great susceptibility to the  effects of cold, and  liability to take cold
easily.
   Bowels generally costive.
   The eye has a  peculiar  whiteness and lustre.
   The skin and  mouth become dry in  the afternoon ; chills occur
about midday, followed by fever, during which the cheeks are flushed.
   As the second stage  advances  to its close, a dry, burning heat
afflicts the palms  of  the hands and soles of the feet.
   Night-sweats occur at this  time.

   Observations. — A hollow,  elastic body, containing air, gives, when
struck, a clear sound.  The dulness of sound on percussing the chest,
arises from  the absence of air in the air-cells, — these having been
pressed together, or obliterated by the deposit of a mass of tubercles. 
214
DISEASES OF THE CHEST.
The destruction of these cells causes the cessation of the respiratory
murmur.
  This stage of the disease is often accompanied by an inflammation
of the mucous membrane lining the air tubes.   The air, pushing its
way through the mucous secretions in these tubes, forms bubbles, the
bursting of which causes the rattle.  The crepitant rattle is produced
by inflammation around the tubercles.   The moist, crackling rattle is
caused by the softening of the tubercles.
  The lungs, rendered more solid by the deposit of tubercles, become
better conductors of  sound ; and this causes  the  beating of the heart
to be  heard as far off as under the collar bones.
  Bronchial  respiration gives  the idea  of air blown through a tube ;
cavernous respiration, of air passing into a large enclosed cavity.

                         Third  Stage.
  Physical Signs. — In this stage  cavities are formed.  If the cavities
be  small, and considerable tuberculated lung surrounds  them, the
sound, upon percussion, is still dull.
  If the cavity be large, and near the surface, there is occasionally a
tympanitic sound.
  Sometimes a sound is heard like striking a cracked pot.
  Gurgling;  cavernous rattle;  cavernous breathing;  amphoric breath-
ing ; now and then, metalic tinkling; pectoriloquy ; cavernous cough.
  General Symptoms. — Great loss of flesh, and weakness ; diarrhoea
and night-sweats; swelling of the  feet and legs; sore mouth; and rais-
ing of matter with specks of tubercle in it like crumbs of cheese.
  Observations.— The gurgling  rattle  is  caused by air  displacing
liquids, and the formation and bursting  of bubbles.  It resembles the
sound produced by blowing through  a tube immersed in soap-suds.
  Cavernous breathing is nothing more nor less than the sound pro-
duced by air, breathed in and out, entering and retiring from a cavity.
The air appears, sometimes, to one listening with the stethoscope, as
if it were  sucked  into his ear during  inspiration, and blown  back
again during expiration.
  Amphoric  respiration is  simply  an augmentation  of  cavernous
breathing,  and results, of course,  from an  increase of size in the
cavity.
  In pectoriloquy, words uttered by the  patient, seem to pass through
the stethoscope, into the ear of the listener.  The  cavity should be
empty, moderate in size, and have dense walls, in order  to  furnish
the best specimen of this sound.
  Air suddenly driven backward through the windpipe, and out of the
mouth and nose, by smart- raps upon  the chest  over a cavity, gives
the sound of the cracked  pot.   It is best  heard when the patient's
mouth is  partly open.   The same sound is  produced, on  the same
principle,  by locking the fingers  of the two hands, and joining the
palms, so  as  to leave a small space or cavity between them, and then
expelling the air from  that cavity, by gently striking the back of one
hand  upon the knee. 
DISEASES OF THE CHEST.                  215
  Causes of Consumption. — The human constitution as shown  by
Liebig, in his  profound work on  Animal  Chemistry, is governed  by
two  forces, the nervous and the vegetative.  The former disposes the
particles composing the body to a state of motion ; the latter inclines
them to a position of rest.
  In vegetative life there is motion in one direction only, so to speak;
that  is, motion which tends  to the opposite of motion, namely, rest.
In vegetables, whose life is wholly under this power, there is no waste;
for here, all ultimate particles,  having once taken  a place  of rest,
remain undiiturbed.   In a tree, a  layer  of matter  once deposited,
always remains.   Hence there is growth as long as the tree lives.
There  is no power to break up and destroy.
  But  in  the  animal body there is motion in  two  directions, or a
circuit  of  motion.  Particles which under the vegetative force  have
been put to rest, are perpetually being displaced by the nervous energy,
and  reduced  to  unorganized amorphous compounds, to be burned in
warming the system,  or cast out  by the several excretory processes.
  So constant is the action of  these two forces, that John Hunter
compared the  human system to a whirlpool, into which the particles
of matter are  perpetually poured, under  the influence of the vegeta-
tive power, and out of which they are  as constantly  whirled  by the
nervous force.
  By a little  reflection upon these  antagonisms, the  reader will see
that  it is  just when  the vegetative force transcends the nervous, that
the body increases in weight,  and acquires that  state in which the
blood corpuscles  abound, and  the tendency, if to disease at all, is to
that of the inflammatory kind.   It is the  tonic condition of  the sys-
tem.   Nutrition  is  more rapid than destruction.   New  particles are
laid down faster than old .ones  are taken up.  The body grows.
  On the other hand, when the nervous force overmasters the vegeta-
tive, when the outward or centrifugal motion of the whirlpool prevails,
then it is  that the  body is attenuated, the blood thinned and made
serous, and the consumptive or atonic condition is established.  Now,
there is too much motion.  The  nutritive particles, instead of tending
to a state of deposit for the re-suppiy of waste matter, become  fugi-
tive  in their  habits,  perpetually fleeing, like convicts escaped  from
prison.  Introduce this power, in excess, into the vegetable kingdom,
and the matter deposited upon the tree, instead of remaining to swell
its bulk, would be driven off by  the nervous force ; and  the  tree, in-
stead of growing, would be annually lessened,  become sickly, and die
of consumption.
  In Tubercular  Consumption, the system is like a field deluged with
a flood ; nothing  can.  take root.   The repeated shocks of the nervous
battery sent to the absorbents so quicken them  in  their work of  re-
moving waste matter, that they dislodge much which is not yet worn
out, and assist in casting out of the system not a little designed to be
used in its renewal.   A healthy deposit is thus prevented, and nutri-
tion  is at an  end.   The  nutritive arteries, those little builders of the
human frame, are  overmastered by the stimulated lymphatics ; the
constructive material is  wrested from  them, and borne beyond  their 
216                 DISEASES OF THE CHEST.
   reach, and the body wastes from want of nourishment.  The blood
   becomes thin  and watery; and from the increased serous portion,
   chiefly albumen, are  depoited upon the lungs  and other tissues the
   albuminous tumors called tubercles.
     Here is found the cause of that  peculiar smallness of bone  and
   muscle, and thinness and tallness of  person, so peculiar to consump-
   tives.   The  absorbents, under the  power of a very active nervous
   system, take down " the  house we live in" faster than the nutritive
   arteries, confused  by the  motion around  them, can effect its recon-
   struction.   It  is  simply  an unbalancing  of the antagonistic forces,
   which build and pull down our earthly tenement.   The men that de-
   molish are more numerous and better fed than the artisan builders.
     It is  this  destructively  nervous force which  gives to consumptive
   persons their proverbial mental activity;  which causes them often to
I   dazzle the world with the splendor of their gifts, and  to bless  their
   friends  with the  warmth of their affections.   They are usually the
   choice spirits, the idols of  their relatives, and the favorites of the com-
   munity in which they live.  Their mental movements,  and  the exer-
   cise of  their affections, are characterized  by brilliancy and warmth.
   Of all persons, they are best fitted to enjoy life, and to impart happi-
   ness.   Loving all, they are by all loved  in return.  They  are speci-
   mens of partially etherealized  humanity,  stepping lightly across the
   earth, to whom  friends passionately stretch out their 'arms, and em-
   brace — their shadows!
     These views will appear the more  reasonable, if we consider  that
   in children the  vegetative power is  very active, while the nervous
   energy  is comparatively  weak.  The preponderance  of the former
   over the latter causes the rapid growth of children.   The little arterial
   builders work  faster  than  the  lymphatic demolishers.   This explains
   why so few children die of consumption.
     But from the age of seventeen to  thirty-five, when the vegetative
   power is losing something of its extraordinary activity, and the nerv-
   ous  force is showing its highest capabilities, — then it is,  as  this
   theory indicates, that tubercular consumption does its dreadful work,
   — then, that the outward whirl of this physiological Maelstrom casts
   upon the shores of mortality so many thinned, exhausted, and lifeless
   human forms.   More than three fourths of all who sink under this
   disorder die between the ages just named.   The brain, between  these
   points of time, acquires its full size and force.
      This disease prevails most, too, in those countries where an enlight-
   ened civilization gives to  the nervous system its fullest development,
   as  in  Great Britain,  France,  and  the United States, and in  those
   where the nutritive process is  most retarded  by a relaxing climate;
   and it is carcely known  among those people who are but little en-
   lightened and have small brains, and among those who live in high
   and invigorating latitudes.  As the  most  enlightened, however, are
   generally found in temperate climates, and those  with the least culti-
   vated brains in low latitudes, the  rule is not perfectly explained by
   facts; yet it shows  itself sufficiently to establish its validity, and to
   afford another proof of my theory. 
DISEASES OF THE CHEST.                 217
                  Bronchial Consumption.

   The persons exposed to bronchial consumption are generally of an
opposite habit to those described above, — having the nervous force,
in health, well  subordinated to the vegetative, the assimilation good,
and the  blood  well supplied with red globules.   They have usually a
full habit and an active circulation.  The absorbents, and other ves-
sels in the lungs, working in the midst of a large amount of  caloric
evolved by an energetic respiration, often take cold, which  brings on
lung fever and  pleurisy, and these lay the foundation for the ultimate
destruction of the lungs.   For the  same reason, the skin of this class
of persons becomes diseased, and more often the  inner skin, or mu-
cous membrane, and most often that portion of mucous  membrane
which goes down int» the  lungs and lines the air tubes.  It is inflam-
mation of this  which constitutes bronchitis, and which lays the foun-
dation for true  bronchial consumption.
   As that class of persons who are exposed to the tubercular form of
the disease suffer a general loss of carburetted hydrogen in its several
forms, colliquative diarrhoea, sweats, increased breathing, and all con-
ditions that  carry fat out of the system, so those who suffer from
attacks  of the  bronchial type  of the disorder are generally afflicted
with the opposite condition.   They have  too much carbon.
   It is well  ascertained that carburetted hydrogen, accumulated in
the system, acts as a poison.  And that class of  bilious  persons who
are subject to this disease often have their excretions badly performed.
For this  reason, carbonaceous  compounds accumulate in the system,
and give rise to the symptoms of morbid  poison circulating  in the
blood.   This led Dr. Madden to suspect  the presence of such  poison
in the blood of all consumptive  persons.  He saw the evidence of it
in numerous cases,  and  not distinguishing the one class from the
other, he inferred its presence in all.

                 Constitutional  Difference.

   The constitutional difference between the two forms of consump-
tion appears to be this: the tubercular type is usually attended, in its
origin, by a tolerably good state of the digestive functioti, in connec-
tion with bad  assimilation; while  the  bronchial  form generally has
its  foundation  laid  in connection  with  bad  digestion, accompanied
with healthful  assimilation.  In  the  former case, the food is well di-
gested, the pabulum is properly prepared, but the nutritive  arteries do
not use it for renewing the tissues.   In the latter case, the digestion
is bad, the pabulum poorly elaborated; but the re-constructive vessels,
under the control of a well-developed system of  organic nerves, use
it to the  best advantage.   In the one case  there are  good brick-makers,
and lazy brick-layers; in the other, the reverse.
  It happens, however, that  before the fatal  close of the disease, tu-
bercular  patients  usually  become  afflicted, more  or less,  with bad
digestion, and bronchial patients with defective assimilation ; so that, 
218
DISEASES OF THE CHEST.
in the end, they present us with much  the  same class of symptoms.
Starting from  opposite poles in life's  celestial sphere, they meet at
the culminating point of death, and disappear under identical aspects
of the heavens.

    Exciting Causes  of Tubercular Consumption.

   The preponderance of the nervous  force being the state which pre-
disposes to disease, whatever unduly excites the nervous  energy in-
vites an attack.
   These causes relate, mostly, to the prolonged exercise of the intellect,
the passions, and the sentiments.
   Few  are aware  of the mischief done by excessive  stimulation of
the mind  during the most active period of life, — especially if the
muscular system  be left half developed.   Here is where  ambitious
students commit great errors.
   The constant plying of the mental powers, in the present modes of
educating  children, leads to a dreadful • abridgment of human life.
Better to train the bodily powers first, and let the mental culture
come in later time.  lie who would build a lasting structure  must
lay a solid foundation.
   The age in which we live abounds in the causes of excitement.   The
world is trembling with excess of mental life.  The. pine trees burned
by the steam  engine  are scarcely more numerous than the human
constitutions consumed by the train of  thought it has set on fire.
   Nor are  the passions and sentiments  less  exercised, or less destruc-
tive.
   Briefly, the  causes of consumption embrace all those things which
bring a destructive  force against the digestive and assimilative  func-
tions, as insufficient and improper food, debaucheries, night-watches,
sedentary  habits, anxiety of mind, etc.; and those which  act injuri-
ously upon the breathing organs,  as impure air, inflammation of the
lungs, pleurisy, measles, hooping cough, etc.; and such as disturb.the
swearing process, as insufficient clothing, sudden changes of temper-
ature, sleeping in  damp sheets, etc.  These exalt the nervous  force,
or  depress the vegetative,  or inflame the mucous lining  of the air
tubes, or the substance  of  the lungs, or the  membranous sack which
encloses them, so  as  to induce one form or other of consumption on
the principles  I have explained.

   Can Consumption be  Cured ? — In  many cases it can.   It may be
cured, first, by the absorption of the tubercles.   The celebrated  John
Hunter shows, in his work on 'the blood, that the absorbent vessels
have a sort of elective affinity, by which they take up and remove " all
adventitious new  matter, as tumors," (tubercles are albuminous tu-
mors,) more easily " than those parts which were originally formed."
Were this not so, an activity in these vessels equal to the removal of
• tubercles, would cause  them  to waste  all the tissues, and  aggravate
rather than  cure   consumption.   Probably this does  occur where
proper  hygienic means are not used to quicken the excretions.  This 
DISEASES OF THE CHKST.                  219
   hygienic  treatment, to be  spoken of hereafter, is not generally em-
   ployed,— certainly not as effectually as it should be.  Here is the
   source of Laennec's fatal remark, so often quoted and so widely en-
   dorsed, that " nature's  efforts towards effecting a cure are injurious,
   and those of art are useless."  Laennec's position cannot be true, if
   Hunter's  statement is  correct.   If the absorbents, by an elective in-
   stinct, take up  adventitious matter  rather than the natural tissues,
   then the reason why they reverse this rule in consumption  is, that by
   a weakened state  of the constitution, the ultimate  particles are not
   well put together, and  are  more  easily taken apart than those of the
   adventitious tubercular tumors ;  and if we would restore these  vessels
   lo their natural activity,  we must improve assimilation, and knit the
   unloving  molecules into  a  firmer brotherhood.  We  must make the
   flesh hard, so that  the  absorbents cannot pick it to pieces.   Do this,
   and "nature's efforts to effect a cure," will not "be injurious."
     A second form of cure  is the  reestablishment of  the assimilative
   function,  the building  up of the general health, the  arresting of the
   tubercular deposit, the  reducing of tubercles already formed  to an in-
   dolent state; and  then, by a strict observance of the  laws of  health,
   keeping them in that condition  through life.
     A third mode of cure is the healing of the cavities after the tuber-
   cles have  softened, broken down, and been expelled in the form of
   expectoration.
     A fourth method of cure  is^a. change of tubercles to calcareous mat-
   ter.   These  calcareous tubercles, Laennec says, "are consequent to
   tuberculous  affections  that have  been cured?"1   And  Andral, at one
   time, hoped to learn how to effect cures by changing tubercles to " the
   calcareous phosphate."
     I  have  had   several  cases  of cure by this  last method, and have
   quite a collection  of calcareous substances which my patients have
   coughed  up, — one of  which was raised in  my presence by a  lady
   who was a  few years before in hopeless consumption, but is now in
   good health.

     Treatment.— This should be of two kinds, local and general.
     The local treatment of consumption is by the inhalation of vapors
   and  powders into the lungs. It has been  practised, more or less, by in-
   dividuals, for many years, particularly in  Europe;  but for some unac-
   countable  reason, the profession  generally have never used it, and do
   not know much about it.   I had the  honor, some years ap:o,  to  bring
   it freshly before the American  public, in some articles written for
   popular reading, since which time it  has  been rapidly gaining  public
   confidence,  and is  now attracting much attention.   Conveying the
»   remedy directly to the diseased  parts, it strikes  the common-sense
   mind as eminently reasonable and necessary.
     I shall speak of inhalation, therefore, very earnestly, not as  a pallia-
  tive  of consumption only, but as far more, as a remedy.   After long
  and  patient use, my experience allows  me to say, that I know it, in
  many cases, to  be  such ;  and knowing this, I should be criminal not
  to press it upon the public; for it is  the  great multitude of sufferers, 
220                 DISEASES OF THE CHEST.
pressing fast through the gate of death, who need to hear words of
hope.

  Consumption a General Disease. — It is not denied that consump-
tion is a general disease,  needing constitutional treatment; but it has
also a local development  in the lungs, first in the form of albuminous
tumors, called tubercles, and then,  after the softening, breaking  down,
and discharge of these, in the more formidable shape of ulcerous cav-
ities, which, beginning at the summit, devour the  lungs down to the
base.   Can  it be reasonable to apply no remedy directly to this local
disease ?   Not so does our profession deal  with other  local diseases.
To an  inflamed skin we  apply poultices, cold compresses, solu-
tions  of acetate of lead, nitrate  of  silver,  etc.;  to leprous or scaly
affections, sulphuret of potash, bichloride of mercury, zinc ointment,
nitrate of mercury  ointment,  sulphur, creosote,  etc.;  to weak  and
inflamed eyes, sulphate of copper, sulphate of zinc, nitrate of silver,
and  opium;  to chronic  ulcers upon the  skin, tannin, pulverized
rhubarb, opium, or  cinchona;  and to an inflamed throat,  nitrate of
silver and other articles.   These  are but specimens of the thousand
cases in which we use local remedies.  Why, then, when the mucous
membrane, which lines the air tubes,  becomes inflamed through all its
branches, should we neglect, by the inhalation of  medicated vapor, to
apply a remedy directly upon the whole  inflamed surface?   Why,
when tubercular matter is beginning  to be deposited upon the surface
of the air cells, and of the small bronchial tubes, should not the vapor
go right to those parts, and cause, as it would, the immediate  expul-
sion of this offending and dangerous matter ?
   Uneducated common  sense  sees the reasonableness of these sug-
gestions at  a glance.  Many  a person, with pulmonary disease,  dies
of suffocation, not  because there  is  not muscular  strength to expel
the matter which is strangling him, but because the lungs below the
large pellets of mucus, which plug up the bronchial tubes, cannot be
inflated, and have  therefore no means of  driving out  the  offending
substance.   Yet a proper medicated vapor, drawn in with the breath,
would either dissolve the mucus, or rouse up the  expiring membrane
to cast it off.
   If the reader were to place  one end of a stethoscope  directly over
the disease upon the breast of a person in the third stage of consump-
tion, and should then ask him  to talk, the words spoken would seem
to rise up through the instrument, and enter, well articulated, into his
ear.   This, in technical  language,  is called pectoriloquy, — a word
signifying chest-talking.   It implies a cavity in  the lung.  If now the
patient be asked to cough, a  gurgling and  splashing sound will be
heard.  This  denotes that the cavity is partly filled with fluid, which
is dashed about by  the air explosively driven through it by the portion
of lung below.  Here we have an excavated ulcer, with all its filthy
contents, composed of pus, mucus,  serum,  and  dissolved  tubercles,
lying in it day and  night to aggravate its unhealthy condition.   What
more reasonable, what more  necessary, than that a soothing,  altera-
tive, or astringent vapor should be drawn into this cavity, to cause its 
DISEASES OF THE CHEST.                 221
 sides to heal, and  its absorbents  to remove this fluid ?   A surgeon
 who  should  permit an ulcer  upon the surface of the body to remain
 in that condition without a local dressing, would be deemed unfit to
 practise his profession.             •
   Both in tubercular disease arid in simple bronchitis, the bronchial
 tubes almost aways suffer some physical change.  The  mucous mem-
 brane lining these  tubes is generally  softened.  At other times the
 tubes become enlarged  through their  whole length, so that many of
 themtfrom the size of a quill, reach the bigness of the finger of a glove.
 In still other cases,  the straining produced by coughing  causes a tube
 to belly out  at  some  point, forming a sack, which is generally filled
 with  mucus  or  purulent matter.  At still other times, a tubercle will
 press against a tube so as to flatten it and  convert it into a musical
 instrument, the  air, as it is drawn laboriously through, producing a
 high  or low note, according to the size of the  pipe.  These  physical
 changes are all produced by causes which the inhalation of a suitable
 vapor, at the proper  time, would almost  infallibly remove.   How
 strange that  this remedy, — so  simple, so effectual, so easily compre-
 hended, — should have been so little used !
   Right  at this vital  point in the lungs, where the blood runs in a
 ceaseless current, — where the whole of it goes every two  minutes to
 renew its  vitality  by contact with  atmospheric  air, — we have, in
 thousands of cases  daily occurring, inflammation with roughening or
 softening of membrane, with its consequent  harsh breathing; we have
 mucus, tough or glairy, to impede  and  interrupt respiration ; we have
 tubercles in the  hard or soft  state, adding to the  general embarrass-
 ment, and  not only lessening the vitality of the blood, but disturbing
 all the sympathies  of the system; — and yet the practice has been,
 and is, to attack these central disturbers  of life only through the cir-
 cuitous path of the stomach, lacteals, etc.
  Since 1849, my undivided attention has  been given to the study
 and application  of this  mode of  treatment.  This is  two years in
 advance of any other physician  in this country.   I have investigated
 faithfully the effects of the various substances proposed  for inhalation
 by European physicians, and  have explored a wide field of new rem-
 edies, not before used, several of which have proved to  have qualities
 of great remedial power.
  Thus much I  have thought it proper to say in behalf of this mode
 of treating consumption, the  most successful yet employed, not be-
 cause it needs defence, but because the great body of the profession
 are ignorant of it, and what is worse, are indifferent.
  The chief remedies I employ for inhalation are the following:

  Alterative Inhalant, composed of iodine, six grains; iodide of potas-
sium, twelve  grains; tincture of ipecac, one ounce; tincture  of  bal-
sam of tolu, six  drams;  ethereal tincture of conium, one and a half
drams; alcohol,  half a pint.   These are to  be mixed.   The dose is
one to two teaspoonfuls, to be inhaled ten or fifteen minutes, in about
a gill  of hot water.
  The ethereal  tincture of conium is made  by keeping a dram of
powdered conium in one ounce of sulphuric ether a week. 
/
222   /            DISEASES OF THE CHEST.
  The above inhalant is used in the tubercular forms of consumption,
particularly that of the scrofulous kind, and in  many cases  of bron-
chitis.
  Expectorant Inhalant. — Take pleurisy root, half an ounce ;  squill,
one ounce; ipecac, two  drams ;  black cohosh, two  ounces ; queen's
root, one ounce and a half;  American hellebore, two  drams ; diluted
alcohol, one pint.  Grind the roots, etc., and add the alcohol.  Let the
whole stand one week, shaking or stirring daily.   Draw off and filter
through paper.  Two teaspoonfuls make a dose, to be inhaled same
as preceding.
  This is to be used when the cough is hard and dry, and the expec-
toration difficult.  It  makes the  raising  easy, lessening  the  soreness
of the chest, and the harshness of the cough.
  Soothing, Febrifuge Inhalant. — Take  belladonna  leaves,  half  an
ounce ; black cohosh, two ounces; American hellebore, half an ounce ;
poke root, two drams ; aconite root, one  ounce ; diluted alcohol, one
pint.  Grind the roots, etc.; add the alcohol.  Let  the  whole  stand
one week, stirring daily.   Pour off, and filter through paper.  Dose,
one to two teaspoonfuls, to be inhaled as the preceding.
  This is excellent in all  cases where  the  skin is hot, the pulse  quick,
the tongue and mouth parched, the chest sore, and the system suffer-
ing during the whole  or a part of each  day, from a general feverish
condition.  It is proper in all the forms of chest disease.
  Astringent Inhalant. — Take of wild indigo, one  ounce;  catechu,
half an ounce ;  Peruvian bark, one ounce ; golden seal, one ounce;
diluted  alcohol, one pint.   Mix, and  let  the whole stand one  week,
stirring daily.  Drain off, and  filter through paper.   Add two drams
of creosote.  One to two teaspoonfuls to  be inhaled as preceding.
  This is to be used when the expectoration is profuse and  easy, un-
attended by  fever, either in'the latter stages of chronic bronchitis,
when the mucous  membrane of the  tubes  is in a relaxed condition,
or, in the third  stage of^tubercular disease,  for the  purpose of con-
stringing, cleansing, strengthening, and healing.
  Antiseptic Inhalant. — Take wild  indigo, one ounce; belladonna
leaves, half an ounce ; diluted alcohol, one  pint.   Mix, and let the
whole  stand one  week.   Pour off, and filter through paper.  Then
add solution of chloride of soda two  ounces.  Dose, one to two  tea-
spoonfuls, to be inhaled as the preceding.
  This  is used  in cases of gangrene of  the lungs,  generally distin-
guished by considerable expectoration having a very fetid smell.
  Auti-IIemorrhagic Inhalant. — Take witch-hazel bark, two ounces;
black cohosh, four ounces.  Grind, and add one pint of diluted alco-
hol.   Let the mixture stand one week, stirring daily.   Pour off,  and
filter through paper.  Add to this two drams of creosote.  Dose, one
to three teaspoonfuls, to be inhaled as preceding.
   This is an excellent remedy for bleeding  from  the lungs.   When
there  is a tendency to bleed, it  should be used for a long time.   It
may frequently take the place of No. 4, as an astringent inhalant. 
DISEASES OF THE CHEST.                 223
  Object of Inhalants. — Being vaporized and inhaled, these  articles
enter every air cell throughout the lungs.  Their object is to soothe and
mollify inflamed mucous surfaces, to reduce enlarged bronchial glands
which press upon neighboring parts and cause bleeding, to stimulate
the absorbents to take up and remove  tubercles, to dissolve tubercles
out of the  pulmonary tissue, to cause ulcerous cavities to expel their
mattery contents, and to stimulate their sides to take on  a  healing
process.  They should be used from three to  six times a day, the in-
halation continuing from ten to fifteen  minutes.
  Other Inhalants. — Great numbers of other  articles have been used,
which  I have net space to describe.  I will  mention, however, that
the following are sometimes employed with advantage :
  For  an Expectorant  Inhalant, take  alcohol, four ounces ; tincture
of camphor, half an ounce ; tincture  of tolu, two drams ; naphtha,
one  dram ; benzoic acid, thirty  grains ; oil of bitter almonds,  four
drops.   Mix.
  For an Anodyne Inhalant, take alcohol, four ounces ; naphtha, one
dram ;   benzoic  acid, thirty grains;  chloroform, twenty-five  drops;
tincture of henbane, half an ounce.  Mix.
  For  an Astringent Inhalant,  take alcohol,  four  ounces; naphtha,
one dram ; benzoic acid, thirty grains ; chloroform, one dram ;  tannin,
eight grains.   Mix.
  Mode of Inhaling. — For inhaling these,  a  sponge is fitted into a
glass cup, to  which a flexible tube is attached.  A small quantity of
the mixture is poured  upon  the sponge,  and the vapor  arising,  is
drawn into the lungs through the tube.
  To the expectorant inhalant  may be added,  occasionally, half a
dram of nitric acid.
  These latter formulas are the principal  ones  used by those who
practise what is called cold inhalation.
  Medicated-Vapor Inltaler. — This instrument I have had constructed
of britannia (sometimes of silver) and glass.  Some
have adopted the mode  of inhaling from a sponge
held in  the hand, which is  an imperfect method;
others,  that of inhaling from a sponge fastened
upon the chest, which amounts to scarcely any in-
halation at all, as only a very small amount of the
vapor reaches the nostrils.   It is, moreover, disa-
greeable to the wearer  and to those around,  and
must soon become extremely filthy.
  Some  use a glass bottle, with an India-rubber
tube ; but  India-rubber soon  becomes  foul inter-
nally, and might produce disease.  Avoid Inhalers
with India-rubber tubes.
  The  cut 91  represents the instrument I employ.
The tube, to which the mouth  is applied,  passes
through  the  cap, communicating with  the   air
above the fluid.  When the air is drawn off, other air rushes into the
Ion" tube to fill the vacuum, and breaking out at the bottom, sets
Fig. 91.
 
DISEASES OF THE CHEST.
 the fluid in  commotion, causing a medicated vapor  to  rise, which is
 drawn into the lungs.

   Constitutional Treatment.— The rapid  breathing  in  consumption.
 creates too much oxydation of the blood,—so much, that the muscles,
 especially the heart, are usually of a bright red.  To prevent the pa-
 tient  from being literally  burned up by  oxygen, the blood must be
 de-oxydated  as fast as possible.
   While there is too much of oxygen, there is, at the same time, a defi-
 ciency of carbon.   Hence  the  cold hands and feet,  and the general
 inability to bear frosty weather.  The little nutritive  arteries, in these
 thin-blooded  persons, stand shivering and torpid with cold, unable to
 perform  their allotted function of nutrition.  There is not fire enough,
 and fuel must be had in the form of carbon.  Hence one of the ad-
 vantages of cod liver oil.  This oil, too, as carbon, devours the  oxy-
 gen of the blood, and prevents its destroying  the patient.   This idea
 also explains the fact mentioned by Bennet and others, that in  their
 post-mortems, they found the evidences of healed ulcers in numerous
 persons who  had been spirit-drinkers while living.  And Liebig helps
 the explanation by saying that alcohol, taken into the system, circulates
 in a free state in the blood, and devours its oxygen.   To which I beg
 to add, that the malaria of intermittent and bilious fever districts, has
 been pretty satisfactorily proved to be an  instable organic body, con-
 sisting of  sulphur,  carbon, and hydrogen, all of which  have an af-
 finity for oxygen, and devour it in the system.  Consumption is not
 found in such districts.
   As I am here treating of the chemical effects of remedies (and to
 this test, most remedies must finally come), I will mention that tar-
 trate of antimony and potassa arrests the  circulation in the pulmonary
 arteries, — which fact gives a complete  and luminous  view of its
 power to prevent  oxydation.   But I am  obliged to detract from its
 merits, by stating that it also retards the circulation in the capillaries
 of the system generally, and so hinders de-oxydation.

   Phosphorus. — There is  an  article which  has  more  recently  pre-
 sented itself to the notice of the profession, to which I wish to invite •
 special attention.   I refer to  phosphorus.  This agent, for a  time,
 challenged our notice in the shape of phosphate of lime; but we could
 never feel sure that this article was dissolved in the fluids of the body.
 We now use, and  with far more marked  effect, the  hypo-phosphites
of lime,  soda, potash, and  iron.  These are  used in the form of the
syrup of the hypo-phosphites.   The dose is a teaspoonful before
each meal.   The effect upon the tubercular disease is immediate and
gratifying.

   Need of Phosphorus. — Cerebric acid  contains  nitrogen and phos-
phorus, and is the  peculiar component of the brain and nervous sys-
tem.  By combustion and  the changes of oxydation  in the brain, the
phosphorus of cerebric acid is converted into phosphoric acid; so that
every act of the brain produces phosphqric  acid.  How rapid, then,
must  be the  consumption  of the phosphoric  element of the cerebric 
DISEASES OF THE CHEST.
225
acid, in that highly active  and excitable state of the nervous system
which  I have described as peculiar to consumption.  And how neces-
sary in order to save the brain from destruction, to meet this increased
demand for phosphorus, by introducing it into the  system.
  Mulder regards the fibrin of the blood as the carrier of oxygen; and
by this oxydation, the fibrin becomes converted into the binoxide and
tritoxide of proteine, — its phosphorus  and  sulphur (for it contains
both),  being converted into phosphoric and sulphuric acids.   Adding
phosphorus and  sulphur, therefore, as medicinal agents, would seem
to be the  proper way to supply the  fibrin with materials destructive
of its freight of oxygen.
  It is well known that the salts  of  phosphoric  acid are  essential for
the formation  of azotic compounds, — compounds which are neces-
sary to sustain animal life.  It should be remembered, too, as collat-
erally illustrating this fact, that the tribasic phosphates of potash, soda,
lime, and magnesia, play an important part in the growTth and perfec-
tion of plants!  They are always found in the  seeds of the cerealia, and
no  mature grains are  produced where phosphates are absent from the
soil.   For the production of abundant grain crops, it is necessary that
these salts should exist in the soil, or be applied to it in manures.
   It is known, moreover, that in  all chronic diseases distinguished by
wasting of the tissues, a much larger  quantity of phosphates is ex-
creted by the kidneys, than in the  normal state.   Hence there is no
healthful  growth; and the human organism, like  the soil,  exhausted
of  its  phosphates by successive  croppings, brings nothing  to perfec-
tion, and needs to have its drained salts re-supplied.
   I cannot but call  attention here to the inorganic substances found
in  healthy human  blood.  According  to very careful  analyses, by
 Scmidt:
1000 parts of blood-corpuscles, contain :
Chlorine,   -
Sulphuric Acid,
Phosphoric Acid, -
Potassium,
Sodium,    -
Oxygen,  -    -
Phosphate of Lime,
Phosphate of Magnesia,
1.686
0.066
1.134
3.328
1.052
0.667
0.114
0.073
1000 parts of liquor sanguinis (serum and
  fibrin), contain :
Chlorine,   -    -    -   -   -  3.664
Sulphuric Acid,    -   -   -    0.115
Phosphoric Acid, -    -   -   -  0.191
Potassium,    ...   -    0.323
Sodium,    -----  3.341
Oxygen,.....0.403
Phosphate of Lime,   -          0.311
Phosphate of Magnesia, -   -    0.222
  Iron is omitted.  Now, I venture the prediction, that out of these
figures, mainly, in connection with those which represent the constit-
uents of the saliva, the bile, the gastric juice, the pancreatic secretion,
and the organic compounds of the blood and tissues, are to  be evolved
within a few years, a correct and partially  demonstrative system of
medication.   In consumption, all the inorganic bodies represented by
the above figures, with the exception of oxygen,- are deficient in quan-
tity.  By reflecting  upon the proportions of these several bodies, par-
ticularly upon the large amount of chlorine and soda in the plasma,
and of potassium in the corpuscles, the mind can hardly fail to  obtain
useful hints.  I have not hesitated to make  one of these hints the 
226                  DISEASES OF THE CHEST.
ground of a  very free use of alkalies, — particularly in the form of
bathing.
  Sugar of Milk. — There is one other medicinal article which I deem
worthy to be made prominent, and to be placed side by side with cod
liver oil and the hypo-phosphites.  I refer to sugar of milk.  It belongs
to that class of non-nitrogenized articles which Liebig has denominated
supporters of respiration.   Its great affinity for oxygen is well worthy
to be taken into the account, in considering its value in consumption.
So great is this attraction, that with ammonia and other alkalies, it
has the rjower of reducing some of  the metalic oxides.  When taken
into the stomach, it is rapidly absorbed into the blood, which, being
an  alkaline fluid, augments its great de-oxydating power to a consider-
able degree.   It unites rapidly with oxygen after entering the blood,
forming carbonic acid  and  water.   A part of it, however, does not
enter the blood  in  an uncompounded state, but  is changed  in the
stomach into lactic acid; and this, in the blood,  becomes an alkaline
lactate.  But the portion thus changed, appears also very useful; for
Lehmann says:  " We know of no substances which could better act
in the blood as food for the respiration, than the  alkaline lactates."
   Corroborative of these views, is  the fact  that all those  kinds of
milk, such as goat's, ass's, etc., which contain the  largest amount of
sugar of milk, have at different times, and  in various countries, ob-
tained a reputation  for curing consumption.   Goat's whey, in which
this article  abounds, and from which it is largely manufactured, has
been celebrated for its virtues in this line.  Ancel  speaks of it as an
excellent remedy ; and Pereira says, " Sugar of  milk, in consumptive
cases and chronic diseases of the digestive organs, is a most valuable
aliment."
   One of the  best forms of taking sugar of milk is that of a gruel,
which is quite  palatable, and may be freely eaten by consumptive
persons.
  The Cough.— The best article 1 have ever used for this, is the " Pul-
monic Cherry Cordial."   1 was five years in compounding this arti-
cle to suit me, and I believe it to be the very best cough preparation
ever made.   Dose, from one to two teaspoonfuls.
   When a more  quieting effect is  needed, a little  morphine may be
added to this preparation; if a more expectorant influence is required,
add a few drops of the tincture  of veratrum viride.  For the  great
majority of cases, it will be  found to be right without any addition.
When this is  not at hand, any of the preparations (108) (112)  (109)
(113) (110),  etc., may be used.

   Night Sweats. — The very best preparation for these sweats, is a com-
pound of the oxide of zinc, one dram; extract of conium, half a dram;
to  be made into twenty pills, of which  one or two are to be taken
every night.   The sponge bath also does much to  check these sweats.

   Diarrhoea. — This is a most exhausting symptom in the latter stages
of  consumption.  The only remedy which has much effect in control-
ling it, is the tris-nitrate of bismuth.  This should be given in doses of 
DISEASES OF THE CHEST.
227
thirty grains immediately after, or at the  time of each  meal.   These
doses are much larger than used  to  be  given ;  but they will do no
harm.   Given to this extent, I find the bismuth very effectual.
  Iron. —This preparation, in  some of its forms (316)  (73) (61)  (84)
(102), is almost always  needed in consumption.  If the scrofulous
habit be strongly marked, give syrup of iodide of iron, in thirty-drop
doses, three times a day.  It should be taken in a glass of water.
  External Irritants. — These are needed where there is much infl-  i-
mation  and soreness of the chest.  Blisters  should  very seldom oe
used.  Croton  oil, from  two to half a dozen drops, rubbed over the
sore part, generally answers very well.  Sometimes the mustard paste,
applied  to the extent of producing redness, two or three times a week
is sufficient.   Nitric  acid, reduced with water to a  strength a little
above the  strongest vinegar, answers  a good  purpose for keeping up
an irritation.
  Atmospheric Inhalation. — It has been said  by Laennec and others,
that asthma  has sometimes the  effect of  arresting  tubercular con-
sumption.  Dr. Ramadge thought  this was effected by an expansion
of the vesicular structure of the lungs;  and he reasoned that the
same expansion by mechanical means, would secure a similar end.
To effect this, he made his patients take long breaths through a tube
constructed for the purpose.
  It is  manifest that the philosophy of atmospheric inhalation  was
not understood by Dr. Ramadge, nor has it  been by any of  his fol-
lowers in this country.
  Rokitansky thinks the tubercular habit depends upon the excess of
fibrin in the blood ; and  says that  the reason of consumption being
arrested by pregnancy is, that this condition offers a mechanical ob-
stacle to the transmission of blood through the lungs, — thus prevent-
ing its  excessive oxydation, and keeping it in a venous state.  This
destroys the fibrinous condition,  on which  he  thinks  tuberculosis
depends.
  Now  this is precisely what is done by atmospheric inhalation.  The
trachea  divides on its entrance into the lungs, into two branches, which
again divide and subdivide until the tubes become smaller than  can
be seen, each  terminating in a minute air-cell.  Over this entire sur-
face the air is intended to«be brought into  communication with the
blood for the purpose of  oxydating it.   By forcible inhalation, the air
vesicles  are inflated to the extent of  their capacity, by which means
the extreme branches of the  pulmonary arteries are  so flattened be-
tween these  extended cells, as to be able to convey but  a small
amount of blood, and but little is oxydated.  This  furnishes a  me-
chanical obstruction to the transmission of the blood, and secures tli3
defibrination of which Rokitansky speaks.
  This is my view of the philosphy of atmospheric inhalation.  The
benefit results, not  from a larger  amount of  oxydation, as is gener-
ally supposed, but from a smaller.  Asthma does the same thing by
producing spasmodic contraction of the extreme bronchial tubes, and
preventing air from entering the cells. 
228                 DISEASES OF THE CHEST.
   The same end is gained in part by certain kinds of employment, as
 glass-blowing, playing upon wind instruments, and the like.  Writers
 of distinction mention  cases of recovery from incipient consumption
 by a  vigorous use of the  lungs  in  singing.  Dentists subject their
 lungs  to a similar process of expansion in the use of the blow-pipe;
 the writer has known  several instances  in  that  profession, in which
 recoveries have taken place.
   The Conclusion to which I come is, that atmospheric  inhalation
 may be used with great advantage in some cases, but should never be
 resorted to except under the direction of a competent physician.  In
 a congested  state of the lungs, with hemorrhagic tendencies, or with
 inflammation and soreness, it is well fitted to produce fatal bleeding,
 and is of course dangerous.
   External Use of Water. — As a relaxation from severe exertions,
 the ancients  had frequent recourse to bathing.  Those who contended
 in the race,  throwing  the  javelin, and  wrestling, at  Rome, plunged
 into the  Tiber while warm and panting with their efforts.   That this
 promoted prowess and physical endurance, none can doubt.
   Louis, the great French authority  on  pulmonary diseases, lays
 down  several rules to be observed by consumptive patients, and par-
 ticularly mentions cold bathing.
   Few things  give tone to the capillaries of the skin like cold water,
 systematically applied.   It rallies the powers of the constitution, and
 improves assimilation.  And by it another object is gained of scarcely
 less importance, — that of guarding the system against taking cold.
 Those in the daily habit of  applying cold water to the whole person,
 seldom suffer from colds and catarrhs ;  and they generally become
 hardened so as to endure the assaults of the elements.
   Consumptive persons should generally use  the sponge bath, with
 cold water, if. it can be  endured, otherwise the tepid bath, to be fol-
 lowed, in all cases with brisk rubbing, with a coarse towel.  If a sense
 of chilliness  and discomfort follows the  bath, a large  portion of the
 water must be squeezed from the sponge, so as to  use but very little,
 and the  washing must be speedy, and the rubbing more lively than
 usual,— beginning with tepid water, and  gradually lowering the tem-
 perature, till  it can be  borne cold.  A large teaspoonful of saleratus
 to each quart of water should be used.


                              Diet.

   The diet, like all other parts of the treatment, must have reference
 to the  present condition of" the patient.   If the disease take the bron-
 chial form, and rapid  breathing,  and other conditions calculated to
 carry fat out of the system have not yet supervented; or if the patient
 have thirst and hectic, the diet must be spare and simple, — consist-
ing chiefly of milk and farinaceous substances.
   But  in all cases where the disease is tubercular,  or, being bronchial,
has reached  the stage  of emaciation,  the  very earliest  moment at
which  the  fever can be subdued, should be improved to build up the 
                     DISEASES OF THE CHEST.                  229

patient with a generous  diet.  I have  seen  cases where the stuffing
sometimes resorted to for fattening turkies for Thanksgiving, would
seem to be almost justifiable.  A good rule is to give the most gener-
ous diet that can be taken without disturbing the stomach, or increas-
ing the feverish  symptoms.  Animal  food, with a good quantity of
salt, should be freely taken.  Fat meats, if well received by the stom-
ach  (and they generally are if taken  cold), are particularly useful.
The same is true of sweet butter and cream.

  Out-Door Exercise. — Without exercise, as a general thing, the con-
sumptive patient will  die.  Exercise involves muscular  exertion,
which is attended by the tension, compression, and greater  compact-
ness of the muscles used.   This  compression of the muscles within
the sheaths (fascia?) which enclose them, sends out their blood, and
pushes it forward towards the surface.  Reaching the extremities of
the  arteries, the  blood passes through capillary tubes, almost incon-
ceivably fine, into the capillary veins  of  similar fineness, whence  it
flows through  larger and larger veins back  to the heart.   At the mo-
ment of its passage from the capillary arteries to the capillary veins,
it ceases to be red or arterial, and becomes purple or venous blood.
The oxygen in the arterial and  the carbon in the venous  blood unite,
forming a literal'combustion, just such as we produce in our stoves
and grates by bringing together the carbon of the wood and the oxy-
gen of the atmosphere.   By this  combustion our bodies are warmed,
and the  little ^secreting, exhalant, and  other vessels, are  raised to a
temperature that enables them to work.
   Every  muscular contraction and compression helps  push along the
venous blood in larger  quantities to  the right auricle of the heart,
which, receiving a fuller supply of its natural stimulus, contracts more
energetically, forcing the fluid into the right ventricle.  From thence
it is expelled with increased energy likewise along its only pathway,
the  pulmonary artery, into the lungs.  Rushing in  here in greater
volume  than  natural, a demand  is  made for deeper  inspirations of
air to vitalize and fit it for  its descent by the pulmonary vein, to the
left auricle.   Coming here also  as the  natural stimulus, in larger
quantities than usual, it gives increased energy to its own propulsion
into the left ventricle, from whence it is driven out through the arte-
ries to all parts of the system, by the powerful strokes of that strong
muscle.                                                     .
   Thus it goes  its round, urged an by exercise, parting with its oxy-
gen more and more  freely in  the  capillaries, giving more activity to
the  vessels of the skin  and other tissues,  increasing the depth and
•strength  of breathing by carrying more venous blood to the  lungs;
improving the digestion, carrying a better elaborated pabulum to the
nutrient  arteries, and causing them to work it  up more  diligently in
renewing the tissues.
   Nor  is this  all.  Every wrench of a muscle forces  some old, worn
out particles from their  places, allowing none to remain  except  such
as are firm, and able to  bear the brunt of exertion.  The flesh of those
who exercise much becomes hard  and enduring. 
230                  DISEASES OF THE CHEST.
  I say  then to the consumptive, if you would live  and not  die,
exercise,  exercise, exercise.  It is  the first, second,  and third  thing.
If you ask for the modes  of  exercise, I say take it on foot, out of
door, every day, to  the  extent  of a small  amount of fatigue.   Don't
be frightened by a single cloud, or even by a cohort of them.   You
have as good a right  to be out as the clouds ; and they will not look
more angry, but rather  more agreeable  from finding you  abroad in
their company.  The elements  of nature are at war with organic  life.
Against them the vital principle has to maintain a perpetual struggle;
and he who  loses  the  power to meet and gain the victory over them
by out-door exercise, is  beginning to die.
  Go  abroad,  therefore, often.  Try it  again and  again.  Extend
your walk a little  every day.   Stretch  it out to the distant  fields.
Gather flowers from the top of the  hills and from the  bosom  of the
vallies, and bring them  home as trophies of your victory.
  If not able to begin with walking, ride as often  as possible in a
carriage.   The jolting  of a vehicle will jog the  blood along  much
better  than no exercise.
  Horseback riding is still better.  It combines, in some measure, the
passive exercise of  carriage riding, with the active exertion of walk-
ing on foot.
  Numerous other modes of exercise may be resorted to with advan-
tages.  Dumb-bells, adapted in size to the  strength of the patient, and
used with caution, are  highly  serviceable.   The  battledoor, the foot-
ball, jumping the rope, pitching quoits, and the athletic sports  of the
gymnasium, all have their appropriate place.  The greater the variety
the better, as by it  all parts of  the system  are brought into play, and
both the  mind and  ths muscles get the change which they need.
  It is hard to impress  patients with the  importance of this subject.
Say what you will, they somehow or other get the  idea that a mod-
erate  amount of exercise, taken  when they feel like it, is  all that  is
required.   Fatal mistake !  Whatever  the physician may do, the pa-
tient has a great deal to do for himself.   He must strive to develop
his physical powers to the  utmost.   He must train himself as runners
and fighters  do when  preparing for their surprising feats; for he is
running against the swiftest disease (or the surest winner) of our cli-
mate,  and fighting with the elements.
  If he regards life as not worth this exertion, of course he will not
make it;  but I beg him to consider that without it, recovery will be
uncertain, and in many cases, impossible.   Do as  I have directed, and
if your medical attendant is  skilful, the  current of health will,  in
many  cases, begin  to flow  back to you.  Life will, renew to you its
policy of insurance, and multiply your days.

  Travelling.— Consumptive  patients have generally been sent  to a
southern climate.   But where the case involves  dyspepsia and affec-
tions of the  liver, low latitudes are generally unfriendly.  Liver com-
plaints are the  bane of a southern climate, and a sallow complexion
is the  inheritance of a southerner.
   Tubercular persons, chilled by our northern climate, are  sometimes 
DISEASES OF THE CHEST.                 231
temporarily relieved by  the warmer atmosphere of the south.  But
the relief is only temporary ;  for, having lost the power, as they im-
agine, to bear the  frowns of our northern sky, they  are  dying, and
will die  anywhere  unless they recover this power.   And the way to
retrieve a lost advantage over an  enemy, is, not to retreat to a point
where  recovery will be harder, but to meet him at once.   If the con-
stitution cannot bear  up against an  enemy under  the  bracing of a
northern atmosphere, it will be still harder to do so under the wilting
of a southern.
   After all, the objects aimed at should be change and travelling.  The
exercise involved, the constant exertion required in getting from place
to place, the agreeable  sensations  produced  by the  motion of cars
and steamboats, the ever varying change of  sights and  sounds, and
the constantly increasing stock of one's  ideas of men and things,—
these are what rally the  constitution, and open  anew the springs  of
life.
   Especially should all journeys for health be taken, if possible, with
an object in view.   Let the consumptive  start with the view of see-
ing the cave of Kentucky, the prairies of the West, the great lakes
of the  North, the falls of Niagara,  the fortress  of  Quebec, the Sag-
uenay river, the doctor, who he has reason to  think will  cure him,—
anything which  he is  willing to make exertion to  see, and that he is
sure his eyes will rejoice in beholding.
   I  have thus  spoken of consumption more at large than of other
complaints, because it is the  great  disease of the world, and  is in-
creasing with the advancement of civilization.

                      Acute Bronchitis.

   This is an acute inflammation of the mucous membrane lining the
air tubes in the lungs.   It is generally quite a serious disease.
   Physical Signs. — The sound upon percussion  is generally good.  If
there be any dulness, it  is commonly in the lower and  back part of
the chest.
   The breathing murmurs are  sometimes more, sometimes less in-
tense than natural.   Occasionally they are almost extinct.
   In the early stage, sibilous and loud rattles.
   In the morp advanced  stage, mucous rattle.
   Now and then sub-crepitant rattle accompanies the inward-drawn
breath.
   General Symptoms. — The disease begins  with chills followed by
fever; tightness  across the chest, difficulty of breathing, hoarseness,
loss of strength, costive bowels, and a quick and hard pulse.  Water
runs from the  eyes and nostrils, and there is a dry, harsh, croupy
cough.
   After a few days, mucous begins to be  raised. This expectoration
gradually becomes  more copious, and is  opaque, yellowish, or green-
ish, and occasionally streaked with  blood.  This mucus is very ropy,
and adheres to the vessel. 
232                 DISEASES OF THE CHEST.
   There is more or less pain in the chest; pain across the  forehead,
 which is increased by coughing; and a pale and  anxious counte-
 nance.
   In severe  cases, the tightness across the chest is extreme, with a
 sense of suffocation, causing the patient to call for the  opening of the
 windows.  There is great difficulty of breathing; a paleness and Av-
 idity of the  cheeks and lips; a loud wheezing  and rattling in the
 throat, followed by cold sweat, insensibility and death.
   In children the disease comes on like a common cold, attended by
 a sore  throat, a great desire to drink, but a disinclination to  take
 food.  But two  or three swallows of drink can  be  taken at  a  time
 for want of breath.  The phlegm is frequently vomited up'spontane-
 ously.
   Observations.— The loud and sibilous rattles are produced by simi-
 lar causes, namely, the passage of air along tubes whose interior is
 dry and rough from inflammation, or whose calibre is contracted or
 altered  in  form  by the swelling of the  membrane, effusion  upon its
 inner surface of a tough mucous  substance, or a pressure  upon its
 external surface of tubercles, swollen  glands,  aneurismal  tumors,
 etc. • The two sounds  differ  mainly in  the  key upon which  they are
 pitched, — the sonorous, or low-keyed, coming from the larger tubes;
 the sibilous, or high-keyed, from the smaller,—just as  the low notes
 of an organ  come from the large  pipes, and the high notes  from the
 small ones.
   The  sibilous  rattle has been compared to the chirping of birds, the
 squeaking  of puppies, the whistling of air passing  through a  key-
 hole, etc.;  the sonorous, to the snoring of a sleeping  person,  the  coo-
 ing of doves, and the  sound of the bass string of the violincello  rub-
 bed with the  finger.

  Causes.— It is generally brought on by a sudden cold, by changes.
 of the weather, and by inhaling irritating substances.   It is a second-
 ary result,  too, of scarlet fever, measles, small pox,  hooping cough,
 and the remittent fever of infants.
  Treatment. — In  mild  cases, give warm balm or flax-seed tea, hot
 lemonade, or other similar drinks, — at the same time, soaking the
 feet in hot water, and, on retiring to bed, apply  bottles of hot  water to
 the feet and  sides, to  produce sweating.   If the bowels be costive,
 some gentle physic, as  rhubarb and magnesia, or salts and senna, may
 be taken.
  In the case of infants, an emetic of wine of ipecac, or compound
tincture of lobelia, should be  given, and followed with slippery  elm
 and flax-seed tea.  The compound tincture of lobelia, with  tincture
of veratrum viride, may be continued for a time as an expectorant.
  In more  severe cases, both of adults and  children, an active emetic
is required, — perhaps  the compound powder of lobelia is as good as
any.  This must be followed with tincture of veratrum viride, in full
doses, so as to reduce the pulse at once, and keep it  down to  the
natural  standard.   This  is one of  the very best  articles in this com-
plaint, and  will generallv very much lessen its violence and duration. 
DISEASES OF THE CHEST.
233
  If there is much difficulty of breathing, the  air of the room must
be kept moist, as recommended in croup.
  The room should also  be kept warm, — decidedly warmer than in
the case of other fevers.
  A gentle  perspiration should be kept  up by small doses of com-
pound tincture of Virginia  snake-root, and by  frequently bathing the
surface, or else by tincture of veratrum.
  Mustard should be applied to the chest, and to the soles of the feet.
  The cough may be managed by preparations  (104) (106) (110),
freely given.
  The diet  should be confined to barley-water,  toast-water, apple-
water, rice-water, and a solution of gum arabic.

                    Chronic  Bronchitis.

  This is an inflammation of the mucous membrane of the air-tubes,
which continues  a great length of time, without  any sudden or re-
markable changes.

  Physical Signs. — The  percussion-sounds are similar to those  of
acute bronchitis.  When  a bronchial tube is dilated, we sometimes
have dulness around the dilated  part.
  The breathing murmur  is always accompanied by a mucous, sono-
rous, or sibilant rattle, — sometimes by a subcrepitant.
  When dilatation of  the tubes exists, the intensity and duration of
the sound of  the  ingoing breath is decreased, — of  the  outgoing
increased.
  In this state of the tubes, we also have cavernous breathing, bron-
chophony, sometimes pectoriloquy, and bronchial or cavernous cough.

  General Symptoms. — A cough  is generally  present, which is in-
creased in wet weather, and by every  slight cold.   This comes on in
paroxysms ;  is generally worse  in the  morning;  and is relieved by
raising freely.  The matter raised is generally yellowish,  but some-
times whitish and sticky; and in the latter stages, is thick,  and some-
times very much like that of consumption.  Indeed, the disease often
ends in bronchial consumption.

  Remarks. — The breathing is bronchial or cavernous when the di-
lated portion of the tube is empty; — if  it contain fluid, the mucous
rattle will be heard.
  Dulness on percussion  will exist if a dilated tube press  upon the
surrounding portion of lung so as to condense or make it solid.
  Dilatation of the tubes occurs only  in chronic bronchitis of  long
standing.   Its  physical signs are  much like.those of a cavity in ad-
vanced consumption.  The examiner may learn to  distinguish them
by  considering that in  consumption, dulness precedes the cavity, while
in bronchial dilatations, the cavity precedes dulness.
   The dilatation or swelling out at some  point of a bronchial tube, is
caused by obstructions to the passage of air through it,-—just as an
India-rubber tube, partially closed up at a given point, will bulge out 
234                 DISEASES OF THE CHEST.
just in front of the obstructed  place, when air is  forcibly blown
through it, and just as the left  ventricle  of the heart enlarges when
the blood is obstructed in its passage through the aortic valve.

   Causes. — It often occurs as the result of acute  bronchitis, and also
of measles, hooping-cough, etc.   But taking cold, and dapip and change-
able weather, are more  frequently its causes.  It  most often follows
chronic inflammations of the throat, which, being neglected, gradually
creep down the  windpipe into  the tubes, and become very obstinate
in their character.
   Treatment.— Medicinal inhalation is one of the best remedies for
this complaint.   The inhaling  powder has, in many cases, great effi-
ciency.  "The dose is about what can lie on a ten cent piece.   It
should be used once a day, in an instrument represented in the cut.
   This instrument I had constructed  in 1850.  It consists mainly of
a  glass tube and a receiver, — the latter being something like a tube
vial, pierced with fine holes around
                                               "Fig 92
the  lower end.  The powder  is
poured  into the receiver, which is        [Patented March 16, 1852.]
placed  in the  larger tube,  and  / ^^^^s&£g^-^y;^^^M^
twirled  between the thumb  and      '" (?                 ItilS^
finger while inhaling.              \[       ^^^^^.ZZZ  ,^/~^v
   When  the powder cannot be
easily got down  into the tubes in the lungs, — as often happens,—
the inhalation of medicated vapor will do better.   If the expectora-
tion be difficult, the expectorant inhalant, described under " consump-
tion," should be used ; if the  expectoration be too profuse and free,
the astringent inhalant must be taken.
   The cough preparations recommended  for consumption, also (113)
(112), will be the proper ones in this complaint.
   The daily alkaline bath, and  brisk friction, are particularly service-
able.
   Out-door exercise is  almost  as necessary in this disease as in con-
sumption.

      Enlargement  of the  Air Cells.—Emphysema.

   This disease consists in enlargement of the  air cells, the obliteration
of their vessels, and the  wasting of their walls.
   Physical  Signs. — Thumping upon the chest gives a clearer  and
louder sound than natural, — one which is tympanitic, or drum-head
like.
   The murmur of the ingoing  breath is diminished both in duration
and intensity, — of the outgoing breath, it is increased.
   Dry, crepitant rattle attends the ingoing breath  only; occasionally,
sibilous rattle.
   General Symptoms. — Habitual shortness of breath, and very great
difficulty of breathing, occurring  in paroxysms, which cause  the pa-
tient to rush to the open window for air. 
DISEASES OF THE CHEST.                  235
   There is generally a cough, and the matter raised is frothy, liquid,
 and mucous, or watery.
   The face has a peculiar dusky color, and the countenance an anx-
 ious, melancholy expression.   The  nostrils are thick, and the  lower
 lip full.  The muscles of the  neck are large, and  the  gait of the pa-
 tient is stooping.   The  strength  is wasted in proportion to the diffi-
 culty of breathing.
   Emphysema tends to produce disease of the heart, Bright's disease,
 and venous congestions in the head.
   Observations. — The tympanitic sound  is caused by the increased
 amount of air in the cells.
   The air cells having lost  their elasticity, the air, in  a great degree,
 remains in them,— not passing in  and  out, — hence the absence  of the
 vesicular murmur.
   The  crepitant rattle  attends the  ingoing breath only, and is sup-
 posed to arise from  the  expansion of  lungs which are in a drier state
 than natural.   It has been compared to the sound produced by  blow-
 ing into a dried bladder.
   Treatment.— To whatever extent  the air-cells are destroyed,to that
 extent, of course, the disease  is incurable.  It may, however, be pal-
 liated and relieved to a great extent.
   Generally, bronchitis exists in  connection  with emphysema; and
 when this  is found  to be case, the remedies for that disease must be
 employed.
   The inhalation of tincture of stramonium, in one or two teaspoon-
 ful doses, the same as the alterative inhalant is used, will be useful.
   To be taken internally, an  excellent preparation may be made by
 uniting one dram of ethereal  tincture  of lobelia, with two drams of
 tincture of ipecac, and two ounces of  ammoniac mixture.   The dose
 is  one to two tablespoonfuls.  Half grain to grain doses of extract of
 cannabis indica, are excellent to relieve the difficulty of breathing.
   The diet must be very carefully regulated, as overindulgence at the
 table aggravates the symptoms.
   Change  of air is  often highly  beneficial; but  it is impossible to
 predict its effects beforehand in each individual case.

   Swelling  of the  Lungs.—Hypertrophy of the  Lungs.

   This can hardly be regarded as a disease.   It generally takes  place
in  but one lung, and is the result of the inaction of the other.  Thus,
when one lung is diseased, the other has to do the work of both  ; and
being overworked, it enlarges as the  heart,  or an arm does,  when very
much exercised.
   The only treatment required is to eat sparingly, and exercise with
great moderation, so as not to increase the rapidity of the breathing.

                    Pulmonary Apoplexy.

   This is  generally the  result of  a  disease of the heart, particularly
of the mitral valve. 
236                  DISEASES OF THE CHEST.
  Physical Signs. — Percussion  yields  a clear sound, except where
the engorgement of blood is large, and  near  the  surface, — in which
case, it is dull.
  The sound of breathing is feeble or absent  over a limited space.
  Bronchial breathing is heard in some places, and bronchophony in
part, in the same regions.
  Mucous rattle is also heard.
  Observations. — In this disease the small air-tubes and  air-cells are
the seat of bleeding; and the blood becoming coagulated here, closes
these  vessels against the entrance of air.   This explains the feeble-
ness or absence of the breathing murmur.
  The fluidity of blood  in the  immediate  vicinity, gives rise to the
mucous rattle.
  General Symptoms. — These  are, difficulty  of breathing, tightness,
and dull pain in the chest.  The mucus raised is tinged or streaked
with  blood.  The blood raised is darkish, and dirty-looking.   This
last symptom, the dirty look of the blood, is peculiar in this disease.

  Treatment. — The most important remedy is dry-cupping upon the
chest.  This will often arrest the  disease at once.   Counter-irritation
by croton oil is also useful.  A free movement of the bowels  by a
preparation  containing croton  oil, or elaterium (31) (33), has an ex-
cellent effect.               •

             Air in  the Chest.—Pneumothorax.

  This disease consists  in the  presence of air in the cavity of the
pleura.   Generally, there is also water in the  pleural sac at the same
time ; the water,  being the heavier fluid, occupying the lower part of
the cavity, and the air the upper part.
  Physical Signs. — Tympanitic or drum-like sound over the upper
part of the side.  Dull sound over the  lower part.  Breathing  mur-
mur diminished or  suppressed.  Amphoric  breathing.   Metallic  tink-
ling.
  General Symptoms. — Great  oppression of the chest, and  difficulty
of breathing; generally attended  by palpitation of the heart, and fre-
quently by  severe pain  under  the breast-bone, on the affected  side.
The patient generally has to remain in the sitting  posture, and cannot
lie an instant on the sound side.
   If) on percussion, one side of the chest sounds louder than the other,
and the  breathing murmur is heard distinctly on the side which  gives
only a moderate sound, and is not heard at all  on the loud-sounding
side, we may be sure it is a case of air in the chest.

   Observations. — The metallic  tinkling is like the sound produced by
dropping a pin's  head into a metallic dish,  or like the distant tinkling
of a sheep-bell, or the gentle pulling of the  string of a violin.
   It is supposed  that when the  fluid in the  cavity of the pleura hap-
pens  to be higher than the orifice, the air,  when it enters at each 
DISEASES OF THE CHEST.                 237
in-drawn breath, forces its way up through the fluid, in the shape of
bubbles, and, bursting at the surface, gives the tinkling sound.   This
sound is sometimes produced, too, by the falling of drops of liquid
from the upper part of the cavity, upon the surface of  the fluid.
  The amphoric  breathing is  like the sound  produced by blowing
obliquely into an empty cask.   One writer says he heard the same
sound when out shooting in a rough day, produced by the wind blow-
ing sideways into the gun-barrel.
  Treatment. — I would recommend the use,  two or three times a
day, of the antiseptic inhalant,  mentioned under the head of con-
sumption.
  To this should  be adde'd dry-cupping over the whole chest, which
generally gives great relief.  Blisters may also be used.
  Sweating  must be encouraged in the manner recommended under
acute bronchitis.
  For the  difficulty of breathing, give half grain doses of cannabis
indica, or five drop doses of tincture  of aconite, or  one-sixth of a
grain doses of morphia.   Extract of belladonna, or of stramonium, is
also worthy of trial.


            Water  in the  Chest.—Hydrothorax.

  This disease cbnsists in a collection 6f water in the cavity of the
pleura.
  Physical Signs. — There is a dull sound over the effusion.
  The breathing murmur  is diminished, and  gradually  disappears
altogether over the space occupied by the effusion.
  Bronchial breathing is heard in the same part.
  When the  amount of fluid is small, egophony is heard in the mid-
dle regions of the chest.
  Bronchophony  is heard when the effusion is larger.
  General Symptoms.— Either upon lying down, or using active bodily
exercise, the patient finds his difficulty of breathing increased.  When
in bed, he  lies with his  head and shoulders raised, which, by causing
the fluid to settle at the bottom of the  cavity, prevents, in a measure,
its  pressure upon the lungs, and gives him a little rest.  His sleep is
interrupted by sudden starts, with  alarm and  terror.  The pulse is
hard, the thirst great, the  urine  scanty and high-colored,  and has a
sediment.  After a time, the  feet swell, the face  is pallid and livid,
and the countenance expresses anxiety and alarm.  There is a short,
dry cough.
  When the quantity of fluid in the chest becomes large, the patient
cannot lie down at all, and only gets short and disturbed naps in the
sitting posture.
  Of all the symptoms, the starting in sleep is the most certain sign
of the disease.
  Causes.__In some rare cases, this may occur as a primary disease*
— that  is, as a disease not dependent upon any other  as  its cause. 
238                 DISEASES OF THE CHEST.
The greater  number  of cases, however, are secondary.   They  arise
from organic disease of the heart, or liver, or stomach.  Inflammation
of the pleura is a very frequent cause.
  A plethoric, or full state of the  system,  predisposes to this  com-
plaint,— particularly  in  those persons  who indulge freely  at the
table.
  It may arise, too, from the striking in of skin eruptions;  from the
free  use of liquors ; and  from frequent excessive bleedings or purg-
ings.

  Treatment. — Dry-cupping is a  valuable remedy, and should always
be practised.
  The chest should be painted with the tincture of iodine, and a  good
degree of  substantial  soreness  be  kept up.
  The internal  remedies are  purges  (31)  (14)  (30), and diuretics
(128) (129) (130) (131).
  The iodide of potassium, in doses  of five or six grains, once in
three or four hours, is an excellent remedy.  The following  is a  good
form of taking it, — iodide of  potassium, one ounce ; fluid extract of
pipsissewa, two ounces ;  water, half a  pint.   Dose, one teaspoonful.
  The skin should be bathed and rubbed daily.


                     Pleurisy.—Pleuritis.    ,

  Pleurisy,  or pleurisy fever,  as it is sometimes called, is an  inflam-
mation of the pleura, or the membrane which lines the chest, and, at
the same time, is folded back so as  to  cover the outer surface of the
lungs.
  The pleura, as is elsewhere  explained, is a short sac or bag, whose
inner sides  are kept  moist, so that they may slide easily upon  each
other as they are moved by  the alternate contractions  and expan-
sions of the  Jungs in the act of breathing, and whose outer sides are
made to grow, — one to the inside of the chest, and the  other to the
outside of the lungs.
  Pleurisy and lung  fever, then,  must be kindred diseases,  and  exist,
more or less, together. In truth there is almost always some affection
of the pleura in  lung fever, and some affection of the lungs  in pleu-
risy.   The pain in lung fever  is owing to  some inflammation of the
pleura; and  the  appearance of the  rusty-colored  phlegm in  pleurisy
indicates that the lungs have been reached by the inflammation of the
membrane which covers them.

  Physical Signs. — Dulness on  percussion, at the lower part of the
chest, which ascends  as the effusion of water increases.
   If the effused fluid is not great, there is puerile breathing at the top
of the lung.
   Friction sound is heard occasionally.
   Egophony is heard when  the amount of fluid  in the pleura is
 small.
   As the amount of water increases, bronchophony appears. 
DISEASES OF THE CHEST.                  239
  General Symptoms. — This  disease is most frequently  introduced
by shiverings, which are soon succeeded by high fever, with a pecu-
liarly hard, resisting pulse; sharp, stabbing pain in the  side, — gener-
ally just below  the nipple, but  sometimes extending to the shoulder,
arm-pit, and  back; hurried and interrupted breathing; and a short,
dry cough.
  The pain is greatly aggravated by motion, coughing, or an attempt
to take a long breath.  It holds the patient under constant and power-
ful restraint.   We find  him lying upon his back, or his well side ; his
countenance  full of anxiety,—fearing to move, cough, or even breathe
needlessly; and often crying out from  the keen  torture these neces-
sary acts inflict in spite of all his caution.
  At a more advanced' stage,  when the  tenderness  has  somewhat
abated, he will  prefer  to  lie on* the diseased side, as this leaves  the
healthy lung  more at liberty.

  Observations. — The first effect of the inflammation of the pleura
is to dry up the  moisture with which its inner surfaces  are lubricated,
or made  smooth and slippery.  As a consequence, these surfaces be-
come rough,  and rub harshly upon each other, and produce a sound,
in the early stages of pleurisy, like that of rubbing two pieces of wet
leather together.  It may be imitated by rubbing the finger back and
forth  upon a table.  It is sometimes  a creaking  noise, like  that of
new shoes.
  As the disease  advances an  important  change takes place in the
state  of  things.   Instead  of an unnatural dryness, a watery fluid is
poured out copiously from the  inflamed surfaces of the pleural sac.
This  is called the period of effusion.   This generally,  though not al-
ways, relieves the pain.   But, by compressing the lung, causes dan-
gerous difficulty of breathing.                                    •
  The air-cells are compressed by the effused fluid, and are not pene-
trated by air.  Hence the absence of the breathing murmur.
  The pouring  out of water  between  the layers of the pleura, com-
presses the lung, and removes it from the  wails of the  chest.   Hence
the dulness or deadness of sound upon  percussion.
  When listening with the stethoscope, the voice of the  patient sounds
feeble and interrupted, like the bleating of a goat, and is hence termed,
egophony, or  goat-voice.
  This peculiar voice is  heard only when the  effusion of water has
been  moderate  in quantity, and only  a thin layer of  liquid  lies be-
tween the ribs and lung.   It is caused by the voice passing over this
thin layer, which  is thereby thrown into  vibrations, or wavy, quiver-
ing motions.   When thus agitated, the fluid reacts upon  the  voice,
making it sharp and tremulous.
  When  the effusion  has become large, these effects cease ; but an-
other  sign then shows  itself,  and  distinguishes  pleurisy from  the
healthy state, and likewise from the solid, hepatized state of the lung
in lung fever.  It  may be discovered thus :
  If the hand  be laid flat upon the chest of a healthy person, while
he is  speaking, a vibration or thrill will be felt.   If, in like manner, 
240                  DISEASES OF THE CHEST.
the hand be laid upon the chest of a person having lung fever, with
hepatized lung, this thrill will be found  still more perceptible.  But
when the hand is placed over the place of watery effusion on the chest,
of a person having pleurisy, there will be discovered, when the person
speaks, no thrill whatever.  The  absence  of this thrill, then, is one of
the very best signs of pleurisy with effusion. ,
   Persons recover from pleurisy sometimes very rapidly, before effu-
sion has  taken place.  It is then said they have  had  an attack of  dry
pleurisy.   When liquid has been poured out,  even in considerable
quantity, it is sometimes reabsorbed, and  the  patient recovers per-
fectly. In other instances, it compresses the lungs, interferes seriously
with breathing, reduces his strength, and he sinks rapidly.

   Treatment.— The first remedy generally employed  in  this disease
is  bleeding.   This is pushed to the extent of the patient's endurance,
and in many instances repeated several  times.  This commonly re-
lieves the pain.
   As a general thing, I am opposed to bleeding, and am even  reluc-
tant to recommend it in pleurisy.   Yet  if there is a  human ailment
which will justify it, pleurisy is that one.
   Sweating should be  encouraged immediately.  The compound
tincture of Virginia snake root, given every half hour, in teaspoonful
doses, will generally produce a free  perspiration, and give immediate
relief.  It may be given  in infusion of catnip, balm, or pleurisy root.
At the same time, the affected side should be fomented with hops,
tansy, wormwood, etc., applied very hot.
   If this does not  afford relief, or  only partial relief, give an emetic
of the compound powder of lobelia, and follow  it with the. compound
powder of jalap, or the compound  powder of leptandrin, or prescrip-
tion (31), as physic, — at the  same time, keeping  up  the perspira-
tion, with full doses of tincture of veratrum.
   To procure sleep and perspiration at the same time,  Dover's powder
may be given in six grain doses.
   For the fever, nothing is equal to the tincture of veratrum viride.
   The diet must be of the very lightest kind.
   When absorption of the  fluid does not  take place, a puncture is
sometimes made, through the walls of the chest, and the water drawn
off.   This operation is called paracentesis thoracis, and is  generally, in
uncomplicated cases, entirely successful.  When this  is not done, let
the affected side be painted daily with tincture  of iodine, keeping up
considerable soreness, and giving iodide of potassium at the same
time, (146).


                 Lung Fever.—Pneumonia.

   This  disease, by  common usage, has been called a fever;  but by
physicians it is reckoned one of the inflammations.   It is inflamma-
tion of the  lungs or lights ; and whatever fever there may be, results
entirely  from this local inflammation. 
DISEASES OF THE CHEST.
241
   Signs  and Symptoms. — A patient suffering with lung fever, is gen-
 erally found lying upon his back, with some  pain in the  side; more
 or less  difficulty of breathing;  a cough, at first dry, but soon accom-
 panied by raising a thick, sticky, rusty-colored matter, composed of a
 mixture of  phlegm and blood.   As the  disease increases  in  severity,
 this matter wTill become more sticky and tenacious, so that it will ad-
 here to a spit-cup turned upside down.  There will be more difficulty
 of breathing, greater prostration, and perhaps some delirium.
   For the  purpose of more clearly  describing this  complaint, it  is
 found convenient to divide it into three stages, or degrees  of progress.

   First Stage. — This is called  the stage of engorgement.   The lungs
 during  this  stage are engorged or crowded with blood.   If we could
 inspect them, we should find the inflamed portion redder,  thicker, and
 heavier  than usual.   We  should find them weaker,  that  is, more
 easily torn  than in the natural state ; with less air in them, and con-
 sequently crackling less upon pressure, — yet not entirely  destitute of
 air  and crackling,  and not so  heavy as to sink  in water.   Rapping
 upon the chest at  this period gives out a flatter, duller,  or less hollow
 sound than usual.   On applying the stethoscope, we  hear less of the
 natural  rustling sound of health ; and, either mingling with, or over-
 coming it, we hear a minute crackling sound, as the air passes in and
 out in breathing.
   This  crackling has  been  compared to that produced  by  fine  salt
' thrown  upoi red-hot coals ; or by that of rubbing a lock of  fine  hair
 between the thumb and finger near the ear.  It is caused  by small
 bubbles of air  being forced along the moist and sticky  sides of the
 small tubes and air-cells.  It is heard only while the breath  is being
 drawn in.
   Second Stage. — If the inflammation  advances to the  second stage,
 the  swelling of the diseased lung increases  so as. to force out the air
 entirely, and it becomes solid, and wholly useless for the  purpose of
 breathing.   In  solidity and general appearance, it resembles a piece
 of liver.  Hence it is said to  be hepatized, or liverized;  and this  is
 called the stage of hepatization.
   As the lung  grows  more solid, its vitality and strength diminish;
 it is not near as strong as a  piece of healthy liver, though  it looks like
 it;  it is  soft and easily broken; indeed it seems to be in a state of
 commencing decay or rottenness.  Hence some writers,  in  order to
 be more  precisely correct, call this the stage of red softening.
   With  increased solidity,  there  is  of course increased dulness on
 percussion.   When the stethoscope is applied to the chest, we hear
 no sound of air passing into and out of the diseased lung; no natu-
 ral  rustling, or  minute crackling; but in their stead, we  have a kind
 of whistling, produced by the air passing back and forth in the wind-
 pipe and its branches, but finding no entrance into the solidified air-
 cells.   The breathing  sometimes  sounds like a sort of  puff, — owing
 to  the  column of air rebounding  when  refused admission to the
 closed-up cells.
   The general symptoms now increase in severity.   There is greater 
242
DISEASES OF THE CHEST.
  difficulty of breathing; the phlegm is more gluey ; perhaps some de-
  lirium shows itself; and the patient grows weaker.
    Third Stage. — At this period, the lung changes from red hepatiza-
  tion, or red softening, to gray hepatization, or gray softening, and mat-
  ter is now found diffused through  its whole  substance.  The percus-
  sion sounds are much the same as in the, second stage.  On listening,
  we  hear  more of the rattling sound produced by disturbed phlegm.
  The matter raised is thinner, — more like liquid  ;  and looks like
  prune-juice.  The symptoms generally indicate that the patient is
  sinking.  Patients may recover from  the first and second  stages, but
*< rarely from the third.
    Treatment. — This is  one of the diseases in which  the treatment
  generally begins with bleeding; but I cannot recommend it.   I  be-
  lieve it may be dispensed with, and the patient recover quite as well.
    The first thing is generally an emetic of tartrate of antimony, or
  pulverized  ipecac, or compound powder of lobelia.   The  next thing
  aimed at should be to produce sweating by  the use  of the compound
  tincture of Virginia snake root, hot fomentation of bitter herbs to  the
  chest, and bottles of hot water to  the sides, etc.  If  the fever be high,
  and the pulse rapid, it is better  to promote sweating, and  loosen  the
  phlegm, by the use  of the tincture of veratrum viride, in three to  ten
  drop doses every hour.   This tincture will act more  decidedly for this
  purpose, and to  reduce the pulse and fever, than any other article we
  have.
    Blisters are sometimes applied;  but they are inconvenient, as they
  hinder a proper examination of the chest.   Mustard will generally
  answer every  purpose.   It should be put on and  taken oft' several
  times, and when the surface grows sore, it  must be changed  to  an-
  other, so as to affect the chest extensively.
    If the  bowels be costive, they must be opened with some prepara-
  tion of salts (7)  (18) (20) (27).
    The drink must  be marshmallow, slippery elm, flax-seed, etc., and
  the diet  confined to barley water, lemonade, sour  apple  water, thin
  Indian meal and arrow-root gruel, crust-coffee, and the like.
    As the fever abates, the cough will need special attention, and to
  keep this quiet, and make the  raising easy, preparations (104) (112)
  (110) will be suitable*
    Should the patient be feeble and low when the fever is gone, give
  tonics (63) (64) (69) (73) (84) (81).
    Guard especially against a relapse.

          Typhoid  Lung Fever. — Typhoid  Pneumonia.

    This is an inflammation of the lungs, differing from the preceding
  only in the character of the  fever attending it, which is of a low,
  typhoid character.   The disease, like typhoid fever, is characterized
  by  great debility and prostration.
    Symptoms. — These are a combination of the symptoms of pneu-
  monia and of typhoid fever.  The disease begins with great weariness, 
DISEASES OF THE CHEST.
243
lassitude, dizziness, pain in the head, back, and limbs.   Soon there is
much difficulty of breathing,  tightness across  the chest, with a dry,
short, hacking cough.
  As the diseaes advances, the active symptoms pass away; there is
a dull pain across the chest; drowsiness is very apt to come on, with
the various symptoms of sinking peculiar to typhoid fever.   The skin
is harsh and dry, the  tempetature uneven, the tip  and edge of the
tongue red, and the middle covered with a yellow or brown fur.  The
bowels  are tender, swollen, and drum-head-like ; while there is often
a diarrhoea, — the discharges having a dirty-yellow color.
  Treatment. — This should be like the treatment of pneumonia and
typhoid fever united.
  Great care  must be taken not to use reducing remedies.  While
active purging must not  be. used, yet, if there are  symptoms of an
inactive state of the bowels, podophyllin  and leptandrin (34) (39) may
be employed with advantage.
   When there are symptoms of great depression, use tonics (46) (48)
(50) (53) (60) (64) (67) (73), taking care to keep the cough loose by
flax-seed, slippery elm, and marshmallow  tea,  and by some external
irritant.

                           Asthma.
   Asthma may be  defined to be great difficulty of drawing in the
breath — coming on suddenly, sometimes gradually — accompanied
with a sense of extreme suffocation, and a desire for fresh air; — con-
tinuing for a longer or shorter period, and then passing away, and leav-
ing the patient a period of comparatively easy  respiration.
   Symptoms. — There are sometimes no premonitory symptoms, the
attack  coming on suddenly,  and  without warning;  but  more  fre-
quently there are  for some days before the onset, loss of appetite,
flatulence, belching of wind, irritability,  languor, chilliness, oppression
and drowsiness.   The hard breathing generally makes its appearance
in  the  night — quite often at three  or  four o'clock in the morning,
when the°nervous  system is at its lowest ebb.   There is first a sense
of tightness, or stricture, across the chest, which seems to expand with
difficulty.   The  patient can no longer remain lying down; he rises
up, draws up his knees, and, leaning forward, puts his elbows upon
them, and his head upon his  hands, and then  struggles hard to draw
in  his  breath; which, passing in  slowly and laboriously, produces  a
loud wheezing sound.  Sometimes  he feels that he must have fresh
air  and, rushing to a window, puts his head far out, to catch a stir-
 ring breeze.  The hands and'feet are cold, the face haggard and dis-
tressed,__sometimes a little red and  swollen, but more generally  pale
 and  shrunk, — the body wet with perspiration, the pulse irregular,
 feeble and small, though sometimes not  disturbed.   These symptoms
 continue for  some hours, more or less, when  the breathing becomes
 more easy,  and there is a little phlegm raised, sometimes considerable.
 This cessation of difficult breathing may be complete, or only partial,
 and lasts for a longer or shorter period, when the attack again recurs. 
244
DISEASES OF THE CHEST.
  Causes.— It is well known that Asthma has its cause mainly in the
nervous  system.   The air-tubes  are encircled  with a series of little
bundles of fibres, which are, in fact, muscles, and like all other mus-
cles, have the  power of contracting or shortening themselves.   These
muscles, too,  like all  others,  have nerves distributed to them;  and
when these nerves become diseased, or irritable, they will become dis-
turbed on  certain occasions, and cause  these small, circular, pucker-
ing strings to contract and close up the air-tubes near their  termi-
nations, very much as the puckering string  closes the mouth  of the
work-bag, so that very little air can pass into the air-cells, and  that
little  with  great  difficulty and slowness.  When these contractions
take place, and the air is thus shut off",  the  result is a fit of asthma.
This disease may be brought on by any  of those states of the atmos-
phere which disturb or irritate the broirchial surfaces, or by any of
the numerous  causes which mysteriously unbalance the  nervous  sys-
tem.  A fit may be brought on by whatever disturbs the mind.
  Treatment. — The disease has been regarded as extremely difficult
of cure.  There  are certain remedies, however, which have a remark-
able control over it, and, if skilfully used, will frequently bring it to
a complete termination,  and, even in the worst cases, to a  state of
very great mitigation and improvement.
  Inhalation. — The most  important and certain  remedy, is the use
of the Alterative Inhalant, described on  page 221.  I  have with  this
article alone effected some surprising cures, yet it is well to combine
other treatment with it.   I have  had several cases of a most distress-
ing character, — the attacks continuing night and day,—in  which
the inhalation, judiciously administered, has caused the disappearance
of the complaint within twenty-four hours, and in which no return of
suffering has occurred for several  weeks, and then only in a modified
form.  This remedy should be used four  or five times a day.
  Iodide of potassium is  a  most valuable  internal  remedy in  this
complaint; indeed, in a certain sense, it is almost a specific.  It should
be used  (prescriptions  101, 138, 140, 151) at the same time with  the
inhalation.   The following preparation is a very good remedy for this
disease.  Ethereal tincture of lobelia, two ounces; tincture  of assa-
fcetida, one ounce; laudanum, one ounce; iodide of potassium, two
ounces;  simple syrup,  four ounces.  Mix.  Dose, from a teaspoonful
to a tablespoonful, every hour or two.
  Several other remedies are used for asthma, with more or  less  suc-
cess,— such as electro-magnetism, smoking  stramonium leaves, burn-
ing paper dipped  in a strong solution of  nitrate of potash, and  inhal-
ing the smoke, etc.; but none of these have as much value as the two
remedies first named.
  In  as  grave a complaint as a severe case  of asthma,  it is always
well to seek the aid of a physician.  I intended to have given some
interesting cases, but want of  space forbids. 
DISEASES OF THE CHEST.
245
              Hay-Asthma.-Hay-Fever.
  This is a very  troublesome complaint, which seems to combine the
peculiarities both of asthma and of influenza   Fortunately, it attacks
Tut few  persons, and those only at particular seasons of the year,
namely, while hay is in blossom, and during hay-making.
.  Symptoms.- These are a combination of the symptoms of the two
d2  above  named.  There is great irritation of the eyes with
sneezing,  and a free discharge  from the nose.   There is  tightness
acrosfhe chest, difficulty  of breathing, and a pricking sensation  m
the throat  These symptoms often  appear in great seventy, making
the complaint a  really distressing one.
   Cause. -This disorder appears to  have but one cause  namely, some
 sort of emanation from the  grasses, flowers, etc, white in blossom,
  vh ch emanations come in contact with the mucous liningjof the eyes,
 nose and throat, producing very great and teasing irritation.
   Treatment.-One of the best remedies for this troublesome com-
 plaintToavoui the cause, by removing, during the flowering and
 & season, to some large city,  or, still better, close down  to the
 *ea-shore  where flowers and hay do not grow.
   Of Ted^es, the tinctnre of'lobelia, taken in  moderate doses  ,sa

 TalL^re™^^^




   i tfc £„r»Un be diDDed in one of these solutions, and hung about
  t^ne-nt"* o? tfhouse.   The hands and face may likewse be

  W^S ^a^r^eroVnr-vomica, made into pills
  tw^grains'ofthe zinc to half a grain of the extract to each P.U,  and
  one pill taken morning and evening, should not be forgotten. 
HEART  DISEASES.
  Life rests upon a tripod, — the brain, the lungs,  and the heart
These are equally important to its wTell-being and continuance.
  In  substance, the human heart is a bundle of muscles, so put to-
gether as to bear the greatest possible  amount of work.   In  size,
shape, and look, it is much like the heart of the  hog.   I wish it never
had a likeness to it in its moral nature.
  The heart is enclosed in a case  or sac, called the pericardium.  It
lies between the two lungs, a little to the left side of the chest.   Its
point is under the sixth rib on the left side, and its lower surface rests
on the diaphragm,—a horizontal partition between the chest and belly.
  The heart is double.  It has four cavities, — two for receiving the
blood, which are called  auricles,  and two for  driving it out, called
ventricles.
  The venous, or dark  blood, is  brought from all parts below, and
emptied into the right auricle through the  ascending vena cava, and
from  all parts from  above, and poured into the same cavity through
the descending vena cava.   From this it passes into the right ventri-
cle, which  contracts, and  forces it through the pulmonary artery into
the lungs, where it  becomes red, and  passes  into the  left auricle
through the pulmonary vein, thence into  the left ventricle, which  con-
tracts, and throws it out through the great aorta to all parts of the
body.  Fig. 93 gives a good idea of the  circulation through the heart
and lungs.
  The heart is divided into two sides, which are  separated from each
other by a muscular  partition, — each side having an auricle and a
ventricle.
  The auricles have  comparatively thin walls, as they are only used
for reservoirs.  The  walls of the ventricles are much thicker, being
used,— particularly that of the left side, — for forcing the blood  over
a large surface.
  Between the auricle and ventricle on the right side, are three folds
of triangular membrane, called  the tricuspid  valves.  Between the
auricle and ventricle on the left side, are  three valves, called mitral.
  At the beginning of the pulmonary artery, and the aorta, are three
half-moon shaped folds of membrane, called semilunar valves.
  The office of all these valves is, to close  after the  blood has gone
through, and prevent its  flowing back while the cavity is being again
filled.   They do the same duty, in fact, as the valves of a pump. 
HEART DISEASES.         .           247
  Through this heart, thus constructed, all the blood in the body, —
about twenty-eight pounds, — passes once in about one minute and a
half.  This is r. pid work;  and  when  we  consider that the heart
works in this wTay through the whole .life, resting not, day or night,
we cannot wonder that it gets out of order.
Fig. 93.
  The whole heart is  seldom affected.
to disease than the right.
The  left side is more liable
                   Impulse  of the  Heart.

  The ear when placed over the heart, feels, at each beat, a slight
shock.   This is felt at the same time the first sound is heard.   This
impulse is caused  by the apex or point of the heart being thrown up
against the  ribs by,the contraction of the ventricles.  It is felt best
between the cartilages of the fifth and sixth ribs on the left side.

                The Sounds  of the Heart.

  On applying the ear to  the  chest just over the heart, two sounds
are heard. *  The first one is dull and slightly prolonged; the second
is a shorter  and smarter sound, having a sort of  clack.  These occur
in pretty rapid succession, and then comes a brief interval.  And this
round  of action, first a long and  dull sound, then a short and 'smart
one,  and then an  interval, — called the heart's rhythm, — is repeated
continually.   If the space of time occupied by the rhythm be divided
into  five parts, the first sound will take about two parts, the second
one,  and the interval of repose, the remaining two.  The first sound
is heard about the time of the contraction of the ventricles, and is
therefore called the  systolic sound; the second is synchronous with 
248                     HEART DISEASES.
the  opening of the ventricles,  and  is called the diastolic sound.
The syllables too-to — too-to, very fairly represent the two sounds of
the heart.   These sounds are heard  over the largest space in lean
persons.

                    Percussion Sounds.

   If the ends of the fingers be struck  upon the chest over the  heart,
a dull  sound will be heard over a space from one and a half to two
inches  square,— beginning at the fourth rib on the left side, and ex-
tending down nearly to the  sixth.  The  dulness  is diminished  by
lying upon the back, and increased  by  leaning forward, and by taking
a full breath.  The deadness of sound is caused by the heart being
a  partially solid body.   The  lungs which surround it, yield a  clear
sound.
   If a  solid substance, as large as the heart, were placed on the inside
of a drum, against the head, only a dead sound would be obtained by
striking on that spot; everywhere else, the sound would be louder.


              Altered Sounds of the Heart.

   These sounds are  changed by disease in a variety of ways, both as
to their character and duration.   One  or both sounds may be turned
into a noise like the blowing of a pair of bellows.   This is called the
bellows sound.  When  this sound  is very  harsh, it may  become like
the noise of a rasp, or file, or saw.   These  altered  sounds are all pro-
duced by an altered condition of the valvular passages through which
the blood  passes.   If you build an aqueduct of  equal  dimensions
throughout, and  smooth  on the inside, you may send a certain vol-
ume of water through, at a given speed, without noise.   But if you
make sudden contractions in  the aqueduct, or allow large stones to
project into it, and then  attempt  to send through  the  same body of
water,  at the same rate of speed, you will hear all sorts of noises.


   Enlargement  or  Hypertrophy of the  Ventricles.

   This is simply a thickening, or an increase of bulk, in the walls of
the ventricles.  The  muscles  composing the walls of one or both of
these cavities, grow thick and large.

  Physical Signs. — Impulse stronger than  natural.  When consider-
able, it is accompanied with a lifting and heaving of the parts.   Dull
sound on percussion over a larger space.  First sound of heart pro-
longed ; second sound feeble.  The interval of silence, shorter  than
natural.  In bad cases, the second sound is nearly extinguished.

  General Symptoms. — Hypertrophy of left ventricle gives a strong,
prolonged, and tense  pulse.  Palpitation more  constant than in any
other disease of the heart.  In advanced stages, the patient is easily
out of breath.  There is a rush of blood to the head on making exer- 
HEART DISEASES.                     249
tion, or stooping, with more or less throbbing and lancinating head-
aches, which are aggravated  by suddenly lying down  or rising up.
There are vertigo, ringing in the ears, sparks of light and other illusions
before  the eyes; also a purplish, violet or livid color upon the  cheeks,
nose, and lips.   In many cases  there is a dull, severe, aching pain in
the region of the  heart, and extending towards the shoulder and the
inside of the arm.
   When the right ventricle is enlarged, there is a swelling of  the ex-
ternal jugular veins.
   Causes. — The walls of the heart are thickened by overwork, in the
same way that the blacksmith's arm is made muscular and large.  All
muscles  grow in  the same way.  More action sends more blood to
them, and this causes an increase of nutrition.
   Whatever interposes an obstacle to the passage of the blood through
the valvular openings, will cause the ventricles which force it through
to work harder.  Hence, obstructions  in the semilunar valves cause
hypertrophy of the ventricles.
   Any  excitement of the mind, or any  great exertion, which causes
the heart to beat harder and faster, if it be often repeated, will induce
a thickening of  the ventricles.

   Treatment. — First, remove, as far as possible, all causes  of excite-
ment which produce palpitation.  If the  head is much affected, apply
wet cups to the  back of the neck.  The same may be  applied over the
heart.   This will generally improve the symptoms  at  once.  A blister
placed over the  heart will likewise make  a favorable impression.
   The meals should be taken at regular intervals, and should  be very
light.  The food  should be  plain and simple, and composed much
more of vegetable than  of animal  food.  In fact, the diet  should be
so spare as slightly to reduce  the strength.
   The patient  should be careful never to take violent exercise, or, in-
deed to be in a  hurry about anything.  In bad  cases, walking up hill,
or against a strosg wind, is  often out of the question, and must in
any case be attempted with great caution.  Stair-cases  are to be
shunned as enemies.   An attempt to run, even to avoid being left by
the  cars, might, in some cases, prove immediately fatal.  Carriage
riding is not objectionable.
   The passions must be held in the most thorough subjection.  Ex-
citements of all sorts are dangerous, and must be avoided.
   For the first  week or  two of treatment, active  purgatives  will be
useful.   For this purpose,  epsom salts and.senna will answer a good
purpose, and should be used so as to procure two  or three watery
stools a day.                                                    *?
   In addition to this,  some sedative to lessen the force of the' heart s
action, is  generally needed, — especially when  there is considerable
palpitation.  For this purpose, tincture of black cohosh, and  tincture
of scullcap, or  the former  with tincture of digitalis (285) (94),  are
quite useful.   Three to ten drops of tincture of the  American  helle-
bore (veratrum viride)  will  reduce the  action" of  the heart  perhaps
more effectually than any other medicine. 
250
HEART DISEASES.
               Dilatation  of the Ventricles.

  The several cavities of the  heart hold about one and a half ounces
each.   Dilatation is simply an enlargement of these cavities, so that
they will hold more.   And this increase in the  size of the cavity in
simple dilatation is  generally at the cost of the walls, which are  made
thinner and weaker,—just as the walls of a bladder are made thinner
by blowing into it and increasing its internal dimensions.

  Physical Signs. — Impulse more  abrupt, and less marked than nat-
ural.   Dull sound  on  percussion commensurate in extent with  the
dilatation.  The first beat of the heart, clearer, louder, and shorter
than natural, and more nearly  resembling the second.

  General  Symptoms. — Difficulty of breathing; terrific dreams;  start-
ing from sleep ; swelling of the feet and legs ; purple, violet, or blue
color of cheeks, nose, lips, and especially around the eyes ; feeble and
oppressed  palpitation;  various  disturbances in  the head;  bleeding
from the nose, stomach, bowels, and womb; and frequently enlarge-
ment of the liver.
  Explanations. — The first sound of the heart is short and  not well
marked, in consequence  of the muscular walls  of the ventricles in
this disease being  thin  and in a weakened condition, so that  every
stroke  they make is short, quick, and spasmodic, instead of strong
and lifting, as in hypertrophy.   For  the  same reason,  the impulse is
a brief blow  dealt  the walls of the  chest, which gives a slight shock,
but has not power enough to lift the chest  up.  The  blow is quick,
because the muscle is thin and can contract quicker than a thick one.
  Dilatation, by thinning the walls of the cavities, enfeebles the  heart,
and shows us an obstructed  circulation.   Accordingly the blood is
not transmitted by  the left ventricle, and being retained  in the lungs,
it causes a crowded state of the vessels, and difficulty of breathing;
also congestion of the brain, with terrific dreams, etc.    And this en-
gorgement of the  lungs, being propagated backwards to the  right
heart, great veins, and  all their  ramifications, produces dropsy of the
feet and legs, discoloration of  the face, passive hemorrhages, and con-
gestion of the brain, liver, and membranes.  Fig. 93  gives an idea
of how all  this happens.
  Treatment. — As  in many other diseases, search out the causes, and
remove them.  If it be obstruction of the circulation in the lungs by
bronchitis, or other  complaint, that needs the first attention.  If it be
caused by  violent exercise, by  strong emotions of the mind habitually
indulged,  or  by drunkenness, or any other irregularity of life, these
habits must be corrected without delay.
  If it be caused by organic disease of the valves  of the heart,  relief
cannot be so readily obtained; but even in these cases, it is  to be
sought and expected.
  The circulation  is to be kept as tranquil as possible by a strictly
quiet and  orderly life, and a plain,  moderate, unstimulating  diet  In 
HEART DISEASES.                     251
this disease, however, it should be more nutritious, and composed to
a larger extent of meats, than in hypertrophy.
  In some cases the general health and tone of the system will need
to be improved by bitters (50)  (67) (64)  (69) (79), mineral acids (60),
iron (269) (61), and aromatics  (115).   The compound mixture of iron
is a good preparation when this mineral is called for by a low state of
the blood.
  The stomach should  be kept in the best possible condition, as a
very small disturbance of it, even from acidity, will set the heart to
beating very violently.
  If hysterical symptoms are  present, the compound galbanum pill,
and valerian (97), and other nervines will be called for.
  In attacks of great difficulty in breathing, immerse all the extremi-
ties in warm water, and throw a blanket around the patient to pro-
mote sweating, — at  the same time admitting fresh air to satisfy the
desire  for breath.  Give a draught, composed of ether, laudanum,
ammonia, etc. (135).  This may be  repeated two or three times, at
intervals of half an hour, or an hour, according to the urgency of the
case.

          Hypertrophy with Slight Dilatation.

   This is one of the most common complications of  heart disease.
It consists both  in a thickening of the walls of the heart, and an  en-
largement of the cavities, — the former being more  marked than  the
latter.
   Physical Signs. — Both sounds are louder than in  any other disease
of the heart, and are heard sometimes over the whole chest.  The
impulse is strong and heaving, with an abrupt back-stroke.  In bad
cases,  the whole person, and even the bed, is shaken by it.   The dull
sound on percussion covers a large space.
   General Symptoms. — The same as  those of the two  diseases of
which it is composed, slightly modified by the action  of  each upon
the other.

          Dilatation with  Slight Hypertrophy.

   This is  an enlargement of the cavities of the heart, with a slight
thickening of  its walls ; the dilatation being the predominant disease,
or greater than hypertrophy.
   Physical Signs.— Percussion gives a dull sound in the region of the
heart,  in proportion to  its size.  The first beat resembles the second.
The second beat is louder than natural.
   The impulse is a short, quick stroke, which contrasts strongly with
the slower and heaving one of hypertrophy with dilatation.
   The general symptoms and  the treatment are a modification of
those of the two diseases united  in it.  It is, however, to be kept in
mind that the dilatation takes the lead; and, furnishing the predomi-
nant symptoms, is specially to be regarded in the treatment. 
252                    HEART DISEASES.
            Aneurismal  Tumors  of the  Heart.

   When, from some obstruction in the valves, the blood cannot easily
pass out of an  auricle or a ventricle, its inner walls may become
unable  to bear the distending force, and giving way, let the blood
through against the outer coats, which stretch, and swell out into the
shape of a tumor, — the inside of the  tumor becoming a regular sac.
Such a state of things constitutes an aneurism of the  heart.   Of
course it is incurable.

                  Softening of the  Heart.

   In this disease the substance of the heart becomes soft, and easily
broken.  It is generally the result of some form of inflammation.
   Physical Signs.—r- The contractions of the heart being weakened by
softening, the impulse is reduced in force,  and both beats  are weaker,
and often they are intermittent.   The  first beat becomes short and
flapping, like the second.
   General Symptoms. — A quick,  feeble,  small,  and faltering pulse,
great anxiety, and  a disposition to faint.   General languor ;  a sallow,
bloodless, withered complexion, with a purple, livid tint of the lips
and cheeks,  and frequently, general dropsy, from the inability of the
heart to propel its contents.
   Treatment. — When accompanied by acute inflammation, softening
is to be treated  on the  same principles as inflammation of the heart-
case.
   If it be a result  of chronic inflammation, it calls for iron, bitters,
nutritious animal food, and good air.

                 Induration  of the  Heart.

   The muscular substance of the heart sometimes undergoes a hard-
ening process.   It  is occasionally so much hardened  as to sound,
when struck, like a hollow horn vessel.   The disease is rare.
   It increases the  heart's  impulse, like hypertrophy; and it requires
about the same treatment with that disease.

          Fatty  Degenerations  of the   Heart.

   The heart sometimes becomes overloaded with fat, which is depos-
ited between the heart-case and the muscular substance, — covering
the organ all over externally, and in some cases penetrating to some
depth into  its substance.   The muscular walls  themselves  become
thin and flabby.
  Symptoms. — The sounds of the heart are diminished, — especially
the first.  The pulse is irregular.  Pain,  and a feeling of oppression
in the region of the heart, with general signs of  retarded  circulation, 
HEART DISEASES.
253
such as congestion of the brain and liver.  There is occasionally gid-
diness, loss of memory, and palpitation.
  Treatment. — Exercise, mental excitement, and stimulating drinks
must  be avoided ;  and the patient must live for one or two years on
a very light diet, taking but very little animal food.         4

 Bony and Cartilaginous Productions in the Heart.

  These productions in the heart  are  fortunately rare.  Yet they
occur; and the  point of the heart,  in its  whole thickness, is  some-
times changed to cartilage.   The ventricles are sometimes so ossified
as to resemble the bone^jof the head.
  The symptoms of these degenerations  are obscure; and  as such
cases  are not curable, it is of less consequence that  we should be able
to know their precise nature during the life of the patient.  The treat-
ment  can only  afford temporary relief, and should be such as is pre-
scribed in other heart diseases with similar symptoms.


            Shrinking  of the  Heart.—Atrophy.

  The  heart, like  any other- muscle, is  liable to defective nutrition,
and in  consequence of  it may become small.   It  shrinks, in some
cases, to the size of an infant's heart.
  The complaint is generally caused by whatever reduces the general
flesh,  as consumption, diabetes, chronic  dysentery,  cancer, and  exces-
sive loss of blood.
  It can hardly be called a disease.  Persons who have it are  less
subject  to  inflammatory diseases than others, though they faint from
slight causes, and have nervous affections.
  Treatment. — If  its causes can  be discovered, treat them ; if  not,
the treatment should be the same as for dilatation.

Acute Inflammation of  the  Heart-Case. — Pericarditis.

  The  pericardium, or heart-case,  is a membranous sac, in  which
the heart is contained.  It is composed of two layers.  The outside
one is fibrous, dense, and white; the inside one is serous.  The  serous
layer  forms the  lining of the fibrous one, and then is reflected over
the heart, and the roots of the  large blood-vessels.
  When the pericardium becomes acutely  inflamed, it  throws  out,
both  lymph, and serum or water.   The lymph often causes the  two
layers of the sac to grow together.
  Physical Signs. — The impulse is  strong when the effusion of water
is small, — feeble and unequal when it is large.  Percussion  yields a
dull sound in proportion to the amount of fluid in the sac.
  When listening  with the stethoscope, a rough noise is heard, resem-
bling either the rasping of wood, the grating of a nutmeg, the rustling
of silk, or  the crackling of parchment   Sometimes it is softer, like 
254
HEART DISEASES.
the blowing  of  a pair  of bellows.   Occasionally, it resembles the
creaking of a new shoe-sole, or  has a low creaking, like the  tearing
of linen cloth.
  When there is effusion, the ordinary beats of the heart sound dull
and distant.
        *
  General Symptoms. — Acute inflammatory fever generally preceded
by chills, with pungent pain in the region of the heart, shooting to the
left shoulder-blade, shoulder, and upper arm.
  Pain  increased by taking a full breath, by stretching the left side,
by percussion, and by pressure between the ribs over the heart.  Some-
times the pain is in the epigastrium, or left hypocondrium.  Inability
to lie on the left  side.                     %

  Explanation. — The noises mentioned above, are produced by the
rubbing together of opposite surfaces of the  heart-case, made rough
by the exudation of lymph.   The rasping is  supposed to be  caused
by firm and rugged lymph; the rustling and creaking, by soft and wet
lymph;  the  bellows  murmur, by soft  and dry lymph; the creaking,
croaking, and crackling, by dry, tough lymph.  These sounds may all
be imitated   by  rubbing a damp finger upon the back of the hand,
while listening with the  stethoscope applied to the palm.

       Chronic Inflammation of  the  Heart-Case.

   When acute pericarditis runs for more than ten days or a fortnight,
it becomes chronic.  It is chronic from the beginning, when it runs a
slow, insidious course, without marked or violent symptoms.
   The symptoms are much the same in kind with those of the acute
form, only less in degree.  This low  grade  of the symptoms of the
disease  renders it more obscure than the acute.

  Treatment. — In the acute form of  the disease, apply wet cups over
the region of the heart, or apply from a dozen to forty leeches to the
same parts.
   At the same time, move the bowels freely by an injection (247), or
by a purgative pill (31).
   The strength and amount of the remedies employed in each case,
must be in proportion to the vigor  of  the patient's constitution.
   It is  of great importance  that the treatment should be active and
prompt, and  that the disease should be broken down early.
   Diluent, cooling drinks (132)  (129) (298)  (299)  should be  allowed
as freely as the patient desires, in  order to dilute the  blood, and ren-
der it less stimulating to the heart.
   At the same time, five to fifteen-drop doses of tincture of veratrum
viride should be given  every hour, to bring down the action of the
heart
   Let the diet  be wholly of barley-water,  thin  gruel, weak tea, or
arrow root                          *
   During recovery, the diet must be spare,  and the greatest tranquil-
lity of mind and body be preserved. 
HEART DISEASES.
255
  In the treatment of chronic cases, when the cavity appears to con-
tain fluid, counter-irritation is suitable.   Blisters, croton oil, the com-
pound tar plaster, and  especially the tincture  of iodine.   The diet
may be a little more nutritious than in the acute form of the disease,
— embracing light animal food and broths.

         Inflammation  of the Heart. — Carditis.

  This is an inflammation of the muscular  substance of the  heart.
When existing alone, it is a  very rare disease.   Being mixed up with
other  forms of heart disease, it does not require  any separate account
of its symptoms or treatment

   Acute Inflammation of the Lining of the  Heart.
                          Endocarditis.

  The heart is  one of the citadels of life.  Disease  attacks it  on all
sides.   In this complaint, it has entered the fort, and taken possession.
The inflammation is on  the lining membrane.        *
  Physical Signs. — The impulse is violent,  abrupt,  and regular, as
long as the circulation through the  heart is free, but when this  is im-
peded, it is at first a confused tumult (which generally happens when
a fort is first taken), and gradually sinks  to a feeble flutter.
  The dull  sound upon percussion  covers a space of from three to
seven square inches.
  The beats of the heart are generally accompanied or marked by a
bellows murmur, — the loudness of which depends on the strength of
the heart's action.
  General Symptoms. — Inflammatory fever.  The action of the heart
being generally violent and abrupt, the pulse corresponds- with it, and
is strong, full, and haro:
  Explanation. — The- bellows sound is  supposed to depend on the
inflamed and swollen condition of the valves.
  The  dulness  on percussion will  be  slight when  the circulation
through the  heart is  free; — more distinct and marked when it  is
obstructed.
  Dr. Hope  says the disease may be anticipated, if a person be sud-
denly  attacked  with these three  signs:  namely, fever, violent  action
of the heart,  and a murmur which did not exist before.
  This disease, like inflammation of the heart-case, is often produced
by, and is intimately connected with, acute  rheumatism.


     Chronic  Inflammation  of the  Heart's Lining.

  Physical Signs. — The impulse more  perceptible and diffused than
natural.
  The dull  sound upon percussion covers a space  of from four to
eight  square inches. 
256                     HEART DISEASES.
  There is a sawing, rasping, or filing sound.  This sound may cover
one or both beats of the heart.  Sometimes these unnatural sounds
are double ; in which case, the first is caused by an obstruction to the
natural flow of the blood forward; the second, by the  regurgitation
or retrograde, flow of the blood from some defect in the valve,—just
as a pump valve may  get out of order, and allow the  water which
has gone through to flow back.
  Explanation.— A variety  of organic changes  occur in the valves,
which give rise to the  murmurs.   Inflammation of the lining  mem-
brane of the heart, reaches the valves, causes puckering, thickening,
vegetatious, cartilaginous, bony, and fat-like degenations, which obstruct
the  blood in its onward flow, or prevent a closure of the valves, and
allow it to flow back;  the former causing the first sound, the  latter
the second.  If the unnatural noise be synchronous with the first beat
of the heart, it implies  disease in either set of the semilunar valves,
or an impossibility of closing the auriculo-ventricular openings; if it
accompany the second beat, it signifies that either set of the semilu-
nar valves may be  open.
  A murmur attending the first beat of the heart, must be caused by
a current of blood from a ventricle; one  attending a second sound,
by a like necessity, is produced by a current into a ventricle.
  Treatment. — The same as that for pericarditis. It should be equally
prompt and vigorous.   It must not be forgotten that this disease leads
to various organic diseases  of the valves of a very grave  character,
and  that  such mischiefs can only be escaped by cutting the disease
short in the very beginning.

            Disease  of the  Semilunar Valves.

  The inflammation of the  lining of the heart makes sad work with
the  valves.  The semilunars are  subject to various changes in their
structure.
  Physical Signs. — Obstructive Murmur. — In disease of the semilu-
nars,  the first  beat of the heart is accompanied or obscured either by
the bellows murmur, or a sawing, rasping, or filing sound.   The un-
natural  murmur, whatever  it is, appears  superficial or near.   The
second beat is natural.
  When  the opening  into the aorta is contracted, or in any way ob-
structed  by unhealthy  growths, so that the blood is subjected to more
than  a natural degree of friction in passing, this sound  will be  heard.
It is  called  obstructive, because  it arises from  the obstruction of the
blood in its forward course.
  Regurgitant Murmurs. —  First beat of heart natural.   Second beat
accompanied or replaced by bellows murmur.  There is sometimes a
musical murmur.
  Explanation. — The  regurgitant murmurs arise from the valves be-
ing  too  small, or  defective,  in some way, and  allowing the  blood to
flow back through the  orifice. 
HEART DISEASES.                    257
  This murmur is loudest opposite the semilunar valves, and is more
audible above these valves than below them.
  When the aortic valves are contracted or shortened, and the open-
ings are not guarded by them, so as to prevent the backward passage
of the blood, there is a double bellows murmur, — one when it  is
driven through the orifice, and another when it flows back.

               Disease  of  the  Mitral  Valves.

  Physical Signs. — Obstructive  Murmur. — First beat of heart natu-
ral.   Second beat accompanied or replaced by bellows murmur.

  Regurgitant Murmurs. — The first beat of the heart accompanied by
a loud and rough bellows  murmur.  This  sound  is  like sawing or
filing,  it is loudest  above or below the nipple, between the  fourth
and seventh ribs.  There  is  occasionally a musical  murmur.   The
second beat of the heart is natural.  Sometimes there is a purring
tremor.
  General Symptoms of Valvular Disease. — Cough, in many cases
with watery expectoration; difficulty of breathing; frightful dreams,
and  starting from sleep;  congestion  of the lungs; expectoration
stained with dark and grumous blood ; swelling of the jugular veins ;
a livid look  of  the face ; a feeling as if a cord wTere tied tight around
the  lower part of the chest;  general dropsy, of the legs and feet in
particular;  passive hemorrhages from the mucous  membranes; en-
gorgement of the liver and spleen; congestion of the brain, with feel-
ings of oppression.  When the mitral valve is contracted, admitting
regurgitation, the pulse is small, weak, irregular, and intermittent.
   These are the worst symptoms of an advanced stage.

  Explanations. — The examiner will distinguish the various sounds
thus :
   The murmurs generated at the  origin of  the arteries, spread their
sonorous currents upwards along these arteries.
   Those produced in the auricular orifices, will be conducted into the
auricles, and propagated downwards towards the apex of the heart.

  Which Set of Valves. — To learn in which  set of  valves it origi-
nates, therefore, find its seat, and trace its direction.
   Finding the  murmur to be in the aortic orifice, it is then known to
be obstructive,  if the first sound is morbid, and the second sound natu-
ral;  and regurgitant, if the first sound is natural, and the second sound
morbid.
   But if the murmur be in the mitral orifice, it is obstructive when the
first beat of the heart is natural, and the second beat  morbid; and re-
gurgitant, when the first beat is morbid, and the second beat natural.

  The Pitch or Key of a murmur  depends on the distance of its seat
from the ear of the listener ; — nearness giving a high, and distance a
low key.  Thus, a murmur seated in  the orifice  of the  pulmonary
artc-v. beinp1 nearer the surface, has a higher pitch than any other. 
258                      HEART DISEASES.
It is  on about the same key with a whispered s, — sometimes a little
lower, and depending somewhat on the  strength of the current of
blood, — a strong current elevating, and a weak current  depressing the
tone.
   The mitral orifice is situated opposite the junction of the cartilage
of the third rib with  the  left side of  the breast  bone.   The  aortic
orifice is about half an  inch  to  the right of this, and  the same dis-
tance lower.  It is  known by the key  being lower, — about like  a
whispered r, which is the ordinary type of  the sawing sound.
   Murmurs from pulmonic and  aortic regurgitations,  are about two
tones lower, in  consequence of the currents of the blood being weaker.
They are like whispering awe by inspiration; and if the click of the
valve be heard, the sound will be changed  to paw.
   Murmurs in  the mitral  valve, being more deeply seated, are  about
four tones lower, and are like a whispered  who.
   The tricuspid murmurs  are higher than the mitral, because nearer
the surface.
   The musical  murmur has been  compared to whistling, the cooing
of a dove, and  the  mewing of a kitten.  It generally results from re-
gurgitation.
   The purring tremor is caused, generally, by regurgitation through
the mitral valve.
  Other Symptoms  Explained. — The difficulty of breathing, frightful
dreams, congestion  of the lungs,  hemorrhages, engorgements, etc.,
mentioned above, all proceed from such valvular stiffenings, pucker-
ings, ossifications, enlargements, and contractions, as occasion a decid-
edly obstructed  circulation.
   The small, weak, irregular, and interrupted pulse, is caused by con-
traction of the  mitral valve, which occasions an insufficient or irregu-
lar supply of blood to the ventricle, and causes the ventricle,  by losing
the* resistance of the valve, to expend its force in  a backward as well
a forward direction, — thus sending but little  blood into the  arteries.

  Treatment.— The tendency of valvular disease is to produce hyper-
trophy and dilatation.   The strong and ceaseless  efforts of the ven-
tricle  to drive  the  blood through  an  orifice obstructed by valvular
disease, will of course make the walls grow thick, which  is  hypertro-
phy ;  and at the same  time, the accumulation of blood which cannot
be driven forward  fast enough, must tend to swell and enlarge the
cavity, — which is dilatation.
   The great object of treatment, therefore, is to diminish  the  force
and activity of  the circulation, — to induce the heart to cease striving
to do what cannot be done.
   To accomplish this,  give sedatives (285) (94)  (124).  The hellebore
and cohosh will be found particularly serviceable.
   The tincture of  the American hellebore is about the  best of all.
Purgatives may be given according to the  strength of the patient.
   When there  is dropsy, and a scanty secretion of high-colored urine,
diuretics, or medicines to increase  the action of the kidneys, are very
important  For this purpose, digitalis  and acetate of potash (130) 
HEART DISEASES.                     259
are excellent.   Should this  not succeed in  reducing  the  dropsy, an
active purgative (31) may. accompany it.
  Diaphoretics,  or  medicines which  promote perspiration, are  also
useful.   This opening of the skin,  however, is  generally brought
about by the hellebore, etc. (124).
  The diet  should  be unstimulating, and yet should be  sufficiently
nourishing to prevent the patient  from running  too low.  Animal
food of the  most digestible kind may be taken once a day; though
there are many cases requiring its entire rejection.
  The passions should be kept in the most  perfect  subjection, and
the life should be as tranquil as possible.  Nothing must be done in a
hurry.

      Water in  the Heart-Case.—Hydropericardium.

   This disease is common as an attendant of general  dropsy.

  Physical Signs. — The  impulse  is undulatory,  as  if transmitted
through a fluid, and it is not always of the same strength.
   The dulness extends upward in a conical form, in proportion to the
amount of fluid ; — sometimes rising as high as the second rib.   The
impulse does not coincide with the first beat of the heart.

  General Symptoms. — The patient has a sensation of the  heart being
in a floating state.   The pulse is small, frequent, and intermittent.

  Explanation. — The  reason  that the impulse does not occur at the
same time with the first beat of the heart is, that the  apex  does not
immediately strike the walls of the chest, — some time being required
to push it up through the fluid.
   The beats of the heart sound more distant than natural in  conse>
quence of the organ being pushed away from the walls of the chest
by the fluid.


   Palpitation.—Nervous  Palpitation.—Anaemic Palpitation.

  There  is a great deal of palpitation of the  heart dependent on
dyspepsia, hypochondria, hysterics, mental agitation, excessive study
with deficient sleep, venereal excesses, and masturbation.
  Palpitations likewise occur from what is called ancemia, or a low
and deficient state of the blood.

  Physical Signs. — The impulse is weak, fluttering,  or tumultuous,
— generally increased by trifles.
  The beats of the heart are increased in frequency, and  sometimes
marked by  intermission.  Now and then they are accompanied by a
bellows murmur.   There  are musical murmurs in the jugular veins,
— loudest a little above the collar bones.

  General Symptoms.— The complexion is generally pallid  and blood-
less ; the lips and the inside of the mouth partaking of the  same pale- 
260                     HEART DISEASES.
ness ; the pulse .quick, small, weak, and jerking; and during palpita-
tion, it sometimes has a thrill.  Slight causjes produce breathlessness
and faint ness.   A  dislike  of animal food, and a fondness for acids.
The monthly discharge in  females is deficient, and the whites take its
place.  Sometimes  the menses are too profuse, lasting for several days,
and consisting only of blood.   In  this state of things there  is great
feebleness both of mind and body, with rushing noises in the ears.

   Explanations.— The murmurs depend on alack of blood. The con-
ditions of their existence are, thinness of blood, a swift and spasmodic
circulation, and particularly an unfilled condition of the blood-vessels.
A  brook is  the  more  babbling in proportion as  its water is more
shallow.   It  is a law in physics, that heaviness of freight gives stead-
iness of motion ;  and lightness  of freight  gives unsteady  motion.
The fireman's hose  trembles and vibrates when only half full of water.
In like  manner the blood-vessels are agitated when imperfectly filled.

   Treatment.— This is to  be governed  altogether by the cause of the
trouble.  If it  be dyspepsia, hypochondria, hysterics, etc., these sev-
eral diseases  require their usual treatment; when they are cured, the
palpitation will stop.
   But when it is caused  by a  low state of the blood, then give for
several weeks, iron, the compound mixture, and (316) (310).
   The food  must  likewise  be  nourishing, — tender meat, beef and
mutton, with broths, etc.
   Gentle exercise  will be required, and much exposure to a bracing,
out-door air.

       Neuralgia of the Heart.—Angina Pectoris.

   This  is a  strictly nervous  disease.   It  begins  with a sensation of
pain and constriction in the region  of the heart  This pain is accom-
panied with  more  or less  pain and numbness in the left arm.   In
females it is not uncommon for it to be attended by great sensitive-
ness and pain of the breasts.  When  the attack is violent, the pain
in the heart is excruciating, and even terrific.   There is attending this
a  feeling of  great  oppression in the chest, amounting,  in the  worst
cases, to  a sense of suffocation.  The  heart palpitates  violently, the
brain is oppressed,  and fainting  sometimes occurs.
   The disease is brought  on, in nervous subjects, by over excitement
of the  heart.   Walking up  hill, against a strong wind, may bring it
on.  If walking at  the time of the attack,  the patient is compelled to
stop, and stand still till the pain subsides.
   The disease is often connected with organic changes in the heart's
structure, such as ossifications, and other alterations.

   Treatment. — When .the complaint depends on  organic disease of
the heart, the treatment must be directed to  the cure  of these dis-
eases.
   To relieve a severe attack, the patient should be  instantly placed
in a quiet position;  wind in the stomach, if present,  should be ex- 
HEART DISEASES.                     261
pelled  by peppermint or anise water, or ether, or (115), or some other
aromatic.  If there is acidity or sourness of the stomach, it must be
corrected by a teaspoonful of soda  in  half a tumbler of water; and
if the stomach be full of undigested food, let the patient take a table-
spoonful of ground mustard, stirred up with  a teacupful of warm
water.  This will cause almost instant  vomiting.
  These things  being  done, give some quieting, or  antispasmodic
medicines, as one sixth  of a grain of morphine, or one of the following
prescriptions:  (285) (97)  (135) (124).
  Great relief is often obtained  by sending a current  of magnetism
through the region of the  heart, by applying one pole of the machine
in front, and the other upon the back.
  During the intervals, the general health  is to be improved by a
wholesome, nourishing diet,  gentle,  out-door exercise, and a careful
control of all the passions.

                   Polypus of the Heart.

  A portion of the fibrine sometimes separates from the blood in the
heart and large vessels, and becoming  more or less organized, forms
polypuses, which fill the cavities to which they are attached, and seri-
ously obstruct the circulation.

  Physical Signs. — When the  pulsations  of  the  heart,  previously
regular, become suddenly anomalous,  confused, and obscure, so that
they cannot be analyzed, we may suspect a polypus.

  General Symptoms. — A sudden and great aggravation of the bad
breathing, without any visible  cause, — the patient being in agony
from a sense  of impending suffocation, and tossing about  from side
to side, struggling for  breath.   The pulse small, weak, irregular, in-
termittent,  and unequal;  the surface and  extremities cold; the  face,
livid, —to which there  is generally added nausea and vomiting.

  Treatment. — When  the polypus is  once formed, the case is hope-
less.  The  treatment, therefore, can only be preventive.
  The chief  things to be done are, to keep the patient in a state of
entire tranquillity, and to bring the circulation to the surface, by keep-
ing the skin warm, and excited by friction.  This will call the blood
away from the heart and great vessels,  and lessen the chances of the
polypus.

               Displacements  of the Heart.

  The heart may be misplaced  from  birth. I have seen a case in
which  it lay  upon the  right  side, and  had always been in that posi-
tion.   Its action was natural.
  A variety of causes may tend to push it out of its place, as water
in the cavity of  the pleura.   In  such cases, it will return to its place
when the water  is drawn off or absorbed. 
DISEASES  OF THE  ABDOMINAL  CAVITY.
  Under the above head I shall  consider most of the .diseases which
occur in the great cavity below the diaphragm, called the abdomen
or belly.   These affections are quite important, and make up a con-
siderable part of the ills we suffer from disease.
  Before speaking of these diseases, however, I will call the reader's
attention to a profile view of the
relative position of the several or-
gans lodged in this cavity.
  In Fig. 94, L is the liver, S the
stomach, C the colon, R the rectum,
B the bladder, P  D  the pancreas,
and I the intestines.  The double
lines, folded  back upon each other,
and surrounding  most of the or-
gans,  represent the peritoneum,  a
membrane which  lines  the  great
cavity of which I am speaking.
  It will be well,  too, before pro-
ceeding further, to make the reader
acquainted with the names of cer-
tain regions  of the  abdomen which
he will  find constantly spoken of
in medical  books.  I  have not
used  these   terms much in my
book;  but it will be convenient
to be acquainted with them. Phy-
sicians who  are careless  in their
readings, are not always  familiar
with their exact locality.
  In Fig. 95, the abdomen is di-
vided  into nine different regions
by the  drawing  of two  parallel
lines up and down, 2, 2, and 3, 3,
and two lines across, 4, 4, and 1, 1.  This  gives three regions above,   I
three in the  middle, and three below.
  In the upper row, 6 is the epigastrium, or  epigastric region, in which
are the left lobe of the liver, and a portion of the  stomach ; 5, on the
Fio. 94.
 
DISEASES OF THE ABDOMINAL CAVITY.
26y
^
Fig. 96.
right side, is the right hypochondrium, in which is the right lobe of the
                          liver; and  5, on the left side, is the left
                          hypochondrium, which contains the spleen,
                          and a portion of the stomach and liver.
                            In  the  middle row,  7 is the  umbilical
                          region, which contains the small intestines.
                          On the right side, 8 is the right lumbar re-
                          gion, which holds the right kidney and the
                          ascending  colon ; and 8, on the left, is the
                          left lumbar region, which contains the left
                          kidney and the descending colon.
                            In the lower row, 9 is the hypogastrium,
                          or hypogastric region, which contains a por-
                          tion of the small intestines and bladder.
                          On the right, 10 is the right iliac fassa,
                          containing the ccecum or caput coli; and 10,
                          on the left, is the left iliac fassa, contain-
                          ing the sigmoid flexure.
                            And  now I  may as well  present, in
Fig. 96.
Fig. 96, a front view of
many of the organs both
in the chest and abdo-
men : 1, 1, 1, 1, are the
muscles of the chest;  2,
2, 2, 2, the ribs ; 3, 3,  3,
the  upper, middle,  and
lower lobes of the right
lung; 4, 4, the  lobes of
the left lung; 5, the right
ventricle of the heart;  6,
the left ventricle ; 7, the
right auricle of the heart;
8, the left auricle; 9, the
pulmonary  artery; 10,
the aorta; 11, the vena
cava descendens; 12, the
windpipe; 13,  oesopha-
gus ; 14, 14,  14, 14, the
pleura ; 15, 15, 15, the
diaphragm; 16, lo, the
right and  left  lobes of
the liver; 17,  the  gall
bladder ;  18,  stomach ;
26,  the spleen ;  19, 19,
the duodenum;  20, the
ascending colon; 21, the
transverse colon ; 25, the
descending colon; 22, 22,
22,  22,  the  small intes-
tines ; 23, 23, the walls of the belly  turned down ; 24, the thoracic
duct, opening into the left subclavian vein (27).
 
264           DISEASES OF THE ABDOMINAL CAVITY.
            Acute Inflammation  of the Liver.

  The liver is the largest gland in the body.  (See Fig. 31.)  It lies
in the right side, find  at the top  of the great abdominal cavity, di-
rectly under the midriff,  and lapping  upon  the  stomach.  Fig. 94
shows its relative position.  Its office is to take  the superabundant
carbon out  of the blood.   This carbon it unites with other elements
and  forms bile, the peculiar bitter substance, which is poured into the
upper bowel, and greatly aids digestion.
  The liver is  liable to become inflamed  from several causes, such
as gravel stones, external violence,  suppressed secretions, hot climates,
inflammation of the  duodenum, etc.

  Symptoms. — These  are  sympathetic fever,  with pain, and a sense
of tension in the right  side, inability to  lie  on the left side, difficulty
of breathing, a dry cough, vomiting, and hiccup.
  The pain is acute  and lancinating  generally,  though sometimes
dull  and tensive.  When sharp, it is like the stitch of pleurisy, and it
indicates  that  the peritoneum  which  covers the liver is inflamed.
When dull,  it is the body of the organ which is suffering.   When the
convex surface of the liver is the seat of the disease, the  pain is apt to
run up to the right collar-bone, and to the  top of  the right shoulder.
Breathing, coughing, and lying on the left side, increase the pain.
A soreness is felt by pressing over  the liver.  The  pulse is full, hard,
and  strong, the  bowels are costive, and the stools are clay colored,
owing to not being tinged with bile, — this having stopped flowing.
The  tongue is covered  with a yellow, dark brown,  or even black coat,
and there is a bitter taste in the mouth.

  Explanation. — The  bile, secreted by the liver,  is poured into the
upper bowel, and gives the brown  or the yellow color to the contents
of the bowels.   When the liver is inflamed, it cannot work, — it se-
cretes little  or  no bile, and the  discharge  from the bowels lose their
color.  The bile is slightly physical, and when it ceases to flow  into
the bowels,  they become bound or costive.  When the  liver does not
work, the bile has to be taken out of the blood by the kidneys,  and
the urine becomes of  a deep  yellow color.  Much of it  goes  out
through the skin, too,  which is likewise yellow,  and the sweat be-
comes so yellow as to stain the linen.

  Treatment. — Apply  wet cups or leeches over the liver pretty freely.
  Purgatives will also need to be used pretty freely at first  Those
which produce watery  stools  (31)  (247)  (34)  will be of the greatest
service.
  After the  cups and purgatives have been thoroughly used, blisters
will  be useful, and it  will be better  to apply several  in succession,
rather than  to  keep the first one  open.  Or, in the milder cases, a
mustard poultice may  be applied over the whole side, and even along
the spine.
  Frictions over the stomach and liver with the nitro-muriatic  acid, 
DISEASES OF THE ABDOMINAL CAVITY.           265
and a  foot  bath of the same, will sometimes do  well.  The acid
should be reduced with water to about the strength of sharp  vinegar.
Water a little soured with this  same  acid makes an excellent drink
for the patient.
  Perspiration should be induced by the spirit vapor bath, and kept
up gently by  the tincture of the American hellebore, from  three to
ten drops every hour.  Or, the same thing may be done by prescrip-
tion (126).
  When the urine  is small in quantity  and red,  give  some diu-
retic, as infusion of  marshmallow root,  pumpkin  seeds, or trailing
arbutus.
  The diet should be rice-water, gruel, and. toast-water.  While get-
ting  up, it  may gradually be improved, and  some  light tonics (49)
(58)  (64) be added to it.

           Chronic Inflammation  of the Liver.

  There are  few chronic diseases for which, the physician is more
often consulted than this.   In the warm climate of  the South, in the
bilious  districts of the West, and indeed even  in the Middle  and
Eastern States, it meets, us  continually, and demands our attention.
That it is  difficult to cure  must be admitted; but a constant famil-
iarity with chronic diseases, for several years,  has convinced  me that
it is generally curable.
  Symptoms.— A sense of fulness and weight in the right side, with
some enlargement, and shooting pains felt in  the same region, partic-
ularly  when it is pressed, with  pains  in  one or  both shoulders, and
under the shoulder  blades; uncomfortable sensations when lying on
the left side; yellowness of  the skin, eyes, and urine ; bowels irregu-
lar, loose, or costive ; appetite  disturbed; sometimes a dry, hacking
cough;  shortness of breath; tongue whitish, and  brown or yellow
towards the root; a bitter and bad taste  in the morning.  The urine
deposits a sediment on standing.   There is generally a low and des-
ponding state of mind, with  irritability and peevishness of  temper.
   The  skin is often covered with yellow spots, and with a branny
substance.   The various symptoms of dyspepsia are often present.
The nervous  system is  generally much  disturbed, and there is a dis-
inclination to  apply the mind.   There is frequently a great dread of
imagined evil, supposed to be impending.
  Treatment___This does not require to be  as active as that for the
acute form of the disease.                                       .
   If there  is much tenderness of the liver, begin  with mustard poul-
tices, and the  compound pills of podophyllin, or the compound pills
of leptandrin, or (36).                   .    .             .       ,
   I  have abandoned the use of mercury in this^disease as.in mobt
others ; but if any  prefer to use it, the blue pill (52) will be found the

mTLUScompfourna  tar plaster  placed  over the liver, in bad cases, is
often very serviceable. 
266           DISEASES OF THE ABDOMINAL CAVITY.
  An alterative (138) (146) will be found useful.
  The daily alkaline sponge bath must on no  account be omitted.
Vigorous  friction must follow  it.  Vigorous constitutions will  bear
the shower bath;  in such cases  it may, occasionally, take the place of
the sponge bath.
  The diet must be  simple, yet  nourishing and wholesome, — and
embracing but a small amount  of fat, — as this  is composed largely
of carbon, and the liver  is unable to  remove what is already in the
blood.
  Especially and above all, out-door  exercise must  be taken to the
full amount of the strength, and the thoughts be  occupied with cheer-
ful subjects.  Let the hot sun be avoided, and the  summer exercise
be taken in the cool hours of  the day.
  The recovery from this, as from all other  chronic  diseases, must
necessarily be slow.

     Acute  Inflammation  of the  Spleen.—Splenitis.

  The spleen is in the upper part of the belly, on the left side, oppo-
site the liver.   It is subject to acute inflammation, which is known by
a pain just under the short ribs  on the left side, also by swelling,  sore-
ness to the touch, and by more  or less fever.  The pain  often shoots
up through the midriff and to the left shoulder.   There is a short, dry
cough; a feeling of tightness  about the heart;  a  sickness at the stom-
ach, and vomiting;  and a discharge  frequently  of black blood  from
the bowels.  The urine is scanty, is  passed  with some difficulty, and
is high colored.
  This disease appears most frequently in hot climates, and is often
connected with intermittent fevers.

          Chronic Inflammation of the  Spleen.

  This prevails  most fn  fever  and ague districts, and is a frequent
result of chills and fever.  It is generally very stubborn, often lasting
many years.
  Symptoms.— A feeling of weight, tightness, and sometimes pain in
the left side, — the pain being increased by pressure,  or an attempt to
lie  on  the  left side.   The organ  sometimes enlarges  very much, so
that it can be felt by the hand.  This enlarged mass passes under the
common name of " ague cake."   There are sometimes numbness,
weakness  of the legs, difficulty  of breathing, palpitation of the heart,
inability to exercise much, obstinate  constipation, vomiting of  food,
piles, dry skin, tongue coated white or red, low spirits, and occasion-
ally dropsical affections.
  During  the chill in fever and  ague, the spleen  becomes enormously
loaded with blood.  Surfeited  and stretched in this way again and
again,  it is not strange that the  organ should become diseased.
  Treatment. — This should be  about the same with  the treatment for
acute and chronic inflammation of the liver. 
DISEASES OF THE ABDOMINAL CAVITY.           267
  After the active symptoms of inflammation are subdued, the warm
bath may be used once or twice a week.
  In the chronic form of the disease, counter-irritation with the com-
pound tar plaster, with mustard poultices, croton oil, or tincture of
iodine, will be particularly needed.
  Among medicines, muriate of ammonia (53) has a high reputation.
To keep the bowels open, podophyllin, quinine, and  nux vomica (46),
have a fine effect  Iron may be given (73) when the patient is blood-
less and pale.

                      Jaundice.—Icterus.

   The  jaundice is a very common  disease, and to  be known, needs
only to be seen.
   Symptoms.— The most prominent symptoms are, yellowness of the
skin and whites of the eyes, saffron-colored urine, and whitish  or clay-
colored  stools.   So full is  the urine of bile, that  a piece of white
linen, dipped in it, receives a bright yellow tinge.
   Beside these leading symptoms, there are impaired appetite, a loath-
ing of food, the sense of a load at the pit of the stomach, sourness of
stomach, sometimes sickness and vomiting, a bitter taste in the mouth,
disinclination to move about, sleepiness, a dull pain in the right side,
which is increased by pressure.
   The  entire  body  of a person who has  died of jaundice, including
bones, muscles, and membranes, are found to be full of bile, and col-
ored yellow.
   Explanation. — The bile  flows into the upper bowel, a little below
the stomach, through a duct or tube  about as large as a goose-quill.
This little tube or vessel receives the bile from a smaller tube, called
the hepatic duct, and from another  which goes to the gall-bladder,
called the cystic duct.
   These little  tubes sometimes  get obstructed or plugged up by
sticky, thickened, or hardened bile,  or  by gall-stones, formed in  the
liver, and the bile finding no  outlet through its natural channels, is
taken up by the absorbents, distributed over the system, and produces
the yellowmess we witness.   When  these  ducts and the gall-bladder
are filled and stretched by this thickened  and hardened  bile, they be-
come tender and sore.  Hence the sore feeling in the side when pres-
sure is  made.                                     . ,  ,
   There is another explanation of the way in which the yellowness
of  jaundice is produced, and it matters not whether it, or the  one just
given, be adopted.   It is this: The  bile is formed bythe blood, and
not by the liver.  The office of the liver is to draw or sjrain oft  the
bile from the  blood.   And when this organ is inflamed, or gets slug-
gish and will  not work, the blood is not relieved of its yellow freight.
The  bile accumulates, and in attempting to escape through other
channels, it lodges in the various tissues, particularly in the skin.
   Treatment.__If there be much inactivity of the liver, the treatment
may begin with an emetic (1)  (2) (4). 
268 .          DISEASES OF THE ABDOMINAL CAVITY.
  An infusion of thoroughwort, drank freely every day, is a valuable
remedy.   The inner bark of the barberry steeped in cider, or this arti-
cle compounded with others (286)  (287) will be found excellent
•  The diet should be plain,  wholesome, and nourishing, but com-
posed mostly of vegetable  articles, particularly green vegetables and
berries when they are to be had.
  Cold water should be the principal drink; or drink and medicine
may be combined in the shape of five  drops of  muriatic acid, and
three drops of nitric acid, dissolved  in  a tumbler of water slightly
sweetened.  This is generally a pleasant drink, arid will assist very
much in the cure.
  The warm bath once or twice a week, and the alkaline sponge bath
every day, with smart friction, must not be omitted.
  When jaundice is caused by the passage of gall-stones  through the
bile duct, there is sometimes  terrible pain and suffering, — the stone,
occasionally, being as large as a nutmeg, and forcing its way through
a quill-sized tube.  So great is the distress that the patient sometimes
rolls upon the  floor in agony.  To alleviate this pain, large doses of
opium, laudanum, or morphine, are required.   A large teaspoonful of
bicarbonate of soda dissolved  in a tumblerful of hot water is an ex-
cellent remedy if drank at a single draught  It relieves the acidity
of the stomach, and acts as a  fomentation to the internal seat of the
pain.  Mustard poultices, or warm fomentations, over the seat of the
pain, are required.  The warm bath is excellent.
  The acid bath, made by mixing three parts of muriatic acid with
two  parjs of nitric acid, and adding as much of this mixture to water
as will make it about as sour as weak vinegar, is valuable in jaundice.
Only a quart of water need  be taken; and  the  solution should  be
applied with a sponge.  It is of  the  right  strength, if it produce a
slight tingling of the skin.
   ■
                Gall  Stones.—Biliary Calculi.

  These  are concretions, or hardening of bile into masses of all sizes
from that of mere grains, to that of a nutmeg.  Fig. 97 is a specimen
of them.   They are found in the gall bladder, the cystic
duct, the hepatic duct, and  are  sometimes  precipitated   FlQ-97-
from the bile after it has passed  into the  bowels.   In pass- <9jk
ing through the ducts, if of considerable size, they  produce
intense pain, particularly  if they are jagged  upon their
surface.
  These  stones,  so called, are  composed, chemically, of
cholesterine, bile pigment, choleic acid, choleate of  soda, mucus, earthy
salts, and margarin and its  compounds.   A nucleus seems to  be
first formed, and then a gradual  accumulation takes  place upon its
surface.

  Symptoms.— An  almost constant uneasiness in the right hypochon-
driac region, with spasms of pain, coming on suddenly, and lasting
for a time with great severity, and  then subsiding.  The pain is caused
 
              DISEASES OF THE ABDOMINAL CAVITY.          269

by a stone being suddenly forced into the duct and moving forward in
it, and it subsides when the stone either stops, or gets through the duct.
When the stone reaches the bowels, it passes off with the stools.
   The patient generally has a pale, sallow complexion, a small, feeble
pulse, and often suffers  from  nausea and vomiting, and from restless-
ness and hurried breathing.
   Treatment. — To  reduce the spasm, give Dover's powder in full
doses, or chlorodine.  Also, apply mustard over the right hypochon-
drium and  stomach, and follow it with hot fomentations with hops,
or use wet cups.
   If  the stomach is  irritable,  give the neutralizing mixture until  it
moves the bowels.  A  warm infusion of thoroughwort, given to the
extent of producing vomiting, will sometimes do well, and lobelia
enough with it to relax the duct may be useful.
   To relieve  the  acidity on  which  the formation of these  stones so
' often depends, a neutralizing preparation (338) may be given for a
long  time,  the diet, in the  mean time, being well regulated.  The
sponge bath, with saleratus and water, should be taken daily, followed
by brisk rubbing; .and free  exercise  in  the open air  should  on  no
account be  omitted.

    Acute Inflammation of the Stomach.—Gastritis.

   This  is a rare disease.  It is generally induced by  irritating and
corrosive substances taken  into  the  stomach.   Poisons, as arsenic,
aquafortis,  corrosive sublimate, and the  like, are the most  common
causes of it.   Blows, sudden stoppage of  sweat, and  excessive use
of ardent spirits, may also excite it.
   Symptoms. — It is marked  by burning  pain  in the stomach, thirst,
restlessness, anxiety, constant vomiting, prostration of strength, a
quick, hard, and  small pulse, incessant  retching,  a sunken counte-
nance, hiccough, cold hands and feet, and a damp skin.
   Treatment. — If the  inflammation be excited by poison,  the reme-
dies  named under antidotes for poisons must be first employed.
   The poison being neutralized or thrown off, the inflammatory con-
dition must be combatted with the remedies usual for such  states.
 Mustard poultices to the feet, along the spine, and particularly over
the pit of the stomach, will be among the first things to be employed,
and should be followed by hot fomentations of stramonium leaves or
hops,__both  the fomentations and the poultices to be repeated as oc-
casion may require.  Dry cupping over the region of the stomach is
useful.
   Drinks.__Cold water, bread-water, rice-water, arrow-root gruel, in-
fusion of slippery elm  bark, and of marshmallow.   These should be
taken in very small quantities,— say a teaspoonful at a time, — about
 twentv drops of  tincture of aconite root  being added to half a tum-
 blerful.  Lumps of ice may be held in the mouth, and occasionally
 swallowed. 
270           DISEASES OF THE ABDOMINAL CAVITY.
  Injections. — Emetics and physic are not  proper, but  injections
(248) (253), or simply soap suds, will be required.
  The remedies must be pursued until all tenderness has disappeared
from the pit of  the stomach.
  While the  patient  is recovering, great care must be taken not to
overload the stomach with food.  Arrow-root, sago, and milk  are
among the first articles to be allowed.   After  these, will come  grad-
ually beef-tea, chicken broth, soft-boiled eggs, and beef-steak, until the
whole diet can be restored.

        Chronic Inflammation of the Stomach.

  •This is a much more common disease  than  the  preceding; indeed
it is very common.  Though it does not put life in  immediate danger,
it perverts the feelings of the stomach, and  causes many of the symp-
toms of indigestion.   Dyspepsia,  however, is a different complaint,
and not necessarily connected with inflammation.
  Symptoms. — There is generally pain in the stomach, which is in-
creased by the presence of food, and by external pressure.  The pain
is  sometimes  felt only during digestion.   The fermentation of the
food  in the stomach  generates a gas, which is frequently belched up.
This is what is meant in common  language by having " wind in the
stomach," and  "belching wind."   The meals  are  frequently vomited
up; the appetite is fickle, sometimes voracious, and again  nearly ab-
sent ; the  thirst is likewise variant; the tongue is white in the centre,
and red at the  sides and tip, — sometimes smooth and red all over,
like a slice of raw beef.  The urine is scanty and high-colored.
  The disease  is very liable, if badly managed, to lead  to  ulceration
of the coats of the stomach, and  thence to a fatal end; for an ulcer
may penetrate the walls of the stomach, and let its contents into the
abdominal cavity, which would excite an immediately fatal inflamma-
tion.
  Treatment. — If there be much tenderness, we  may  apply leeches
over the stomach.  With  less tenderness, counter-irritation will an-
swer,— as blisters, croton oil,  mustard poultices, the compound tar
plaster, or dry cups.
   The  skin of the whole surface should receive special attention.
The warm or the cold bath should be used  often, according to the
strength of the patient.  When the reaction is good, a cold compress
bound upon the stomach every night, will do much to bring relief.
   The diet cannot  be too carefully managed.   While there is consid-
erable tenderness, the nourishment must be of the most simple  and
unirritating kind, —  consisting  of little more than the most  bland
nutritive drinks; and even these should be taken  in small quantities
at  a time.  Gum  arabic water, rice-water, barley-water,  arrow-root
gruel, tea, and toast without butter, will be amply sufficient to keep
soul and body together, and will, in  two  or three weeks, generally
starve the enemy out of his quarters.  After this, a more nourishing
diet may gradually be resumed. 
DISEASES OF THE ABDOMINAL CAVITY.           271
                 Indigestion.—Dyspepsia.

  Dyspepsia is a disease of civilization.  Savages know nothing of
it  It  is the • costly price we  pay for luxuries.  All civilized nations
suffer from it, more or less, but none so  much as the  people of the
United  States.  It is here, in the new world, that the disease has be-
come domesticated,  and we,  as a people,  who have  threatened to
monopolize its miseries.
  Few  disorders inflict upon  their victims greater suffering; yet it is
not particularly dangerous, and it is even doubtful whether it tends
very much to shorten  life, unless  the length of life be judged to con-
sist in the sum of happiness enjoyed, — in which case, few complaints
shorten it more.

  Symptoms. — These  vary very much  in different stages of the dis-
ease, and in different persons.  In general the complaint begins with
a sense of fulness, tightness, and  weight in the stomach, sooner or
later, after  meals, and  a  changeable,  diminished, or  lost appetite.
Occasionally, the appetite is  craving, and when, in obedience  to its
promptings, a large meal is taken, there is pain  in the stomach, with
general distress  and nervousness, and  sometimes  vomiting.  Flatu-
lency and acidity are  common, with sour and offensive belching of
wind;  and very often  there is a water-brash,  or vomiting of a clear,
glairy fluid when the  stomach is empty.  Diziness  is  a prominent
symptom.  There is a  great deal of what patients call an " all-gone "
feeling at the pit of the stomach, — a weakness so great at that par-
ticular spot, that it is  very hard to  sit up  straight  There  is a bad
taste in the  mouth; the tongue is covered with a whitish fur;  there
is headache, heartburn, palpitation at  times,  high-colored urine, and
tenderness, now and then, at the pit of the stomach.  The bowels are
generally irregular, sometimes very costive, at  other times loose, when
portions of food are passed off undigested.

  IVervous Complication. — Such are  the symptoms in a case of sim-
ple  disorder of  the  stomach, when  no* other  part of  the system is
materially involved.   This is indigestion, well-marked, and distressing
enough; but it  is only  a  part of what is  understood by a case of
modern  dyspepsia.   In this, either the  indigestion,*in its course, dis-
turbs and involves the nervous system, or the nerves become them-
selves  disordered, and  produce the indigestion.  Sometimes one hap-
pens, sometimes the other, it matters not which ; both are present, —
the affection of the stomach and of the nerves, in a case of thorough
dyspepsia.  To make out a full case, in its tormenting completeness, we
must add to the above symptoms, great depression of spirits, amount-
ing at times to complete hopelessness and despondency ; a dread and
fear of some impending evil; a lack of  interest in passing events; un-
willingness to see company or to move about; an irritable and fretful
temper; a desire to talk of one's troubles, and nothing else; a sallow,
haggard, sunken, and  sometimes  wild  expression of countenance;  a
dry, wrinkled, and harsh skin, with unrefreshing sleep, disturbed by 
272           DISEASES OF THE ABDOMINAL CAVITY.

all sorts of annoyances and difficulties, such as shipwrecks, falls down
precipices, and nightmare.
  The man who has all these symptoms, or any considerable  portion
of them, has dyspepsia, and is about as miserable as if all the sorrows
of life were electrical currents, and were running through him contin-
ually.
  Causes of Dyspepsia. — To  healthy  digestion, three conditions are
especially necessary, — that  the food should be  well  chewed  and
mixed with saliva before it is swallowed; that  the  stomach should
pour  out and mix  with it the right amount of healthy gastric juice ;
and that it should be  well churned while in the stomach.
  It is well known  that the first of these conditions, a thorough chew-
ing of food is rare in this country.  We eat too fast;  we do not mas-
ticate our food ;  we bolt it whole.
  This is the first cause of dyspepsia,  and it is the  fruitful mother of
causes.  It furnishes  the occasion for  eating too  much ;  for when the
food is swallowed  with such rapidity, the stomach is taken  by sur-
prise, as it were; it cannot secrete  gastric juice fast enough to be
diffused through  the  fast-growing mass; and the  appetite does not
decline until a great deal too much is taken.   The  coats of the stom-
ach, being stretched unnaturally, do not pour out the gastric juice at
the right time, or as  much of it as  is wanted, and what there is, is
altered in quality.
  Moreover, the stomach being  overburdened, cannot turn over  and
churn its contents properly.
  To fast eating, we  may add, high-seasoned dishes, too stimulating
for the stomach; eating between meals, and at unseasonable hours,—
particularly at bed-time ; excessive use of strong drinks and tobacco;
habitually sitting up late at night; inactive  habits of body; and ex-
cessive use of the mind.
  No  causes of dyspepsia are more  active than  those which  disturb
and fret the  mind.   It is surprising how suddenly any mental agita-
tion will put an end to the  appetite, and suspend  digestion.   And
when  these mental disturbances are protracted, when care becomes a
daily and hourly companion, dyspepsia is almost sure to show itself.
Considering  the  numerous causes  of unpleasant  mental excitement
which we have in  the politics, the business, the ambition, the family
jars, etc., of this country, it is a wonder that dyspepsia is not even more
prevalent.  It is hard for the sensitive to escape.
  Urinary Deposits. — Before speaking of the treatment of dyspepsia,
it will be proper to take notice of certain  deposits in  the  urine, to
which persons suffering from this complaint are liable, and  the dis-
covery of which, will, in many cases, indicate the treatment
   Many dyspeptics have acid urine, which is loaded with crystals of
oxalate of lime.  These persons  are  much  depressed in spirit, and
look upon the dark side of everything. They are  painfully disturbed
by small annoyances, are irritable  in temper, incapable of exerting
themselves, look with dread upon the future, and  generally have the
dark and dingy look of the face, which indicates functional derange-
ment of the liver. 
DISEASES OF THE ABDOMINAL CAVITY.           273
  The most of these crystals are octahedral in form, and in the field
of a good microscope, are beautiful objects for inspection.   (Figs. 98
and  99.)   To obtain  them, take a portion  of  urine' passed in the
morning (urina sanguinis), and let it stand till a deposit takes place.
Pour off the upper portion of the urine ; put a part of the remainder
in a  watch glass, and gently heat it over a lamp.  The heat will cause
a deposit of the crystals!
Fig. 98.                   Fig. 99.                  Fig. 100.
  The oxalate of lime is frequently found in urine, having the form
of dumb-bells.  When examined by polarized light, they appear beau-
tifully colored and striated.   (Fig. 100.)
  The urate of ammonia, and uric acid gravel,  are  likewise found in
large quantities, in the urine of many dyspeptics.  Some are exhausted
by them, and reduced almost to skeletons, and to a wretched state of
health,.— having  boils, eruptions, etc.
  To find the urates, put a  little of  the  urine containing the deposit
in a test tube, and warm it  gently over a lamp.   If the deposit readily
dissolve, it is probably urate  of ammonia (Figs. 101 and 102), and may
then be examined under the microscope, to make the matter sure.

             Fig. 101.                            Fig. 102.
  To find uric  or lithic  acid, let morning urine stand until a solid
deposit has sunk to .the bottom ;  then pour off the liquid, and place
some of the  solid portion upon a glass, and examine it with a micro-
scope, and if  this acid  be present,  its  peculiar  crystaline forms
(Fig. 103) will  be discovered, either  alone, or mixed with urate of
ammonia.
  In  those cases  in which there is a great prostration of the nervous
 
274
DISEASES OF THE ABDOMINAL GAVITY.
system, with a loss of sexual power, bad feelings in the head, perhaps
pain and weakness  across the loins, and a tendency to consumption,
                           we may suspect the presence of the triple
                           phosphates in the urine.  Phosphorus is
                           one of  the elements  of the brain and
                           nerves, and when  there is a constant drain
                           of this element through the kidneys, the
                           nervous  system is gradually exhausted.
                           To find  the  triple phosphates, put some
                           morning urine in  a glass vessel, and let it
                           stand  till a sediment has gone to the bot-
                           tom.  Put some of the sediment in a test
                           tube,  and  warm  it  gently over  a lamp.
                           If the warmth do not dissolve the deposit,
                           add to it a little  acetic acid;  if the de-
                           posit dissolve in the  acetic acid, it proba-
                           bly consists of earthy phosphates.   This is
                           then to  be examined under the micro-
                           scope to ascertain whether it is the phos-
phate of lime, the triple phosphate, or a mixture  of both.
	Fig	.103.
	* b	OBII
	■■0	
		mil
		
		
Fig. 104.
Fig. 105.
Fig. 106.
Fig. 107.
  Fig. 104 shows us the prismatic crystals of the triple phosphate.
In a few rare  cases, these are penniform (Fig. 105).  Fig. 106 gives
us another specimen of the crystals of the
triple phosphates, as they appear under the
microscope, mixed with amorphous particles
of phosphate of lime.   If an excess of am-
monia be  added to the urine,  the crystals
become star-like, and foliaceous, as in Fig.
107.
  Treatment of Dyspepsia. — As  there  are
few  complaints which  distress the patient
more than dyspepsia, so there are few which
give the physician more trouble.   Generally
our art has failed upon it because  too  much
has been required of us.   We have not merely been  asked to cure
the disease,  but to do it while the  patient continues the indulgence of
his appetite, or his excessive application to  business or study.   It has
 
DISEASES OF THE ABDOMINAL CAVITY.           275
 been expected of us,  that with  medicine we  should contravene the
 laws of nature, and restore health while the causes of disease are in
 full activity.
   This complaint  is  often brought  on by not  keeping the bowels
 open.   To  cure it, therefore, one. of the first things to be  done is to
 remove costiveness and regulate the bowels.
   One of the very best articles I know of to remove constipation is
 Mettauer's  Aperient.  I have placed it in the department of  Phar-
 macy ; it ought  to be in  the United States  Dispensatory.  Taken
 immediately after meals, in doses of  a teaspoonful, it corrects acidity
 of the stomach, it gently opens  the  bowels, and when its action is
 over, will be found to  have diminished the costiveness, rather than in-
 creased it, as most kinds of physic do.   It is excellent  in the bilious
 forms  of dyspepsia, — acting finely upon the  liver, — particularly if
 a few  drops of aqua regia in water be taken before meals, — the ape-
 rient being  taken after.
   If piles exist, this mixture  will be objectionable on account of the
 aloes,  and the  fluid neutralizing extract may  take its place.   Sweet
 tincture of  rhubarb and soda  (37) is sometimes preferable to the ape-
 rient.
   Several other preparations (38) (289)  (39) (290) will be found use-
 ful to remove costiveness and debility of the stomach.
   For acidity,  beside the remedies already mentioned, prepared char-
 coal may be used, in teaspoonful  doses, or carbonate of magnesia, or
 fluid magnesia, or trisnitrate of bismuth.   A good remedy  is pulver-
 ized guaiacum, rhubarb, prepared charcoal, and carbonate of  mag-
 nesia, equal parts;  also (28) (37) (38) (42).   If crystals of oxalate of
 lime be found in the  urine, give a few drops of  aqua regia, in water,
 three times  a day.
  Hygienic  Treatment. — The diet must be managed with great  pru-
 dence.  Food  must be taken in such quantities only as the stomach
 can digest, however small that quantity may be; and it must be taken
 slowly, and  well chewed.   No article should be  touched, or thought
 of, which disagrees with the stomach.  Costiveness may frequently
 be entirely removed by eating no bread except that  made  from un-
 bolted wheat flour, commonly called Graham bread, or by making
 one  of the  three  daily meals  of boiled cracked wheat, with milk or
 molasses.   If the triple phosphates be found  in the urine, there is a
 special reason why the unbolted  flour, or the cracked wheat should
 be used.  The wheat  grain  abounds in  phosphorus, the largest por-
 tion  of which is in  the bran, and this is much needed when the  kid-
 neys are robbing the brain of  its phosphoric element.

  Not  too much. Brain-Avorh. — It is  important  that  the  brain  and
 nervous system should be relieved of the burden of  too much work,
 and that the thoughts should be turned into the most  agreeable chan-
 nels.   If the patient would get well, the disinclination to move about,
and  see  company  must be resisted.   In many cases, dyspeptics are
like sea-sick persons, — feeling as though they would  rather go  over-
board  than  move.  In such instances, friends must not be harsh with 
276           DISEASES OF THE ABDOMINAL CAVITY.
them,  and frown  upon their  listlessness  as if it were a  fault; but
rather  treat them affectionately, and beguile them out by all sorts of
pleasing enticements.  Exercise must be  had, every day, and be con-
nected, if possible, with an object, so that it may be performed cheer-
fully.  It is important to engage the mind  in the exercise; and for this
purpose, some contested game is very useful, as  playing at billiards,
rolling nine-pins, pitching quoits, or, where  the  strength will permit,
playing ball.

  Cheerfulness. — Nothing does more to drive away dyspepsia than a
cheerful, lively, and even mirthful state of mind.   All the nervous in-
fluences  sent from the  brain  to  the stomach should be*of the most
agreeable kind.   Some people think it vulgar  to laugh.  Let such
stand with long faces in life's  shadows, if they choose.  As a general
rule, the  best men and women laugh the most.  Good, round, hearty,
side-shaking laughter, is  health for everybody; for the dyspeptic, it is
life.
  Dyspeptics who have  a taste for  it, and  can endure the expense,
should travel.  A voyage to Europe, and a year  spent in  seeing the
wonders  of  the old world, will generally cure the  most stubborn case
of indigestion.   This, however, depends  upon  circumstances.  For
those having the finer organizations and the higher natures, extensive
travelling is sometimes indispensable.  The narrow circle of thoughts,
associations, and  things, in their own neighborhood, do not fill the
compass of  their wants;  their many-sided faculties need to be drawn
on by the large variety to be found only in  travel.  Their  large and
impressible natures want to be filled  full in order to drive out disease,
and it  takes a world, or a considerable  part  of it, to fill  them.  The
dyspepsia of such natures is not comprehended by the multitude, and
even physicians are often amazed that their narrow prescriptions do
not reach it.


                   Heartburn. — Cardialgia.

  This is a gnawing and  burning pain  in the stomach, attended by
disturbed appetite.  It is generally  caused  by great acidity of the
stomach, and is a symptom of dyspepsia, and  often  afflicts pregnant
women.  Whenever too much food is taken, it is liable to ferment,
and  become extremely  sour, — causing  heartburn.   In such  cases,
vomiting often occurs; and what is thrown  up, is sour, and  some-
times bitter.

  Treatment. — Immediate temporary relief may be obtained by swal-
lowing a teaspoonful of soda, magnesia, or chalk,  in a tumbler of cold
or warm  water.   Fluid  magnesia, or lime water,  will answer  the
same purpose.  If there  is wind in the stomach, as well as acidity, a
teaspoonful  of the aromatic spirit of ammonia,  or  (135),  will often
still the uneasiness in a moment.
  To cure the  complaint, the stomach  must  be  strengthened by the
remedies directed for dyspepsia. 
DISEASES OF THE ABDOMINAL CAVITY.
277
    Spasm  or  Cramp in  the  Stomach.—-Gastrodynia.

  Though generally  of shorter duration, this  is more violent than
heartburn.  It is attended by a sense of fulness, by anxiety, and by
great restlessness.   In females, hysterical symptoms are often coupled
with it.  Great quantities of air or gas are generally expelled, and the
pain shoots through to the back and shoulders.
  Treatment. — A strong purgative injection (248) will often bring
immediate relief.   The sweet tincture of rhubarb and soda (37), with
a few  drops  of tincture  of cayenne mixed  with it, will often bring
speedy relief.  So  will a mustard  poultice laid upon  the  stomach.
The mustard poultice is a remedy of great excellence, in many cases.
It deserves to be called the poor man's friend.

                 Water Brash.—Pyrosis.

  This consists in a discharge from  the  stomach, generally in the
morning, of  a thin, glairy, watery fluid, sometimes insipid,  at other
times, sweetish, and at still others, sour.  A burning heat or pain in
the stomach  attends, and seems to be the immediate  cause of the
discharge.  The discharge appears to be the natural  mucus of the
stomach, which is poured out in large quantities in consequence of a
kind of catarrh of its mucous lining.   The amount thrown up varies
from a spoonful to a pint or more.
  The complaint is caused by a poor innutritious diet, or by whatever
causes the blood to become thin and watery.
  Treatment. — Ten or fifteen drops of water of ammonia,  in half a
tumbler of water, will  quiet  the distress, and  check the discharge.
The most effectual remedy I am acquainted with for breaking up the
discharge, is the trisnitrate of  bismuth, taken at meal times, in from
twenty to thirty-grain doses, three times a day.  The compound pow-
der of  kino is a valuable remedy.  The compound  tincture  of senna
and the tincture of balsam of tolu, in equal parts, and administered
in tablespoonful doses, are sometimes useful.  The tincture of  nux
vomica is a good remedy.
  To restore  the blood, some of the various  preparations of iron (74)
(80) (73) (316) will be required.
  The diet  should consist of easily-digested,  nutritious food, — as
soups,  broths, fresh meat, potatoes, and unbolted wheat bread.

                          Vomiting.
  This occurs  under a great variety  of circumstances.  It may be
induced by acidity  of the stomach, by irritability of the stomach, by
distress of mind, by injury of the brain, by offensive odors, and by all
organic diseases of  the stomach.
  Treatment — Generally, it  is cured by treating the disease which
induces it  But in many cases, it persists very obstinately, and may
become the chief thing to be attended  to.   In such cases, it may re-
quire a sixth  or quarter of a grain of morphia to check  it.   But gen- 
278           DISEASES OF THE ABDOMINAL CAVITY.
erally some aromatic, as ginger, spearmint, peppermint, or spice  tea,
will put an end to it.   Some cordial or stimulant, as brandy, cham-
pagne, tincture of ginger, paregoric, elixir solutis, or cherry brandy,
will answer well.   Strong coffee, without  sugar or milk, will, in some
cases, act like a charm.   If it is dependent on acidity, the remedies
are given under "dyspepsia."  If caused by irritability of stomach,
a pill of extract of belladonna and ipecac  (339) will do well.
   While vomiting, the patient should lie still in bed, and in bad cases,
a mustard poultice should be placed upon  the stomach.
   The vomiting of children may sometimes be stopped by wetting a
piece of cloth with laudanum, and laying it  upon the pit of the stomach.

                         Seasickness.
   This is the great terror of persons, who, for the first time, cross the
ocean.  It is said that dark complexioned  persons suffer more from it
than others.
   If it cannot be entirely prevented, it may be  mitigated by lying flat
upon the back.   To lie on deck, in the open air, is much better than
lying in the close air of the cabin, or  state room.  A wineglass of
brandy, or from ten to forty drops of laudanum will relieve the sick-
ness very much. For a child, it is sometimes sufficient to wet a cloth
with laudanum, and lay it upon the  pit of the stomach.   Morphine
is  sometimes even better than laudanum.  Creosote, one drop at a
dose, made into a pill, is excellent.   Ten drops of hartshorn, in half a
tumbler of water, is good for some.  But the best known remedy is
chloroform, taken in doses of from forty  to eighty drops, suspended
in water by means of a little gum arabic.

                       Milk  Sickness.
   This disease prevails in the West, chiefly in the neighborhood of
level, heavily-timbered, rather wet oak land.
   The cattle, horses, and sheep, which range in these  lands, are  fre-
quently attacked by a disease which the people call the trembles.   It
is  supposed to be produced by eating some plant growing upon those
lands, as cattle  which  feed in the neighboring regions are  free from
it until  they find their way into these low grounds.  It has been  sug-
gested that the  offending plant may be the poison ivy (rhus  toxicoden-
dron).   Be  this as it may, the calves, soon after sucking cows which
have run in  these grounds, are seized with trembling, and  frequently
die of the disease.  Dogs which lap the  milk, are affected in a similar
manner.  Children  drinking  it,  leave the table  and vomit.  Upon
grown persons  the effects are more severe, but not so sudden.   The
eating of the beef, mutton, or veal, of affected animals, brings on the
same disease.
  Symptoms. — The  disease  sets in with sickness at the stomach,
which  is preceded by general debility, more particularly of the legs.
There is nausea, vomiting, and the breath  is so offensive and peculiar
that those acquainted  with the complaint  immediately recognize it
from this smell. 
DISEASES OF THE ABDOMINAL CAVITY.          279
  These existing for weeks, constitute, in some cases, the whole  of
the symptoms.   In other cases they are more severe, being attended
by chills and flushes, great oppression about the heart, anxiety, deep
breathing, heat in the stomach  compared to fire and  boiling water,
violent  retching and vomiting, alarming  beatings  of the  heart, and
throbbings of the large vessels, and cold extremities, — producing,  all
together, extreme distress.
  In most cases, the vomiting returns every  hour or two, attended  by
great burning at the  pit of the  stomach, the  substance  thrown  up
having  a peculiar bluish-green  color, and  a  sour smell.   As soon  as
this discharge takes place, the patient falls back upon the  pillow, and
lies easy until  another turn  comes  round.   The  tongue is covered
with a whitish coat, the  bowels are obstinately costive, and the pulse
is small and quick.
  Treatment. — It is believed that the neutralizing mixture, given in
tablespoonful doses every time the nausea and burning sensation are
felt, is the most effectual remedy yet used.  It relieves the acidity,
and seems well adapted to allay the irritation.   Some  antibilious
physic (40) to move the bowels should also be given.
  Beside these remedies, a mustard poultice should be put  upon the
stomach, and hot bricks to the feet, and the patient be kept still for
some hours.   The diet should be very mild, only toast  water, rice
water, or thin gruel.


 Acute Inflammation of the  Peritoneum.—Peritonitis,

  This disease affects the extensive membrane which lines the whole
inside of the  belly, an  extension of which forms the omentum  or
apron.  It is an inflammation  to which  women are much 'exposed
after confinement, and is known, in such cases, as child-bed fever.  It
is common among men, also, and is a grave  disease.
  Symptoms.— Like other forms of fever  and inflammation, it is pre-
ceded by chills, with increased heat of surface, thirst, full,  strong, and
frequent pulse, flushed face, and red eyes, dry tongue with red edges,
dry skin, restlessness, short quick breathing,  nausea and vomiting.
  The pain is increased by the  patient sitting  or standing up,—the
bowels  being thus pressed against the inflamed membrane.  Lying
upon either side is painful for the same reason.  To lie flat upon the
back, with the feet drawn up, is the only endurable position.  The
patient iies still, for all movements give pain.
  The pain in this  disease is generally sharp, cutting, and pricking,
but is not always equally intense.  It is aggravated by the passage of
wind along the bowel, by which the inflamed membrane is slightly
stretched.
  When the disease is advancing towards a fatal termination, the belly
becomes greatly swollen  and tense, — having to the hand a peculiarly
tight, drum-head feeling; the pulse is rapid and feeble; the counte-
nance is full of anxiety, and is pinched and ghastly; and a cold sweat
breaks out. 
280           DISEASES OF THE ABDOMINAL CAVITY.
  Treatment.— Small  doses  of antimony, lobelia, or ipecac, to pro-
duce nausea, and a moisture upon the skin, is  generally among the
first  things given.  The tincture of veratrum viride, in five to ten-
drop doses, repeated every hour, will accomplish the same thing more
effectually than any other known  article.  For  such  purposes,  I give
it the first place among medicines.  A large poultice of white  bread,
rye meal, or flax-seed, may be spread  over the  belly; or cloths wet
with cold water, will be still better, if the patient be full-blooded, and
naturally strong.  The bowels should be moved at once by some
active  physic,  as  butternut, salts,  magnesia, castor oil, or cream  of
tartar (20) (17) (18)  (27), or by podophyllin, etc. (40) (41)  (31).
  The drinks should be lemonade, soda water, tamarind water, current
jelly dissolved  in water, and preparations (298) and (299).  Indian
meal gruel, toast-water, barley gruel, and the like, are the only  allow-
able diet.


       Chronic Inflammation  of  the Peritoneum.

  When the  acute inflammation of the  peritoneal membrane is not
successfully treated, it  may run on for  a time, and then subside into a
lower grade of inflammation, called chronic, and in this state remain
for an  indefinite time.   But it often arises independently of the acute
disease, and attacks persons of both sexes, and of all classes and ages.
Scrofulous children have it, and, wasting away under it to mere skel-
etons, are said to have consumption of the boivels.

  Symptoms. — These  are sometimes very obscure, and the advances
of the disease  stealthy.  At  first, there  may be only a little soreness
of the belly, so slight as not  to be noticed except after hard work, or
upon some wrenching  motion.  Generally, there is a sense of fulness
and  tension of the belly, although it  may not  be increased in size.
After a time, it enlarges a little, and its tension or tightness increases,
especially towards evening.  By  pressing carefully with the hand, a
deep-feeling tension may  be detected, giving  to the  hand a  sensa-
tion as of a tight bandage  underneath,  with  the skin and integu-
ments  sliding loosely over it.   If  water has been poured out into the
abdominal cavity, its fluctuation may frequently be detected by press-
ing upon one side of the belly with the palm of one hand, and strik-
ing the other side with the  ends of the fingers.
  As the disease goes on,  the features become  sharp and contracted, ■
and the countenance grows pale and sallow.  Costiveness  comes on,
sometimes chills and fever, with debility, loss of flesh, cough, difficult
breathing, hectic, and swelling of the legs.

  Treatment. — Costveness, if present, may be relieved  by Mettauer's
aperient, or the neutralizing mixture, assisted by coarse  bread, and
boiled cracked wheat.
  Daily bathing is specially necessary, particularly the alkaline sponge
bath, with vigorous friction over  the bowels.  The warm bath once
or twice a week, will  be useful.   In  some cases, the wet towel laid 
DISEASES OF THE ABDOMINAL CAVITY.
281
upon  the  bowels over night, and well covered by flannels, will afford
relief; or the compound tar plaster may occasionally be used.
  If there  be dropsy of the belly, iodide of potassium (138) should
be taken  freely, and  the  skin  made sore over the inflamed part, by
tincture of iodine, well rubbed in, once a day.
  If the patient  be pale  and  bloodless,  give iron,  quinine, etc. (74)
(75),  and let the  diet be nourishing;  and if  nervous symptoms be
connected  with the debility and paleness, add some nerve tonic (93)
(81) (316).

     Acute Inflammation of the  Bowels.—Enteritis.

  By inflammation of the bowels is generally understood an inflamed
condition of the  mucous  membrane  which lines them; but this, most
commonly, is only a part of the disease ;  it  involves, more or less,
beside this mucous lining, the whole substance of the  bowel.

  Symptoms.— The disease begins with a  chill, and with uneasiness
and slight griping pains, which increase in severity until they are in-
tense  and  burning.   Pressure aggravates the  pain, which is most
intense about the navel, but  extends more  or  less  over  the  whole
bowels.
  From the beginning there is sickness at the stomach, and  some-
times vomiting; there is loss  of strength, costiveness, great anxiety,
thirst, heat and fever, dry, furred, and red tongue, and but little urine,
with pain in passing it.   The matters passed from  the  bowels are
dark and fetid; and the  whole  belly is tender and sore to the  touch.
The pulse is quick, hard,  and small.
   The stomach will be but little affected, comparatively, when the
disease is at some distance  from it in the lower portion of the bowels.
Indeed, the nearness of the inflammation  to  the  stomach, or  its re-
moteness  from it, may be  judged  pretty correctly by the degree of
disturbance in that organ.  The length of time after drink and  medi-
cines are  swallowed, before they are vomited  up, is a pretty good
measure, likewise, of the distance of the disease from the stomach.

   How to Discriminate. — This disease is liable to  be  confounded
with colic, and with inflammation of the peritoneum.  It is important
to  distinguish it  from colic, particularly, for  the treatment for that
would aggravate this.  In this disease, the pain is increased by pres-
sure  ; in colic, it is not, but is rather  relieved.   In  enteritis, the pain
remits, but never ceases wholly, as it  does  in colic.   In enteritis,
the knees are drawn up,  and the breathing is  short; in colic, it some-
times gives relief to  stretch the feet  down, and the breathing is not

   To distinguish it from inflammation of the  peritoneum, take notice
that  diarrhoea is much more common than in  this latter complaint,
while the pulse is not as  quick, nor the pain as severe.

   Treatment___This  should be very much the  same as  that recom-
 mended for inflammation  of  the  peritoneum.  Perhaps  in both dis- 
282           DISEASES OF THE ABDOMINAL CAVITY.
eases, it might be well to begin with covering the belly all over with
leeches.  As for  taking  blood from  the  arm, in large quantities, as
recommended in most of the books, I cannot think it necessary.
  The tincture of veratrum viride, in full doses, so  as to keep up a
free perspiration, cold compresses, mustard poultices, hot fomentations,
poulti^s,  blisters, soothing and quieting injections, and  demulcent
drinks, as  slippery elm, marshmallow, flax-seed, etc., if judiciously ap-
plied, will do about all that we have it in our power to accomplish;
and  under such treatment, the patient will recover faster, and get up
better, than when blood is freely drawn.
  In this disease it is well to inquire if the patient has a hernia, for if
so, it is liable to  become  strangulated without his  knowledge.  A
strangulation of the gut may be the cause of the disease.  When this
happens, the complaint is very unmanageable.   The  bowel may pos-
sibly, in such case, be disentangled by applying a large dry cup; or,
what is better, a number of small ones ; but  the tenderness of the
belly makes the use of this remedy difficult.

          Chronic Inflammation of the Bowels.

  Like other chronic inflammations, this  may follow the acute form,
but it also  results from  various other causes, as unripe fruit, taking
cold, drastic physic, and improper treatment of other  diseases.
  Symptoms. — Red  end  and borders of the tongue, dull pain in belly,
increased by pressure and rough motion, abdomen either swelled or
flat, skin dry  and husky, feet and hands cold, small frequent pulse,
thirst, loss of flesh,  low  spirits, urine scanty and  high-colored, and
dirty, slimy discharges from the  bowels, from one  to four times a
day.
  Treatment. — To begin with, blisters, or croton oil, or mustard  poul-
tices, or dry cups, if  the tenderness is not  great, or leeches if it is.
  If the bowels are hot and feverish, bind a cold compress upon the
belly  over  night, — covering  it well  with flannel.   The warm  bath
should be  used twice a week.
  The diet must be of the most simple, unirritating kind, — beginning
with a solution of gum arabic, rice-water, barley water, arrow-root or
sago gruel, and gradually rising, as the symptoms improve, to  beef-
tea, mutton and chicken broth, tender beef steak, etc.
  When the  strength will permit, gentle exercise must be taken in
the open air, but not on horseback, or in hard, jolting carriages.
  As soon as the  inflammation is subdued, some  mild laxative  (35)
may be given, in connection with an infusion of wild-cherry  bark,
geranium, and Solomon's seal, equal parts.

       Wind Colic—Flatulent Colic.—Interalgia.

  This is  a severe and distressing  pain in the bowels, — sometimes a
stoppage, and a swelling about the pit of  the stomach and the navel.
What children call belly ache is a mild form of it.  The wind passing 
DISEASES OF THE ABDOMINAL CAVITY.
283
 from one portion of the bowel to another, causes a rumbling noise.
 The pain is not increased by pressure ;  and this  distinguishes it from
 the pain of inflammation.   It moves about, too, from  place to place,
 and is much relieved by the escape of wind up or down.
   The  complaint may be caused by a weakness in the digestive or-
 gans, by eating indigestible food, or unripe  fruit, by costiveness, and
 by taking cold.   Some persons always have the colic  excited by eat-
 ing certain kinds of fruit.

   Treatment. — When the complaint is  caused by an indigestible sub-
 stance taken into the stomach, the offending matter should be thrown
 off by an emetic as soon  as possible.  If this does not bring relief,
 let it be followed by a dose of salts, salts^and senna, compound infu-
 sion of senna, elixir  salutis, elixir pro., or sweet tincture of rhubarb.
 If there is no sickness of  the stomach, a little essence of peppermint
 or spearmint in hot water, or brandy,  gin, or whiskey, in hot water,
 may prove sufficient to expel the wind, and relieve the pain.   Ginger
 and hot water does well with some.  If there be costiveness, and the
 pain is  obstinate, let the bowels be unloaded by a stimulating injec-
 tion (248)  (249) (250).

                 Air-Swellings. — Tympanites.

   It is quite common for persons in delicate health, — particularly
 females, — to have their stomach  and bowels  swell  up,  sometimes
 slowly,  sometimes suddenly, so  that they  cannot bring their clothes
 together.   They do  not know what  to make of it;  it  sometimes
 alarms them ; and they ask their medical adviser what it means.

   Explanation. — This is the meaning  of it.  It is neither more nor
 less, in many cases, than the air within  the muscles and *nembranes
 swelling up  and distending them in consequence of their being in a
 weakened condition.   There are two ways in which the flesh may be
 caused  to  bloat  It may  be caused by placing a cupping gfass over
 it, and taking off' the external air.   When  this is done, the.air within
 seeks to fill the vacuum above, and lifts up the flesh.  So, likewise, if
 the parts are weak, and  lose their tone, they give way, and let more
 air into their substance, and they stretch and puff up.
  But these  swellings may occur from an accumulation of air within
 the bowels, and  also within the  abdominal cavity. This  latter gives
 the belly a peculiarly hard  feel, like the head of a drum, and when it
 is pressed upon with the fingers, no indentation remains.

  Treatment.—  If the air  be in the intestinal tube, a stimulating in-
 jection may bring away the wind.  It may be composed of one pint
 of infusion of peppermint, one  gill of tincture of prickly ash berries,
 half  a gill of tincture of castor, and a teaspoonful of ginger.  The
 bowels of tfie patient should be rubbed for a long time; and in all
forms of the complaint, it would be well to do this every day.  Some-
times the wind may be drawn off by inserting into the rectum a long
gum-elastic tube. 
284        .   DISEASES OF THE ABDOMINAL CAVITY.
   The best constitutional remedies are'tonics, — iron, quinine, mineral
acids, and bitters, (48) (55) (59) (60) (62) (63) (64) (71) (73).
   Exercise in the open air, and a careful regulation of the  diet will
do much towards removing these troubles.  Costiveness must be care-
fully guarded against.

                        Bilious Colic.

   This is a dangerous disease.   There is pain of a griping,  twisting,
tearing kind, — what the ancients called atrocious pain.  It  is chiefly
about the navel, but sometimes tortures the whole belly.   It comes
and 'goes in paroxysms.   Sometimes the abdomen is drawn in, at
other times it is swelled out,  and stretched  like a drum-head.   At
first the pain is relieved by pressure; after a time the belly is  tender to
the touch.  There  is thirst and heat, and a discharge of bilious mat-
ter from the stomach.  In the worst cases, the pulse is small, the face
pale,  the  features  shrunk,  and the whole  body covered with  cold
sweat.  While the head is hot, the feet are cold.   In advanced stages
of the disease, the  action  of the  bowels is sometimes reversed, and
the fecal matter forced up through the mouth.
   Causes. — Costiveness, irritating substances in the  bowels, thick,
vitiated bile, long exposure to cold,  torpidity of the  liver and skin,
great unnatural heat, with  dampness, etc.
   Treatment.— Administer an  active purgative injection immediately
(251) (252).  Internally, dioscorein, camphor, etc. (340), every fifteen
minutes, till relief is obtained, — at the  same time covering the whole
belly with a large mustard poultice-   A strong decoction of the wild
yam root, drank  freely, is a medicine of some value, — so is a decoc-
tion of scullcap  and high-cranberry  bark, equal parts.  This latter
article is  excellent  in spasmodic affections, on which account, it has
gained the name  of cramp  bark.   The  sickness at the stomach may
be allayed frequently by effervescing drafts, to which  twenty-five  or
thirty drops of laudanum  are added.   Croton oil, given in  one-drop
doses, done up with crumb of bread, will sometimes succeed well  as
a  purgative  medicine;  or  castor  oil  and spirits of turpentine, equal
parts, in two great spoonful doses, may be tried before  the  croton
oil.
   The warm bath is worth  remembering,  and  trying, too, if the
means are at hand.  Hot  fomentations of the bowels with a decoc-
tion of poppy leaves, stramonium leaves, hops, wormwood, boneset,
or peppermint leaves, should not  be overlooked.  Bottles filled with
hot water, or hot  bricks rolled in flannel, should be placed at  the back
and feet, to promote perspiration.
   Persons subject to this  complaint, may derive advantage from one
pill composed of extract of high cranberry bark, etc. (100), taken after
each meal for some months.  At the  same time a reasonable amount
of exercise should  be  taken out of doors, and a sponge bath, with
friction, be employed daily.  Care should be taken not to  be often
exposed to the hot sun. 
DISEASES OF THE ABDOMINAL CAVITY.           28d
               Painters'  Colic. — Colica Pictonum.

    This form of colic is caused by the slow  introduction of lead  into
  the system, — generally the carbonate of lead.   It passes under the
  different  English names of painters'  colic, Devonshire colic, and dry
  belly-ache.  The  first of these is the name by which it  is most com-
  monly known, from  its frequent occurrence among painters, who use
  white lead (carbonate of lead)  a great deal  in the preparation of their
  colors.
    Symptoms. — The disease generally  comes on in a very  gradual
  way.   At first, the appetite is impaired, there is slight nausea, belch-
  ing of wind, languor, very obstinate costiveness, transient pains, with
  a feeling of weight and tightness in the belly, and a disinclination to
  make any exertion.
    By degrees, the pain in the bowels, and particularly about 'the na-
  vel, becomes more  severe, and has a twisting  character.  The belly
  becomes hard, drawn in, and a little tender to pressure, and the stom-
  ach  very irritable.  The  pain occasionally  slacks  off a  little; but
  never, even in mild cases, entirely stops, as in other kinds of colic.
     In  some  severe cases, the pain runs up to the chest, and down the
  arms ; also down to the bladder, causing the urine to be passed  with
  pain  and difficulty, and giving a  sense of  weight and bearing down
  in the lower belly.  During  the  severest pains, the countenance is
  pale,  contracted, and  full of suffering; cold sweats  break out upon
  the face  and limbs, and anxiety and agitation seize the patient.
     When the disease is not seasonably removed, it degenerates into
  the chronic form, the  mental  and physical energies  become torpid,
  the circulation in the small vessels inactive, the skin dry, harsh, shriv-
  elled, pale, sallow, or of a leaden hue, the  temper irritable, despond-
  ing and  gloomy, and the body wasted.   Beside all this, the  muscles
  which lift up the lower arm  become palsied, so that, when the  arms
  are raised, the hands  hang down  in a helpless condition.  In some
  cases, there is a blue line along the edges of the gums.

     Treatment. — For relieving  the  pain and opening the  bowels, the
  treatment should be  very much  the same as  that for bilious colic.
   There is one article, however, which  is thought  to have some special
  influence in curing this disease, after it has become chronic; it is
'  alum.  Fifteen grains of alum, two of aloes, two of jalap, and four
  of Dover's  powder, may be mixed, and taken for a dose two  or  three
  times a  day.  If the muscles of the arm be  palsied, one sixteenth of
  a grain of strychnine may be added to the  above.  The aromatic sul-
  phuric acid, taken as a drink, fifteen  drops to the tumblerful of water,
  is always worthy of trial.
     The use of the electromagnetic machine  may be tried for the palsy;
   or a splint applied to the arm  and hand, with vigorous friction applied
  once or  twice a day, will sometimes do much for recovering the use
   of the muscles.
     But the best remedy for the palsied  muscles  is iodide of potassium 
286           DISEASES OF THE ABDOMINAL CAVITY.
(146), taken freely.  The sulphuret of potassa, on/? ounce dissolved in
a quart of water, and taken in teaspoonful doses, three times a day, is
also worth a trial.  The affected arm should be soaked an hour, once
or twice a day, in the same amount of  this latter salt, dissolved  in a
gallon of water.
  Means  of Prevention. — The numerous  persons who work  in lead,
should comb their hair with a fine comb, wash their hands and face,
and rinse their mouth several times a day, and also wash the whole
person with soap once or twice a week, and with  clear water, or sal-
eratus and water, once a day.  Their working clothes should be of a
kind to admit of being washed once or twice a week, and they should
be'put off for others when out of the workshop.   A paper  cap should
be worn while at work.   The food of the workmen should not be ex-
posed to the vapors  or floating particles of lead, and  consequently
should not be carried into the shop; and when much of the poison is
floating in the air of the work room, it is a good plan to wear a mask
to prevent its being drawn with the breath into the throat and lungs.
  It has been said that those who eat freely of fat meats,- butter, and
other oily substances, are not attacked by the disease, though exposed
to the poison.   I know not what protection this can give, unless  the
skin is in this way kept more oily, which prevents the absorption of
the poison.  This would  seem to afford a hint  in favor of anointing
the whole person once or twice a week  with sweet oil.


                Costiveness.—Constipation.

  Few disorders are more common than costiveness.  By this term
I mean a sluggish state of the  bowels, which causes  them to retain
the feces longer than is warranted by health.  In this complaint, the
discharges from the bowels are  not  always less  frequent than they
should be, but they are less in quantity, are compacted and hard, and
are passed by  hard straining, and sometimes with considerable pain.
  Symptoms. — Headache, dizziness, feverishness, bad feelings in the
head not easily described, loss of appetite,  sometimes nausea,  but
little desire  to go to stool, a weight and  heaviness about the .lower
part of the belly, and a  sense of confinement over the whole body.
  Causes. — Sedentary habits, particularly when connected with close
application of the mind ; astringent articles of medicine; stimulating
diet, composed chiefly of  animal food; various diseases, particularly
those of a nervous character, and especially, a neglect to  evacuate
the bowels at proper periods.   All these causes tend to weaken the
bowels, and gradually to arrest that peculiar undulatory  movement,
or worm-like  action, called the peristaltic motion of  the bowels.  It
is this continual  contraction of the muscular fibres of the intestines
from above downward, wThich pushes the contents steadily  along; and
whatever weakens the  force of tlys vernicular  play of  the intestinal
walls, brings on constipation.
  Treatment.— One of the first things to be done is to establish the 
DISEASES OF THE ABDOMINAL CAVITY.           287
habit of attempting to evacuate the bowels at a particular hour every
day.  The best time for most persons is soon after breakfast in the
morning.  Whether successful or not, the attempt to procure an evac-
uation should on no account be omitted.  This  regularity will often
do much to break up the costive habit.

  Diet. — To this should be added a careful regulation of the diet
The quantity of food  taken should be no greater than can be easily
digested.  Full meals which distend the stomach and cause it to press
upon the bowels embarrass  their  movements.  Bread  made from fine
wheat flour is  an abomination in this  disorder.   Eat only that from
unbolted flour.   Cracked wheat, prepared as directed among dietetic
preparations, is  excellent for the cure of costiveness.   Fresh vegeta-
bles, as peas, beans, potatoes, squashes, and ripe fruits, in their sea-
son, are all wholesome, and  tend to relieve costiveness.  But rich pies,
puddings, cakes, doughnuts, and all that sort of trash, increase the
disorder.

  Water Injections, etc. — One of the best remedies is water,  cold or
tepid, according to the condition of the patient, injected into the bow-
els with the domestic syringe.   The best  syringes for this purpose are
Mattson's, and Davidson's,  one of which should be in every  family.
Water used externally, in the form of the sponge bath, is also useful.

  Medicines. — All the above  measures  having  failed to give relief,
take Mettauer's  aperient, or the neutralizing mixture.  If these fail,
podophyllin, etc. (36), may have a trial.  A cold decoction of thorough-
wort, drank daily, sometimes has an excellent effect   It must  be re-
membered that medicines may make matters worse, and they should
be used cautiously.
  All the causes of the disease must of course be avoided.


                    Piles.—Hemorrhoids.

  There are  few  complaints more  common  than  the  piles,  and
scarcely any which  cause more trouble and misery.   They consist in
a fulness of blood, and languid circulation in the lower portion of the
lower bowel or rectum.   In consequence  of this congestion, either the
veins of tiie gut become  enlarged or varicose, or the blood gets infil-
trated into  the cells beneath the mucous membrane, and collects so
as to form bloody tumors.
  These tumors, which are seldom absent, are the leading features of
the piles.  They sometimes appear externally, around the anus ; this
is external piles. * At other  times they are within the bowel; the com-
plaint is then  called  internal piles.   They are  called bleeding piles
when blood is  discharged, and &.',;:c piles when it is not

  Symptoms. — Usually there is  a  sense  of  weight and weakness in
the lower part of the back  and loins, with a painful itching about the
anus.  On going to stool, there is a burning, cutting pain experienced,
which is followed by bearing down and tenesmus.  If it be bleeding 
288           DISEASES OF THE ABDOMLNAL CAVITY.
piles,  the little tumors will bleed at every  motion  of the  bowels.
There are frequently disagreeable sensations in the head, general las-
situde, an irritable state of mind, and a sense of fulness and anxiety
in the stomach.  The pains experienced range all the way from the
slightest twinges up to the most terrible sufferings, which appear like
tearing the body asunder.

  Causes. — Everything that irritates  the  lower bowel, and causes a
determination of blood to the part  All drastic physic has this effect,
— particularly aloes, which acts especially  upon the rectum.  Habit-
ual costiveness, straining  at stools, riding  much on horseback, sitting
a great deal, tight lacing, high-seasoned food, and stimulation gener-
ally, lifting and carrying heavy  weights, and indurations of the liver.
  Females during pregnancy are much afflicted with piles, which are
induced by the costiveness so peculiar to their condition, and by the
pressure of the enlarged womb upon the veins of the pelvis.

  Treatment.— This should be  medicinal and dietetic.
  Great care  must be observed not to push medication  too far.  Ac-
tive purging will do great mischief.  Yet  costiveness must in  some
way be corrected.   For this purpose, no remedy that I have  ever
tried  has 'done better  in this complaint than an electuary composed
of confection  of senna, flowers of sulphur and cream of tartar (6),
taken in doses just sufficient  to  procure  one natural motion of the
bowels each day.  Pills made of extract of thoroughwort are said to
do well.   If the liver be  in a congested state, take some of the arti-
cles recommended in the chronic inflammation of  that organ.
  For the local treatment, nothing is better than  two ounces of lard
and one dram of the flowers of sulphur mixed, and rubbed between
two plates of  lead until they are  well blackened.  This ointment is
not only soothing, but curative, both in the bleeding and blind piles.
An ointment of almost equal excellence may be made from one hand-
ful  each of witch hazel  bark, white oak  bark, and  sweet-appletree
bark, boiled together in one pint of water down to one third of a pint.
Then strain, and add two ounces of lard, and simmer away the water,
— stirring continually before and after  removing from the fire, till it
cools.
   If there is much inflammation and distress, an emolient and sooth-
ing poultice should be applied, composed of slippery elm  bark and
stramonium or poke leaves.  Steaming the parts is sometimes useful,
by sitting over a hot decoction of hops, stramonium, and poke.
   Piles may often be cured by  the use of the domestic syringe.  Daily
injections of cool or cold water will do much to strengthen the bowel,
and restore the dilated veins to their natural condition.
   The  food should be of a laxative nature,  corn bread, rye pudding,
bread of unbolted wheat flour, mealy  potatoes, ripe fruit,  pudding
and milk, buckwheat  cakes, broths, and a little tender meat once a
day. 
DISEASES OF THE ABDOMINAL CAVITY.           289
            Looseness  of the Bowels.—Diarrhoea.

     Looseness, or relax of the bowels, is manifested by frequent, copi-
  ous, and thin, or unusually liquid discharges.  The excessive discharge
  may be caused either by irritating and unwholesome food, by inflam-
  "mation and ulceration of some portion of-the bowels, or by debility.

     Symptoms. — Rumbling  noise in the bowels, with more  or less
|  weight and bearing down, and uneasiness in the lower  part  of the
  bowels.   This pressing down  and  uneasiness are relieved as soon as
!  the evacuation takes place, but returns when another is near at hand.
|   Griping is generally present, the strength is reduced, and the skin  is
j   pale, dry, and, after a time, sallow.

I     Treatment.— When the complaint  is caused by  irritating food, it
   will generally stop as soon as the offending substance is removed, and
   not much medicine will be required.
      To neutralize any  acidity,  to remove wind, allay  irritation, and
   strengthen the stomach, the compound syrup of rheubarb and potassa
   is well adapted, given in tablespoonful  doses, every  hour, till it oper-
   ates.  A little paragoric added to it occasionally, or essence of pep-
   permint, or spearmint, may aid its good effects.
     If nausea and  vomiting are present, put a mustard poultice upon
   the stomach, and give a few drops of laudanum.   If there  is much
   griping, give an injection (248), with twenty drops of laudanum in it.
   A common  diarrhoea  may generally be arrested at  once  by prescrip-
   tions 159 or 162, in teaspoonful doses, after each discharge.
     When there is inflammation and ulceration of the bowel, the treat-
   ment must be similar to that for  dysentery, — fomentations exter-
   nally, and the occasional use  of starch injections, mild cathartics (9)
   (10), and Dover's powder internally.


                        Chronic Diarrhoea.

      The  acute  form of diarrhoea, not being  properly managed, often
   runs on, and becomes chronic, and is at times exceedingly difficult to
   cure.

     Symptoms. — Frequent  discharges, generally with some pain and
I   griping, restlessness, thirst, poor appetite, debility,  loss  of flesh, dry,
I   rough, and somewhat sallow skin, and tongue dry  and  dark-colored.
I   The food often passes through  the  bowels pretty much in the condi-
j  tion in which it was swallowed.   The  liver is generally out of order,
  and the bowels are frequently afflicted with a low grade of inflam-
  mation.

     Treatment. — In this form if the disease, astringents  and tonics will
  generally be required.   Sometimes a teaspoonful of brandy, in  a little
  sweetened water,  or in clear water, several times a day, will effect a
  cure.  Good cherry brandy  is a valuable remedy; so is blackberry 
290
DISEASES OF THE ABDOMINAL CAVITY.
brandy.  Many of the  worst cases have been  cured by taking no
nourishment, for a long time, except milk, with a little lime water
in it.                                  t
   When the liver is  involved in the complaint, as evinced by light-
colored stools,  leptandrin, geranium, etc. (341), may be given with
advantage.
   In  some  instances, when  there  is considerable debility,  pills of
quinine, catechu, etc. (342), will do well.
   A sponge  bath  must be taken daily, and  the skin be well rubbed
after it.

                      Cholera  Morbus.

   The above name is given to a disease common in warm weather,
and characterized by sudden attacks of bilious vomiting and purging,
with  severe pain in the belly, cramps, and general fever and subse*
quent prostration.   The great amount of bile secreted and discharged
has given it the name cholera, from  choler, bile.

   Symptoms.— The disease  begins by sickness  and distress at  the
stomach, which is succeeded by violent  gripings, with  vomiting of
thin, dirty-yellowish, whitish, or greenish fluid, with discharges from
the bowels similar to that vomited.  The nausea and distress, with
some few exceptions, continue between the vomiting and purging,
and the pain, at times, is intense.   The pulse is rapid, soon becoming
small and  feeble, the tongue dry, the urine high-colored, and there is
much thirst, though no drink can be retained on  the stomach.  It is
to be distinguished from diarrhoea by the bilious discharges.

   Treatment. — Apply a large mustard poultice over the stomach and
liver, and give  tablespoonful  doses  of compound powder of rhubarb
and  potassa, every  half hour, until the vomiting  and nausea  are
checked, adding to each dose five to ten drops- of laudanum, if neces-
sary.   Perhaps it  would generally be best, however, to give liberal
draughts of warm water, at first, or flax-seed tea, that all the solid con-
tents of the stomach and bowels may be washed out.
   A teaspoonful of laudanum in a wineglassful of flax-seed tea, given
as an injection, every two hours, will sometimes do excellently well; or
a tea made of chamomile flowers, or Colombo, and made sour by a few
drops of nitric  or sulphuric acid, and given internally, will sometimes
succeed better  than most other things.   One  grain of morphine  and
thirty grains of bicarbonate of soda dissolved in an ounce of sweet
tincture  of rhubarb, and given in teaspoonful doses, every half hour
will often have a fine effect.   The prescription 162 is also valuable.
   Hot bricks should be applied to the feet, and warm flannels, or
other kinds of  dry heat, to the whole body.

                       Asiatic  Choiera.

   Beside the above  name, this fearful disease  has been called  epi-
demic cholera, malignant  cholera,  spasmodic  cholera,  and cholera 
DISEASES OF THE ABDOMINAL CAVITY.           291
asphyxia.  It first attracted  notice  in  Bengal, in 1817, whence  it
spread westward through Europe, and in June, 1832, it reached Que-
bec, on this continent.

  Symptoms. — First  Stage. — The first,  premonitory stage, is marked
by derangement of the digestive organs, rumbling in the bowels, pain
in the loins or  knees, twitchings  of  the calves of the legs, impaired
appetite, thirst, and  especially, a slight diarrhoea;  and these symp-
toms continue from  a few hours to several days.  I should  add to
these symptoms what is said to have been recently discovered, namely,
that for several days before the. attack, the pulse is  down  to forty or
fifty beats in a minute  This, if it prove to be reliable, is a very valu-
able symptom.       '

   Second Stage. — This stage is marked by vomiting and purging a
thin, colorless fluid, looking almost exactly like rice water; by severe
cramps in  the calves  of the legs, which  soon attack the bowels  and
stomach.  These cramps  are excessively painful, and draw the mus-
cles into knots.  The tongue  is pale and  moist; the pulse feeble,
though sometimes full and firm ; the breathing hurried, with distress
about the heart; great thirst; a feeling of internal warmth ; and the
secretion of urine, entirely stopped.
   These thin, colorless discharges by vomiting and purging, are the
serum or wTatery portion of the blood, which oozes through  the sides
of the blood-vessels, and  runs off" rapidly, leaving the crassamentum,
or red, solid part of the blood, stranded  upon the inner surfaces of the
arteries  and veins.   When so  much of this is discharged that the
blood cannot circulate freely, the patient sinks into the

   Third Stage,  which is  characterized  by  great  prostration ; pulse
hardly  perceptible; skin  cold  and clammy; face blue or purple, and
eyes much sunken ;  hands dark-colored and sodden, looking like a
washerwoman's;  breathing short and laborious; a sense of great  heat
in the stomach;  and intense  thirst.  Recoveries from this stage sel-
dom take place.

   Treatment. — In the first stage, the  diarrhoea should  receive the
most prompt  attention.   From five  to ten drops of laudanum, re-
peated a few times, every three hours, will generally put a stop to it.
Morphine  (162) is also a suitable remedy.' The compound syrup of
rhubarb and potassa, with some other articles (343), in tablespoonful
doses, every hour, till it  operates gently, is  worth a trial.   The  diet
should -of course be  very carefully regulated at such a time, though
not  particularly changed, except to leave oft' any indigestible article
which is known to be injurious, and to be made a little more sparing
than in a time of perfect health.
   When the second  stage has set in, or the stage of vomiting, purg-
ing, and cramps, the  treatment must be  energetic.   The sinking pow-
ers must be sustained by chloroform, opium, and ammonia (119), or
by camphor, opium,  and  cayenne (344), giving one pill every hour.
Brandy may also be given freely. 
292           DISEASES OF THE ABDOMINAL CAVITY
  The warmth of the surface must be promoted by all possible means,
hot bricks and bottles, tincture of cayenne, friction, etc.
  In the third stage, the remedies recommended above are to be pur-
sued with increased energy, particularly the stimulants, and the efforts
to promote the warmth of the surface.


          . Dysentery.—Bloody  Flux.—Colitis.

  This  is an inflammation of the mucous membrane lining the lower
or large bowels.   The small bowels begin at the stomach, and are
eight or ten yards long; being largest near the stomach, and  dimin-
ishing in size as they approach their termination^ at the caecum.  The
lower or large bowels are two or three times as large as  the small
ones, and from  their junction with the latter, they extend  about six
feet to  the  outlet, or anus.   The  large  bowels are composed of the
caecum, the colon,  and the rectum.   The rectum is about one foot in
length.
  In most cases of dysentery, the rectum, and  about half the adjoin-
ing portion of the colon, experience  the chief  force of  the inflamma-
tion.  Sometimes  the whole of the  colon and  caecum are affected.
Sometimes the mucous membrane lining these  is ulcerated, and, be-
coming wholly disorganized, passes off in shreds.

  Symptoms. — The disease  comes on with loss of appetite, costive-
ness, lassitude, shivering,  heat of skin, and quick pulse.  These are
followed by griping pain in the bowels, and a constant desire to pass
their contents.  In general the passages are small, composed of mucus
mixed with  blood.  These  passages are  attended  and followed by
severe gripings and inclination to strain, learnedly called tormina, and
tenesmus.   They are sometimes, in the early stages, attended  by nau-
sea  and vomiting.   The natural feces, which do not  pass  off much,
are small in quantity, and formed into round,  compact balls, or irreg-
ular, hardened lumps.  This  tenesmus, or  great  desire to strain, will
continue, perhaps  increase, for several days, — the discharges being
mostly  blood in some cases, and chiefly mucus in others.  Having,
generally, but little odor, at first, these discharges become, as the dis-
ease advances, exceedingly offensive.

  Causes. — Dysentery is very frequently caused by sudden  changes
from hot to cold, by which  sweating is  suddenly checked, and the
blood repelled from the surface.  Hot climates, and dry, hot  weather
are predisposing causes.   All green, unripe, and unwholesome food;
and all  indigestible food of every sort, may induce it

  Treatment. — In mild  cases, give a tablespoonful of castor oil and
two teaspoonfuls  of paragoric, mixed, once  a  day.   Sometimes, in
place of the above, a dose of rochelle powder, dissolved in water, with
thirty or forty drops of laudanum, may be taken.  A moderate quan-
tity of  flax-seed or slippery elm tea,.may be taken as a drink, and the
bowels be well emptied by an injection of starch.
   When there  is  much pain in  the bowels, a mustard poultice laid 
DISEASES OF THE ABDOMINAL CAVITY.           293
 upon them, will have a good eff'ect.  The starch injections should, in
 such case, have half a teaspoonful of laudanum mjjced with it.  The
 compound syrup of rhubarb and potassa will often act favorably, given
 in tablespoonful doses.
    If there is reason to suppose  the liver is affected, give podophyllin,
 etc, (46).
    The patient should not be allowed to sit up, and must be kept very
 still, and be allowed  only a very scanty diet, as  flour porridge, well
 boiled, rice water, etc.

                       Chronic Dysentery.

    When  dysentery  "runs on"  for  some  time,  it may  become
  chronic.
    Symptoms. — Looseness of  bowels, — the discharges being  un-
  healthy, more or less bloody, attended by  bearing down, or a desire
  to strain, and being in number from  two  to forty a day.   There is
  great debility, the pulse is weak and quick,  the tongue slightly furred,
  the appetite lost, the face pale and sallow, and the skin dry and parched.
  Sometimes the  relax alternates  with costiveness.

    Treatment..— In  this form of the  complaint,  astringents will be
  necessary (159) (161) (162) (345) (346) (347).
    Injections  may be used, if  necessary, composed  of nitrate  of sil-
  ver, fifteen grains to the ounce of water, or  an infusion of golden seal,
  with a little tincture of prickly-ash berries added to it
    The diet must be very light, easy of digestion, and nutritious.   In
  some cases, it should be composed chiefly of wheat  flour porridge, or
  boiled milk and boiled rice.  In other cases, a little tender beef steak
  should be taken once a day.

                         Worms.—Vermes.

     The  intestinal canal is subject to  various disturbances  from the
  presence of worms.  Of  these troublesome  tenants, there  are three
  principal varieties.

     The Ascaris,  or pin-worm, called also maw or thread  worm,  is a
  small, wrhite, thread-like worm  from half an inch to an inch in length.
  These worms live, in great numbers, in the*rectum, where they excite
  great irritation and itching.

     The Lumbricus, or ascaris lumbricoides, is a round worm, about an
j  eighth of an inch in thickness, and from an eighth  to a quarter of a
  yard  in  length.  Its color varies  from a milky  whiteness  to a deep
i  red.   It generally occupies the  small bowels.            ,

     The Tenia Solanum, or tape-worm, is a flat worm, with four suckers
  at the head, is from a few feet to some hundreds in length, and full of
!  joints.   It dwells in the small bowels, and feeds on the chyle as it
  comes along, before  it is  absorbed by the lacteals.  In this way, it 
294           DISEASES OF THE ABDOMINAL CAVITY.
robs the body of nourishment, and produces great  loss of flesh, and
an enormous appetite.
  Symptoms. — In the grown person the symptoms of worms  are
quite obscure, except an intolerable itching within  the anus, which
generally indicates pin-worms.
  In children worms are  indicated by paleness, itching of the nose,
grinding of the  teeth and starting in sleep, irregular appetite, bad
breath, swelled upper lip, picking of the nose, hard swelled belly, and
one cheek constantly flushed.
  Treatment. — For expelling worms various articles have been used.
Among these spirits of turpentine (155) has a high  reputation.   The
following preparation does well: Spirits of turpentine, half an ounce ;
essence of anise,  half an ounce;  castor  oil, one ounce;  worm-seed
oil, one ounce.  Mix.  The dose for a child one or two years old, is
ten to twenty drops,  every two or three hours.  In two or three days,
a brisk physic should be given,,   The worm powder is quite success-
ful.
  One of the most popular remedies is the  pink-root.   It should be
united with a purgative.  The following is a good preparation :  Pink-
root and senna, each half an ounce ;  bitartrate of  potassa, one drain;
pulverized jalap, half a dram ; cardamom seeds, half a dram ; extract
of liquorice, two drams.   Mix, and add half a pint of boiling water.
Let the whole steep an hour.  Give a tablespoonful or two, occasion-
ally, till the worms are expeffed.
  An injection composed of quassia (66), or aloes (22), or of  simple
sweet  oil, is very effectual  in removing pin-worms from the  lower
bowel.  So is an  injection  composed of the red  iodide of mercury,
one  grain;  iodide of  potassium,  half a  grain ;  and  two pints of
water.
  Most of the above preparations are thought to be successful in ex-
pelling all kinds of worms; but for the tape-worm, no other  remedy
has yet shown itself as effectual as pumpkin-seeds.   The seeds should
be well bruised, and  steeped in water.  This should be drank  freely
for several days, if need be.  It is believed to be a sure remedy, even
in cases of several years' standing.
  In all cases of worms, the diet should  be carefully chosen, and be
connected  with  proper exercise,  pure air, frequent  bathing,  and all
those measures which tend to improve the general health.
   After the  expulsion of the worms, tonics should always be taken
to strengthen the bowels, that the same evil may not return.


    Acute Inflammation of the  Kidneys.—Nephritis.

   Before speaking of this disease, I wish to give  the reader a general
idea of a kidViey, and shall do so by the use of two cuts.
   Fig. 108  presents the external surface of the right kidney, with its
renal capsule mounted on top ;  i,  being its upper edge ; /, h, superior
and inferior branches of the emulgent artery ; c, d, e, three branches
of  the emulgent vein ; a, the pelvis of the ureter; b, the ureter. 
DISEASES OF THE ABDOMINAL CAVITY.           29t>
  Fig. 109 is the same kidney laid open; 1, being the supra renal
capsule ; 2, the vascular portion ; 3, 3, the tuberlar portion, consisting
of cones; 4, 4, two of the calices receiving the apex of their corres-
ponding  cones; 5, 5, 5, the three  infundibula;  6,  the pelvis; and 7,
the ureter.

             Fig. 108.                              Fig. 109.
  The kidneys are glands, and their office is to draw  or  strain off.
from the body those effete or worn-out particles, or products of decay
which contain nitrogen, while the liver takes away those  carbonaceous
matters which  have no nitrogen.  These useless substances  which go
out through the kidneys are generally in the form of urea.   In carry-
ing off these matters, the kidneys may have more to do than properly
belongs to them ;  and may be so stimulated, or irritated, or injured
in some way, as to  become inflamed.

  Symptoms.—Like most other inflammatory diseases, it begins with
cold chills and rigors, especially  in  the  back  and loins, followed by
fever and pain.  The pain frequently extends to the bladder, the loins,
and the  thighs, and is of a severe, lancinating kind, — though some-
times obtuse.   Pressure, motion, straining, or taking a full breath, add
to its pungency.  The urine is scanty, high-colored, sometimes bloody,
and can only be passed drop  by drop.  In the loins there  is a sense
of heat, gnawing, and constriction; the bowels are either constipated,
or relaxed by diarrhoea.   A numbness of the  thigh, and drawing up
of the testicle on the affected side, are marked  and peculiar symptoms.
In some cases, there are nausea, vomiting, oppression at the stomach,
faintness, hiccough, drum-head distention, and  rumbling of the bowels.
The skin is hot and dry, the pulse hard and frequent

  Causes.— The use of cantharides, oil of turpentine, and other di-
uretics, taking cold, violent  exercise, mechanical  injuries, the transla-
tion of rheumatism or gout, the  striking in  of skin  eruptions, and
gravelly formations in the kidneys or ureters.
 
296           DISEASES OF THE ABDOMINAL CAVITY. '
  Distinctions. — This  disease is to be distinguished from colic by
the pain being increased by pressure, and by the frequent but difficult
discharge  of red urine;  from lumbago, from its  being confined fre-
quently to one side, and also by the urinary  troubles, and by the
nausea and vomiting; and from all other diseases, by the numbness
of the thigh, and the drawing up of the testicles.
  Terminations of the Disease. — It runs a rapid course, and  may
terminate  by resolution, or by suppuration.  When the latter happens,
it is indicated  by the  decline of  the  more violent symptoms, a throb-
bing and  a sense of weight, with chills, followed by  flushes of  heat,
and sweating.   The matter formed; generally small in quantity, may
pass into the cavity of the kidney, and thence through the  bladder to
a natural  outlet with the urine.
  Treatment. — Either put the feet  into a hot  mustard bath, or put
mustard drafts upon them.  At  the same time apply a large mustard
poultice upon the small of the back,  and follow it up with hot fomen-
tations of stramonium leaves and hops, or stramonium and worm-
wood or tansy.
   Let  perspiration  be induced as soon as possible by five to ten ten-
drop doses of tincture of veratrum viride, repeated every hour, or by
teaspoonful doses of the compound  tincture of Virginia  snake-root,
given every half hour.
   If costiveness exist, the  bowels must  be opened  by epsom  salts,
cream of  tartar, or salts of  tartar; or by copious  injections of warm
water, containing a few drops of  the tincture of arnica leaves.   Such
injections  not only unload the bowels, but act as a local bath, by lying
in the bowel near the inflamed kidneys.
   The drinks  must be mucilaginous and diuretic.   The marshmal-
low root and peach leaves, slippery-elm bark, flax-seed, mullein,  elder
blows, haircap-moss, and cleavers, are all valuable.  If the  disease is
caused by gravel,  twenty  drops of  liquor  potassae, largely dilated
with flax-seed and upland-cranberry tea, and taken freely as a drink,
is excellent.

          Chronic Inflammation of the  Kidneys.

   This is frequently the  result of the acute form of the disease,  but is
also produced by injuries, and other  causes.

   Symptoms. — A weakness in   the small of the back, and a dull,
heavy pain in the kidneys.   The urine is passed often, and in  small
quantities.  It is alkaline, — sometimes  white  and milky, — and has
in it deposits of phosphate of lime, and triple phosphates.

   Treatment. — Infusions of  pipsissewa, uva  ursi,  trailing arbutus,
wild carrot, queen of the meadow, buchu leaves,  or foxglove are use-
ful diuretics, and may be taken with advantage.
   The bowels must  be  kept open  with  some gentle physic (18), if
they are costive; and the alkaline sponge bath, with  friction, be used
daily. 
               DISEASES OF THE ABDOMINAL CAVITY.           297

   An eruption may be brought  out upon the small of the  back by
 rubbing on a  few drops of croton oil;  or, if the patient prefer  it, a
 mustard poultice may be applied two or three times a week.
   The food should be nutritious, and easily digested, and a little exer-
 cise be taken daily in the open air.

      Acute Inflammation of the Bladder.—Cystitis.

   This disease affects the lining membrane of the bladder, — some-
 times its muscular substance.  It may attack the upper  portion, the
 middle, or the  neck of this organ.  It runs a rapid course.

   Symptoms. — Burning, piercing, and  throbbing pain in the region
 of the bladder.   The  pain extends to the  perineum,  and in some
 cases, to the testicles and thighs, and is  much increased by pressure.
 The perineum, the space between the  fundament and testicles, feels
 sore to the  touch.  The desire  to pass urine is incessant,  but the
 effort to  do  so is mainly ineffectual.  The water passes off drop by
 drop, with great pain, or is entirely stopped, — causing  enlargement
 of the bladder, and great distress.  Mucus from the  inflamed lining
 of the bladder passes off with the water.  Nausea, vomiting,  and
 great anxiety  are common.   The bowels  are bound, and when the
 disease is on the side next the lower bowel, there is a desire to emptv
 the  bowels;  and if the inflammation be in  the neck, there is great
 pain in the perineum, and frequently an entire retention of the water.
 The  pulse is full, hard, and frequent, the skin hot and dry, the thirst
 urgent, and the patient restless and dejected.

   Causes.— This disease may be produced by taking cantharides and
 turpentine; by irritating substances forced into the  bladder with a
 syringe, or by pushing bougies or catheters into  it;  by gravel stones
 in  the  bladder; by retained urine; bV external injuries; by gonor-
 rhoea ;  and by  cold applied to the feet, or to the lower portion of  the
 abdomen.

   Treatment.—If the  urine be retained, it is of the utmost impor-
 tance that it  be early drawn off with the catheter, lest a distention of
 the bladder bring on mortification.  Great care is required not to pro-
 duce irritation  by any roughness in introducing the instrument
   Leeches should be applied upon the lower part of the bowels  the
 perineum, and  around the anus.  When these  are  removed, warm
 poultices  should be applied.  Cold compresses will often do as weU
 The bowels must  be opened with epsom salts.   Injections of ^
 water with a few drops of  tincture of arnica leaves, will act findv m
 a local bath,-the water being retained as long as possible      *
  The  tincture of veratrum viride will be required in five to ten-dron
 doses, or  the compound tincture of Virginia snake-root, to  induce
 „ation.  Dover's powders may sometimes be used for the same

  Drinks must  be  taken Very sparingly.   A small amount of cold  in
fusion of slippery elm bark, or marshmallow and peach leaves, or 
298           DISEASES OF THE ABDOMINAL CAVITY.
cleavers.  This mucilaginous drink must  be the  beginning and the
end of the diet during the active stage of the disease.


  Chronic Inflammation  of the  Bladder.— Cystirrhcea.

  This is much more common than the  active form of the disease.
It often arises  from the same causes which produce acute inflamma-
tion of the bladder.
  It often passes  under  the title of  " catarrh of the bladder."  It is
a chronic inflammation of the mucous lining of the bladder, and is a
very common  and  troublesome affection  among old people.

  Symptoms. — Slight lancinating pains, with a feeling of heat in the
region of the  bladder, and a sense of weight  and tenderness in the
perineum; frequent and  tormenting  desire to pass water, with occa-
sional spasmodic action  of the  bladder.  The urine is  loaded with
tenacious  mucous, just as the expectoration  has  large quantities of  f
mucus in it when there is inflammation  of the membrane lining the
windpipe and  bronchial tubes.   When the water has stood a while,
this mucus  settles at the bottom of the  vessel, leaving the fluid clear
above.  Great quantities of this are sometimes passed, — amounting
even to pints in a day.   The triple phosphates of  magnesia and am-
monia are often found in the water.
  Frequently  there are  derangements of the appetite and digestive
functions, a  white  or brown fur upon the tongue, a harsh, dry skin,
with  thirst and general debility, — especially in the back and loins.
Sometimes there is a little fever.

  Treatment. — To reduce the  inflammation, apply leeches, or  mus-
tard, or croton oil,  or a cold compress every night.
  As a diuretic, give an infusion of buchu, uva ursi, trailing arbutus,
queen of the meadow, etc.  Tincture of veratrum viride  and sweet
spirits of nitre (125) is a good remedy.  The  compound infusion of
trailing arbutus is well recommended.  So is the compound  balsam
of sulphur.  An infusion  of the pods of beans has been well spoken of.
  An injection into the bladder, once a day, of a tepid infusion of
golden  seal  root, with  much care, may be  of great service; or an
infusion of equal parts of golden  seal, witch  hazel, and  stramonium.
It may be done with a gum-elastic catheter, and a small  syringe.
  The bowels must be  kept open with the neutralizing mixture, or
some  other  mild physic; and  the skin bathed with saleratus  and
water once a day, and rubbed well with  a coarse towel.
  Should there be  any scrofulous, or gouty, or rheumatic condition of
the system, the remedies for those complaints may be used in addition
to the above.

         Disease of the Supra-Renal Capsules.

  The  supra-renal capsules are small bodies situated above the kid-
neys.  (Fig. 109,  1.)   Their office is not well understood.  It has 
DISEASES OF THE ABDOMINAL CAVITY.           299
been found of late that they are subject to a disorder, having peculiar
symptoms.  This is a new disease.

  Symptoms.— The most  marked symptom is a peculiar change in
the color of the skin, called "bronzing."   This bronzing process be-
gins in patches on those parts exposed to the  sun, and to friction,
as the neck, the backs of the hands, the fronts  of the thighs, and the
aims.   These patches look, in color, like  spots upon a bronze statue,
deprived of their gloss.
   Another marked symptom is a peculiar debility, which comes on
without any apparent cause, — there being, generally, no  evidence of
organic  disease, and no loss  of flesh, — and is  attended with  fail-
ings, loss of energy both of body  and  mind, a  peculiar flabbiness of
flesh, and an early death, apparently from  sheer weakness.
   The blood becomes early  depraved, and loses its coloring matter,
as shown by the paleness of  the skin where there is no bronzing.
   The pulse is generally very soft and compressible.  The stomach is
irritable, the appetite gone; there is nausea, and  sometimes vomiting,
with pain and a  sense of sinking at  the  pit  of the stomach.   Fre-
quently  there is costiveness,  sometimes diarrhoea, and  pains in the
back and loins.   In some cases there  are epileptic fits, failure of
memory, change of temper, or a numbness of the fingers, legs, etc.

  Treatment.— The disease  is a  peculiarly fatal one.  As no  mode
of treatment has yet proved  successful, it is well to observe caution
in prescribing.
   The treatment prescribed for chronic inflammation of the kidneys,
would perhaps  be as safe as any that could at present be proposed.

    Bright's  Disease  of the Kidneys.—Albuminuria.

  This peculiar disease was first explained to  the profession in  1837,
by Dr. Bright, of England, whose  name it  took.  It consists of  a dis-
order of  the kidneys, — probably a congestion  and an obstructed cir-
culation in them* from  which  arise two most important effects;  first,
albumen, an essential alimentary constituent of the blood, is secreted
and  passed  off, in  larger or smaller quantities, in the urine;  and sec-
ondly, urea,  the worn-out matters  in the blood  which the kidneys are
made expressly to  carry off,  is permitted to remain.   If the urine of
a person having  Bright's disease  be  examined, therefore,  albumen,
which should not be there, will be found, and urea, a natural constitu-
ent, will  be absent.

  Method of Examination. — To discover albumen in urine suspected
to contain it, place a little in a test tube, and  boil it over a  spirit
lamp.  If albumen be present only in minute  quantity, it may cause
only a delicate  opalescence; if in larger quantity, it may separate in
curdy flakes, and fall to the bottom as a more or  less abundant white
precipitate.  If very abundant, the liquid may become nearly  solid.
  The albumen is the same as the white of  an egg, and the boiling has
the same effect  in whitening and hardening it, as upon that substance. 
300
DISEASES OF THE ABDOMINAL CAVITY.
  Albumen is  sometimes found in  the  urine  in a  coagulated state,
and  having the shape of tubes or worms.   (Fig. 110.)   This is quite
common in Bright's disease.  The deposit seems
to be made up of fibrous casts of the uriniferous
tubes of the kidneys.

  Symptoms. — The two unnatural conditions
mentioned above, give rise to the symptoms of
Bright's  disease.   One  of them, however, is it-
self the most constant  and characteristic symp-
tom  of the disease, namely, the presence of al-
bumen.  This,  too, being one of the nutritive
constituents  of  the  blood, its abstraction  thins
the serous portion of the blood, and causes it to filter out of its vessels
into  the cells, — causing  dropsy of  the  cells,  usually called cellular
dropsy, or anasarca.  This  general  dropsy begins  frequently in the
face, and spreads rapidly over the whole body and limbs.  In addi-
tion  to this, there are pains in the back and loins, a gradual failing of
strength, and a derangement of digestion.  The skin becomes dry,
with a pale and bloodless appearance, and there are frequently thirst,
nausea, and vomiting.   The urine frequently has fat, blood, epithelial
scales,  mucus, blood discs, fibrous casts of the  uriniferous tubes, and
saline  sediments; and is  generally lighter by weight than in health,
and less in quantity, and is apt to be red, brown, or  dingy in color.
  The retention of urea in  the blood acts as a poison, and causes,
toward the latter end of the disease, when accumulated in large quan-
tity,  drowsiness, convulsions, and apoplexy.
  A frequent desire to make water, with a shifting back and forth
of the  bowels between costiveness and diarrhoea, are common symp-
toms.

  Treatment. — The results of treatment in this disease are often un-
satisfactory.  Yet if taken in season, investigated  with proper care,
and treated with due diligence, much may be done for its cure.  It is
one of those harassing  complaints, which  physicians in  family prac-
tice  seldom have the patience to investigate and manage with suffi-
cient care.
  Let  the  healthy and  active condition of all the vessels of  the skin
be the  first object aimed at.   This will relieve the laboring and falter-
ing kidneys of  a portion of their burden.  The alkaline sponge  bath
with vigorous friction every  day, will secure, this object.
  In the next place, the skin being put in a working condition, should
be made to work by some internal  diaphoretic, — as the tincture of
veratrum viride, in doses of  from five to ten drops, or the compound
tincture of Virginia snake-root, in teaspoonful doses.
  The kidney may be still  further relieved, especially when  there is
considerable tenderness, and other signs of inflammation, by cupping,
leeching, mustard poultices,  and croton oil.
  The bowels should be regulated by some  gentle physic, as cream of
tartar dissolved in flax-seed  tea, or rochelle powders, or epsom salts,
the  lenitive electuary, or the white liquid  physic.  In  some cases,
 
DISEASES OF THE ABDOMINAL CAVITY.           301
podophyllin and leptandrin (40), or the  compound  powder  of jalap
(41), are useful.
  When there  is dropsy of the cells, elaterium may be used as physic
(31), or the kidney may be  jogged by digitalis (130) (129), its effects
being carefully watched.  Cider, freely drank, has  been found  useful
in some cases.
  To restore the blood, iron (73) (93) (74) (75) (72) (71) is the  essen-
tial article.   When there  is considerable debility, some of the vegeta-
ble bitters, as  quinine, quassia, gentian,  Colombo, etc., may  be used
daily.
   Coffee, and  all indigestible  articles of food, as  rich pastries, new
bread, high-seasoned meat, and fats must be avoided, — in  a  word,
nothing must be taken, either in kind or quantity, which the stomach
cannot easily digest

                           Diabetes.

   This disease is a kind diarrhoea of the kidneys.  Tire amount of
urine secreted and discharged is large, sometimes enormous in  quan-
tity,— amounting  even  to several gallons  in  twenty-four hours.
Everything taken into the  stomach  seems to run off by the kidneys.
The food and drink being mostly converted into urine, do but little
good.  The kidneys having got into an exalted state  of action, do too
much, —just as the mucous  membrane of the air tubes does in  bron-
chitis.

  Nature  of the Urine. — Not only is there too much urine discharged,
but, instead of  being lighter than healthy urine, as in  Bright's disease,
it is heavier, and instead of holding albumen in solution, it contains
grape sugar.

  To Detect Sugar.— Put  a little of the suspected urine in a test tube,
— add to it a drop or  two  of solution of sulphate of copper, which
will give the  fluid a pale blue tint.  Now add liquor potassa in excess;
if sugar be present, this will throw down  a pale blue precipitate (hy-
drated oxide of copper),  which will immediately re-dissolve,  forming
a purplish blue liquid.  Boil  this over a lamp; if there be  sugar, a
reddish or yellowish-brown precipitate (sub-oxide of copper) will  be
thrown down ; if no  sugar, a  black precipitate (common oxide  of
copper) will fall to the bottom.

  Another Test. — Place a little urine in a  test tube; add to it half
its volume of liquor potassa, and boil five minutes.   If there be sugar
present, the liquid will take  a brownish or bistre tint.

  Growth of Torula as a  Test. — Place a  portion of sacharine  urine
in a warm place, and a scum will soon rise, as if a little flour had
been dusted  on  it.   This,  when  examined  under  the  microscope,
proves to be minute oval bodies.  These expand and dilate the  vesi-
cle  containing  them, into the form of a tube.   They still continue to
enlarge, and project from the parent bladder, like buds.   The whole 
302           DISEASES OF THE ABDOMINAL CAVITY.
;j  then resembles a jointed fungoid growth (Fig.  Ill), which finally
 |  breaks up, and falls to the bottom, as a copious deposit of oval vesi-
   cles or spores.

     Other Symptoms. — Great thirst, craving ap-
   petite, dry skin, a sense of weight and uneasi-
   ness in the stomach after eating, dry and parched
   mouth, white and foul or clean and red tongue,
   wasting of flesh, languor and aversion to exer-
   cise, debility, pain and weakness in the loins,
   costiveness, loss of the sexual feeling, and cold
   feet.  As the  disease draws towards a fatal end,
   the gums  become   spongy,  the breath  fetid,
   sometimes smelling like urine.

     Treatment.— The skin should have about the same treatment as
   that recommended in Bright's disease.  Also, the same counter-irrita-
   tion over the  kidneys.  The bowels must be kept open by some gentle
   physic (13) (12) (15).

     Tonics. — These will be required to restore the tone of the system,
   particularly iron, — same preparations as recommended in Bright's
   disease.

     Astringents to check the flow of urine  will be needed.  Alum, in
   three-grain doses, three times a day, or sugar of lead, or white vitriol,
   or clear opium,  will be serviceable.  Creosote, in one or two-drop
   doses, and tincture of cantharides, have each cured cases.
     One scruple of Peruvian bark, one scruple of wild cranberry leaves,
   powdered, and half  a grain of opium, mixed and taken three  times a
   day, is a good remedy.
     All  articles which contain sugar and  starch  must be  forbidden
   in the diet.   Bread  and potatoes  contain a large amount of starch  ;
   and beets, parsnips, and some other vegetables, have sugar.  It is best
   to confine the patient almost entirely to tender, fresh  meats ; and the
   drink, notwithstanding the great thirst, must  be restricted to a very
   small quantity.

        Bleeding from  tne  Kidneys, etc. — Hematuria.

     By this I mean a discharge of blood from the urinary  passage.  It
   may come from the kidneys, the ureters, the bladder, or the urethra.

     Symptoms. — The passage of  the  blood is preceded by pain  in the
   region of the bladder  or  kidneys,  and accompanied  by faintness.
   There is  generally  heat and distress in the  loins,  and tenderness
   upon pressure in the region of  the  bladder or kidneys, according to
   the place from which the blood comes.
      It is sometimes difficult to  decide whether the coloring matter in
   the urine is really blood. In such cases, the  microscope will generally
   detect the blood corpuscles, if present.   They commonly appear as in
   Fig. 112, — having  a yellow color, and pretty uniform size.
 
DISEASES OF THE ABDOMINAL CAVITY.           303
  Treatment. — This must of course vary according  to the nature of
the case, and the immediate cause producing it.  Where active bleed-
ing exists, the patient must have absolute  rest       no. 112.
in bed, with applications of cold to the hips  and
loins.  If the patient be strong and full of blood,
wet cups or leeches  may  be  applied over  the
kidneys, or the bladder.  In such cases, too, the
bowels must be freelv moved with some prepar-
ation of salts (14) (18)  (20) (25).
   Sugar of lead is  a valuable remedy; but it
should  be given in large doses for a short time,
rather than in small doses for a long time.  It is
best taken in form of solution (348), two great spoonfuls every two
hours, until five or six doses are taken.
   But the best remedy is gallic acid.   It seems to have extraordinary
power  in this complaint.   It  should  be given in   five-grain  doses,
mixed with a teaspoonful of mucilage of gum  arabic, and ten drops
of tincture of henbane.

         Suppression  of Urine.—Ischuria Renalis.

   This  disease is,  in  one respect,  just the  opposite  of diabetes.
While immense quantities of urine are secreted in  that, none is se-
creted in this.  In  that, the kidneys  do too much ; in  this, they do
nothing.
   This  complaint is  sometimes called paralysis of  the  kidneys.  It
usually occurs in old persons, and those inclined to corpulency.

   Symptoms. — The  patient makes no water ; and if the catheter be
applied, none will be found in the bladder.   The patient feels unwell,
restless, anxious, with a slight pain  in the loins and  bowels, perhaps;
but on  the whole not illness enough to give any very good account
of it.  After a little time,  nausea comes on, and perhaps vomiting,
and soon drowsiness, wanderings of mind, incoherent talk, hiccough,
stupefaction, and death. "These head symptoms are caused by the
shutting up,  in the kidneys, the  natural* outlet of urea, of an excre-
mentitious  matter,  which  acts as  a poison to the  nervous system.
Before death, the perspiration has a strong smell of urine.

  Treatment. — The cause of this  complaint not  being known, the
treatment must necessarily be a little  uncertain.   We cannot go
amiss, however, in placing the patient immediately in a warm bath
for fifteen or  twenty minutes.  Then apply wet cups over the  kidneys,
and*follow these either by mustard poultices, or by hot fomentations.
  Let the bowels be opened by the  compound powder of jalap, or by
elaterium (31).  Epsom salts or cream of tartar might in some cases
be substituted for  the above.   A stimulating iniection is also desira-
ble (246).                                 5   J

  Diuretics, as sweet spirits of nitre, digitalis, queen of the meadow and
peach leaves, equal parts, and marshmallow, are of course called for.
 
304
DISEASES OF TH7. ABDOMINAL CAVITY.
   Much of the poisonous matter retained may be got out through the
skin, by a free use of the compound  tincture of Virginia snake-root
or tincture of veratrum viride in full doses.
   Although  the  symptoms,  in the earlier stages of this complaint,
may not attract much  attention, or be thought worthy of notice, yet
the treatment should be prompt and energetic, as a fatal termination
is sometimes reached in the brief space of forty-eight hours.

                     Retention  of Urine.

   This disorder  is often confounded with suppression of the urine,
but it is different in every respect.   In suppression, the  urine is not
formed by the kidneys ; in retention,  it is formed, and, in some cases,
poured into the bladder, but is retained on account of some inability
to pass it.

  Ischuria. — This is one of the forms of retention.   In this complaint,
the urine has passed from the  kidneys to the bladder, but from some
cause, generally palsy of the muscles of the bladder, it  cannot be
passed off  In this  case, there is no pain, but the stream of water
flows off with slower and slower pace, — the  patient  having to stand
a long time, and make tiresome efforts with the abdominal muscles
to get the bladder emptied.   As the quantity discharged diminishes,
the desire to  urinate grows more  urgent.   Pressure just above the
pubes, gives pain, and the bladder feels under  the hand like a large
hard tumor.

  Dysuria. — In this  form of the complaint, the water  is passed to
some extent, but with pain and  heat along  the water-pipe.   This is
generally caused by some inflammation along the urethra.

  Strangury. — In this,  the water is  only passed,  drop by drop, and
with great burning, scalding, and tenesmus in the neck of the bladder.
When there is considerable inflammation, the skin becomes hot, the
pulse hard and quick, and the tongue  covered with a white fur.

  Causes.— These several forms of the complaint are caused by palsy
of the bladder, gonorrhoea, inflammation in the neck of the bladder
or the water-pipe, mechanical injuries of the  bladder in child-bearing,
or otherwise, by tumors pressing upon it, by irritation from gravel or
stone within its cavity, by stricture or partial closing up of the urethra,
by disease of the prostate gland, by taking  spirits of turpentine or
cantharides, or by the absorption of this latter article when used as a
blister.
  Treatment. — It is  obviously necessary in this complaint, that treat-
ment, in order to be of any avail, should be prompt; for when the
retention is complete, the  bladder will burst in from two to five days,
and cause the death of the patient.
   The treatment must vary according to the  cause of the retention.
   If it be caused by palsy of the bladder, the common flexible cathe-
ter must be  used daily until the muscular  fibres recover their  lost 
DISEASES OF THE ABDOMINAL CAVITY.           305
 power.  When much irritation is caused by introducing it, it is better
 not to withdraw it, but to close its external orifice with a small plug,
 which the patient can remove as often as necessary  to let  off the
 urine.   To remove the paralysis, the electro-magnetic machine is
 worth a trial, — the current being passed through  the bladder.   At
 the  same  time let  the  patient take  strychnia (85)  (86)  (83)  (95).
 Cantharides, in the  form of tincture, or in connection with  strychnia
 (291), is often useful.
   If the retention be caused by inflammation of the neck of the blad-
 der, leeches should be applied to the perineum, and three or four drops
 of croton oil may be rubbed on just above the pubes to bring out an
 eruption.   Warm fomentations will  also be serviceable, and warm
 hip baths.  Cooling diuretics, as  infusions of marshmallow, cleavers,
 pumpkin seeds, buchu, sweet spirits of nitre, etc., must not be omitted.

         Inability to Hold  the Urine.—Enuresis.

   This complaint,  generally called  incontinence of urine, is quite
 common among children.   In some cases the child has no ability to '
 hold its water at any time ; but generally it  is only passed off invol-
 untarily at night while in bed. In adult  life it is less frequently met
 with, except among  the old.
   Causes. — Irritation of the roots of  the spinal  nerves which go to
 the  bladder, mechanical injuries of the bladder, palsy of the bladder,
 particularly in  old people, debility of  the neck of the bladder, a gen-
 eral weakness  of the nervous system, worms in the bowels, piles,
 whites, gravel or  stones in the bladder, etc.
   Treatment. — As a general rule, the change of constitution which
 occurs at purberty cures this complaint.   But as this does not always
 happen, it is important that parents do everything in  their  power to
 break it up early, lest it become an affliction  for life.
   Children who  suffer  from  this  disorder are apt  to drink largely.
 This habit should be restrained.  But little drink  should be  allowed,
 whatever the desire for it.   Care should be taken that the child make
 water before going  to bed, — also that it be roused at a late hour for
 the same purpose.
   The skin should  be washed all over, every day, with cool or cold
 water, and vigorously rubbed  with a coarse towel.  This will cause
 the excess of fluids to pass off through the skin, and lessen the action
 of the kidneys.
   In some instances children urinate  in bed  through carelessness,—
 being half conscious of what is occurring, but not caring enough to
 rouse themselves.  In  such cases, they are often  cured  by some  de-
 cided correction, —the  impending act of passing water, connecting
 itself in  their minds  with the correction, and recalling them  instantly
 to full consciousness. Of course this mode of relief should be resorted
 to with great judgment and caution.
   When the complaint  proceeds  from debility or relaxation  of the
neck of the bladder, the compound infusion  of trailing  arbutus, and
                                39 
306           DISEASES OF THE ABDOMINAL CAVITY.
the isinglass custard found among dietetic preparations, may be used
freely.   The tincture of cantharides, from ten to forty drops to chil-
dren, may be given, and increased gradually to a hundred, or until slight
difficulty is felt in passing the water.  Then stop, and give the articles
mentioned  above.   Spirits  of  turpentine is  useful to some  extent,
given also in small doses, and continued for some time.
  If the disorder be caused by irritation of the spinal  nerves, cold
water douched upon the back, or croton  oil rubbed along  the  spine,
or a warm stimulating or irritating plaster upon  the lower part of the
back, will be reouired.  The electro-magnetic machine may do well
in -*ome cases.

           Urinary  Deposits.—Gravel.—Stone.

  Unnatural deposits in urine  are to  be  regarded  simply as evi-
dences of changes  which disease is  making  in  the  body.   As such
they are valuable, — more valuable, in many cases, than any  or  all
other symptoms  we can study, and most valuable from the ease with
which  they may be investigated.  Yet, but very  few physicians, com-
paratively, pay any special attention to them, or make any effort to
acquire the small amount of knowledge needed for their detection.
  Sources of the Urine. — The urinary secretion has  three sources.
The largest bulk of it comes from the superabundance  of drink taken
into the stomach.   This is  shown  from  the free flow of pale urine
after taking copious drafts of water or other fluids.   Such quantities
of water as are often drank, would embarrass the functions of animal
life, were it not pumped off  by the kidneys.
   A second source of  supply for the urinary secretion, is to be found
in the elements of  imperfectly digested food,  and also some abnormal
elements arising from  incomplete  assimilation.   Oxalic acid is a
specimen of the latter, being sometimes  largely excreted, in dyspep-
sia, soon after a meal.
   The third source of urine  is found in those old and worn-out atoms
of the system, which can serve no further useful purpose in the ani-
mal economy, and  which cannot be got rid of by the lungs or skin.
It is only, however, one portion of the dead tissue, namely, that which
is rich in nitrogen, which  goes  out through  the renal  strainer, — an-
other portion, which has  a  preponderance of inflammable elements,
carbon, hydrogen,  and  perhaps  sulphur, takes the  outward channel
through the liver, as bile.
   Characteristics of Urine.—Healthy urine has a light  amber color, is
transparent, and has different degrees of density, — its specific gravity
varying from  1.003 to 1.030.   It has an aromatic, violet-like  smell,
and a bitter, disagreeable taste, like salts.
   That which is passed a  little  time  after  drinking largely, is pale,
and has a low specific gravity, varying  from 1.003 to 1.009, and  is
called  urina potus.   That passed soon after the digestion of a full
meal, is called urina chyli, or urina cibi;  it has a specific gravity from
1.020 to 1.030.  That which is  secreted from the blood, and is passed 
DISEASES OF THE ABDOMINAL  CAVITY
30V
before eating or drinking in the morning, is called urina sanguinis; and
has a specific gravity from 1.015 to 1.025.   This is the best specimen
of the average density and nature of healthy urine.
   Healthy  urine contains urea, uric acid, sulphuric acid, phosphoric
acid, lime, magnesia, phosphate  of soda, etc.  It is  only when these
are discovered in excess, that they indicate disease.

   Examination of Urine. —Let a piece of blue litmus paper'be  first
dipped in  the  urine ; if it  be acid,  the color of the paper will be
changed to red, or reddish-brown.  Should the blue color remain un-
changed, then use  yellow tumeric or reddened  litmus paper;  if the
urine is alkaline, the tumeric will become brown, and the reddened
• litmus will be changed to blue.  If the color in  both cases  remains
 unaltered, the urine is neutral; that is, neither acid nor alkaline.
   This being done, let  the specific gravity be taken.   This  is easily
 done by the urinometer (Fig. 113).   This instrument is known  also
 by the names hydrometer, and  gravimeter.   It  is  generally fig. 113.
 made of glass.  When  placed in distilled  water, it  will  sink
 to a certain point; and as all bodies immersed  in  fluid dis-
 place a bulk equal to themselves, it follows that in  a  fluid
 denser than water, the instrument will not sink so deep.   The
 space above the large bulb is marked off into degrees corres-
ponding  to different densities.  When this instrument is im-
mersed in  urine, and has  come to rest, the number  on the
graduated  scale, which  stands at  the surface of the liquid,
when added to 1000, will represent the specific gravity of the
fluid.   If, for example, the surface of the liquid corresponds
with 9 on  the  scale, the specific gravity of the urine will be
1.009; if at 25, it will be 1.025.
   By attending  to  the specific gravity of the urine, the phy-
sician may often gain important information respecting his  patient,
as  it may be made to show him how much solid matter is daily  car-
ried out of the body through the kidneys.   This, at the bed-side, may
often give useful hints in regard to treatment.
   The following table, constructed by Dr. Golding  Bird, shows at a
glance the amount of solid matter in 1000 grains of urine of different
densities:
Specific
Gravity,
 1001
 1002
 1003
 1004
 1005
 1006
 1007
 1008
 1009
 1010
Solids. Water.
| [Specific
I Gravity
 2.33
 4\66
 6.99
 9.32
11.65
13;98
16.31
18.64
20.97
23.30
997.67
995.34
993.01
990.68
988.35
986.02
983.69
981.36
979.03
976.70
1011
1012
1013
1014
1015
1016
1017
1018
1019
1020
Solids. Water.
25.63
27.96
30.29
3262
34.95
37.23
39.61
41.94
44.27
46.60
974.37
972.04
969.71
967.38
965.05
962.72
96039
958.06
955.73
953.40
Specific
Gravity.
Solids Water.
1021
1022
1023
1024
1025
1026
1027
1028
1029
1030
48.93
51.26
53.59
55.92
58.25
60.50
62.91
65.24
67.57
69.90
951.07
948.74
946.41
944.18
941.75
939.42
937.09
934.76
932.43
930.10
Specific
G ravity
1031
1032
1033
1034
1035
1036
1037
1038
1039
1040
Solids. Water.
72.23
74.56
76.89
79.22
81.55
83.88
86.21
88.54
93.87
93 20
927.77
925.44
923.11
920.78
918.45
916.12
913.79
911.46
909.13
906.'80
  The mode of using the above table is  this.  Having  learned the
density of the  urine  passed in twenty-four hours  by means  of the 
308           DISEASES OF THE ABDOMINAL CAVITY.
urinometer (Fig. 113), a glance at the table will show the proportion
of .solid matter and water  in  1000 grains of the urine.  Then, by
weighing the whole quantity of urine passed in twenty-four hours, the
weight of solids drained off by the kidneys, may be determined by the
simple rule of proportion.

  Symptoms  of Gravel. — A sudden attack of pain in the region of
the kidneys, so acute and  severe, frequently, as to  cause  fainting, and
even convulsions.   The pain runs down to the groin  and thigh, caus-
ing a numbness on the affected side, and a drawing up of the testicle.
The pain is excessive at times, and then remits. Finally  it stops sud-
denly.
  Leading from the kidneys to the bladder are two small tubes about
the size of  a  goose-quill, called ureters, — being the appointed chan-
nels of the urine.  The pain, of which  I have spoken, is  caused, gen-
erally, by the passage of a stone along  one of these small tubes.  If
the stone happen to be a little too large  for the tube,  or uneven or
ragged upon  its surface so as to bruise and tear the delicate lining
of the ureter, severe pain  is  the result.   The pain  is intense when the
stone moves along; remits  when it stops ; and suddenly ceases alto-
gether, when it gets through, and drops into the bladder.
  Sometimes there  is no pain, the gravel being so fine as to pass
through the  ureters  very  easily.   It then passes  through the urethra
also, and is found as  a sediment of the  urine  at the bottom of the
vessel.
  These urinary deposits  are various, and quite unlike each other in
kind.  They indicate different states  of health,  and require' to be
spoken of separately.

                      Uric-Acid Gravel.

  This form of deposit passes indifferently under the name  of uric
acid gravel, or lithic  acid  gravel.   The  person who is in  the habit of
passing this  kind  of deposit largely, is said to  have  the  lithic or uric
acid diathesis or condition.

             Fig. 114.                            Fro. 115.
  The urine of persons in this state lets fall after it has stood awhile,
a reddish  sediment, like  brickdust   This consists  chiefly of urate of
ammonia  (Fig. 114 and 115),  tinged with certain coloring matters.
 
DISEASES OF THE ABDOMINAL CAVITY.          309
   This coloring substance may be more or less abundant, and give to
   the deposit various shades, as dirty-white, yellow, pink, and red.  The
             no. 116.           pure uric acid sometimes appears as fine
                             sand, or large crystals (Fig. 116).  The
                             urine is of a dark copper  color,  about like   j
                             brown sherry, and is more scanty than in
                             health.  It  is also highly acid, giving to
                             litmus paper a deeper shade of  red.
                                Persons who pass this kind of gravel   j
                             largely, are  apt  to  be  troubled with in-
                             flammatory  complaints;  with acidity of
                             stomach  and heartburn ; and some  of
                             them with  gout  and rheumatism.
                                Placed under a blowpipe, uric acid is
                             decomposed, and  gives out  an odor  like
                             that of burnt feathers, combined with the
                             oil of bitter  almonds.   It is dissolved by
                             liquor potassa, from which muriatic and
                             nitric acids precipitate it; and by sulphu-
   ric acid, from  which it is  precipitated  by water.   Acetic, nitric, and
   muriatic acids, alcohol, ether, and water, do not dissolve it.
      Causes. — Uric acid  is the form in which nitrogen and  the  effete
   compounds which contain it are got out of the body.   It is the result
   of the decomposition of the tissues of the body.  Its gravelly particles
   are the sands  of  life daily washed out of us, — reminding us always
   that We are wasting away.  Whatever causes the body to waste rap-
   idly, produces it  in excess.  We  find  it, therefore, in the urine of
| j  those who suffer from gout, rheumatism, dyspepsia, fevers, debility
j|  of the  genital organs, straining of the  loins, etc., which produce loss
! i  of flesh.
ll                           .       .                                   i
ij    Treatment — The remedies for this uric acid gravel  are the alkalies,
||  bicarbonate of potash, bicarbonate of soda and magnesia.   The first   i
j|  named is generally the  best  It may be used in  the form of the neu-   ]
j|  tralizing extract, — especially if there be costiveness.  If the bowels   I
|J  do not need physic, let the potash be taken in the shape of lye made
j|  from hard-wood ashes (300).  Fluid magnesia is an  excellent remedy;
|j  so is liquor potassa, taken in twenty or thirty-drop doses.  The urine
jj  must be watched, and  these remedies discontinued when it becomes   I
|i  alkaline.
     At the same time the stomach should be supported by some bitter
j  tonic, as the infusion of quassia, gentian, columbo, Peruvian bark, etc.
I    Iron  is, in many cases,  not  to  be overlooked.   If the patient be
   pale  and bloodless, some of the  preparations of this metal will be
j  needed (61) (73) (74).
     Acids must be carefully avoided, both in food and drink.
     The diet must be plain, digestible and nourishing, and quite mod-
j  erate in amount.  The quality is of less consequence than the quantity.
     Exercise is of great consequence, and must be regular, and, if pos-
   sible, in the open  air.
 
310           DISEASES OF THE ABDOMINAL CAVITY.
  The skin must  receive daily attention in the shape of an alkaline
sponge bath, with friction.  This  will throw upon the skin much of
the labor done by the kidneys.

                    Phosphatic Deposits.

  These deposits are indicated by a state of the urine just the oppo-
site of that which contains the uric acid  gravel.   They are contained
in urine which is either alkaline when passed, or becomes so very soon
by standing.
  As the urine cools, a white sand falls to the bottom, and frequently
a film forms  upon the surface of the water.   Looking at this film in
different lights, you may see in it  the several colors of the rainbow.
Skim off this pellicle, place it upon paper, and let it dry; and you
may then see the  little shining crystals.   This urine  quickly  grows
putrid and  offensive.   Sometimes it smells strongly  of ammonia.
The more phosphates it contains, the sooner it becomes alkaline.
  These deposits are generally the triple phosphates.   Healthy urine
contains  the  phosphate of magnesia  in  a  state of solution.   Under
some circumstances, the  urea of the urine is decomposed in the kid-
neys, and ammonia is disengaged.  This combines with the phosphate
of magnesia, and forms the triple salt of the phosphate of ammonia
and magnesia, which is not soluble.

  Symptoms. — A  sallow complexion, a languid,  spiritless state  of
mind, and an exhausted, debilitated condition of body.  The urine is
pale, rather copious, slightly turbid, has a low specific gravity, and
smells unhealthy, having sometimes  the faint odor of weak  broth.
There is generally derangement of the digestive organs, windy stom-
ach and  bowels, nausea,  constipation, or diarrhoea, stools of various
colors, and sometimes, in  diarrhoea, resembling yeast, and an aching
pain and weakness in the  loins.

  Causes. — These  deposits are produced by great  debility of the
constitution,  by  injuries  of the spine, dyspepsia, defective assimula-
tion  of food, bad diet, irritation of the  neck of the  bladder, and  or-
ganic disease of the kidneys.  But they are caused more especially by
whatever wears and exhausts the nervous system, as heavy cares, de-
pression of spirits, sedentary habits, great  mental exertions, mastur-
bation, and venereal excesses.

  Treatment. — These  deposits being connected with great  debility,
care must be taken not to make  the matter worse by taking active
purgatives, by extreme fasting, or by any means which will  increase
the weakness.
  On the contrary, the strength must be supported by all the  means
that can be  commanded.  With  this view, the citrate of iron (p5)
may be taken.  Morphia combined with iron (BO), to allay irritability,
and impart strength at the same time, may be used.  The valerianate
of iron (93) is excellent for the same purpose.
  Connected with a state of urine just the opposite  to  that  which 
DISEASES OF THE ABDOMINAL CAVITY.           311
   holds the uric acid deposits, this form of gravel calls  for the opposite
   remedies.  Instead of the  alkalies, the acids are wanted.   The nitric
   and muriatic acids, with a vegetable tonic (76), may be used.  Opium
   is spoken of in high  terms, and is thought by  some to  have great
   power in turning alkaline urine acid.  The  compound balsam of sul-
   phur is highly spoken of, and the compound infusion of trailing arbu-
   tus is also mentioned with approbation.
     It is  all-important to throw off care, and to give the mind a chance
   to rise  up with ail the elasticity it has.  To bring this about, journeys
!   and amusements are useful.  The society of lively, laughing, witty
j   friends will  do a great deal to  give  the  spirits a rebound, and the
j   whole  health an upward movement   Such persons are a  blessing to
!   the world ; and he who reckons a few of them among his friends wTill
i   live the longer for it.
I     The skin  should  have  the  benefit  of the  daily tonic  effect  of a
   sponge bath, with water at first tepid,  and afterwards cool; and  exer-
   cise, out of doors, should be habitual, and connected, as much as pos-
   sible, with objects of pleasure.
 i    The drinking of hard water is highly injurious ; and if  none other
   can be had, it should be  distilled, and then spread out to the atmos-
   phere,  in shallow vessels, that it  may recover its pleasant taste  by
   reabsorbing air and carbonic acid.

                          Oxalic  Deposits.

     Oxalate of lime in the urine is the  cause of this kind of gravel.
   It appears in the form of dumb-bells, and octahedral crystals.  (Figs.
|   117, 118, and 119.)
Fig. 117.                   Fig. 118.                Fig. 119.
j!     The urine has a specific gravity of 1.015 to 1.025, and is generally
j   of a dark amber color, and clear, and bright; it is generally acid,
j   though occasionally alkaline or neutral.  Urea is generally found in
j   it, and  epithelial cells (Fig. 120).   Unlike  the  uric and .phosphatic
|  -urines, it is quite free from sediments, except, as often  happens, there
   is a large amount  of urea in it, in connection with the oxalate of
   lime.
j      When the urate of ammonia is combined with the oxalate of lime,
j"  it often happens that the latter has to be dissolved with a little liquor
   potassa, before the former can be seen with the microscope. 
312
DISEASES OF THE ABDOMINAL CAVITY.
  Symptoms. — Great depression of spirits, excitable state of the ner-
vous  system, painful  susceptibility to external impressions, dyspeptic
symptoms, and disturbances of the liver, a fear
and dread of consumption, emaciation, inability
to make exertion, — the smallest exertion caus-
ing fatigue, — in  men a deficient sexual power,
a pain  and weight across the loins,  and some
irritability of the bladder.

  Causes. — These  deposits are supposed to re-
sult, like most other derangements  connected
with  loss of flesh, in  too  great a degree of oxi-
dation.   Vegetables produce oxalic acid by just
the opposite process, namely, deoxidation.
  Whatever  depresses the vital powers, may generate this deposit:
as mental depression, overwork of the  brain, burdensome cares, idle-
ness of mind or body, masturbation, debaucheries, intemperance, vene-
real excesses, and injuries of the spine.
  This deposit may also be produced  by certain articles of diet, which
contain the oxalic  acid.  Among these may be  named the rhubarb
plant, which in summer is largely used for tarts ; and sorrel.

  Treatment.— The treatment for these deposits should be very much
like that for the phosphatic.   The  stomach and liver  should  receive
some special attention.  A pill of leptandrin,  podophyllin, etc. (39),
may be used with advantage.   The preparation of nitric  and hydro-
chloric acids  (76) must generally be taken for some time.  In cases
of great irritability, the sulphate of zinc (82) does  well.
  The diet should  be plain, digestible,  and  nourishing,—:all  articles
containing the oxalic acid being rejected, as the rhubarb plant, sorrel,
tomatoes, onions, etc.
  For the rest, follow the directions  for the treatment of phosphatic
deposits.

               Urate of Ammonia Deposits.

  The urine which contains these deposits is  generally pale, an3 of
low specific gravity,  about 1.012.   It  becomes opaque  on cooling,
from the deposition of a nearly white urate of ammonia.  Instead of
falling down  readily,  this forms ropy masses in the fluid, and looks
like mucus or pus, or  something between the two.  Its real nature is
discovered by applying a little heat, which quickly dissipates it.

  Microscopic Characters.—Place a drop of this turbid urine between
two  slips of glass,  and examine it closely with  a microscope;  you
will  see myriads of  minute globules   adhering  together  in  linear
masses.   Now  place a drop of the  turbid urine in a watch-glass, and
gently warm it; as  soon as it has become clear, add a  drop  of^ hydro-
chloric acid to it, and  when it is cold, examine it with the  microscope.
The muddiness will be gone, and you will now see lozenges, or thick
cohering prisms of  uric acid (Fig. 121).  The  explanation of this is,
 
DISEASES OF THE ABDOMINAL CAVITY.
313
that the hydrochloric acid combines with the ammonia, forming muri-
ate of ammonia in solution, and Uberating the uric acid crystals.
   Urate of soda (Fig. 122) is sometimes found  in  urine, which has
similar chemical reactions with urate of ammonia.

   Causes. — These deposits are generally produced  by some overeat-
ing, or derangement of the skin.
   The treatment is the. same as that for uric acid gravel.


                 Hippuric Acid Deposits.

   These deposits appear in the healthy urine of the cow and the horse;
and also in  that of human beings, but in such small quantities as to
be scarcely appreciable.
   They  sometimes, however  appear in unhealthy  proportions; but
they never show themselves as a sediment, until after the  addition of
                    a stronger acid.  The  urine containing them  is
                    generally slightly acid or neutral, — sometimes
                    alkaline, — having a low specific gravity, from
                    1.006 to 1.008.  The triple phosphates are often
                    found  in it
                      To  detect these desposits, fill a large watch-
                    glass with urine, and evaporate it over a lamp to
                    a few  drops.   Then add to it about half its bulk
                    of  hydrochloric acid,  and  set it  aside.   The
                    addition  of  the  acid  produces  a bright pink
                    color, and an odor like  new hay.   After a few
hours, if the hippuric acid be present, its  peculiar crystals  will be
seen.  (Fig. 123.)

   Cause. — In man,  this deposit  is supposed to depend on  the ab-
sence of food having a good  share of nitrogen.  The urine of vege-
table eaters contains it in largest quantities.
   Treatment. — The only treatment required  is  a diet composed  in
good  proportion of animal food,  a proper attention to  the  skin by
bathing, etc., and when debility exists, tonic medicines,  as iron and
bitters, with out-door exercise enough to keep the muscles in working
order.
 
314           DISEASES OF THE ABDOMINAL CAVITY.
                        Cystine  Deposits.

     These do not occur in healthy urine, and rarely as an element in
1   diseased action.  They contain twenty-six per cent of sulphur.
j     Urine which, contains  cystine is of a pale  yellow color, and has a
   low specific gravity.  It  frequently has  an oily appearance, and its   J
1   smell is peculiar, resembling that of sweet brier.   Sometimes its odor
j   is fetid, like putrid  cabbage.  On being kept for a short time, it has   j
I   its surface covered with a pellicle which looks oily,  and consists of a
!   mixture of crystals  of cystine, and the  phosphate  of ammonia and   |
j   magnesia.                                                           I
I     The  cystine deposit appears to be diffused through the urine, which   '
   is always turbid when boiled.  It is a white or fawn-colored powder,
   and falls to the bottom  as a seidmenti   It undergoes no change  by   i
   warming the urine, and this distinguishes it from white urate of am-   j
'   monia.  It is not soluble  in diluted hydrochloric or strong acetic acid,
   which distinguishes it again from the earthy phosphates.               j
|     To test,this  deposit, add liquor ammonia to a portion of it, and
   shake them. If the deposit be cystine, it will dissolve readily.  Allow   |
   a few drops of the  solution to evaporate on a slip of glass, and the
   six-sided tables of cystine will remain, which may be examined under
   the microscope.  (Fig. 124.)                                         , j
Fig. 12*                  Fig. 125.                Fig. 126.
|     Causes.__An  excess of sulphur in the tissues, a scrofulous consti-
'   tution, and  hereditary predisposition,  with defective oxidation, and
   torpidity of the liver.  It is often found in the urine of girls who have
   the green sickness.

     Treatment.__The great object  is to improve the general health,
!   which is to be done by attending to the skin, and the  administration
 
DISEASES OF THE ABDOMINAL CAVITY.
315
of iron and bitters, and also alteratives.   The syrup of iodide of iron
is a valuable remedy.  Podophylfin and  leptandrin (34) are wanted
to regulate the liver.   The nitro-muriatic acid (76) should be tried.
   The daily sponge bath, and  daily exercise, as in most chronic com-
plaints, must on no account be neglected.

                      Stone.—Calculus.

   It often happens that the proper treatment for removing urinary
deposits  is not adopted in season.  In such cases, gravelly particles,
finding a lodgment for a time, in the  kidneys  or bladder, are apt to
draw other  particles to themselves, which  become fastened to them,
and form a layer quite round them.  Over  this, other layers  form in
succession, until a stone is produced so large  that it cannot pass off.
These grow to various sizes, — being sometimes  so large as to fill the
bladder.
   Uric Acid Calculus.—The most common of these formations is the
uric acid calculus.   It is generally smooth or slightly tuberculated on
the surface, and  varies in  color from a pale yellowish-fawn, to a red-
dish-brown.   When sawn through the centre, its  layers will  be found
tolerably regular, but of different thickness.   (Fig. 127.)
   To test it, place a small fragment upon platinum foil under the
blowpipe.  If uric acid, it blackens, and gives out an odor like  burnt
feathers mixed with the oil of bitter almonds.
Fig. 127.
Fig. 128.
   Mixed Calculus---These calculi are frequently composed of two or
more different kinds of matter arranged in irregular layers.  Fi°\ 128
is a mixed calculus, — the dark layers being oxalate of lime, the light
ones, uric acid.                                                °
   In  testing such, fragments of each ingredient should be separately
examined.                                                 r      J

   Urate of Ammonia Calculus—We  occasionally meet  with  a cal-
culus composed of the urate of ammonia.  These calculi, when found,
are generally small m size,  smooth or slightly tuberculated upon the
surface (Fig. 129),  and of a pale slate or clay color.  When heated
before the blowpipe, it gradually disappears.

  Phosphate of Lime Calculus.-This has a smooth polished surface,
and quite regular layers which  separate  easily when the calculus is
cut asunder.  It has a pale fawn or stone color.  (Fig. 130.) 
31$           DISEASES OF THE ABDOMINAL CAVITY.
  It chars before the blowpipe, and  gradually becomes white as the
carbon burns  away.  Diluted nitric or hydrochloric acid dissolves it
without effervescence.

  Oxalate of Lime Calculus. — This is frequently met with uncom-   |
bined with others, but more generally its nucleus is uric acid or urate   j
of lime.   It commonly has a brown, dark olive, or dirty-purple color.
Its surface is irregular and somewhat rough.  It looks like the fruit
of the mulberry, and is  known as the mulberry calculus.  (Fig. 131.)
  It dissolves, without effervescence, in diluted nitric or hydrochloric
acid.  When  thus dissolved, the  addition of a little  ammonia will-
cause it to fall to the bottom as a white precipitate.
Fig. 130.                   Fig. 131.                  Fig. 132.
  Fusible Calculus. — This is a mixture of phosphate of lime, and the
phosphate of ammonia and magnesia.  It  is the most common of
all the calculi, except  the  uric acid.  It  has an oval, irregular 4brm
(Fig. 132), and is white, soft, and friable, like chalk.  Sometimes it is
hard.
  It may be known by the  readiness with  which it melts down before
the blowpipe, without being consumed.

  Causes. — The causes of the different  kinds  of gravel  have been
already explained.  Generally stones of the  bladder are formed in the
kidney, and descending through the ureters into  the  bladder, are  pre-
vented from passing out through the water-pipe by an enlarged pros-
trate gland.   Remaining in the bladder, they soon get encrusted  over
by other matters in the urine, and grow by accretion to be  stones.

  Symptoms.—When a stone in  the bladder reaches  a certain  size,
especially if it is rough, it always produces suffering.  A dull, annoy-
ing pain is felt at the end of the penis.  The desire  to make water is
frequent, and there is a sense of weight in the perineum.  Sometimes
the stream of urine is suddenly stopped by the stone falling on the
orifice  of the  urethra.  As the  bladder  becomes nearly  emptied, it
embraces the stone, and the pain is increased.  Jolting  in a carriage
causes great pain.  Mucus passes off  with  the urine, and  sometimes
blood.   After  a time, the appetite  fails, hectic sets  in,  albumen ap-
pears in the urine, and the patient sinks under inflammation of the
bladder.
  These symptoms being found in diseases  of the kidneys and blad-
der, no one  is  authorized  to pronounce upon the existence of stone,
until the stone has been touched  by a  metalic sound introduced into
the bladder. 
DISEASES OF THE ABDOMINAL CAVITY.           317
   Treatment. — The only effectual treatment is a choice between two
 operations, — lithotrity and lithotomy.
   The former consists in introducing an instrument, a kind of forceps,
 into the bladder, through the urethra, taking  hold of the stone, and
 crushing it.  The preparatory treatment consists in correcting the un-
 healthy state of the urine, and the frequent introduction  of bougies or
 sounds to enlarge the water-pipe  for the easy entrance of the crush-
 ing forceps.  The after treatment  consists in diluent drinks to increase
 the urine, injections of warm water to wash out the  fragments, with
 Inp baths, soothing injections, and leeches or  cupping upon the peri-
 neum.
   Lithotomy consists in making an incision into the  bladder through
 the perineum, and taking out the  stone or stones whole.

               Dropsy  of  the Belly.—Ascites.

    This is a collection of water in the cavity of the belly; sometimes
 the fluid is outside of the peritoneum, and next to the muscles.

    Symptoms. — An enlargement  of the belly, with a sense of disten-
 sion and weight, — particularly on the side on which the patient lies.
 When the collection of water  is  large, the breathing becomes short
 and difficult, and the swelling is uniform over  the whole abdomen.
    In some instances the fluctuation of the water may be  distinctly
 heard when the  patient  moves  about, — just as we may hear the
 water in  a half-filled barrel when it is rolled over.  This sound of the
 fluid, when heard, distinguishes the complaint from pregnancy,  and
 from the drum-head state of the bowels.   This fluctuation may some-
 times be produced by pressing upon  one side of the belly while the
 patient is standing or sitting, and striking the other side with the ends
 of the fingers of the other hand.
    In some cases, there is loss of appetite,  dry  skin, costiveness, scanty
 urine, oppression of the chest, cough, colic pains, and variable pulse.

    Causes. — A frequent cause of this complaint is chronic inflamma-
 tion of the serous membrane which  lines the  abdomen, — I mean the
 peritoneum.  It may  also be  produced  by scarlet  fever, fever  and
 ague, disease of the heart, particularly dilatation of  the right cavities,
. and diseases of the liver, particularly the shrivelled, hobnail condition
 of the liver, — in short, whatever causes a pressure  upon the portal
 veins, and obstructs the venous blood returning from the intestines.

    Treatment.— The remedies for this disease are  mainly diuretics
" and purgatives.  The bowels  may sometimes be reduced in a few
 days from an enormous size, by medicines which excite the action of
 the kidneys.  Digitalis, combined with  acetate of potash, etc. (130),
 forms an  excellent preparation.   The patient should  have as a con-
 stant drink, a strong infusion made from  two  parts  of  hair-cap moss,
 and one each  of juniper berries and dwarf elder bark; also an infu-
 sion of queen of the meadow.
    The purgatives used in this  complaint are those which produce 
318           DISEASES OF THE ABDOMINAL CAVITY.
watery stools.   One of the best of these is elaterium.  It will some-
times  carry off the water with great  rapidity; combined with some
active cathartics (31), it will  have all its good  effects  without the
griping it is apt to occasion alone.
   Cream of tartar, taken in large doses, every day, will sometimes do
well.   Epsom salts produces watery stools, and is a good remedy.
   For promoting absorption of the fluid, the  iodide  of potassium,
taken  in  from  three to ten-grain doses, three times a day, is a valua-
ble medicine in many cases.  The compound infusion of parsley is
said to be still better.
   The skin must receive careful attention.  The alkaline sponge bath,
with  friction,  will increase the transpiration  of  fluid through  that
organ.  Exercise does much to keep up an active circulation, and to
lessen dropsical effusions.
   The  strictest temperance, both  in  eating  and drinking, must be
observed.  A light  and  nourishing diet,  with water, tea, and  the
diuretics  named  above for drinks ; beyond these the  patient must
not go.
   A kneading and shampooing of the  bowels once  a day has  an  ex-
cellent effect; it gives activity to the  circulation in obstructed veins.
A bandage tied close around the bowels, and tightened as the water
diminishes, has an effect upon  the sluggish vessels  similar to that of
the laced stocking in varicose veins of the legs.  It lessens the liabil-
ity of a return of the complaint.

  Dropsy of  the Cells.—General  Dropsy.—Anasarca.

  Just under the skin is a membrane composed chiefly of cells, called
the cellular membrane.   When a considerable  part, or the whole of
these  cells are filled  with a watery fluid, we call the complaint ana-
sarca, or cell dropsy.   If, beside this, there is  a  collection of water in
the large cavities, we give it the name  of general dropsy.
  Symptoms. — The  disease  generally begins  with a swelling around
the ankle and leg, which is more visible  at night  after  standing and
walking, and is less perceptible in  the  morning in  consequence of the
horizontal position of the night.   To the touch  of another  person,
dropsical feet and legs  feel a little  colder than  natural; and when hard
pressed with the finger, a pit will be sunk in the flesh, which remains
some  time before it fills up.  As the disease advances, the skin of the
legs becomes smooth, shining, and  sometimes even cracks open to let
out the water.  The limbs, and indeed the whole person become stiff,
heavy, and clumsy.
   As  the disease advances, and ascends to the belly and chest, there
is shortness of  breath, a  sense of suffocation on  moving or lying
down, a tightness and  distress  across  the  epigastrium,  thirst,  dryness
of skin, wakefulness, loss of  appetite,  scanty and  deep-colored urine,
and a slow fever.
   Causes. — General dropsy is caused by whatever weakens the gen-
eral system, and by such circumstances as  obstruct the  circulation in 
DISEASES OF THE ABDOMINAL CAVITY.           319
the veins.  The most frequent causes, therefore, are  certain diseases
of the heart and kidneys.                                             |
  Explanation. — Modern physiology has demonstrated that the veins   ,
do a certain part of the work of absorption.   The serous membranes
which line the larger cavities of ,the body exhale watery fluid enough,
and no more than enough, to keep them moist, and cause the organs
within to  play smoothly upon their surface.   If the  fluid  were not
taken away as fast as it is poured out, the cavity, — being a shut sac,
— would become full, and we should have dropsy.  It is the office of
the veins to  absorb this  fluid and convey it away in the general cur-
rent of the blood.
   This is the method of their  doing it:  The walls of the  veins are
so  constructed as  to permit watery fluids to pass through them, either
in or out.  When they are comparatively empty, or only moderately   j
full, fluids on the  outside  pass in, and mingle with the contents.
This is  called  endosmosis.    When they are very full, the watery
portion of the blood will filter through, and pass out.  This is  called
exosmosis.
   Now,  if the reader will  think a little, he will easily see that  if the
veins  are  barely full enough  not to  allow  any fluid to pass in, the
natural exhalations of the shut  sacs would bring on dropsy; but if
the veins  are so full as to cause water to flow out, then the dropsical
accumulation will be still more rapid.
'   Such  being the  office  and nature of the veins,  the  reader may
learn  how disease  of the right side  of the heart will cause dropsy.
 When the right ventricle is so dilated and  weakened that it cannot
 send the blood forward to the lungs, of course the veins which bring
 it to the  right side of the heart, will become full, and greatly distended.
 Exosmosis will  then occur;  the watery portion of the blood will
 begin to run out,  either into  the large cavities, or into the cells, and
 dropsy, either general or local, will be the result.

   Treatment.— This must be  governed very much by the cause of the
 disease.
    In  dropsy from  disease  of the heart, we may use  diuretics and
 such  other  measures as  are  recommended for dropsy of the belly.
 If the  urine is strongly acid, depositing  the  brick-dust  sediment,
 the alkaline diuretics will  be the best, as the acetate and bicarbon-
 ate of potash combined, and  dissolved in  water.  The  bitartrate of
 potassa, to act upon the bowels, is a proper remedy.   If the disease
 arise  from  general  debility,  the  following powder will be  useful:
 digitalin,  three grains ; cinchonia, half a dram ; phosphate of iron,
 half a dram ; and white sugar, one dram.   Mix, and triturate;  divide
 into sixteen powders, and  give one, in pumpkin-seed tea, four times
 a day. 
VENEREAL OR  SEXUAL  DISEASES.
  Of all  the  diseases to which  flesh is heir, none  bring so much
misery, moral  and physical, as those  called sexual or venereal.  To
the physician, they are the source of the  greatest anxiety and per-
plexity.   They bring him into possession of the most  delicate  secrets,
— secrets  which involve the peace of  families and neighborhoods, —
secrets which his honor as a man, and his truth as a physician,  compel
him to lock fast in his own breast, and hold sacredly apart even from
his nearest companions, — secrets which, if revealed, would fill  domes-
tic circles with unutterable  bitterness  and  heartburnings, and whole
neighborhoods with scandal and immorality.   These secrets are often
a burden to him.   They are in his breast like undigested food in the.
stomach, — disturbing the whole nature.
  The patient, if a man of sensibility, suffers even more, of  course,
than his physician.  In  many cases,  he  is  a man of  virtuous inten-
tions, and perhaps of religious habits, who  has fallen in a moment of
temptation; and he fears that the effect of his sin will spread itself
through his whole system,  and extend  to  the end of life; or, still
worse, that having poisoned the  fountain of his life,  it will go down
as a heritage of misery to his offspring; or, what he would deprecate
as almost  equally calamitous, that the partner of his  bosom may be-
come  the innocent partaker of his disease.
  In this state of apprehension, he turns  to his physician, not  merely
to keep  his secret, but to cure his disease.   How great a pity, that in
such circumstances,' he does not always fly  immediately to  an honor-
able  physician, instead of seeking  the advice, as  many do, of those
miserable  quacks, who lure him to their dens only to  get his  money,
having no intention or ability to cure  his complaint.
  These diseases are divided into two great  branches, characterized,
in part, by different symptoms, and generally held to be entirely dif-
ferent complaints.   The first to come  under consideration is

                        Pox.—Syphilis.

  This  disease  had a very early origin.   It was  known among the
Jews, as we learn very  clearly from the 15th chapter of  Leviticus.
Dr. Adam Clarke's Commentary upon this  chapter, at least, makes  it
apparent   David, the king of Israel, has unconsciously left on record, 
VENEKEAL OR SEXUAL DISEASES.             321
in the XXXVIII  Psalm, a  most  graphic  description of  Tertiary
Syphilis, experienced in his own person.  Dr. Clarke  says:  "It is
most  likely the  Psalm was written in reference to some severe afflic-
tion that David had, after his illicit commerce with  Bathsheba; but
of what  nature, we are left to conjecture from the third, fifth, and
seventh verses."   The Psalm is dated not quite a year after the  act
alluded to, — about the right time  for the terrible  symptoms David.
describes to make their appearance.
   The term syphilis is from a Greek word signifying  filthy.  There
is one unvarying sign of this  disease, — the  existence of an ulcer or
ulcers, usually upon the genital organs.   The French call this ulcer a
chancre.  The common name is simply venereal sore, or ulcer.   A
pimple first appears; on the summit of this a pustule forms; then the
rupture of the top of this, brings to view the ulcer or sore.  This ulcer
is shallow, more or less circular or oval in form, bounded by a perpen-
dicular and slightly jagged border, and furnished with a smooth,  yel-
low base, moistened by an unhealthy secretion.  The skin around the
sore  is a little  thickened  and inflamed.   This is a simple venereal
ulcer.  It generally lasts about five weeks, and then heals.
   But it is not always  thus simple.  It may be  an  inflammatory
 chancre, attended  by excessive  inflammation.  It may be  what is
 called a sloughing chancre, characterized by the perishing  and falling
 off of large parts of flesh.  It may be gangrenous, or marked by a  ten-
 dency to mortification.  It may be phagedenic, or eating, — being dis-
 tinguished by a rapid loss of  substance, or eating away of flesh.  Or,
 finally, it may be indurated, — being noted for the  peculiar hardness
 of the base, and of the flesh immediately around it
   A  venereal sore  is the result of impure connection  with a person
 having  the  syphilitic disease.   The poisonous secretion  of  a sore,
 applied  to the  skin of a  healthy person, produces  inoculation, and a
 new  sore  upon the previously  healthy  person is  the result.   This
 chancre appears in a few days after coition, —a certain  time being
 required for it  to  produce its effect, as in the application of vaccine
 matter to the arm.
   Bubo. — The next symptom in  the order of occurrence, which fre-
 quently follows the ulcer, is the bubo.   It is named  from a Greek
 word which means groin, —from its usually  appearing in that part.
 It is a  painful  swelling of the  inguinal  gland in  the groin, and is
 caused  by the  absorption of  virus or  poisonous  matter from  the
 chancre.  This gland is one of the lymphatics, a class of vessels as
 numerous, all over the system, as  the veins and arteries.  They are
 likewise called  absorbents.   Those that originate  from  the private
 parts, absorb the poison from a venereal sore, and convey it to the
 glands in  the groin, which, being poisoned by  it, inflame and swell.
    The  bubo generally appears  in  from  one  to two weeks from the
 appearance of the ulcer.  It is usually upon the same side which the
 chancre occupies  upon the penis.   When the bubo advances to sup-
  puration,  and becomes an open sore, it is then a glandular chancre.

    Vegetations. — These are peculiar growths appearing  upon differ-
                                41 
322
VENEREAL OR SEXUAL DISEASES.
 ent parts of the skin, which  resemble certain vegetables.   They are
 found most frequently, in the male, on the head of the penis, and on
 the membrane lining the foreskin.   In the female, they are found at
 the entrance to the vagina, and not unfrequently, in the vagina itself.
 They sometimes appear on the  neck of the uterus.
   Primary  Disease.— Thus far, the  diseases noticed are  what are
•called primary.  If properly treated, and cured in season j  the consti-
 tution is not infected, and no subsequent  troubles appear.   But a
 result so fortunate as this, is not common.  Generally, the treatment
 is either too long delayed, or is  too brief and superficial.  The poison
 is, in consequence, absorbed info the  circulation; the whole constitu-
 tion  becomes  infected; the fluids and solids  are so acted on  and
 altered, in fact, that a special constitution is created.  For this reason,
 the affections  of the. skin, the  mucous membranes, the bones,  etc.,
 which follow, are called
   Constitutional. — These constitutional diseases never appear imme-
 diately, as the result of an impure connection, but only after those
 affections already noticed.  The primary diseases are  local; the con-
 stitutional affections are general.
   The first thing which  strikes  the  eye in these  constitutional com-
 plaints, is the  color and appearance they give the skin.  It has a  red-
 dish, coppery tinge, and a peculirly dirty appearance.
   The order in which the  several  parts are affected, are, firstj the skin
 and mucous membranes ;  second, the hard substance surrounding the
 bones,  called  periosteum, the  tendons,  and the  bones themselves.
 Those affections which appear upon the skin and mucous  membrane
 are usually called  secondary, because they are the second  to appear;
 while those affecting the bones, etc., are  denominated tertiary, be-
 cause, in the order of their appearance, they are in the third class.

   Eruptions of the Skin, and Ulcers. — Of the constitutional erup-
 tions, there  is a great variety, — so great that I cannot, in small space,
 give  a  minute description of them.  The breast and arms are not
 unfrequently the first to be affected.   Attending these eruptions, there
 is  little  uneasiness, and no, pain; though there is sometimes a slight
 itching.   The  first  breaking  out  is usually of a copper color, some-
 what paler than  it subsequently is.   The  eruption is often  in the
 form of blotches, — elevated only a very little above the skin.  They
 are composed of small pustules, with a little fluid in them, which
 soon dries away, and the  whole may be rubbed off like bran.  This
 may leave  the skin looking  tolerably sound, and inspire  the belief
 that  no  further mischief is to be experienced.  No hope can be more
 delusive.  Parts afflicted with this complaint, show no tendency to heal.
 The  first crop of pimples is soon followed by a second, which  pro-
 duces a thicker  crust, and  yields a larger amount of bran.  This
 rubbed off,  small ulcers appear  underneath.

   Vesicular Eruptions. — There is another  syphilitic affection of the
 skin, which appears in the shape of vesicles, like small-pox.  These
 dry and leave  a scab. 
 
PI.  5
 
 
 
                 VENEREAL OR SEXUAL DISEASES.             32JJ

  Scaly Eruptions---There is still another affection, which is in-the
form of scales, and one scalp will  be piled upon another.   It begins
with an  eruption of  copper-colored blotches,  which become covered
with scales;  these  are  succeeded  by scabs, and when  these fall off,
shallow ulcers  are  left with copper-colored edges.  (Fig. 133.)   This
is a stubborn form.

                              Fig. 133.
     Tubercular Eruptions. — In  another variety of the disease, broad,
  red, copper-colored  tubercles,  or hard elevations appear, most com-
  monly about the sides of the nose, or on the cheeks.  Gradually, they
  suppurate, and  are  succeeded by deep ulcers, terminating in  scars.
  This is an unfavorable form of the disease, and usually appears some
  considerable time after the primary symptoms, in persons whose con-
  stitution has been shattered.  Plate V.
     This rather belongs to the tertiary form of the disease; and in addi-
  tion to the above, patches of unhealthy inflammation are apt to form
  on the tongue, and after  a time, break,  disclosing  ragged, orange-
  colored ulcers.  Plate VI.   Fig. 2.
     Many other forms of eruption exist; but in a popular work like
  this, it would be useless to make the nice distinctions which their
  description would require.
     Some of the worst forms  of  the  secondary affections, are  found
  upon the mucous membrane of the mouth and throat.   These corres-
  pond,  in  number and kind, with the affections of the skin.  They
  affect the lips, the internal sides of the cheeks, the tongue, the tonsils,
  the pharynx, the soft palate, the nasal cavities, etc.  They are terribly
  destructive in their effects, — forming gaping ulcers, and eating deeply
  into the parts.  They often make -shocking work  in the whole mouth
  and throat;  and, when attended  with  considerable inflammation,
  make  it almost impossible  to  swallow anything, or even to open the
  mouth.  I have often seen breaches through the palatine arch (Plate
  VI, Fig. 1), and even  the whole  arch destroyed  (Plate VI, Fig. 2).
  Persons have often died from starvation,— not being able to swallow.
  The ulcers sometimes take hold of the tonsils, and "dig them out as
  if it were done with a punch."
 •   These ulcerations affect  the mucous  membranes of the genital
  organs.  In the female, they often affect the vagina, and the neck of
  the  womb (Plate VII, Fig. 2);  and thus may exist for a long time,
  as the cause of whites, without being suspected as such.  They affect
j  also the mucous lining of the fundament and the  large bowel.   They
  sometimes exist in the ear,  and more  often in the eye.  This latter
  affection passes  under the  name of syphilitic iritis.   In Plate  V, 
324              VENEREAL OR SEXUAL DISEASES.
  the artist has well represented this form of constitutional disease in
  the eye.
     The disorder, having, by frightful ulcers, run riot upon the delicate
  structures of the skin and mucous membranes, advances boldly on-
  ward, attacking the muscles, the tendons, the hard covering of the
• bones, and the solid bones themselves.  No part of the human frame,
  — not even the  skeleton, — can  escape  this devouring complaint.
  The bones of the nose and face are generally the first to be attacked.
  These perish slowly, — falling  away, piece by  piece, — the nose, in
  the  mean time, sinking down  nearer to  a level with the cheeks.
  From these parts, the disease may spread to the bones of the whole
  system.
     These  affections of the bones,  are attended  by pains of almost
  every kind and degree.  These pains are  sometimes  fixed in  one
  place*, at other times, wandering,—the whole  skeleton being painful.
  In these  latter cases, they seem to the sufferer to reach the very  mar-
  row.  Sometimes when  the pain is fixed  in one place, the feeling is
  such as  might  be  supposed to be experienced  if the bone were being
  bored.  These pains are most terrible during the night
     Upon those parts where the skin is near the  bone, as the forehead,
  or shin, syphilitic  nodes  or tumors  often  appear, which are hard, like
  cancerous tumors.  Beside the above, there are the loss of the  hair
   (alopecia), blindness, deafness, and  various other mischiefs, resulting
  from syphilis which need not  be described.

     Is the  Constitutional  Disease Comimmicable ? — Many believe,—
  even among those who are eminent in the profession, — that the  con-
  stitutional  forms of the  disease are not communicable.   A few years
  ago, indeed, this  latter  opinion wa^  generally  received.  It is  now
  quite extensively  doubted, or  rather, disbelieved.   Facts  are  con-
  stantly occurring under the  eye of unprejudiced physicians, which
  make it  very evident that the constitutional disease may be commu-
  nicated from one person to another.
     The Disease Hereditary.— It is no small amount of suffering, bodily
  and  mental, which the individuals endure who contract  this disease.
   But  the  inflictions visited upon them, severe  as they are, are small,
  compared with the aggregate  of  ills entailed by it upon the long line
   of their  posterity.   Whether it  be the man or the woman whom the
   syphilitic virus  has inoculated, if it be allowed to be  absorbed, so as
   to affect  the constitution, it will be very likely to be sent down to the
   children, and  children's  children.   The  divine  law which  links the
   sins  of the fathers  with the  sufferings of even  the third and fourth
   generation, is nowhere more  painfully illustrated than in the scourg-
   ing descent, through  many generations, of this terrible  disease.  It
   may be  passed down to posterity by either  of the parents; but if
   both be  diseased, its transmission  will be  the more certain.  If the
   mother  be  infected, she will infect the  child while carrying it.   If
   the father's constitution be poisoned, the  child will  receive the infec-
   tion from  him, through  the  semen, and will be likely, while in the
   womb,  to  infect the mother.   I  recollect, but one  author of  note 
VENEREAL OR SEXUAL DISEASES.              326
   (Ramsbotham) who has mentioned this  mode of infection.   I have
   myself seen two cases of it
I     This constitutional  disease, whether it exist in the mother, or be
j   communicated to the  child, and  thence to her, by an  infected father,
   is a frequent cause of  abortion.   Throughout nature, blight is the re-
   sult of a diseased parentage.  Mature fruit is seldom obtained from
   infected seed.

     Is the Constitutional  Disease  Curable ? — No  question  connected
   with the complaint possesses a greater interest than this.   None is
I   pressed more  earnestly upon the physician.  In  a certain sense the
j   disease is  curable.   Its outward  manifestation  may be wholly re-
i   pressed.   The health of the person suffering from it may be restored,
!   and become, in an important sense, good.   But this cure is never
   brought about  by nature; it  may be, and is often effected by medicine.
   I have never failed to  effect such a cure in any case which has come
   under  my  treatment.   Such results  may properly, in general  terms,
   be called cures.
     Yet there is a sense  in which a cure never occurs.   It is a well-
   attested fact, that a system  once thoroughly pervaded by the  poison,
   is never completely purged of it.  It may be shorn of all its  active
   malignancies; but it  has too intimately permeated the tissues and
   solid  bones, to be  wholly expelled.  Pursue it as  we will with the
   remedial forces of our art, it still takes refuge in the most subtle pro-
   cesses  of animal life, — still infects the currents of being, and finds
   expression  in  the  scrofula, in the lupus, and in the scaly affections of
   other generations.   Dr. Erasmus Wilson, the great authority in  skin
   diseases, says: " I  feel convinced  that a considerable proportion of
ij  those diseases which pass under the name of scrofula, are the produce
ii  of the syphilitic poison, — are, in fact, not scrofulous, but syphilitic."
|   Astruc thought the same, and suggested, what is doubtless true, that
i   the transmission of syphilis  must  occur through several generations
11  before it becomes scrofula.  Bierchn, Camper, Stoll, Portal, Hufeland,
II  and Alibert, have all advocated the same opinion.
     This is doubtless right, though there are  many authorities on the
   other side.  He must  be a poor observer who cannot discover a prob-
[;  able filial relationship of scrofula to syphilis.
     A variety of facts, admitted by the whole profession, go far towards
   demonstrating this relationship.   Scrofula is always hereditary.   It
   is a disease of the parent, imparted to the  offspring.   But there is
   scarcely any disease so certainly sent down to posterity as syphilis.
     Scrofula is  like  syphilis in many of its characteristics.  It is like it
|   in its power of propagating itself from parent to child.  It is like it in
   affecting nearly all the children of diseased parents.  It is like it in
   the  variety of the structures  it  attacks, — affecting the  skin,  the
   mucous  membranes, the bones, etc.   Like syphilis it produces hard
   tumors,  ulcers of  the skin, abscesses,  and  decaying of the  bones.
   And finally, the great remedy  for tertiary  syphilis, iodide of potas-
   sium,  is likewise the  great  remedy for scrofula;  and, indeed,  almost
   every remedy which acts favorably upon one, is found useful for the 
326              VENEREAL OR SEXUAL DISEASES.
 other.   This could hardly occur were not the  diseases identical in
* nature.
    We can scarcely be surprised that a disease so widely diffused as
 scrofula should be the product of syphilis, when we reflect how fright-
 fully prevalent were the causes of this latter affection during the
 earlier and the middle ages of the world.
    To pass over the records of earlier times, with merely mentioning
 Abraham, and  Lot,  and Jacob,  and  Reuben,  and   Samson,  and
 David, and Solomon, and numerous females, of whom some singular
 things are written in the elder scriptures, and omitting all mention
 of the incredible and almost universal debauchery and prostitution
 of Greece, and Rome, and  Persia, and  Media, and  Egypt, I may
 say that Europe, in  the middle  ages, was  well-nigh converted into a
 vast brothel.
 ■  Foremost in the race of profligacy, were the priests, bishops, kings,
 and emperors.  The licentiousness of Childeric knew no bounds.  He
 carried off and violated the wives and daughters of his vassals, with-
 out regard to any right, human or divine.  His successors  were gen-
 erally a race  of lecherous men, who spread debauchery on every hand.
  The French monarchs, from Pepin and Charlemagne, were a race of
 debauchees.   Their courts were national brothels, in which  the finest
 women in the land were trained in the arts of seduction and lust
  Francis  I., in' 1515, endeavored to invest  prostitution with elegance
  and  chivalry, and even  to  ennoble  it,  by abandoning the public
  women of the palace to his  subaltern officers, and substituting for
 them, ladies  of noble blood.   In this  movement, the nobles and the
  clergy gave the king their support.   The right of sleeping  with their
  female vassals the first night after marrjage was religiously insisted
  on by bishops and abbes, as high barons, and exercised as their privi-
  lege.  The inferior clergy were content  to haunt the taverns  and
  stews, and the monks paid their pimps with the wealth of the church.
  The grand vicar, in some dioceses, sold indulgences to commit  adul-
  tery for a year; in others, a cask of wine  paid for  the right of forni-
  cation for a lifetime.
    Brantome justifies Francis in his selection of girls of noble blood,
  on the ground that " they could not  communicate the venereal dis-
  ease to the  noblemen  of the courts, like  the common  prostitutes."
  But the king, who was previously diseased, infected them;  and these
  noble women, so called, passing from the  arms of the prince to those
  of the courtiers, presented to them the fatal infection received from
  the king.
     The way in which  Francis himself was infected,  illustrates, in  a
  most shocking manner, the morals of the times.  His illicit loves with
  the Belle Ferroniere, were  not concealed from her husband, who,
  though  obliged, outwardly, to regard the dalliance of his  wife  with
  the monarch as an honor, was inwardly indignant, and determined
  to  become infected himself,  and thus disease his wife, and revenge
  himself upon the king.  This plan was suggested to him by a monk,
  who had another motive, namely, that of punishing Francis for his
  liberality to the Lutherans.  "How,"  said the husband, when the 
VENEREAL OR SEXUAL DISEASES.             327
suggestion was made, " shall I give this disease to my wife, when we
are both sound?"  "Go visit an infected girl," said the monk, "and to
render the matter certain, as I am infected, I will see your unfaithful
wife."   The  result was such as the husband desired; and in 1547,
Francis.  I., the gay and chivalric monarch, perished of the most foul
and loathsome of all diseases.
   Debauchery did not die with him.  It was cherished by his succes-
sor, Charles IX., and his mother, Catherine de Medicis, and his grand-
son, Henry III.   The reigns of  Henry IV., Louis XIII., Louis XIV.,
the Regency, and of Louis XV., were stained by the same licentious-
ness and disregard of public decency, until the whirlwind of  the revo-
lution came to purify the moral atmosphere.
   The reader will now, I  think, be  in  no mood to wonder that the
kings  and queens of Europe, and the  whole royal  progeny, whether
the dishonored occupants  of thrones, or  the  more private recipients
of the  public bounty, are  a scrofulous  and degenerating race.  Nor
need it be much wondered at, that so  large a portion of men and
women everywhere have more or less scrofula in their frames.  Happy
are those who can find no trace of  this complaint in their  constitu-
tion !  They  should rise up and call  their virtuous progenitors blessed.
They should  especially thank God  that  they have sprung  from the
loins of a race more noble and  kingly in the eyes of Heaven than all
the royal lines of all Europe.

   Treatment of Syphilis. — In the treatment of this  disease, the first
thing which  requires attention  is the pimple, pustule, or sore.   This
must be instantly touched with caustic.  There  should  be no delay,
for if  the  sore be not syphilitic, the caustic will do no harm; and if
it be, the most terrible results may be averted.  The general belief is
that poison  remains in the sore for a time before it is absorbed into
the constitution.   It is of the utmost importance that it be destroyed
before the absorption takes place.
   The caustics used  are  nitrate  of silver (stick  nitrate), nitric  acid,
chloride of zinc, potassa with lime, caustic potassa, and the painless
caustic.
   The nitrate of silver is much used, but  the  best surgeons now  re-
gard it as useless.  It does not prevent the absorption of the  poison.
 The caustic  potassa, the potassa with lime, and  the  painless caustic,
are the sure  remedies, — that is, if applied in  season.  But they must
be employed with caution.   It will not do to trust them  in  bungling
hands.  A little vinegar and water must be immediately used to neu-
tralize the caustic when it has  accomplished  what we desire.  After
the sore is cauterized, a piece of lint, dipped in a solution of  watery
extract of opium, one dram to four ounces, should be laid on it; and
the organ inveloped in another piece  of lint soak'ed in tepid water,
and covered in oiled silk.  The  patient  should remain at rest as much
as possible, — keeping the penis elevated, and repeating the opium
dressing to the wound, and  the water  dressing  to  the whole organ,
night  and morning.   In addition, the  patient should take  two pills
(19) to be followed, night  and  morning, for three or four days^ with 
328              VENEREAL OR SEXUAL DISEASES.
a tablespoonful of (20).  In some cases, a piece of lint, wet with the
tincture of muriate of iron, diluted and kept upon  the chancre, will
cause it to heal kindly, and with safety to the patient.
  If this treatment be adopted early and properly, the patient is cured,
and nothing further is needed.   But time is generally lost.  The poi-
son is absorbed before the patient is seen by the physician ; and the
question then is, how it is to be driven out.
  To accomplish this, the diet should be regular and unstimulating;
alcoholic drinks and tobacco  should be forbidden : the mind should
be kept at rest;  a cold or tepid bath should be  taken daily ; the ac-
tion  of the bowels and  kidneys should be kept  properly regulated.
These  things  will put all the expelling  agencies in  proper  condition
for work;  and no single medicine will put them ail into action like
mercury.   For this reason, no  other single drug has enjoyed a repu-
tation for curing pox so wide as  this.
  But it must be used with judgment.   No  remedy is more safe, if
judiciously employed,  or more  destructive, if abused.  The profuse
and ill-considered way in which it was  used in former times, raised a
prejudice against it, which is  unreasonably cherished at  the present
day.   Abuse made mercury a curse; judicious use makes it a blessing,
— at least in this disease.
  The blue pill is one of the best forms of it (148), combined with
extract  of  henbane.  One  pill  at  night is the  usual amount  to be
taken.   Some prefer the  mercury with chalk (149);  others, the  corro-
sive sublimate (150); others, the proto-iodide of mercury (136).   Some
one of these  should  be given about  five days, in the  doses named
under the  recipes, — being careful not  to  produce salivation.   After
the fourth or fifth day, we can  generally increase the  frequency of the
dose.   Should salivation be accidentally induced, it should be arrested
by a solution of chlorinated soda (205), one part to twelve of water.
The  mercurial treatment should continue for a week after the  sore
has disappeared; and  in the  case of the indurated sore, as long  as
there is any hardness.
  Water should be  taken freely, and various diluent drinks.   They
wash the  poison out through the millions of avenues, called  pores,
just as we wash filth out of cities by  pouring water  into the sewers.
  Recently, Ricord, the great French authority on  this subject, has
introduced a  new treatment of syphilis  by iron.  One  part  of the
potassio-tartrate of iron  is dissolved  in six parts of water, and  two
teaspoonfuls are given three times a day.   The same solution  is ap-
plied to the external sore or chancre.   Ricord says that no secondary
symptoms have been known to occur  after this treatment.   The Lon-
don  Lancet sanctions  this treatment as  being capable of doing all
that  Ricord claims.   Should its success  prove  equally great  in this
country, it will take rank among the greatest  gifts to the profession.
I sincerely hope  that in a future edition  of this book, a full trial  of
the  remedy on this side of the Atlantic will permit me to  record such
success.
  I should mention that there  are those who claim to cure the disease
with other remedies,  without mercury, and I am not disposed to be 
 
 
PI 6
J-KnufforSsiia 
 
VENEREAL OR SEXUAL DISEASES.              329
dogmatical, and say it cannot be done.  For this purpose, perhaps as
good a recipe as has been proposed, is the compound syrup of stillin-
gia, tincture of poke root, tincture of sheep laurel, each four ounces,
mixed ; of which, from a teaspoonful to half a tablespoonful is to taken
three  times a day.   I think well of this remedy, especially if it be in
connection with a small amount of mercury.

  The Bubo, if not attended with pain, may be treated with compres-
sion ; by a piece of plaster of ammoniac with mercury ;  or by touch-
ing it with nitrate of silver.  Should there be inflammation, and the
formation  of matter be  inevitable, the bubo should  be opened  by
touching it with the caustic potassa ; and  the resulting sore must be
treated with the solution of opium and water dressing.   Should the
sore  need  stimulating, it may be touched lightly with nitrate  of
silver.

  Eruptions upon the Skin. — In treating the disease after it appears
upon the skin, etc., we shall derive great advantage from the use of
either the warm or the vapor bath once a day.  With this, if the case
be not very old, we may employ (148) or (150) ; bu£ if the disease be
an old one, showing itself in the throat, or attacking the  bones  of the
face, we must  give iodide of potassium (138), combined with com-
pound decoction »f sarsaparilla.   This is the great remedy for tertiary
syphilis; but when the case is obstinate, it may sometimes be discon-
tinued, and the corrosive sublimate (139) be substituted for it.
  It is to be observed that the older the disease grows, and  the more
chronic its character, the more does mercury lose its control of it
In the first  attack, the blue pill  is the best; in the second, as  a gen-
eral thing, the  iodide or the biniodide of mercury ; in the  third, the
corrosive sublimate ; in the attacks, subsequent to this, particularly in
the tertiary form of the disease, the iodide of  potassium.  When the
throat and nose are so ulcerated as to make a  case absolutely terrible
to contemplate, it is surprising to see how rapidly the  recovery will
often take place under the influence of this latter remedy.
   For syphilitic iritis, apply frictions twice a day on  the eyelids and
eyebrows with  ointment (172)  (173) ;  and administer internally two
pills of (136), daily.

   Case I. — Mr.----,  aged sixty, was sent to me by his physician,
from the State of----.  He had deep and  extensive  ulcers  in the
upper cavity of the throat, extending to  the tonsils, and to the arch
of the palate.   Swallowing had become very  difficult, and much fear
was felt both by the patient and  by his physician, that  death  would
follow at  no distant day, from absolute inability to  swallow  at  all.
 The ulcers had the peculiar yellow color which so clearly marks these
sores.  I informed him  that his  disease, was tertiary syphilis.   He
said  he  had once had the disease, many years before, but had sup-
posed himself cured.  The  letter brought me from his physician, a
most respectable man, showed that he also had  no suspicion  of  the
real nature of the complaint.   This case is well represented by  Plate
VI., Fig. 1. 
330
VENEREAL OR SEXUAL DISEASES.
  I put  this patient upon a preparation of iodide of potassium, and
several other articles, which I  keep on hand, and  syringed  his throat
once a day, with a weak solution of the  acid nitrate* of mercury (226),
and in one week, he swallowed his food easily.  In three  weeks, he
went  home, his  throat was nearly well, and his bodily'health, which
had been much  shattered, restored.  His physician, much astonished
at his altered condition, wrote  immediately to know what I had done
for  him.   This patient, though in humble circumstances, has  ever
since, sent me an annual present, which, though not of great value, is
highly prized by me as evincing a gratitude not forgetful of peculiar
benefits.

  Case }I. — In the summer of 1856, a gentleman of distinction came
to me from a distant state; and, being so much reduced  as to make
it doubtful whether he would ever reach  Boston, he brought his family
physician with him to render him assistance on the journey in  case
of possible emergency.
  His voice was reduced very  nearly to  a whisper.  I found a breach
through  the palatine arch, and considerable ulceration in the back of
the  pharynx, though not  as much as is represented in  Plate  VI,
Fig. 1.   He was  harassed  with a  cough, and  his flesh and strength
were so far  reduced that his high official duties  had been for some
time laid aside.  He was supposed by his friends to be verging tow-
ards the  last stages of consumption; and  their consent  was gained
for his journeying to Boston, only because, as they supposed, no hope
opened to him in any other direction.
  My pronouncing it a case  of tertiary syphilis surprised the very
excellent physician who came with him, and who  failed to  recognize
the nature of the complaint only because he had not been  accustomed
to seeing cases of the kind.  The disease was of eighteen years stand-
ing,— being the  lingering constitutional result of a case of gonorrhoea
(and I have seen several such results of gonorrhoea, whatever Ricord
may say  to the contrary), contracted  in a single lapse from virtue  in
early manhood.
  The treatment wTas  almost  identical  with that in  Case I., except
that tonics, — particularly  some  of the  preparations of iron, — were
required to bring up the strength.  The iodide of potassium  showed
its usual  specific power, and  I had the pleasure to send the patient
home  in a tolerably good state of  health.

  Case HI.— One of the worst cases I have ever  treated was  pre-
sented in the  person of Mr.----,  who came from a considerable dis-
tance  to consult me in reference to a badly ulcerated throat, for which
all tried remedies had proved useless.  The  first glance at the throat,
showed the ulceration to be syphilitic.  The uvula  and the entire
palatine arch were gone ; the ulceration had gone deep into the phar-
ynx.  These two circumstances made swallowing extremely difficult;
indeed, nothing could be  swallowed, except the  most bland liquids,
and death by starvation was near at  hand.
  No time was  to be lost.  I put the  patient upon large doses of 
VENEREAL OR SEXUAL DISEASES.              331
iodide  of potassium,  with compound  infusion of gentian and fluid
extract of sarsaparilla, and showered the throat every other day with
a weak solution  of acid nitrate of mercury (226), and in ten days,
tender beef steak was chewed and swallowed with comfort.
  This patient stayed in Boston six weeks, and went home with ten
pounds more flesh than he brought with him; and by using the above
remedies  six  months, has regained  excellent health.   Plate VL,
I7ig. 2, is a representation of  this throat as it appeared when  it came
under treatment.
  Fortunately, .these cases, terribly destructive as they are, are almost
always curable, if properly, managed.

              Clap.—Gonorrhoea.—Blenorrhagia.

   The reader is aware that the nose, mouth, and lungs, are lined with
a mucous membrane, which is liable to become inflamed from various
causes.   This inflammation  we call a cold or catarrh.  During  its
continuance, mucus, and other matters of different color and degrees
of  consistency, are more or less freely discharged.
   The mucous membrane of the  private parts of both sexes, is just
like that of the mouth and throat, and subject to similar  inflamma-
tions and discharges.   But these  inflammations of  the private parts,
instead of being produced by changes of weather, etc., generally result
from the application of the  specific poison of gonorrhoea.   When a
woman abandons herself to unlimited intercourse with different men,
the  private parts  become  stimulated to so unnatural an extent, that
the  secretions of  the parts, which are largely augmented, at length
become altered in their nature, acrid, and finally poisonous, — so acrid
and poisonous that  they  cause  inflammation of the parts, and when
applied to the male organ, in the sexual act, they poison and inflame
that.
   This is the shortest and plainest explanation  I can give of clap.
From this explanation, one  may  learn why a man will sometimes
take a disease from a woman who has never had  any evidences  of
being diseased herself.  If she have indulged her sexual propensities
unreasonably, though not enough  to produce inflammation  upon
 herself, her secretions may yet have become acrid enough to poison
 one whose organs are  delicate and sensitive.  And more than this.
 The secretions of a  female  may  become  acrid and poisonous from
other  causes than excessive  venery.   The discharges in bad cases of
whites will sometimes irritate and inflame the male organ, and induce
a disease which has every appearance of gonorrhoea.  A husband, in
great  distress of mind, sometimes submits a case of this  sort to the
physician's inspection, and lays upon him the delicate and responsible
duty of deciding whether the wife has been unfaithful.  No act in a
whole professional life can be more momentous than  a decision  of
this sort.  If a man be well skilled in' his art, he may give an answer
in  such case, which shall  dispel the most terrible apprehensions, and
save the peace of a loving family.
   The poison when  applied  by a diseased person to the  male  or 
332
VENEREAL OR'SEXUAL DISEASES.
female organs, requires a certain time to produce its peculiar effect,—
generally from three to eight days.
  Symptoms. — The first symptom of the disease is uneasiness in the
end of the penis,  accompanied, generally, with a  little redness, and
difficulty in passing water.   The color of the first  discharge may be
white or straw-colored.  There is tenderness where the parts are red.
Scalding in passing water is sometimes, not always, present at first.
  This is the beginning,  or  first stage of clap.  Now is the  time to
cure it easily.  But, unfortunately, the physician  seldom sees a case
in this early stage.  Before he is allowed  to inspect  it, the second
stage has  generally appeared, which  is  known by  violent scalding
when water is passed, by chordee, or  painful erections of the penis,
and  by an increased  discharge of greenish  matter often tinged with
blood, and coming from much farther down the  urethra,  or water-
passage.   The matter sometimes comes from as far down as opposite
the scrotum, or bag which  holds the testicles.   There is more or less
pain in the loins  and back.  The whole  body of the penis may be-
come affected, and abscesses form.
  A third  and more terrible stage of the disease begins when the in-
flammation has reached the lowest part of the water-passage, just
where it enters the bladder.   Around this  part of the passage, and
lying upon the bladder, is a gland in size and shape  like the largest
chestnut.   It is called the prostate gland.  On either side of it, lie the
receptacles of the  semen, each  of which sends its duct into the water-
passage.   When the inflammation extends through this gland, it irri-
tates  the neck of  the bladder, and causes a distressing desire to pass
water; and from  its  proximity to the larger bowel, it sends its irrita-
tion thither likewise, and  impels a terrible effort to evacuate  the
the bowels, called tenesmus.  It is the same  awful feeling experienced
in dysentery.  Few things  can be more  terrible than these  two dis-
tressing feelings conjoined, — the desire  to pass water and to empty
the bowels'.  Racked with terrible pains,  and awful  tenesmic dis-
tresses, and often with painful  erections, the patient passes  back and
forth  between the bed and stool, — often vowing, in the sincerity of
his heart, that if he can but recover from this, he will  never be caught
again.  The  enlargement of this prostate gland may become chronic
and permanent, and be the affliction of a man's life.

  Stricture. — One of the  most  troublesome and persistent conse-
quences of gonorrhoea is a partial closing  up of the water-pipe, at-
tended generally by quite a serious obstruction to  the passage of the
water.  It  is called stricture.   The mucous membrane which lines
this passage, being long  inflamed, becomes thickened and less pliable
or elastic.   The  tissues  which lie underneath this  membrane, also
become swollen and hardened, and, pressing upon  the water-passage,
lessen it still further, — making the stricture more difficult of cure.
  In stricture, the stream of urine is altered in size, length, and  force.
Its course  is changed, when the stricture is lateral.   The  stream is
often flattened, like the blade of a pen-knife, or  twisted like a gimlet,
or forked,—one stream reaching beyond the other.  In consequence 
VENEREAL OR SEXUAL DISEASES.              333
of obstruction, the bladder  is not entirely emptied, and the desire to
urinate immediately returns, and is very urgent,
  Gleet. — Another very troublesome result of gonorrhoea is gleet, —
a thin, colorless  discharge, which persists, in a chronic form, after all
active inflammation has subsided.   It is very annoying, and very ob-
stinate.   It is often dependent on the altered condition of the mucous
membrane occasioned by stricture.
  Orchitis. — Another very severe  result of clap is swelling  of the
testicles, called  orchitis.  It begins  frequently with chills and fever,
with a feeling of weight in  the scrotum, and pains in the loins.  The
swelling rapidly increases, and reaches its height in from three to five
days.
  Beside the  above, there are still other mischiefs, which  follow  this
disease, such as  inflammation of the prostate gland, already described,
of the bladder, and of the kidneys.                      _
  In the female, gonorrhoeal inflammation affects the external geni-
tals  called the vulva, the water-pipe, the vagina, and the neck  of the
womb.
   There is a difference of opinion as to whether gonorrhoea ever pro-
duces  secondary  or  constitutional  symptoms.  Ricord, the  great
French  authority on this subject, affirms, and with him a great num-
ber of followers, including  most of the profession in this  country,
that constitutional symptoms never follow clap; that  they never re-
sult  from anything but a syphilitic ulcer.  Vidal, a French authority,
safer, in  my judgment, than Ricord,  though not as renowned, says, on
the contrary,  that secondary and tertiary complaints do follow viru-
lent  gonorrhoea.   Wilson, the highest  English  authority,  and many
others, agree with him.  Unprejudiced  observers feel well convinced
that this latter  opinion is right.  I have myself seen not less than
half a dozen cases  of secondary and tertiary  syphilis, which were
preceded by  gonorrhoea, and  nothing more.   Case  I. was of  this
kind.
  Treatment. — In the first stage of  the disease, there  are  two meth-
ods of treatment, either of which may be adopted with  success.   The
first, which has many advocates, is the local treatment  An injection,
with a glass syringe, is immediately made, of a  solution of nitrate of
silver, of the  strength of five to ten  grains to the ounce of water.  It
should be retained from one to five minutes, by pressing the head of
the penis between the thumb and  finger.  If done before the third
day, this will generally cure the disease.
   The physician should have entire control of  the patient, and com-
pel him, if  possible,  to keep his room,  and live  for a few  days on
crackers and water, or something  equally simple.   All  meats  and
stimulating drinks are to be excluded.
  The other mode of treatment, which is perhaps the more commonly
adopted, is more general in its nature.  It embraces the use of warm
baths, warm sweating drinks, and rest   If the patient  is full  of blood,
and strong, from five to fifteen leeches are  applied  to the space be-
tween the scrotum  and fundament  These things, with  a low  diet, 
334              VENEREAL OR SEXUAL DISEASES.
will  frequently reduce the disease in a  few days.  If the  discharge
should continue, after a fair trial of the  above,  then copaiba and
cubebs (272) are to be used.   Several articles are added in the above
prescription, to make the copaiba acceptable to the stomach.  This
preparation can be taken by most persons, and  generally produces
very gratifying results.  Vidal strongly recommends an electuary, or
thick paste (273), of which a piece twice as large as a nutmeg is  to
be taken in .the course of the day.   The prescriptions which contain
copaiba and cubebs are numerous; but the above two are as  good as
a hundred.  With these articles, the baths, the leeches, and the repose,
are to be united.
  Vidal says he never resorts to injections first, but employs the anti-
inflammatory  course  first.   If that  fail, then he  uses the injection
(207), three or four times a day; and if he employs the nitrate  of
silver at all, it is only as an astringent (208).  Prescription (304) is a
valuable injection.
  When the second stage sets in, and the symptoms become  more
violent, injections  must not be used.  For the very severe scalding in
passing water, which is  now felt, take thirty drops of a solution  of
potassa in half a  tumblerful of  water,  twice or three times a day.
Persons of full habit, may be benefited  by dissolving a grain or two
of tartar emetic in a tumbler of  water, and taking to the  extent  of
producing a little nausea.  Relief is occasionally obtained by holding
the penis for some time in warm  water.
  For the painful  chordee, or erections, camphor and opium (120) are
required, — from one to three pills a day.  Thirty drops of laudanum
may be given  when the patient retires.   Cold applications to the gen-
ital organs, or walking barefooted upon the cold floor, will frequently
give  relief.  When other  things fail, three pills a day may be taken
of extract of hyoscyamus, containing from one to four grains  each.
The  quantity of drinks must be diminished, and cold lotions must  be
applied to the penis on going to bed, — the patient covering  himself
lightly.

  Gleet is  generally very  obstinate,  and often  requires  a very pro-
tracted treatment.  If there  be any tenderness  along the under side
of the  penis, it is well to apply three or four leeches.   Occasionally
recipe (272) will have an excellent effect  But  gleet is an unhealthy
action, sustained by habit, and may often be cured by simply  exciting
a new action which  shall break the old habit   It is  always well,
therefore, to resort to injections.  Sugar of lead and sulphate of zinc
(207) answer a good  purpose; or sulphate of zinc and tannin  (209)
may be tried.   Chloride of zinc (210) does well  in  some obstinate
cases.
  But  gleet is often dependent on stricture, and when this is the case,
we must  learn  the location of it by exploring  the water-pipe with a
bongie.  When the Instrument  reaches the constricted  part, the pa-
tient feels  pain, or the surgeon  meets an  obstruction, — often both.
When the stricture is found, it  is either to have the solid nitrate of
silver applied  to it with an instrument called the porte caustique, or a 
VENEREAL OR SEXUAL DISEASES.            ' 336
solution of nitrate of silver (211), or of acid nitrate of mercury (226),
with a shower  syringe which I have had prepared for  the purpose.
When these means fail, we must pass a small bongie gently through
the stricture; then a larger, and then a still larger  one, until the ob-
struction be removed.  They should be used once or twice a day, and
not be  retained long in the passage.  They frequently have to be
used ten or  twelve weeks, and should not be discontinued till the cure
is complete.  Put no confidence in  those quacks who promise to cure
these' old troubles in a few days.   They want your money, but have
no expectation or ability to cure you at all.
   For inflammation of the testicles, apply leeches at once.  To this
should be added warm fomentations, and poultices.  If  these means
fail, more serious measures are to be adopted, which it would be out
of place to  describe in this book.
   Inflammation  of the  prostate gland  is  also  to be  treated with
leeches and poultices, — likewise a  warm  hip-bath.  The water  must
be drawn off with a catheter  until it can  be passed in the  natural
way.

   Prevention of Sexual Diseases.—I have several times been in doubt
as to the best method of presenting some  of the topics which the wide
scope of this book has brought before me; but no  one subject has
perplexed me  like  the  one announced in the above heading, — not
that it is not easy enough to  furnish the rules  for preventing  venereal
disease, but that it is a grave  question in morals whether to instruct
the world in the methods of such prevention is right.  Is it proper to
give any other advice than the simple direction to abstain  from all
liability to disease ?  That is the question.
   If such advice would be heeded, of course no other should be given.
But it would not.  If the  person disregarding it  would alone suffer
the  penalty of the  trangression, it  might then be best to embody the
whole advice in the simple imperative word, abstain! But this  can-
not be.  The infection will be imparted to a third  person, and onward
to thousands;  and  many of these  thousands will  be innocent wives,
who will perish of the  disease, or send the infection  down  to  the
second, the  third, the fourth, and to all  generations!  While a strict
morality might seem, therefore, at first view, to forbid the  inculcation
of rules for avoiding infection, the good of the race would appear to
justify and  require it.
   The first  requisite for prevention is cleanliness.   Frequent washing
is of prime importance.
   The  precautions should not be the same before  and after the vene-
real act, when a person  is about to expose himself to  risk.   Before
the act, the. parts should be carefully examined, to see if there be any
break  in the skin.  The least breach in this covering of the penis
greatly promotes contagion.  Before coition, there should be no wash-
ing  with soap, for this  deprives the parts of the  mucus and oil,—
thus rendering the naked and  exposed skin liable to infection.   On
the  contrary, to apply a solution of alum,  tannin, or a  decoction of
oak bark, or aromatic wine, constringes or hardens the covering of the 
336             VENEREAL OR SEXUAL DISEASES.
organ, and renders contagion more difficult.   An article called  con-
dom is  often used to ward off disease.   It is a sack  madeof  gold
beater's skin, and is drawn over the penis like a glove over the ringer,
and thus protects it from contact with poisonous matter.
  Of still greater importance  are prompt ™™n\eyjJ*Z"™
after  the act.  Lotions should be  immediatelyapplied to f*W£?
of the organ, and in the case of females, should be used as; in^onj
These lotions should be acids or alkalies.   A mixture of vmegar and
water has been recommended as an excellent wash   Reco, I recom
mends  aromatic wine;  Malapert, corrosive subl.mat, (212), in toe
form of solution.  Probably the best preventive is  composed  mainly
of  alcohol and soap (213), as recommended by Lang ^ert
   An exposed person, using any one  of these ^lutions, p^hcutarty
the last, or, in the absence of all these, washing thoroughly with soap
 and water, will be likely to  escape contagion.

   Medical Police—What is called general prophylaxis, or prevention
 or medical police, is not a subject of legislation in this country   The
 moral sensed the American people does not  admit its nec««1y.   »
 Europe,  the authorities watch  over prostitution.   They  en go  so
 far asPto regulate it.   They appoint practitioners, whose duty^it * to
 act as a  sort  of medical police, and  particularly to v si.houses  °1
 prostitution once  or  twice a week,  and examine all the  inmates
 When a girl is found diseased, she is immediate y removed to a hos
 pital, and not  permitted to return until she is  well.

           Self-Pollution. — Masturbation. — Onanism.

    There is probably no vice to which so many boys and young men,
  and even girls and young women, are addicted, and from  which so
  many  constitutions break down,  as  self-pollution   Small  boys and
  Sris learn the vile practice of  the larger ones at school, and generally
  tontiZit up to maturity, without the least suspicion that they are
  inflicting upon themselves either a moral or a physica injury.
    Thisfomes of the false modesty and bastard inorahty which with-
  holds  from the young all knowledge of  the proper functions of their
  sexualOrgans, and of the  inconceivable mischief resulting from their
  abuse   A gentleman of distinction lately said to me : " I instruct my
  boys  as faithfully on this subject as upon any other moral or physical
  nuestion, and I tell my wife it is her duty to  do the same with the
  question^ ^ ^ y ^ ^ ^ ^^ ^ ^^ tQ ^  .

  or airls on the subject, or  give them the least reason  to suppose there
  is any better rule for their conduct than their own desires.

     SvniPtoms.— These are very numerous.   The principal  are, head-
   ache  wakefulness, restless nights, indolence, indisposition to study,
   melancho V,  despondency, forgetfulness, weakness  in the  back and
   m"ivae organs, a lack of  confidence in one's own  abilities, cowardice,
   Kbty tS look another full in the face, and, among  females, hysterics,
   whites, and a desire for seclusion from society and solitude. 
VENEREAL OR SEXUAL DISEASES.             337
  I have  already spoken  of the receptacles of semen, lying on each
side of the prostate gland.  From the fore part of these receptacles,
the semen passes through  two  ducts, about a finger's breadth  in
length, into the urethra or water-pipe, just in front  of the  prostate.
From excessive self-pollution, these ducts become very irritable, and
also debilitated and relaxed, — so much so that they will not retain
the semen; and during lascivious  dreams, it flows off.  These, semi-
nal losses are called " nocturnal emissions."  So constant is the drain
they keep  up  upon many young men who  have  abused themselves
excessively, that the whole  man, mentally, morally, and  physically,
becomes a wreck.   There are few objects  more pitiable to  behold
than  a young man  in this condition, — his  nervous system  feeble,
tremulous, and broken ; his memory weakened and  fading  out;  his
eye unsteady and incapable of looking a friend in the face ;  his loins
and back weakened, giving him the feeble gait of old  age;  his once
erect form cowed and bent; his high sense of manliness all oozed out
of him; his mind taking up  and  dropping  the simplest threads  of
thought, losing its way in the  plainest paths of reflection, and often
starting  back affrighted at  the glimpse of chaotic insanity opening
before him, — turning here and there for relief, but finding little hope
of recovery, except in marriage, and yet knowing himself unfitted to
be the husband of an intelligent woman!

  Treatment. — Every kind of treatment,  no matter how judicious or
well applied, will be unsuccessful, unless the vice which has produced
the disease be absolutely and  entirely abandoned.   This is the  first
thing to be secured.  It  may be extremely difficult for the patient to
do this, with his mental and moral  nature all broken  and in  ruins,—
with no heart  to  feel, and will to  execute; and yet it must be done,
or a cure cannot be effected.
   To  bring this about, everything must  be done by the physician to
strengthen the moral nature of the patient, and to raise his self-respect
and hope.  The most careful directions must be given  for restraining
the imagination.  The patient must be directed and encouraged  to
drive out  from the  mind, instantly, and  upon all occasions, every
lascivious thought;  to cultivate the society of the  most  intellect-
ual and virtuous females; to make himself busy with useful and, if
possible,  agreeable  employment;  to avoid  solitude;  and  to sleep
with  some friend.   He  should sleep on  a  mattress, and  never on
feathers.
   Where there is considerable debility, tonics will be required, as the
mineral  acids  (60)  (62)  (78), and bitters (77) (67)  (66) (59),  and
strychnine (83) (95)  (85), and iron  (80)  (93) (72) (73) (71).   In addi-
tion to some of the  above preparations,  the  syrup of  the hypophos-
phites should be taken for some time.
  The food should be nutritious and easy of digestion, and  the cold
alkaline sponge bath should be taken once a day, with brisk rubbing;
and the  private parts should particularly  be washed daily with cold
water.
  In conclusion, I say emphatically to parents, do  not let your sons
                                 43 
338              VENEREAL OR SEXUAL DISEASES.
and  daughters  remain ignorant on this subject.  It is plainly your
duty to enlighten and to warn them.  It is a matter  in which young
persons are generally disposed to do right,  if  rightly  instructed.
Avail yourself  of your right to give  counsel, and, if need be, to  use
authority. 
FEMALE  DISEASES.
   In addition  to  the  diseases common to both sexes,  women  are
 subject to a class of distressing  complaints  peculiar to themselves,
 and denominated,  in general terms, female diseases.  Involving con-
 siderations of a delicate nature, these complaints have too generally
 and too long been  shut out from works intended for popular  distribu-
 tion.  Hence there is a general ignorance of a class of diseases which
 are fast unfitting woman for  the high duty of continuing the race;
 and the subjects of these maladies are generally themselves  so unin-
 formed of the true nature of their sufferings,  that they are neither
 prepared to seek relief in the proper direction, or to submit to  the
 remedy, if it chance  to be proposed.
   It is intended here to speak of these disorders, as I have done of all
 others, in a plain  and simple way, to describe them, so far as  the
 present state of medicine permits, just as they are, and to make
 known the only modes of treatment which have been found available
 for their cure.  The sufferings of woman require this; the  interests
 of humanity require  it;  and the writer is impelled to it, as he thinks,
 by a just sense of  responsibility.
   Physicians, in my  judgment, are chargeable with  a  great wrong in
 concealing within their own breasts information upon what are called
 delicate subjects, — information which the good of the world requires
 should be  divulged,  and  which they ought to  pour into the public
 mind, and make common, and which they would thus  popularize, but
 for their stiff pride and conservatism.
   The idea that  our knowledge cannot  be imparted to the  world
 without injuring the public morals, is simply absurd.  We are more
 afraid of bringing  the common people too near to us, of letting down
 our  dignity, and of opening  our  profound secrects  to popular eyes.
 The result is as it  should be, that unsophisticated people are apt to
 give physicians a wide berth,  and  to  have nothing to do with them,
 unless  necessity compels.   Let doctors  strip  off their reserve, and
 while they remain gentlemen, become likewise companions, impart-
 ing their knowledge  freely and familiarly to all, and the  public con-
 fidence, now  considerably shaken, will be frankly restored to the pro-
fession.
  It should be the  object of a good physician to know  all he can, and
to impart his knowledge to as many as possible.   Knowledge is not 
340
FEMALE DISEASES.
merely power; it is happiness, it is wisdom, it is health, it is virtue ;
yes, it is always virtue, except in some rare instances, where the worst
natures pervert it.   No physicians are so much loved as those who
are frank, and have no concealments.   The day for mysterious nods
of the  head, and rollings of the eyes, and shrugs of the shoulder, has
gone by.   Men, and women  too, (or those of them who are wise),
wish to know distinctly what their diseases are, and  what is neces-
sary, not to palliate and prolong, but to cure them.

  Time when Female  Diseases  Begin. — Female complaints begin  to
make their appearance at the  period of life called puberty, — the time
when the  girl passes  from childhood to womanhood.   This is the
period  when menstruation is established,  which consists of a discharge
from the genital organs,  composed of blood and mucus, and which
occurs, when regular, every four weeks.  Up to this period, the system
of reproduction has remained dormant.  By the intervention of this
mysterious function, the young female  becomes a new being.   The
heart unfolds itself to new emotions; the mind assumes a  solidity
before  unknown, and  even the body acquires beauty from a sudden
rotundity of form.
  This is the period when the great question of female health is very
apt to  be settled once for all, and for life.  The  girl who  is well
trained at this time, generally  has a foundation laid  for health  and
character, which is worth more to her than riches.  At no time does
the mother  need so much wisdom and knowledge as now., To es-
tablish  the health and develop  the affections of the daughter at this
critical period, is a sacred trust  which she can devolve  upon no other
being;  nor can she meet her responsibilities at this  time, unless better
informed than most mothers are.   The general apathy in regard to
this maternal duty is deplorable.

  False Delicacy. — The refined delicacy which withdraws these sub-
jects from  the public gaze, is  commendable, for it casts a beautiful
charm  over society; but when carried  so far as  to  spread a veil even
over the eyes of mothers, it is quite unnatural, and leads to the worst
results; for in the bad management of girls  at this critical period is
laid the foundation of many of the diseases which  shatter the consti-
tution  of  so many women.   For  this bad  management, it is not
mothers alone who are to be blamed.  The neglect  of  the medical
profession to furnish the necessary information should come in for its
full share of reproach.

  The  Establishment of the Menses. — Nature always comes  slowly
and by degrees to the inauguration or establishment of  any of her great
functions.  It is so in regard to menstruation, or, as it is variously
called,  "the  menses," "the courses," "the change," "the flowers,"
" nature," etc.  For some time before the flow begins, there  are cer-
tain symptoms, or premonitions, which, to the  eye of the physician,
plainly enough  foretell the impending change.   To the mother these
si<ms would be  equally intelligible, were she as well  informed as she
should be.  It is plainly her  duty to be intelligent enough to  assist 
FEMALE DISEASES.                     341
nature in  the establishment  of  this important  function.   But  how
often, either from ignorance, or from false ideas of delicacy, does she
fail to interfere, and allow the daughter to be taken by surprise, and
perhaps frightened and thrown into convulsions!
  From  inquiries made of  about one  thousand  women,  a  distin-
guished English  physician found that about one quarter were unpre-
pared  for the appearance of the menses.   Some of the girls were
frightened  and went  into hysterical fits;  others thought they were
wounded, and washed with  cold water.   The  flow was  stopped  in
several cases; and in some, never restored ; while,  the  health of all
in whom it was interrupted, was seriously impaired.

  Symptoms of the First Menstruation. — A variety of symptoms pre-
cede  and foretell the first  menstruation.   Headache, dizziness, slug-
gishness of thought, and disposition to sleep ; — these, occurring in a
girl, may be taken as hints that the " change " is at hand.  If to these
be  added pains in the back  and lower limbs, the intimations will  be
still more significant.
   At this  time a girl loses a relish for the society of children ; she is
apt to acquire a taste for solitude ;  her temper becomes wayward and
fretful; her  eyes acquire a  peculiar  lustre ;  she  becomes a sort  of
mystery to her friends and herself, — not her physical frame only; her
whole character is changed.  She is  about  stepping into a new life.
Her emotions, thoughts, anticipations, retrospections, are  all new  to
her, and her outward manifestations are new to her friends.   An in-
telligent mother will not fail  now to prepare  her mind for the  impor-
tant event close at hand.

  The age at which this change takes  place, depends very much upon
a variety of  circumstances.   It occurs much  earlier in warm than  in
cold climates.  It is hastened by high living; by the whirl, and bustle,
and excitement of city life ;  by reading novels which are full of love
incidents ; by attending balls, theatres, and parties ; and by mingling
much in the society of gentlemen.

   Early Menstruation not Desirable.— It is a law both in animal and
vl vetable  life, that the later the period at which maturity is reached,
the greater  the solidity of the  body,  and the longer it lives.  Girls
who  menstruate early, do so  because the body is weakened by climate
or  luxury, and the nervous system unduly developed by excitement;
while those  who come late to womanhood, have firmer constitutions,
enjoy better health, and live longer.   Those mothers, therefore, com-
mit great errors, who are anxious and  administer "forcing medicines,"
because their daughters do not menstruate at fourteen or fifteen.  If
girls  are suffering from  no special ill health, no anxiety need be felt if
"the custom of women" do not come  to them till the age of eighteen,
or  even twenty.  The  delay should  excite thankfulness rather  than
regret.  It shows that the constitution has not in it  the seeds of early
dissolution ; that it is fortifying itself against future disease.
   Girls who come thus tardily to maturity, are much more " regular "
in  after life.  They bear children with  fewer accidents, and  are  af- 
342                    FEMALE DISEASES. ■
flicted much less with female diseases.  The duty of mothers is plain;
it is to  bring their daughters forward as late as possible, by refusing
their early admission to society, by withdrawing from them all excit-
ing reading, by prohibiting their early attendance at concerts  and
theatrical entertainments, by prescribing for them the  most unstimu-
lating diet, and by requiring a large amount of exercise in the open
air.
  A wide investigation has shown that the first menstruation occurs,
in hot climates, at the average age of thirteen years and nineteen
hundredths; in temperate regions, at fourteen years and seventy-four
hundredths; in cold latitudes,  at sixteen years and  fifty-three hun-
dredths.   Under the hot-house culture of modern society, and espec-
ially among the wealthy classes, where indolence, luxury, and excite-
ment, unite to weaken  the constitution, this  change is constantly
occurring at a more tender age.

  How  Female Diseases are Induced. — All living things have their
origin in germs.   The germ from which the higher  animals spring,
man included, is an ovum, or egg.  Every  animal and  every vegetable
is provided with  an organ for  the production of germs.   In woman,
this organ is called ovary.  There are two ovaries, about half an inch
in length, — one  lying on each side of the womb, to which they are
attached by ligaments, or cords.  The ovarian bodies contain  vast
numbers of vesicles,  or cells, or  eggs, which are the true germs of
human  life, and the only sources from which it can spring.
   Between the ages  of fourteen  and forty-five (speaking in general
terms),  every healthy  woman matures and deposits an ovum  once in
twenty-eight days.  This vesicle, some time before the monthly flow,
begins to germinate and swell, and after a time, like a grain of wheat
in the earth, it bursts  its covering, and springs forth.  It then passes
through what is called the fallopian tube into the womb, whence  it is
cast off.
   During the swelling and bursting of this vesicle or germ, the  ves-
sels of  the ovaries, and womb,  and, particularly, of the membrane
lining the womb  and  its neck, are so crowded with blood as  to  pro-
duce in the  parts a  state of congestion.  If the parts be examined
with a speculum at this time, they will  be found red, sensitive, and
almost  inflamed.  So great is this congestion, that the woman often
complains of pain in the ovaries and the womb, — and a  general
sense of heat, aching, and dragging down in  the lower part of the
bowels.   The pain often extends to  the back, the  groins, and the
thighs.

   This  Condition Repeated Every Month. — When we  consider  that
this state of things is repeated every four  weeks, and that  the  con-
gested  or crowded state of the vessels begins some days before the
monthly flow, and lasts, in all, some  ten days, making about one third
part of every month, we need not wonder that inflammation so often
supervenes, with all its attendant ill health and sufferings.

   Increased by Various  Causes. — If we  reflect, further, that this con- 
FEMALE DISEASES.
341
gestion is increased, among the wealthy, by high living, and  among
all classes, by over-stimulation of the nervous system, and by the las-
civious morals of the age, we see stronger  reasons for expecting, —
what is really occurring, — a continually increasing amount of suffer-
ing from female diseases.
  And when we know, still  further, that American females are care-
less  of their health; that they often attend balls and theatres at the
very time of suffering  from this  monthly  affliction ; that they  fre-
quently wet their feet, and otherwise expose themselves to colds, we
cannot feel surprise, even when we learn that from one-half to three-
fourths of all women in cities, and  quite a  large proportion of them
in the  country, have inflammation of the  ovaries, or of  the womb, or
of the neck  of  the womb, or suffer some of the forms of displace-
ment of this latter organ.

  Child Bearing. — The inflammatory state of the uterine organs is
often induced by injuries received in child-bearing, and by excessive
indulgence in sexual pleasures.

  Weakness  of the Sexual System. — The womb, moreover, like any
other organ, may  be naturally frail, and easily  affected by  disease.
This weakness  of  the  sexual system  is  indicated by  the difficulty
with  which  menstruation is  established, and the presence  of  the
whites, both  before and after each monthly flow.  Women in whom
the generative organs are weak, are  much more  liable  to inflamma-
tion of the womb, and to all the complaints  peculiar to the sex.

                              Fig. 134.
   Description of the Sexual Organs. — Before describing the particu-
lar diseases to which  the  female generative organs  are liable, it is
proper to give the reader  a brief  description of the  chief of these
organs.

   The Womb  itself, in  its healthy, natural state, is about two inches
long, and one inch broad, — weighing a little more than an ounce;
and is in shape like a  pear.   It is lined with  a  mere rudimentary
mucous membrane.

  The Neck of the Womb has a cavity distinct from that of the body
of the organ,  and  is lined  with a mucous membrane well supplied
with follicles or glands. 
344                    FEMALE DISEASES.
  The Fallopian Tubes open, one from each side of the base, or largest
end of the womb, and extend outward to the ovaries.

  The  Ovaries are a bundle of eggs lying one on  each side of  the
base of  the  womb.   They  are  more  particularly explained else-.
where.
  Fig. 134 gives  some idea of these organs.  A, is the body of  the
womb; B, the neck of the womb;  C, C, the vagina; D, one of  the
ovaries;  F,  F, the  fallopian tubes; E,  E, the fimbriated  extremi-
ties ; G, the small ligament attaching the fimbriated extremity to  the
ovary.
  Inflammation of the Neck of the Womb. — Inflammation of  the
body of the womb is a comparatively rare disease, but inflammation
of the  neck  of this  organ is so common that in nearly nineteen  out
of twenty cases, when females seek  relief for whites, for  painful men-
struation, for stoppage of the menses, or even for what they suppose to
be falling of the womb, a careful  examination will show that this
pendent  portion of  the womb is  in a state of marked inflammation,
or of absolute ulceration.   The whites, if they continue, without  in-
termission, from one menstrual flow to another, are almost always  the
result of one of these conditions of  the uterine neck.
  It would surprise most persons, out of  the medical profession, and
many physicians, to know  how large a proportion of the more grave
diseases  which inflict  such terrible suffering  upon woman, and  so
completely shatter  her constitution, are dependent for their exist-
ence upon a  simple local inflammation, cither in  the  neck of  the
uterus, or in  one or both of the ovaries.   Many  a female  has  for
years suffered agonies greater  than" those of death itself, arising, as
she supposed, from a complication of ills which invade  every part of
the system,  while the  whole of her troubles arose, in fact, from  an
inflamed spot which could be covered by  the ball of the  finger.

  Difficulties of Studying  Uterine Diseases. — The facts stated above
have  been but a short time known to  medical  men;  and  to large
numbers of the profession, are still unknown.  The reason is, that
very serious obstacles have stood  in the way of studying the  diseases
of women.
   The social relations of  the  sexes, and the  great delicacy of  the
matters to be investigated, were long the cause of  inquiries  and ex-
aminations so indirect that little  knowledge was gained, and as little
benefit conferred.
   Woman, always  distinguished for her modesty,  could not be  ex-
pected to invite investigations which were not proffered, whatever the
extremity of  her  sufferings; and  man, scrupulously sensitive lest he
should make himself an intruder  by stepping within delicate inclos-
ures, have both, in times past, mistaken  their duty by misinterpreting
the demands of the highest delicacy,
  Needful Examinations not Indelicate. — Rightly viewed, no inqui-
ries or examinations  are  indelicate which are necessary to a full un-
derstanding of the  nature  of disease, and which  are made  with  the 
 
 
 
 
FEMALE DISEASES.
345
 sole  purpose of rendering its cure possible.   I agree with Dr. Meigs,
 the elder, that the delicacy or indelicacy of examining the  persons of
 females for the purpose of exploring disease, depends on  the motive
 with which it is done.  To pure-minded persons, it is never, I think, a
 source of impurity.   On the contrary, the self-restraint, the honorable
 feeling, and  the nice sense of delicacy which it  calls into  exercise,
 often heighten  the tone of a man's virtue, and certainly increase a true
 woman's respect for it.  Unfortunately there is now and then a gross-
 minded man in the  profession, who, in  these  investigations, will vio-
 late  the most sacred of all trusts committed to his hands ; but such
 monsters, — few in number, — soon find their  level, and  are  shunned
 as the most vile of the race.
    It is now so well understood that these investigations  do not  lead
 to immoralities, that the  most highly  educated,  intelligent, refined,
 and virtuous females, almost, invariably raise the fewest objections to
 such examinations as a physician of character may propose.

    Methods of  Investigating Female Diseases. — The symptoms of •
9 these  complaints will be spoken of in  their proper place, as the
 several diseases  come under a brief review.   I merely wish to allude
 here  to the methods of physical  exploration which modern practice
 has called to its aid.               -                             ,

    The Touch.— These methods consist, first, of  what is called the
 touch, which is  made either  externally upon the bowels, or inter-
 nally, with the index finger, through the vagina, or passage from the
 external genital organs to the  neck of the womb.

    The Speculum. — In the second  place,  of ocular inspection  of the
 vagina and neck of  the uterus, through an instrument called the spec-
 ulum. By this instrument, the eye, as well as the finger, is made to
 assist in learning the real condition of the parts.
    The finger informs us whether there  is any deviation  from nature
 in the bulk, the  firmness, the smoothness, or the sensibility  of the
 parts; while  the sight, through the speculum, affords absolute cer-
 tainty as to whether the parts are suffering from inflammation, ulcer-
 ation, abrasion, or eruption.  The following is the best form of spec-
 ulum yet used.

                                Fig. 135
  The end is so shaped as to catch the neck of the  womb, and then
by drawing the instrument  forward slightly, the diseased surface is
presented for as perfect inspection as if located externally. 
FEMALE DISEASES.
Inflammation,  Ulceration,  and  Enlargement of  the
                      Neck of the Womb.

  Inflammation of the fleck of the  uterus is very common; ulcera-
tion and permanent enlargement (technically called hypertrophy), are
its results, when it  is not arrested in due time.  These affections, in
fact, and the  same troubles as  they affect the ovaries, make up the
bulk of female diseases, — being the real causes of the most of those
symptoms which have passed under the name of whites, suppression,
painful menstruation, sterility, general debility, etc.
  The neck of the womb, when healthy, is  soft  and  smooth.   No
hardness or condensation of tissue can be felt by the finger, on press-
ing over it.  It is elastic, too,  and feels unctuous to the touch.   This
latter  sensation is communicated by the layer of mucus which covers
it  Pressure  upon it produces no pain.   Plate  VII.,  Fig. 1, is a
fine specimen of the size, shape, color, and appearance of a healthy
womb.
  Inflammation, when found  in this  part, may begin in the mucous •
membrane which covers the neck, or in that which lines its cavity, or
in the small glands in the body of the organ.

  Symptoms. — Inflammation  of the mucous membrane covering the
neck of the uterus, destroys the unctuous feel which it has in health.
It also causes the neck to swell, its vessels being crowded full of
blood.   If the body of the organ, as  well as the  surface, be reached   i
by the inflammation, it will be hardened, as well as enlarged; and in
consequence of its increased wTeight, it is apt to drop down somewhat
into the cavity of the vagina.   In married ladies, it is often, by physi-
cal pressure, pushed a little backward, or retroverted.   Examination
with the speculum, shows the  inflamed neck to  be of a vivid red,
instead of a  pale rose-color.  It may be  covered  with red or white
pimples, which are glands enlarged with muco-pus.
  In the healthy state, the mouth of the womb is so much closed as
to be just perceptible when the  finger passes  over it.  Inflammation
causes it to be more or less open, and its lips to be parted.

  Inflammation Followed by Ulceration. — In a majority of cases, in-
flammation of the  neck of the  womb and of its cavity, is soon fol-
lowed by ulceration, which generally appears first around the mouth,
and just within the cavity of  the neck.  From thence it spreads both
inward and  outward.  Plate  VII., Fig. 3, furnishes a good  speci-
men.

  Various Degrees of Ulceration, etc. —Of  course  these  inflamma-
tions  and ulcerations mix and run into each other  in all  possible
forms, — presenting excoriations, or raw places ; granulations, or pim-
ply surfaces; and indurations, or hardened parts.  Sometimes these
pimply patches will be red and  hard, and again the whole surface will
be spongy, and will bleed upon the slightest touch.
  In  many  cases, these  ulcerations make wretched work with the 
FEMALE DISEASES.
347
mouth of the  womb, eating deeply  into the cavity, and giving it a
ragged and unsightly appearance.   Plate  VIL, Fig. 4, may be taken
as a sample.

  Velvety Feel from Ulceration. — Ulceration generally gives to  the
surface on which it exists, a soft, velvety feel, which the finger gener-
ally recog/iizes.  This velvety sensation, with  the  open state of  the
mouth, are the most important evidences we  can derive from  the
touch, of this  form of disease.

  The Discharge from  these  Ulcers is always Pus, or, in common
language, matter.  It is  sometimes poured out scantily, at other times,
very freely.  It may be thick and yellow, or  thin, and of a lighter
color.
   The  inflammatory and ulcerated condition of the  neck  of  the
womb, often gives rise to pain ;  and when the seat of the disease  has
not been examined, as it should be, this pain has frequently  been
called neuralgia.   In this way, ignorance has compelled neuralgia to
stand sponsor for a great many pains with which it has had nothing
to do.

  These  Ulcers Disturb Menstruation. — Menstruation is generally
changed, more or less, in its character, by the presence of inflamma-
tion or ulceration in the neck of the womb.   It usually becomes  more
painful.  In some cases  it is made  more profuse, in others more scanty.
It may come on more frequently, or it may be  postponed,  protracted,
or  abridged in its continuance.   There is generally pain of a dull,
aching kind, low down in the back.  There is often a feeling of ful-
ness, pain, and a sense of bearing down in the  lower part of  the
bowels;  sometimes the pain extends to the groins and thighs.

  Extensive Disturbances from these Inflammations, etc.—The nerves,
with which the womb  is liberally supplied, belong to those of  the
sympathetic system.  Hence,  the condition of the uterus influences a
wide circle of sympathies.  By these nerves this organ is brought into
close relationship with  the organs of animal life.   If the former suf-
fer, the latter suffers also.  The stomach, being intimately connected
with the womb,  physically,  feels keenly  these  inflammations  and
ulcerations of the uterine neck.   At times, the pain, debility, general
disturbance, and dyspeptic state of the  stomach are such as to cheat
both the doctor and the patient  into the belief that this organ is  the
seat of  the disease.  But in  such cases, the symptoms of stomach
disease will all disappear the moment the local  affection is removed
from the neck of the womb.
   The liver, too,  often participates in these troubles, and becomes
sadly deranged. It is sometimes even greatly enlarged  and congested,
and patients frequently  have the various symptoms  of what are called
liver complaints.
  Severe pains are sometimes felt under the breast bone, and over
the chest generally, making the patient apprehensive  of  disease of
the lungs; and indeed consumption is not a very unfrequent result of
uterine diseases. 
348 t                    FEMALE DISEASES.
   Pains are often felt in the region of the heart, which organ is often
 harassed with palpitations.
   The flesh is apt to waste under the symptoms excited by these in-
 flammatory and  ulcerative processes in the uterine neck; and even
 the brain, though lying in some  measure beyond the circle of influ-
 ences set in motion by the organic nerves, suffers disturbance and
 pain.
   Even the special  senses of sight  and hearing may be drawn into
 this general vortex, and both be much impaired.  And  to crown this
 catalogue of ills, it  may be  mentioned that those distressing things
 called hysterical fits, proceed from the same locaf disorders.
   In brief, there is scarce a point in the human body to which these
 inflammatory and ulcerative conditions of the uterine neck may not
 send their sympathetic pains and aches, and where they may not in
 time induce real disease.  This  is the reason  why so many women
 suffering from these local complaints, tell the phyiscian, when  consult-
 ing him, that they are " diseased all over."   If asked where the com-
 plaint is located, they  will answer — " It is everywhere."  In the most
 earnest manner the assurance will be given—"Doctor, there isn't any
 well part about me."

   Treatment. — It js just as  unreasonable  and useless  to  treat these
 inflammations and  ulcerations through the stomach, as it is an in-
 flamed or ulcerated throat  They are  local diseases, affecting a par-
■ ticular part, and the remedy must be local.
   Like all other affections, these  can  only be  managed intelligently
 after their nature is well understood.  Nothing can really be done to-
 wards a cure, until it is known what the matter is; and no competent
 physician will move a single  step in the treatment of one  of these
 cases, until he has made a thorough examination.  He owes this to
 himself and to his  patient, — the more so  as the neck of the womb
 may be as easily examined as the upper part of the  throat,  and the
 local remedy may  be  almost as  readily applied in the former case as
 in the hitter.
   If, upon the introduction of the speculum, the uterine neck be found
 simply inflamed and enlarged, the application of a strong  solution of
 nitrate of silver, once  in five or six days, will often prove sufficient to
 reduce both the inflammation  and the swelling.  If it should not, the
 solid stick  should  be lightly applied.   If this should not  succeed
 (though it will in most cases) then introduce a speculum, and when
 the neck of the womb is fairly lodged in its extremity, drop in two or
 three leeches and allow them to fill.
   If ulceration be present, the  solid nitrate of silver must be applied to
 the ulcer once in five  days.  One who is not accustomed to treat these
 affections in this simple way, will at first be surprised at the rapidity
 with which the local trouble will disappear,  and with it, the thousand
 and one aches and pains which torment the whole  body.   As the
 terrible pains in the whole face  and head, which  are  produced by a
 single tooth, all  instantly come to an end when the tooth is extracted,
 so do the bad feelings all  over the  body subside as fast as the local 
FEMALE DISEASES.                     349
ailments of the uterine neck are cured.   There is no exception to this
rule, except where the sympathetic affection has become fixed by long
neglect of the  primary uterine disease.   It is,  therefore,  surprising
that so many excellent women, whose lives are of the greatest value
to themselves and friends, should be permitted to perish  of these ail-
ments, when the cure is so simple, and  many times so entirely within
the reach of the most ordinary skill.  It  is a reproach to the profes-
sion which should be wiped away.
   If there are a hundred motives for gaining the mastery  over other
diseases, there  are a thousand for learning to control these.  More
than  any other disease,  or all others, they make the homes of men
desolate, by robbing them of woman, their  ornament and solace.  The
physician who neglects  to make himself acquainted with all there is
to be known of these complaints, shows himself not only unfit for his
profession, but deficient in some of the prime elements which combine
to make a true man.

   Hardening of the Uterine Neck. — In many cases the uterine neck
is not only inflamed and enlarged, it is indurated and hardened.  At
times, it is enlarged and  hardened on one side, and not much  on the
other.  In still other cases, there are enlarged spots, or nodes, giving
the whole neck a knotty feel under the finger.
   These hardened conditions  of the uterine neck proceed  from vari-
ous causes, and are more difficult to cure than the ordinary inflam-
mation, or even ulceratioh.  They sometimes indicate  cancerous dis-
ease, and then, of course, involve the most serious considerations.  In
many of  these  cases, nitrate of silver fails to produce its usual effects.
We then have  to resort to  the acid  nitrate of mercury, or, as it is
often called, Bennet's Caustic.  No  definite rules can  be given  as to
the  extent to which this article should be reduced.  It is sometimes
applied very strong, and immediately neutralized by the application
of water.

   Uterine Syringe. — For applying  the several remedies to the inter-
nal cavity of the uterine  neck, I have contrived a silver syringe, which
is bent a little at the extremity, and pierced with fine holes all round.
With this instrument, the remedy is carried directly to the diseased
part, and applied instantaneously to every  side of the cavity.
   Beside these  local applications, it is frequently necessary to resort
to  soothing or astringent injections into the vagina, hip baths, and
injections into the bowels, some mild physic, and rest in  a  horizontal
position.   These matters will all be judiciously regulated by the at-
tending physician, if he is master of his business.

   Case I. — Mrs. F. applied for relief from incessant bearing down,
pains in the back and hips, pressure upon the top of the head, palpi-
tation of the heart, bad  appetite,  the whites, and a brick-colored de-
posit in the urine, after standing a time.
   I made an examination, and found the neck of the womb enlarged
and ulcerated, as in Plate VIL, Fig. 4.
   There was no doubt as to  the treatment required.  I  applied the 
350                    FEMALE DISEASES.
—-----------__.__________!___________________—------------     »»
solid nitrate of silver to the ulcerated surface once in five days, for
three months, — at the same time, building up the health, which was
much broken,  by iron and other  tonics (75) (63), by a generous diet,
and by gentle exercise in a carriage.
  The appetite and general  health came  back, the whites and  pains
all disappeared, and the patient felt, as she  said, " like a new being."

  Case II. — Mrs. C, the mother of two  children, had  suffered, since
the birth of the second child, great pain  low down in  the back, with
bearing down, and  a distressing  desire, a  good  part of the time, to
pass water.  She had a continual  discharge  from the vagina, of a
cream-like  matter, which very  much  reduced her strength.  Beside
these symptoms she had pains everywhere,  particularly  in the head.
  An examination  revealed  that the neck of the womb  was  much
enlarged and hardened, and  badly ulcerated about the  mouth.   (See
Plate VIL, Fig. 3.)
  Once in six days, the solid nitrate of silver was applied to the
ulcerated surface.  This was done five times,  which caused the ulcer
to heal, but did not reduce  the size of the  neck, or diminish its hard-
ness.
  To effect these objects, I touched the whole hardened surface with
acid nitrate of mercury, and immediately pressed upon  the cauterized
surface a sponge  saturated  with water.   I repeated this  twice, that
the acid might not  penetrate too deep.   These  operations were  re-
peated once a  week, for six weeks, — thirty-drop doses of  syrup  of
iodide of iron being given, in the mean time, three times a day, with
a vegetable bitter and mineral acid (63).   At the  end of this time, the
hardness had given  way, and the uterine  neck was brought down to
near its ordinary size.   The other symptoms disappeared, and the
patient has had no return of her sufferings.

     Inflammation, etc.,  of the  Ovaries. —  Ovaritis.

   The  inflamed condition  of the ovaries  is indicated by increased
heat,  and  pain upon pressure.   The pain in the ovarian  region is
sometimes intermittent, sometimes constant, and occasionally passes
down to the loins and thighs.
   There are  acute  and chronic inflammations of the  organs;  but it
will be sufficiently  accurate, in a work of this kind, to treat of them
as essentially one.
   The effects of inflammation upon the ovaries, as upon other bodies,
are various, sometimes enlarging and hardening, at other times, col-
lapsing and blasting them.  ""This last effect, it is hardly necessary*to
say, cuts off all hope of bearing children.
   The Causes of ovarian inflammation  arc numerous.   One of  thet
most important causes has  already been noticed, namely, the conges-
tion of the parts, for several days, at every menstrual  period.   This,
amounting as  it does almost to inflammation, is often intensified by
other causes, such as wetting the feet, taking  sudden colds, excessive
fatigue from dancing, and exciting drinks. 
FEMALE DISEASES.                    351
   Sexual indulgence often  proves a cause of inflammation in these
bodies.   It is particularly apt to have this effect in the  newly-married
female, with whom it is a novel stimulus, and often  applied with im-
moderate excess.  In late marriages, when the stimulus to the ovaries
has long been denied, its sudden presentation is liable to make an in-
flammatory impression.   Its entire absence, too, in persons of strong
passions, may result in ovarian disease.
   This inflammation  may  be  produced by the new state of things
existing  at the critical  period called the turn of life, when it reacts on
the womb,  producing  the floodings  which often  bring menstruation
to a close.  The congestion, too, which has been present every month
for many years, does not immediately cease  at this change ; and not
finding relief by the accustomed flow, the ovarian bodies are exposed
to inflammation.
   In all  large cities, the pest-houses  of civilization, where the women
are more numerous than the men, there are many females whose vir-
ginity is a burden, and numerous others who give themselves up to
sexual excesses ; — to  both these classes, the turn  of  life is very liable
to promote  these ovarian disorders.
   There is  another  class of causes, which,  though not so easily re-
cognized, are equally cogent in exciting this form of disease.  I mean
all those excitements which  arise from unbridled thoughts, from books
of questionable  character, from music, social intercourse, and  stimu-
lating food  and drinks, — all  which promote and intensify burning
desires, which, though  natural and proper in themselves, cannot  law-
fully  be  gratified in a  community where the female sex greatly pre-
ponderates,  numerically,  over  the  male.   When we  consider  how
powerful within a woman's  breast the  conflict often is between the
impulse  of  passion and the dictates of duty, and how strongly this
conflict must  react upon the  sexual organs, and especially upon the
ovaries,  the centre of  the sexual system, we can easily see in  how
many cases they may become  inflamed.
   Another cause of this disease is  suppression of the  menses.   The
engorged and crowded state of the vessels  of the womb, of the ute-
rine neck, and of the ovaries, not finding vent in the accustomed flow,
inflammation in any one of  these organs is a very natural result.
   The inflammation of these  ovarian  bodies is a frequent result, too,
of a similar condition, previously existing in the  neck  of the womb.
In passing from the uterine  neck to the ovarian bodies,  the inflamma-
tory condition often fastens  itself upon the broad ligament, the fallo-
pian tubes,  and their fimbriated extremities.  (See Plate VIIL, Figs.
1 and 2.)  The whole, it will be seen, presents an  amount of disease
which it  is painful to contemplate.
   The womb being turned over, and pressing against one of  the
ovaries, may cause it to inflame by mechanical irritation.   Pessaries,
injudiciously used, may do the same thing.

  Symptoms.— The first and most obvious symptom is a pain a little
to the right  or left of the womb. This pain is almost always increased
by walking, riding, or by external pressure.  It is especially augmented 
352
FEMALE DISEASES.
by straightening the thigh,  by which  the  parts over the inflamma-
tion  are put  upon the stretch.   When standing up, ladies suffering
from this  disease, are generally compelled  to rest the foot on a stool,
so as to bend the thigh, and relax the muscles.  The  pains radiate
from the ovaries, and go down to the loins and thighs, and sometimes
to the fundament.   They are of a dull, dragging, heavy nature.
   Sometimes the ovarian bodies become  vere much enlarged, and
dropping down, somewhat, press upon the lower bowel, causing con-
stipation, or upon the neck of the bladder,  creating a frequent desire
to urinate, and an inability to pass the  water freely.

  Treatment. — As  inflammation of  the ovaries is always increased
during the menstrual flow, it is not proper to meddle with it at these
monthly periods, lest the trouble be aggravated.   Immediately after
one of the turns has passed,  from six to eight leeches should be ap-
plied over the diseased ovary.   When the bites are healed, a blister
may be used in the same place.  The scarf-skin should not be re-
moved, and the irritated surface must be healed as soon as possible.
The blister should  "be camphorated  to prevent strangulation.   The
part should next be rubbed for a few minutes, night and morning,
with an alterative and anodyne ointment (169).
   After the next menstruation, the same things should  be repeated,
and  again  after the next, and so on, for five or six months, or even
longer, if need  be.  The already bloodless condition of the patient
may require,  however, that  the leeches should not  be  applied more
than once, or, at most, twice.
   The bowels should occasionally be  opened by some simple cathartic,
for the purpose of removing all hard substances which may press
against and  fret the  inflamed ovaries.   The  purgatives  employed
should be of the most cooling kind, such as salts or oil;  while aloes,
and  all harsh cathartics must be  avoided.
   Injections of tincture of belladonna and  hyoscyamus are useful for
quieting neighboring parts,  and warding  off external  disturbances.
They act like soft substances thrown upon the pavement in front of a
sick man's house.
   The patient should be kept, as much as possible, in the recumbent
position, lying upon the bed or the lounge, and should only be per-
mitted to move about to such extent as will not irritate the inflamed
parts.
   Case. — Miss R. M. B. suffered a  great  deal of pain  every month
while  menstruating.  She had also  a  great tenderness upon pressure
just at the left of the upper part of the womb, and  at times a  severe
pain in the same region, which  often extended down into the groin
and thigh.
   The left ovarium ,was so much enlarged that it could be distinctly
felt through the walls of the bowels.
   Immediately after the next monthly period, I applied six leeches
over the inflamed ovarium, and when the bites were healed,  put a
blister over the same  region.  After this healed, the same space was
rubbed, twice a day, with an ointment (169). * Immediately after the 
FEMALE DISEASES.                     353
courses, the same thing was repeated for four months, — the patient,
each time, being kept quiet for a few days, and then permitted to take
gentle exercise out of doors.  The diet was generally nourishing.
  The patient was well at the end of four months, and has had no
return of the inflammation.
  This was a simple case, requiring only the most simple course of
treatment; but it furnishes the general  outline to be pursued in all
cases of inflamed ovaries.

             Whites.—Leucorrhcea.—Fluor Albus.

  Leucorrhcsa  is from two Greek words, Xev^o? and pea, and  fluor
albus from two Latin  words, albus  and fluo, having  precisely the
same meaning as the Greek, namely, a white  discharge.  Hence, in
popular language, the disease is called the "whites;" it is also called
"female weakness."
  These terms are well enough, perhaps, if we  have in mind that
they convey to us only the idea of a symptom of disease.   They all
mean, with  the exception of the last, a white discharge from the
female genital organs.   They are slightly inaccurate, as the discharge
is sometimes yellow, or green, or otherwise variant from white.   Any
discharge from the female genital  organs which is not bloody, comes
under the term " whites."                   •

  A Symptom Only. — As the  name of a disease, the term whites has
no specific meaning.  It does not designate any particular complaint
It is a symptom, just as the matter expectorated  and raised in  lung
diseases  is a symptom ;  and as such only should it  be regarded.
When persons cough and raise a great deal, they do not, on consult-
ing a physician,  say they  have got the expectoration ; but they say
they fear they have  some disease of the lungs, because they expecto-
rate.  They look upon  the expectoration as the sign or symptom of
disease.
  So females, and physicians too, must learn to look upon the whites,
not as a disease, but as the sign or symptom of disease, which sign
they should become skilled in interpreting.
  There is no  reason  why the  discharge from  the  genital organs
should not be as well interpreted as the expectoration or discharge
from  the throat.   The  parts from which it comes, may be about as
easily and  as well inspected.

  No Female Ailments so Common.—There are  no female troubles to
which the  attention of the physician is so often called as these annoy-
ing and debilitating symptoms called whites ; and there is no depart-
ment of medical practice, in which the really  able, as well as conscien-
tious  and painstaking physician, is so well tested.   If, regarding these
discharges  as they are, simply as signs, he searches faithfully for their
cause, he will be led to a treatment which in a great  majority of
cases  will  be successful.  And surely no success  in life can be more
prised by a right-minded  physician.  It  procures health, the highest 
354                    FEMALE DISEASES.
earthly boon, for suffering woman, and gratitude, the most prized of
nil rewards, for himself.

  There are Four Kinds of  Discharges from the female genital  or-
gans, — mucus, pus, mucus and pus combined, and the watery.  The
first, mucus, does not, in itself, imply disease; but when pus is dis-
charged,  we know  that  inflammation exists, because such a cause
alone can produce it.

  Seat of the Disease. — The cause which produces the whites may
have  its  seat either in the vagina, or in the neck of the womb; and
in practice, it is of course quite important to know where its location
is.  The character of the discharge generally settles this point.  If.it
be thin and watery, or  thick and cream-like, it is froni the vagina or
passage which leads to the womb ; if ropy, gluey or albuminous, like
white of egg, it is from the cavity of  the uterine neck.

  Treatment. — Some physicians always prescribe the same remedy
for the whites.  They might as well have  but one prescription for
expectoration.   The remedy must  have reference to the cause of the
discharge; until the cause be searched out, every  prescription is a
mere trial  at guessing, — a sort of practice  well enough adapted to
quacks, but not becoming scientific men.
   When a case of whites is brought before a physician who under-
stands his  business, he makes no prescription until he has discovered
what the disease is.  Hacing determined this point, his remedies have
an intelligent bearing upon the case.   This being so, I have no reme-
dies to  set down for whites, simply  as such.   1 shall proceed, there-
fore, to speak of several other complaints  which bear more or less
upon this.


          Absence  of the  Menses.—Amenorrhcea.

   The absence of the menses  is divided into two kinds,—retention
and  suppression.  It is retention when  the monthly flow has never
appeared, — suppression, when, having been established, it is, by one
cause or another, stopped.

  Retention Explained. — The ovaries,  as we have before said, are
the centre of the female  sexual system.  It is the swelling or ripening
of an ovum or egg, every four weeks, which causes  the large flow of
blood to the parts, and the consequent menstrual discharge.
   But it sometimes happens that the ovaries are not developed at the
usual time of  life.  The monthly evacuation does  not then appear.
There is retention.  There may be retention, too, from other causes,
after  the ovaries are matured.  Costiveness may sometimes occasion
it, — so may a degenerated and low state of the blood.
   There may be mechanical causes of retention.  The mouth of the
womb may be entirely closed, or the neck may be so constricted as
to close the passage through it, leaving no outlet for the monthly accu-
mulation.  The hymen, also, may have no opening through it When 
FEMALE DISEASES.
355
these mechanical obstructions exist, there are sometimes large collec-
tions of fluid in the womb, which cause enlargement of the body, and
in some instances, painful suspicions that the sufferer  has committed
imprudences, and is in the family way.  Physicians should be on their
guard against falling into such errors, and lending the sanction of their
name to these blasting mistakes.

  Suppression  Explained. — Suppression, — a stoppage after flow has
been once established, — may be caused by inflammation of  %e ova-
ries,— the blood, in this diseased condition, being  drawn so entirely
to these swelling  and germinating bodies, that the accustomed flow
from the womb does not take place.
  Inflammation*™ the neck of the womb may also  cause a stoppage.
So  may a fright, as from a fire occurring  in  the neighborhood, or  a
cold taken by being  caught  in a shower.   Girls sometimes, in  their
utter thoughtlessness or ignorance, dip their feet in cold water, when
their courses are  upon  them, and bring on a suppression of a  most
dangerous character.  The most lovely and innocent girls have  done
this for the purpose of attending a party;, #nd, in some instances, the
stoppage  induced  has ended in  death  within a few hours.  The pro-
found ignorance of their own mechanism, and of the laws which gov-
ern it, in which girls are kept who are just budding  into life, is a seri-
ous reproach both  to parents  and physicians.
  Suppression may be induced by whatever  reduces the quantity or
quality of the blood, as consumption, or by great depression of spirits.
With some  rare exceptions,  women have  not their turns while in the
family way.

  Treatment. — Before anything can be done in the way of treatment,
the  case must  be thoroughly investigated, and the specific cause  of
the disease searched out.
  If it  prove to be  retention, and arises from  a bloodless condition,
and an undeveloped state of the ovaries, iron is the  proper remedy
(61) (73)  (74)  (75), with a generous diet  and exercise  out of doors.
If caused by an inflammatory state of the uterine neck or ovaries,
the proper treatment lias been already indicated. If from costiveness,
relief may generally  be found from prescriptions  (5) (9).   The me-
chanical causes alluded to above, when found to exist, must be removed
by gently dilating the mouth of the womb or the uterine neck, with
bougies, beginning With the  smallest, and  increasing the size, or by
puncturing the hymen, as the case may require.

  In Treating Suppression, it should be borne  in mind that at a cer-
tain time each month, nature makes an attempt to restore  the lost
function.  Even when she is  not successful, probably an  ovum is ma-
tured and in some way disposed of.  The intelligent physician wTill  of
course avail himself of this favorable moment to try his  skill in bring-
ing about the desired regularity.   When this  time arrives, he should
order three  or  four leeches applied to each groin at night.   The next
night, he should direct the use of a pungent foot bath (242); also (16)
as a cathartic. 
356
FEMALE DISEASES.
  When suppression exists,  it is  not always  proper  to  try in this
direct way  to bring on the turns.   There may be no  blood to spare ;
and  this may be  the sole reason why the courses do not appear.
When this is the  case, nothing is to  be  done but  to build up the
health as rapidly as possible, and when this is sufficiently established,
the courses will be all ri^ht

      •    Profuse Menstruation.—Menorrhagia.

  Menstruation may continue too long, or occur  loo  often, or be too
pi'ofuse while it lasts; or all these irregularities may be experienced by
the same person.   Any one  of them will prove a serious irritation,
and a drain upon the constitution; the whole together, if not arrested,
will undermine and destroy it

  The Cause of this, like the sourse of all other female diseases, is,
in a great majority of cases, overlooked.
  It is not  to be attributed, as so many suppose, to a congested state
of the womb; but  is rather the result, in a great many instances, of
the inflammatory or ulcerated condition of the  uterine neck.
  In  still  another  large number of cases, it arises from a succession
of ovarian abortions.  When the blood has run low, and nutrition is
defective, as  in the  consumptive habit, the ovarian vesicles fail to
reach maturity.  Like other  products  of  the economy, they become
blighted, and abort.  And as these blights occur often,  nature is busy
every two  or three weeks in casting them off.  Hence, the menses
appear often.  They come and  go  without order, because they spring
from a process which is a contraversion of nature's laws.

  Explanation. — It  is not easy to  explain how  inflammation and
ulceration of the uterine neck should  in one case produce suppression,
and  in another profuse menstruation.  Yet it is a settled truth, that
such opposite results dolcome from one and the same apparent cause.
Probably the explanation is  to be found in the different  degrees of
inflammatory action, in the varieties  of constitution, and in the  vari-
ant degrees of tenacity with which the vessels hold the blood.
  Bleeding from the female genital organs  may be produced  by  a
variety of causes which have nothing to
do with menstruation.  Such  bleedings
are properly uterine  or vaginal hemor-
rhages,  and  not  profuse  menstruation.
They are  the  result of inflammations,
or tumors within the uterine neck (Fig.
136), or weakness.  The womb  may
bleed for days, or even for months, from
pure debility.

  Treatment.— As  profuse menstruation
and  uterine  hemorrhage spring from a
variety of  causes, so the remedies are various.   Here again we are
confronted with the same absolute necessity to investigate accurately
 
FEMALE DISEASES.                     357
the true nature of the complaint, before we venture a single prescrip-
tion.  All the cases present one general feature.  There is too great
a loss of blood; and the first thought is that astringent medicines are
necessary to arrest it.  But if the bleeding be  occasioned by a poly-
pus, or by  inflammatory ulceration, astringents would not arrest it,
and might do great mischief.
   When the immoderate flowing is caused by a general breakdown
of the nutritive powers, and by ovarian abortions, the great aim must
be to rally the vital powers  by iron, quinine, porter, wine, a generous
diet, exercise on horseback and on foot, and warm and cold  bathing.
When produced by local diseases  of the ovaries and neck  of the
womb, the treatment is to be local, — such as has been described.  If
a polypus, or other  tumor, be the cause, the remedy must be sought
for under the appropriate head.  If the womb has become relaxed,
and  bleeds  from pure  debility, — as it may, — something must  be
found, if possible,  which will  condense its  substance, — making  it
harder, smaller, and more solid.  For this purpose, cold  bathing, as-
tringent injections  into the front passage, and  acid drinks, are useful.
But one of the best remedies is the wine of spurred rye (267).  One
teaspoonful should be taken three times a day.   This  article, by caus-
ing the womb to contract, solidifies  and condenses it, — thus arresting
the blood which oozes from  its relaxed tissues.

   Case.— Miss S. F. was treated, in 1855, for great loss of blood  by
too frequent and too profuse menstruation.   She had suffered for a
number of years, — her courses  coming on every three weeks, some-
times every two weeks, and lasting from a week to  ten days.  She
had become very pale, and much debilitated; and, as  she  had a slight
cough, her  friends feared that, if not relieved, she would soon sink in
consumption.
   Having made an examination, and learned  that there was  no or-
ganic disease, but that  the  exhaustive  bleeding was  caused entirely
by debility, I  prescribed sulphuric  acid  (60) three times a day, with
half a pint of cold water injected into the bowel once a day, and qui-
nine (67) three times a  day.
   The  patient was required to take a very generous diet of juicy
meats, broths, etc., and  to be in the open air to  a reasonable extent.
   The case began  immediately to improve, and in a few weeks the
courses were restored to a  healthy state.  No other treatment was
used, except to drop the  sulphuric  acid in two instances, for a few
days, usirg in place of it, tannin in one case, and alum in the other.


          Painful Menstruation.—Dysmenorrhosa.

   DYmr.NORRHCBA is from three Greek words Bus, prjv, and pica, which
niean. fiterally, a difficult monthly flow.  These  words  do not precisely
describe the complaint; for  it consists not so much in a difficult, as in
u panful flow.

  Symptoms.— This affection is always marked by more or less pain 
'358
FEMALE DISEASES.
while the courses are on, — especially during  the  first day or two.
The pain sometimes begins two or three days in advance of the evac-
uation.   It extends over the whole lower part of-the belly, — running
down, at times, to the thighs, and causing great distress in the back.
It is frequently so violent as to resemble  the pains of labor, compell-
ing the sufferer to take  the  bed, and drawing from  her  tears and
groans, and occasionally  throwing her into spasms most painful to
witness.  So terrible are  the monthly sufferings which some women
experience from this cause, that the anticipation of  it  destroys  much
of their peace, even during the intervals of  respite.
  The Causes of this complaint are very numerous.   There is, doubt-
less, such a thing as pain in the womb from  rheumatism, and espec-
ially from neuralgia, though these are much rarer forms of the com-
plaint than many suppose.
  Pains  at the monthly periods are often induced by a displacement
of the womb.   If the organ fall over backward or forward, its nerves
are pressed upon in an  unnatural  way,  and when  the  parts are
crowded with blood, it is very natural for painful sensations  to  be
excited.  In these cases, the neck of the organ is bent at right angles,
and the  canal which passes  through it is of course strictured, so that
the evacuations are necessarily made with difficulty.
  And this lead.s me to remark, that the passage through the uterine
neck, becomes, occasionally, from  inflammation or other cause, almost
closed.   The result is, much difficulty and great pain in  passing the
monthly  secretion.
  There are no causes which excite painful menstruation more often
than inflammation in the uterine neck and the ovaries.  An increased
flow of  blood to an inflamed  part always causes pain.  An inflamed
foot or leg  has to be laid up in a chair, because it aches when  put
down.   The reason  is, that when hanging down, it is more full  of
blood, and  the sensitive nerves are painfully compressed.   When the
finger is  hot with inflammation, we assuage the  pain  by holding it up
for the blood to run down.   For the same reason, the inflamed ovaries
and uterine neck ache when the blood flows to them, in large quan-
tities, at  the menstrual period.
  Congestion of the lining membrane of the womb itself is a frequent
cause of painful  menses.   It is  a condition  of  the membrane of the
womb, similar to that of the larynx in membranous croup.  There is the
same pouring out of what physicians call coagulable lymph, which
forms itself into a membrane.  This membrane the womb strives by
strenuous contractions to throw off, and finally  succeeds  in  expelling
it, not whole  and entire, but in  shreds and patches.   These  shreds,
which women sometimes call skinny substances, are characteristic of
the disease.  The efforts to expel them cause pains  very  much like
those of  natural labor, and sometimes almost as severe.

  Treatment. — Painful menstruation, excited  by the falling over of
the womb, backward or  forward, is  cured, of course, by putting the
organ back into its proper position.
  Pains  caused by stricture of the canal through the uterine neck, are 
FEMALE DISEASES.                    359
cured only by enlarging the passage*   This is effected by introducing
at first a very small  bongie, and  then  a larger and a larger, until the
passage is of the usual size.  It is a delicate operation, quite success-
ful in careful and skilful hands, but liable to produce mischief when
improperly conducted.
   In  all the forms  of this disease, the treatment should aim, not
merely  at palliation, but at a cure.   And generally, 1 am happy to
say, a cure  is attainable.  Yet  how  many women suffer for years,
until  health has fled, and life has become a burden, — receiving from
their  medical attendant the assurance  that palliation  only is pos-
sible !
   It is  necessary at each monthly turn, to do something,  in these
cases, to quiet the pain.  For this purpose, twenty  drops of lauda-
num, in a wine  glass of tepid water, thrown into  the bowel, will be
highly serviceable.   For a like purpose, one pill (116) may be taken
twice a day, beginning one day before  the menstrual  flow.   A bella-
donna ointment (170) may be  rubbed upon the  neck of the womb
with great advantage.
   In the congestive form of this disease, — that in which the membrane
is formed on the internal surface of the womb, and thrown off in frag-
ments,— the liquid acetate of ammonia, or spirits of Mindererus, is a
very valuable remedy taken in  two  teaspoonful   doses, in  a table-
spoonful of cold water, three or four times a day, while the pain lasts.

   Case I. — Miss E. S.  of B.,  aged  twenty-two  years, applied, in
1856, for  relief  from great suffering  at  her monthly periods.  Her
menses  had been disturbed some time before by taking cold, since
which time, her  mother stated, her pains, for a short time  before the
flow began, and during the first day, had been terrible, not much less
severe, indeed, than  those of natural labor,  or child-bearing.  The
pains, at these times, had been of a terribly bearing-down  kind; had
frequently been preceded and accompanied by sickness, vomiting, and
fever; and  finally,  what came  from  her at  first  was not so  much
blood, as a kind  of skinny substance, in shreds and patches.
   It was  immediately evident that this  was a case of painful men-
struation  (dysmenorrhcea)  of the congestive  kind.    The womb was
every month too full of blood, — its internal surface, in fact, if not its
whole substance, inflamed.   Hence, a false  membrane  like  that  of
croup, was formed, which the womb contracted and struggled hard to
throw off, and finally tore to pieces, and expelled in shreds.
   Of course this local inflammation was  to be reduced, which was
done by first giving a brisk purge (31), which was followed by apply-
ing half a dozen leeches directly over  the womb.   On the following
day, a blister was  raised in the same place.  In  two  weeks, three
leeches  were applied, and  again followed by a blister.   These appli-
cations  were repeated every fortnight, for three months, being careful
not to use them  within three days of the monthly turns,  either before
or after.
   The pain, at each  turn, was assuaged,  by injecting into  the bowel
twenty drops of laudanum in a gill of tepid water, by rubbing upon
* 
FEMALE DISEASES.
the mouth of the womb some of, the ointment  (170), and by giving
two teaspoonful doses, in a little cold water, of the liquor of acetate
of ammonia, three times a day.
  The patient was cured in three months, and has since had easy and
natural menstruation.

  Case II. — Mrs. L. C. was treated for a case  of painful menstrua-
tion, in 1857.
  The lady also  had terrible  pains, attended  by forcing down as if
her bowels were all coming out of her.   Yet she had  but a very
scanty discharge.   Every month  she  was made literally sick, and
was obliged to take to her bed.
  On examination, it was found that the great difficulty in passing
the menstrual fluid, as well as the scantiness  of the quantity, wTas
owing to the smallness of the passage through the neck of the womb;
this passage was nearly closed  up;  it was strictured.
  There could be no doubt as to the treatment  required.   Medicines
could do no good.   This passage must be gradually opened.  To do
this, I introduced a small metallic male catheter into the strictured
passage,  and, gently turning it once or twice round, withdrew it.
This was done once in three  days, for three  months, — using each
time a slightly larger instrument.  Thenceforward,  her menstruation
was natural and easy.  She was well.

                 Chlorosis. — Green Sickness.

  Before the age of puberty, the girl is only a child.   She  has within
her only the elements of a  woman.   The change to which  she is des-
tined, brings with  it a wonderful development  both of  body and
mind.
  To effect this development, and bring out the new being in the
perfection designed by the Creator, a large amount of hidden  nerve
power is required.   She requires to have been born  with a well-vital-
ized constitution, and to  have been physically trained in a way to
harden and energize it   Without these antecedents, her  develop-
ments  at puberty will be feebly and imperfectly  made.   Her devel*
opment and  evolution of germs will be  so  defective as to cause her
menstruation to  be only partially established, or to fail altogether.

  Symptoms. — Where the inherent powers of the system  are just
sufficient to bring about  a first menstruation, it  often happens that
they seem to be  spent by the effort, and that  the  evacuation fails to
appear again for several months.  Indeed, the whole organization may
break down at this point, and beeome blasted, as it were, like a blade
of wheat which  has grown well for a time*  but which  fails to develop
the kernel.
   The blood  at this period, may  become  impoverished, and fail to
distribute adequate nourishment and development to  the various  tis-
sues.  When this occurs, it loses  a part of its red globules, and in-
creasesgits watery  portion.  As a  result, the skin becomes pale, and
0 
FEMALE DISEASES.                    361
sometimes of a yellowish hue;  the  bowels become torpid and con-
fined ;  the  nervous system sensitive and  weak;  the  digestion is im-
paired ; the appetite is either lost, or perverted, — longing for unnatu-
ral  food;  the tongue is white;  the  heart palpitates; the spirits are
depressed; the temples and  ears throb;  the head occasionally aches
and whirls with dizziness; the  sleep is disturbed  and abbreviated;
and hysterics are  now and then superadded to  close the catalogue
of ills.
  This is Chlorosis, briefly depicted  in  its origin and its symptoms.
The word is from the Greek ^Xoj/jo?, which means green and pale.
By nurses it  is called the " green sickness."
  Its Causes are quite numerous, among  which may  be reckoned im-
poverished diet, damp atmosphere, sedentary habits, long  confine-
ment indoors, overworking the mind in  childhood, constipation of the
bowels, and au inherited feeble constitution.

  Treatment. — Chlorosis, as a general thing, is connected either with
retention or suppression of the menses ; and in treating it, physicians
are too much in  the  habit of  resorting  indiscriminately to forcing
medicines, called emmenagogues.   From such practice, great injury
often results.
  It is not always sufficiently considered that a woman fails  to  men-
struate, or ceases to do so, because she is sick; and if  we  would cause
her courses to return, we must restore her  health.  To do  this should
generally be the great object of treatment.   Let the health be  restored,
and the menses will come back.   The only philosophical treatment is
that which will invigorate the^system.
  In  chlorosis, the vital powers are in a state of dilapidation.   How
can they be roused ?  By exercise on horseback and on foot; by wear-
ing clothing enough to keep warm; by a tepid bath two or three times
a week, and brisk rubbing with a coarse towel; and by a generous
diet, composed of  tender meats, animal broths, etc.
   This treatment, however,  should be preceded by unloading the
Dowels with  prescription (35) or (40), according to  choice.   One pill
should be taken at  night.   When the liver is considerably deranged,
prescription  (40)  will be  particularly  serviceable.    Half a pint of
tepid  water  thrown into the bowel, night  and morning, will help
relieve costiveness.
   The bowels having been well opened,  give a tablespoonful of pre-
scription  (59), two  or three  times a day; or, of prescription (60), a
teaspoonful,  the same number of times, each day.
   In- the  treatment of this disease,  iron,  in some form,  is almost al-
ways  needed.  Prescriptions  (61) (71)  (73) (74) (75) (80) and  (316)
are suitable preparations.            \
  A girl  suffering from this  disease should always  be taken out of
school.  The mind should be divided between rest and recreation.

  Case. — Miss J.  T., aged nineteen, was  treated  by me for this com-
plaint in 1858.
  She had always  been delicate.  Her first menstruation was at the 
362                    FEMALE DISEASES.
age of fourteen; but it was  quite defective  in  quantity, and was
imperfectly repeated two or three times, at irregular periods, when it
stopped altogether, and had not again appeared up to the time of her
being brought to me.
  She was very pale, and a little yellowish, — her lips being nearly
white.  She was very costive, — habitually so, — was  without appe-
tite, and her  tongue was  coated white.  She  had dizziness, palpita-
tion of the heart, neuralgic pains in various parts, and was extremely
nervous and irritable.  Having, in addition to  the above symptoms, a
pretty constant  cough, her friends feared consumption, and  brought
her to me from some distance for that reason.
  I found no physical' signs of lung disease, and had no difficulty,
therefore, in making it out to be a case of chlorosis, — particularly as
there was no expectoration attending the  cough.
  The parents were chiefly anxious to have the menses brought on.
With me, this was of minor consequence; the main thing was to rally
the prostrate powers of  life, and restore the blood to health.
  To do this, it was necessary to rouse the  liver, for which I gave
leptandrin, etc. (34), which I ordered to be taken once  a day, namely,
at bed-time.   This  not only caused a flow of bile, but  the scutelanne
calmed and strengthened the nervous system.
  It  was necessary, too,  to correct  the  habit of  costiveness.  To
effect this, she was ordered to take two  teaspoonfuls of Mettauer's
aperient, after breakfast and dinner.
   To restore the blood, iron  was ordered, particularly the citrate of
iron and strychnine (316).  This had a fine  effect to raise the blood
and  support the nervous system.
   She was ordered a generous diet of tender meats, broths, etc., and
to take unrestrained and free exercise out of doors.
   Her improvement was immediate  and visible, and  was not inter-
rupted  during the  three  months of  her stay in Boston.  Soon after
her  return home, her menses appeared, and she has since enjoyed
pretty good health.

         Cessation of the Menses.—Turn  of Life.

   There is  probably no period in woman's  earthly  existence which
 she  approaches with so  much anxiety as  that  which she  is in the
 habit of calling " the turn of  life."   The anxiety is not without some
 reasonable ground for  its existence.  She  has been accustomed, for
 thirty years  or more, to  lose, every four weeks, a certain  amount  of
 blood.   When  this evacuation stops, disturbances of the system- may
 well be expected.   So well is  this understood, that this climacteric
 has  come, by general  consent, to  be called  the "critical period" in
 female life.
   If it be well  and safely passed, the health  is generally better than
 before, and a " green old age " is likely to  follow.  But if the seeds
 of disease are  in the system, —if there be a tendency to cancer or
 other malignant disease, which has been held in check by the monthly
 flow, it now takes up its destructive  work,  and shows itself; or, if 
FEMALE DISEASES.                     363
 there be a predisposition  to  apoplexy or congestion of any organ, it
 is more likely to become active, now that the accustomed waste-gate
 is closed.   A distinguished writer has said'that about half the deatns
 among women, about the age of forty-four, are from cancer.

   Nervous Complications. — It is the duty of the  physician  to  look
 carefully after those females who come under his care at this critical
 time.  For, in addition to the organic and malignant diseases which
 attack her at this time, she is exposed to a host of nervous irritations,
 which, if  neglected or badly  managed, make her life a cross and a
 burden.   The symptoms of these irritations are in number, legion.

   Age at  which the turn  of life comes. — As a general rule, the  turn
 of life comes  between the ages  of forty and fifty ; but occasionally
 occurs at  other periods, varying from thirty to seventy.  If the menses
 appear early in life, they terminate early.
   Symptoms.— When there is a tendency to corpulency at this period,
 the symptoms are headache, dizziness, and a sense of suffocation.   It
 is common, when  the period  of cessation  approaches, for deviations
 from  regularity to.occur.   At one  time the menstrual discharge  will
 be profuse; at another, scanty.  It will now disappear for a time,
 and be  replaced by the whites.   Then it will appear for a few times
 with considerable regularity.   Next will come a suspension for  sev-
 eral months, to be followed by a flow of such profusion as to amount
 almost to  flooding.
   Mixed  up with  these  irregularities,  will be  palpitations  of  the
 heart, constipation  of the bowels,  a variable appetite, and  broken
 sleep, weakness and inquietude, timidity, a dread of. impending evil,
 irritability of temper, hysterical attacks, bad feelings in the head, with
 sounds in the ears, as of  the  rolling of carriages, sparks before  the
 eyes, and an unsteady gait

   Treatment. — If there be at this  period, fulness of habit, with  diz-
 ziness, headache, sparks before the eyes, a sense of suffocation, etc.,
 there is a plain indication that the brain is oppressed  with  too much
 blood.   I  am  not  much  in favor of bleeding, but  this is a case in
 which from a gill to a half pint of blood  may, if ever, be drawn from
 the  arm with  positive  advantage.  Cups applied to the back of  the
 neck wdl  also be useful.   Give at night, also, three  of the compound
 cathartic pills, and  then  keep the bowels regular  with  prescription
 (18;, — a wine-glassful to be taken occasionally.   The diet should be
 spare, and strictly vegetable: —to which should be added much daily
 exercise.                                                         J
   Purging should not, in  any  case,  be  carried too  far.   If nervous
 affections  show themselves, with disturbance of the digestion, and
 general debility, even leeches would be improper, and physic should
 be swallowed very sparingly.
   When serious organic disease is suspected, — as cancer, — it is  the
duty of the physician to investigate the case very thoroughly, and to
give the patient the advantage of the  most  prompt  and decided
treatment.   That treatment is spoken of in the proper place. 
364
FEMALE DISEASES.
 »                  Hys.t erics.—Hysteria.

   The name of this complaint is from a Greek word, signifying the
 womb.  It took this name from the belief that this organ is the  seat
 of the irritation which produces the hysteric disturbance.
   This belief is correct, if we include with the womb, the ovaries,
 and the other sexual  organs.   The sexual system is doubtless the
 centre of the reflex nervous derangement, called hysteria.
   It has been sufficiently demonstrated that hysterics are dependent
 for their existence either upou organic disease, or upon simple irrita-
 tion of the sexual  organs.  Sir Benjamin Brodie  mentions cases of
 the hysteric paroxysm, produced by pressing  upon an inflamed  and
 tender ovary.

   Symptoms. — An attack  of hysterics is generally preceded  by de-
 pression of spirits, restlessness, and a frequent desire to pass water.
 It is  sometimes marked by convulsions, or  fits; at other times, it is
 not.   At times, the attacks are local, and are manifested by spasms
 of the throat  at the top of the windpipe, or in  the bronchial  tubes;
 the patient feels a  ball rise up in  her  throat (globus hystericus), her
 heart beats violently, and she laughs and cries  by turns.
   When the disease is more general, the muscles of the limbs  are
 thrown into spasms; the patient  struggles  violently; rising up in  a
 sitting posture, and then throwing herself back;  twisting the body
 from  side to side,  clenching the hands, and throwing the arms about,
 so that she is with difficulty held by persons much  stronger than her-
 self.   Soon after these  paroxysms, the patient generally passes a large
 quantity of very pale urine.

  The Causes  of this  complaint are as  numerous as the causes of
 female diseases, for in truth there is no female  complaint which may
 not produce it.  Whatever develops and excites  the sexual system,
 and at the same time weakens the constitution, lays the  foundation
 of this malady.  Nervous women are much inclined to it.  In large
 cities there is more of it than in the country,  because there is more
 excitement and luxury, and more of their  consequences, — nervous
 and female diseases.

  Treatment. — To treat this complaint successfully, it is necessary to
 search out its cause, and remove  that  Like the  whites, it is not so
 much a disease in itself, as  a symptom.
  The first inquiry to be made should have reference to the real
 origin of the complaint  Is it dependent upon inflammation of  the
ovaries or the womb, or to displacement of this latter organ ; or does
it arise from the low state of the blood, and the weakened condition
 of the. nerves, acted upon by some irritation or heightened sensibility
 of the sexual organs.
  If dependent upon inflammatory disease, that is to  be treated ac-
 cording to directions elsewhere; if  upon  falling  of the  womb, no
 remedies will avail, until that is put in its proper place.  If diluted 
PJ. 8.
Pio". 2
Fk,3
Kcf.4.  /i
 
 
FEMALE DISEASES.                    365
blood and weakened nerves be the cause, iron and quinine are the
remedies.   When the complaint arises from  deficient menstruation,
iron  and aloes (47) will  be serviceable.   The  nervous  spasm  can
sometimes  be broken up by pouring cold  water upon the head, or
face, or limbs of the patient.

  The Hygienic and Moral Treatment are of great consequence.  The
complaint is very much under the control of the  will.   Whatever
tones the moral nature, and strengthens the will, tends to subject this
disorder to the control of the patient  Plain wholesome diet, exercise,
bathing, and the enforcing, as far as possible, of  a rugged, self-reliant
habit, generally go far towards breaking its force.

                   Polypus of the  Womb.

   This is simply a  foreign body, or tumor, growing  either within the
womb, or in the vagina, and attached to the uterine neck.  It is rather
a serious affection.
   These Juniors vary in weight from half an ounce and- less, to many
pounds.   They are, in color, whitish, red, brown, and  even black.
They have  almost  every  consistence, — being, soft, spongy,  gristly,
and hard.

   The Symptoms of polypus are various, resembling those of almost
every other womb complaint.  It is often mistaken  for displacement
of the womb, for dropsy of this organ, and  for pregnancy.
   These tumors are apt to give rise to dangerous bleeding from the
womb, and other discharges which greatly weaken and derange the
system.  They are  liable to terminate in cancer.  In pregnancy, they
may produce miscarriage.  When they  are  suspected, therefore, the
utmost scrutiny should be employed to search them out.  This  is
especially desirable, since  the fallen or inverted womb may  carelessly
be taken for a polypus, and be operated on as such.

   Treatment.— This  is of  two  kinds, medical and surgical.  The
first consists in means of supporting the  strength of the patient, and
checking the  discharges by means of injections, rest, etc., and in en-
deavoring to cause  the removal of  the tumor by absorption.
   This last object  is sometime  effected^by  an unstimulating  diet;
and by the use of iodine (101) for  some time.  This treatment does
not often succeed, however, and cannot be relied upon.
   If the polypus be within the womb, of course it cannot be reached.
 The only thing to  be done, in such  case, is  to cause its expulsion.
This is sometimes  effected by causing the womb to contract by the
use of spurred rye  (267), or by the  use of the  electro-magnetic
machine.   This latter remedy can do no  harm, and had  better be
tried first
   When the  polypus is outside the womb, the methods of removing
it are various.  It  is sometimes done by cauterization, or burning it
off by hot iron or caustic.   This is a  harsh method, and not resorted
to by skilful surgeons.  Another method is that of crushing the tumor 
366                    FEMALE DISEASES.
with an instrument.  Another stili  is that of torsion, or twisting it
off.  And  still another, that of applying a ligature, or tying a string
around the neck of the tumor, and strangling it by preventing the
blood from going  to it.  By this means  it falls off in  a few days.
There is one other method, that of cutting the  tumor away with a
knife, or with a pair of curved scissors.  These three last methods
are the chief ones now used by skilful surgeons.

  Case I. — Mrs. J. W. H.,  from one of  the cities in New England,
applied  for treatment for an affection of the lungs, from which she
had  suffered  for several months.   She was thin in flesh, feeble, and
pale from loss of blood; for she informed  me that  her  courses had
been upon  her a large part of the time  for several months.   I  tried
the usual remedies for profuse menstruation (for she at first declined
an examination), but without effect   The hemorrhage was unabated,
and  she rather  lost ground.  I again proposed an examination, and
apprized her  that upon it hung the only  hope of my being able to do
anything for her.   She assented without  further hesitation.
   Upon introducing the speculum, a pendulous tumor, hanging  from
the mouth  of the  womb, immediately dropped into  it, precisely like
that in Plate VIIL, Fig. 3.  I immediately put a ligature around its
neck, and in a few days it came away.   Upon being apprized of this,
I applied to the root a small amount of acid nitrate of mercury, with
a camel's hair pencil, and immediately after pressed  upon the cauter-
ized surface a small velvet sponge, thoroughly wet with soap suds.
By this last  application, the acid was  decomposed, and prevented
from spreading.   The bleeding stopped at once.   Under the use of
iron, and a thoroughly rallying treatment, the lady began to come up.
The affection of the lungs, no longer encouraged by the drain upon
the system, gradually yielded, and she recovered.

  Case II. — An unmarried lady, from  an interior  town in another
state, sought relief for a throat disease,  complicated with  a slight
affection of the lungs.  As my custom  is, I inquired respecting her
menses, and  learned that  her " turns," as  she said, came upon her
every two weeks, or oftener, — indeed, that she  was  seldom entirely
free  from  some flow.  Upon making an  examination,  — to which,
like  a sensible  woman, she* assented without hesitation, — I  found
about the  mouth  of the womb, as  in  Plate  VIIL, Fig. 2, several
small projecting tumors, looking  like ripe, red currants.  With the
forceps, I took  hold of them, and in a few moments, without pain to
the patient, I twisted them  all off; and then made the same  applica-
tions as in the preceding case. The bleeding was ended  at once; and
the patient got well, not only of the hemorrhage, but of the throat and
lung complaints.

                     Uterine Hydatids.

   This name is given to a bladder-like  substance, occasionally found
growing in the womb.  It  is  filled with a white or yellowish  fluid. 
FEMALE DISEASES.                    367
 Sometimes a bundle of them grow together, like a bunch of grapes.
 Some  are elongated, like  a bean, and  have a sort  of claw, by which
 they are attached; others are shaped like an egg.
   Those with a.claw are generally supposed to  be  living beings, like
 worms  in the bowels.   When expelled from the womb, they move
 about if placed in warm water.
                        *
   The Causes which produce these singular growths,  are  obscure."
 Probably whatever improperly excites or irritates the uterine organs
 may produce these vesicular bodies.

   The Symptoms may be easily mistaken  for those either  of preg-
 nancy, or of water or inflammation in the womb.
   From the  growth of these bodies,  the  bowels  may enlarge, the
 breasts swell, and the menses stop.  If to these  symptoms be  added
 sickness at the stomach, the woman, if married, feels confident she is
 in the  family way.  There  is no  certain method  of correcting  this
 mistake, until the collection of bladder-like bodies is expelled from
 the womb.
   It is rare that these bodies appear in the  virgin woman.   They are
 supposed to be  connected,  in some  way, with imperfect conception.

   Treatment. — No very exact directions can be given in regard to
 treatment, because we can seldom say absolutely that hydatids exist,
 until we see  them expelled.   Whatever will produce contractions of
 the womb, will  cause their expulsion ;  but it will not do to give these
 remedies indiscreetly, lest the cause be one of real pregnancy instead
 of hydatids.

            Inflammation of  Womb.—Metritis.

   This disease very often follows delivery, and is connected with
 child-bed fever.

   Various Causes also produce it in the  unimpregnated state.  The
 inflammations of the ovaries, or of the uterine  neck, may extend to
 the womb.  Falling of the womb may  cause  it to be irritated by
 being placed  in a new position, and thus bring on inflammation.  In
 some temperaments, marriage may produce this disease ; in others,
 singleness.  It may also be  brought on by painful menstruation, by
 forcing medicines, by constipation, by tight corsets, by solitary vices,
 and by excited sexual feelings.

  Symptoms.—-When the  membrane lining the  womb is involved in
the inflammation, the symptoms are dull, constant pain in the region
of the womb  and in the loins.   The passage of water or feces causes
pain.   There  is a sense of weight  which  causes  the patient to bear
down and strain, as in labor.  The belly swells, and is painful and
tender, not  bearing even the weight of the clothes.   There are chills,
fever, and sometimes even  delirium.

  Treatment. — In this, the aim must be to reduce the  inflammation. 
368                    FEMALE DISEASES.
The bowels must be  opened with some saline medicine (18), perspi-
ration must be induced, and the hands and feet must be made warm.
A large meal  poultice should  be put upon the belly, and leeches or
cups on the inside of the thighs.  The patient should  lie  upon  the
back with her knees raised so as to keep the clothes from pressing on
her.  If the  purgative medicine  does not operate, an injection  (249)
should be used.                         9
  The food must be reduced almost to entire abstinence, and no stim-
ulants whatever should be taken.  The  room must be well ventilated,
and kept still.

         Falling  of the Womb.—Prolapsus Uteri.

  The womb is often found  out of its natural and  proper  place.
There  are certain ligaments and muscles intended to act  as  stays,
and hold  it up in  its position.  These, from various causes, become
rlaxed.  It then, losing its support, drops down into the vagina, be-
tween  the bladder in front and the large bowel called rectum, behind.
It is then  said to be fallen, or prolapsed.
  The womb  of married  women is  more apt to become prolapsed
than that  of the unmarried, because it is more liable to have its weight.
increased by congestions.

  The Symptoms are  dull pain in the  small of the back, a dragging
sensation in the groin, and a feeling  of fulness around the funda-
ment.

  Treatment. — The complaint  is  easily cured  if  the remedies be
applied early.   If the falling be occasioned by a relaxed and  weak-
ened condition of the parts, a very effectual relief may sometimes be
derived from simple injections of cold  water  into the front passage,
alternating them sometimes by an infusion of white oak bark, or of
nut galls, or a solution of tannin.
   If the womb have been long down, these simple remedies will not
be  sufficient to restore it.   It is then  necessary to put it back in its
place, and employ some mechanical means to keep it there, until the
ligaments and muscles recover their strength so far as to hold it.  For
this purpose, passaries, of various styles and materials, are employed.

                Falling Over of  the Womb.

   Anteversion. — The womb sometimes falls over forward upon  the
bladder, towards the  pubes.   This is called  anteversion.   The top is
turned forward to the bladder; the mouth,  back  towards the large
bowel.   (Fig. 137, b.)

   Retroversion. — When the womb falls over backward, between the
rectum and the vagina, it is said to be retroverted, d.  This  is just
the opposite of being anteverted.  In this displacement, the mouth is
turned forward, the top backward.
   This displacement  may occur suddenly or gradually.  If the former, 
FEMALE DISEASES.                     369
there is generally great distress, and the organ should be immediately
put back in its  place ; if the latter, the pain will be less intense, and
the replacement must be effected by pessaries, — particularly with the
ring pessary, made from India rubber.

                              Fig. 137.
  Anteflexion and Retroflexion. — When  these  occur, the womb is
doubled upon itself, the mouth of the organ not being tilted up before
or behind, but retaining its natural position.   These flexions are rep-
resented by a, c, and e.
  Beside these  more common displacements of the womb, there are
several slighter  deviations which it is scarcely necessary to describe.
There is the obliquity of the womb, which is simply a leaning of the
organ backward or forward, or to one side.
  There  are still other more serious troubles, which are so very rare
as not to require me to dwell upon them, such as  the inversion  of
the womb, or turning it wrong side out, like the finger of a glove;
and  the hernia of the  womb (hysterocele), which is like that of the
bowel.

               Inflammation  of the Vagina.

  This may be produced by many of the same  causes which induce
inflammation of the uterine neck.   It may follow tedious child-bear-
ing,— especially  if instruments have been  used.   Marriage is  not
an infrequent cause of it, — so may a pessary be, if an improper
one.

  The  Symptoms are pain  in the groins, a feeling of heat and tight-
ness  in the passage, and a difficulty in passing water.  In a few days
a discharge, like gum water, begins to flow, which gradually becomes
thicker, like cream, and is  green or yellow.  Sometimes the disease
gets  well in a few days; at other times, it degenerates into the chronic
forms, and  lasts a long time.   It should be cured as soon as possible, 
370                    FEMALE DISEASES.
rio. 13s.
lest the inflammation cause the walls of the passage to grow together,
and make a stricture, as in Fig. 138.
  In this Figure, b, represents the mouth
of the  womb; a, is  the lower entrance to a
narrow passage in the vagina, called  a
stricture.   It is caused . by inflammation,
which  so thickens the walls of the vagina
as to  bring  their  inner surfaces near to-
gether.   In examining a case of this sort,
a practitioner needs to be on his guard lest
he mistake the entrance to  the stricture, a,
for the mouth 06 the womb, b, — a mistake
which  might lead to  evil consequences as
well as seriously damage his professional
character.
  Treatment. — The diet should  be light
and  unirritating.    The bowels  should be
kept open.   A cooling  wash  (207)  (218)
should be used several times a day, until
the discharge becomes thick,—then employ
injections (232) (202) (244)  (243) of a more
astringent nature.   Let  the marriage bed
be abandoned till the  recovery is complete.
   When  the discharge  arises from  small
granular elevations upon the inner surface
of the vagina,  the  whole diseased surface
should be painted  over with a solution  of
nitrate of silver, twenty grains to the ounce
of water, — the disease being brought  to
view by the use of  a speculum.   This may
be done every other day.
 Itching  Of the External Parts. — Prurigo of the  Vulva.

  This complaint is apt to attack females about the cessation of the
menses, though they are liable  to it at other  periods.  It  is a most
annoying and distressing affection.   So  terrible and tormenting at
times, is the  itching of the external genitals, that the woman is una-
ble to avoid rubbing and scratching, and she is occasionally compelled
to absent herself from all society.  She feels, as she says,  as though
she should tear herself to pieces.
  Sometimes this  irritation  of the sexual organs excites venereal
thoughts so dominant and controlling as to constitute a real mania,
called nympho-mania, from the name of a part involved.
  This complaint  generally indicates some disease of the womb, or
its appendages, or  of the bladder.   When this is the case, of course
it cannot be cured without seeking out and removing the disease, of
which it is a symptom. 
FEMALE DISEASES.                    371
  Treatment. — To alleviate  the local suffering, the lotion (223), or
the ointment (171), may be applied to the parts several times a day.
I prefer the lotion.  A weak solution of nitrate of silver (211) will
sometimes do well.
  When the disease is brought on by masturbation, as it sometimes is,
this habit must of course be broken off before a cure can be effected.
In this case, also, cold water must be applied  to the parts several
times a day; some of the preparations of iron should be taken, and
some active employment be  engaged in, which shall absorb the ener-
gies of mind and body.

                  Sterility or  Barrenness.

   It has  doubtless occurred  to  every person who  nas thought upon
the subject, that there must  be some  special reasons  why so many
women do not  and cannot bear  children.  These  reasons I propose
now to explain as simply and as plainly as the nature of the subject
admits.   To this explanation, I shall add some  remarks upon  treat-
ment ; for, in nine cases out often,  barrenness is completely curable.

  Reproduction. — Throughout nature, life is perpetuated by. repro-
duction.   The vegetable and the animal die;  but before death comes,
they reproduce the germ of a new  thing  or  being, which  lives after
them.   The law of reproduction, throughout the realm  of nature, is
one, and but one.   All living things have male and female structures.
Every new being is evolved  from an egg, the product of an antece-
dent parent.
  Reproduction consists in the growth of an egg or germ in connec-
tion with some living  part, until it is capable of  independent  exist-
ence.   This germ or egg is the product of the female parent, and will
abort or perish unless brought in connection with a fructifying fluid
from  the male.   Thus, two  palm  trees, growing  about forty  miles
from each other, the one without stamens (the male organs), the other
without pistils (the female organs),  bore no seed  for many years; but
when they had risen in height above all intervening and obstructing
objects, the  winds bore  the  pollen  from  the stamens of one  to  the
pistillate  flowers of the  other, which immediately began to produce
fruit.   A knowledge  of this  great  law, as  applicable to all living
things, enables horticulturists to  raise  such varieties of fruit as they
wish, by shaking the blooming male branch, which has stamens, over
the female  flowers, supplied  with pistils.   Sometimes the male and
female flowers are upon the same plant, —at  other times, upon differ-
ent ones.  The strawberry is of the latter kind, —the pollen  being
found  only on the plants which have the largest flowers, —the pistil-
lated flowers being only on the smaller plants.  The  pollen, or dust,
is carried from the male to the female plant on the  feet of honey-bees,
as they fly  from  flower  to flower.   It has been recently discovered
that the reason why many  beds are  unfruitful (strawberry beds, I
mean)  is that  the  large male plants are allowed to monopolize  the
beds to the exclusion of the  smaller female plants.   The plants with 
372                    FEMALE DISEASES.
large  flowers should be thinned out, leaving only a  few to furnish
pollen for the females, which are the real bearers.

  A New Branch of Industry. — It  is only quite recently that this
law has been understood  in its wide applicability.  How wise and
merciful an arrangement of Providence that an unseen  hand should
turn for man the mystic  leaves of knowledge at the very time  when
he is most in need of the instruction imparted!  At this very moment,
the more complete  knowledge of this great law is opening a new
branch of industry and a new supply of food, and is thus helping the
solution of the  great  problem of how the  increasing inhabitants of
civilized  countries are to be worked and fed.  I refer to the propaga-
tion and culture of fish.
  A committee  appointed by the legislature of Massachusetts, in 1855,
reported very ably upon this subject.   It appears that the eggs of the
fish may be fecundated almost as easily as the pistillate flowers of the
plant  It is only  necessary, when the eggs of the female are mature,
to hold her over a basin of water, and make gentle pressure upon the
belly, when  the eggs will pass freely into the water; then to pass the
milt of the  male into the same water, and shake  them thoroughly
together.   By this means, the  eggs are impregnated, and fish may be
raised to  any extent.
  The egg of the higher animals is more difficult to fecundate, and
that of the human female,  most difficult of all; for in nature as in art,
the more perfect structures are begun and reared with less ease.

  Propriety  of  Imparting  this Knowledge. — Men are naturally curi-
ous, and love to understand the mystery of  their own origin ; and yet
there  is scarcely any subject upon which they have so  little reliable
information.  It  has  been held that this  is a kind  of information
which it is not proper to impart to the multitude ; that  the curiosity
which seeks this  knowledge is based upon improper feelings; and
that to gratify it by imparting what is sought, would lead to immor-
ality.
  I do not believe it.   Such ideas are based upon a shallow philoso-
phy.  They overlook the  fact,  that nothing excites the imagination
like that which  is covered  with mystery.  It is because the immensely
important subject of the procreation of the  race is so carefully hidden
from  the public eye ;  because it is purposely buried so deep in obscu-
rity, that any allusion to it excites improper thoughts.   If the subject
be properly  viewed, it is no more  indelicate to  explain  the mode of
reproducing a  human being, than to explain that of propagating a
plant or a fish.  Both are  effected in the  same way, under precisely
the same natural law.
  True, the propagation  of the human being involves moral laws
likewise; but these relate  only to the social relations in which it may
take place, and do  not affect in any way  the propriety of  making it
understood by the people.

  The Germ Furnished only at Certain Periods. — These  general re-
marks bring me  to the immediate subject in hand.   Throughout 
FEMALE DISEASES.                     373
Fig. 139.
animated nature, the  female furnishes the mature germ or egg only
at certain periods.  The healthy human female, — as  I have  already
                                    explained,  — matures a  germ
                                    once in four  weeks.   These
                                    germs or  eggs  are constantly
                                    advancing, in succession, from
                                    the rudest  beginning, to a state
                                    of ripeness, or maturity.  Every
                                    person must have seen the eggs
                                    taken from the hen when  killed
                                    in the laying season.  Fig. 139
                                    furnishes a good  illustration.
                                    They are in  all stages  of pro-
                                    gress, from the  invisible germ,
                                    up to the nearly mature egg.
                                      Such  is  the  progress of the
                                    human egg, — only that it does
                                    not  attain to  any  such size.
                                    So far as the  maturing is con-
                                    cerned,  it  occurs in  the  same
                                    gradual way.

   Conception or Impregnation can take place only when a germ or
egg is ripe;  and as an egg ripens, bursts, and passes into the fallopian
tubes leading to the  womb, only at the time of menstruation, it is
plain that conception  must  happen  somewhere in the neighborhood
of this period.  Intercourse with the male may take place at interme-
diate times; but, except  in  some rare instances, conception will not
occur, because there is no mature egg to be impregnated.
   Now, as every healthy  woman brings to maturity a germ  or egg at
the time of  every monthly flow, and as every ripened egg is capable,
under favorable circumstances, of being fecundated, it follows that
every woman who  menstruates, and  is well, can, under  certain cir-
cumstances, be impregnated.  To effect it, it  is  only  necessary that
the vivifying portion  of  the male semen, called spermatozoa, come
into union with the ripened  egg.
   This  union (for, that men and women may         Fm. 140.
have a chance to know as much about them-
selves as they  do about fishes and plants, I
propose to make the whole subject plain) takes
place in the following way.  In the act  of
copulation, the male organ  penetrates the  va-
gina, and deposits the sperm, spermatic fluid,
semen, or, as the scriptures call it?, the  "seed,"
directly  at  the  mouth of  the uterine  neck.
Some suppose that when the sensation of the
female is at its height,  the womb opens  to
receive the injected semen.   But this is uncertain.
   This  spermatic fluid is composed, in a  large  part, of  mucus.  A
smaller portion of it is secreted by the  testicles, and is the  true semen,
 
374                    FEMALE DISEASES.
or life-giving  principle.  This last portion is composed, almost  en-
tirely, of fertilizing filaments or vesicles, which  look like small ani-
mals (Fig. 140), and for a long time, were supposed to be animalcules.
They are generally called spermatozoa.  By some mysterious law of
their nature, they are endowed with the power of motion ; and when
deposited  near the mouth  of the womb, they immediately begin to
move,  as if by  instinct, in search of             fig. 141
a ripened egg.  Passing through  the
uterine  neck,  they enter  the womb,
and thence glide onward into the right
and  left fallopian tubes, and through
these to the ovaries.    If  an  egg  be
found, in its ripened condition, either
in the womb, or the  tubes, or about
leaving the  ovarian bundle, they  im-
mediately embrace it, and, in  some
mysterious way,  mingling  their own
fluid contents with the  contents of  the
egg,  they impregnate  or  fertilize  it
Fig.  141  shows  the  womb  divided
lengthwise.  A, is the internal mouth
(os   internum),  or point  where  the
canal through  the- uterine neck enters
the  body of the womb; B, is the  ex-
ternal mouth ( os externum); the space
between A and B, the passage through
the  neck; and C, C, the points where
the fallopian tubes begin.   By looking
back  now,  and  examining Fig. 134,
the whole thing will be understood.
  This  is a very brief and simple account of impregnation.  It is
supposed to be capable of taking place either  a little before or a little
after the monthjy flow, and not at intermediate  times, for the reason
already stated.   There are  some reasons for  believing that the same
egg or germ, if fertilized just  before the courses, will  grow to be a
male, while, if fecundated after the turns, it  will be a female.  One
reason for this  supposition is^ that plants may be made to bear male
or female flowers by simply subjecting them  to different degrees of
heat   If there be more heat than light, male flowers  are produced;
if more light than heat, female  flowers are the result   The heat of
the  female generative  organs is raised to its highest degree about  the
time the egg bursts its  covering, which  is just before the beginning of
the flow.
  It has been thought  that the right  ovary produces males, and  the
left ovary females; but this theory  is not supported by  any facts, and
is probably not trne.

  Causes of Sterility. — From what has been said, it  would appear
that  to ensure childbearing, it is only necessary that semen or seed,
containing spermatozoa, come in contact with a germ  vesicle or egg,
 
FEMALE DISEASES.                    375
at the right time; that there be no hindering disease; and that the
parties cohabiting be adapted to each other.
  It is evident enough that a want of adaptation between the parties,
physical  or moral, or both, is  often an absolute bar  to  conception.
A lack of moral adaptation was probably the obstacle in the case of
Napoleon and  Josephine, — her marriage with  a previous husband,
and his with  a subsequent wife having both  been fruitful.
  It is certain that indifference on the part of the wife towards the
husband, and especially repugnance, may prove an obstacle.  A mere
lack of sexual  feeling does not necessarily prove a  bar, though  it-
probably lessens the chances of a fruitful union.
  Conception may fail to take place from the diminutiveness  of the
male organ, — the semen  not being deposited in  the right place;  or,
from its  excessive largeness, — penetration of the vagina being impos-
sible.  In'some rare  cases, the womb  is absent  The inflammation
of  the ovaries often prevents the ripening of eggs.  The fallopian
tubes occasionally get diseased and plugged up, so that no egg can
pass to  the womb.   Inflammation in  the cavity of the uterine neck
is  probably  the most frequent of all the  causes  of  sterility.  The
viscid, gluey  matter which is  secreted in inflammatory conditions of
tiiis part, plugs up the passage, so that no spermatozoa can pass  up
in  search of the egg.   The acrid discharges in most of the cases of
whites destroy the fertilizing spermatozoa, and render conception im-
possible.  All the displacements of the  womb  may act as bars to
impregnation.   If it fall over backward or forward, the mouth  is
tilted up before, or down  behind, and is not in the right position to
receive the semen

  Treatment. — Judicious treatment will, in most cases, remove ster-
ility, and open that " well-spring of pleasure," which the poet  has so
felicitously described as — "a baby in the house."
   The obstacles to conception, stated above, are  chiefly those diseases
which had been previously described.   To  cure those diseases, is to
remove  the obstacles.  When it is dependent on  the causes  which
produce  painful menstruation, or profuse menstruation, or a suppres-
sion of menstruation, the remedies are the  same as are pointed out
for those complaints.  If inflammation of the ovaries  be the cause, a
cure may be effected, provided  the inflamed condition be removed
before the bundle of eggs be destroyed.   If inflammation or ulcera-
tion of the neck of the womb  be  the obstacle, the remedy may be
found in the  treatment recommended*for those affections.
   Sterility depending  on the  causes just mentioned,  I have had the
pleasure of curing many times.   When dependent on  a lack of phys-
ical or moral adaptation  between the  parties, it does  not, of course,
admit of relief.  It is a  misfortune to be  borne in silence.   It has
happened, perhaps, through a lack of judgment  or care in selecting
a partner, and  is one  of  the mistakes of a lifetime which a lifetime
cannot repair.  When this want of adaptation is not complete,  a rem-
edy may frequently be found.
  Unfortunately, many females do not regard sterility as an evil to 
376
FEMALE DISEASES.
 be deplored, but rather as a blessing to be desired.  Life, to them,
 has no high aims or duties, — it is a round of fashion and pleasure.
 To bear and rear children interrupts their frivolities, and they seek to
 escape such abridgment  of their pleasures.   This is wrong.  Life is
 a great theatre, in which all  should  strive to act some worthy part,
 and feel that, upon retiring, it would be wrong to leave their garments
 upon the vacant stage, with none to put them  on, and continue  the
 drama.

   Case. — In 1854, a lady, twenty-five years of age, was brought 'to
 me by her husband, in the hope that some relief might  be obtained
 for some' female complaints, from which she had suffered" for a num-
 ber of years, and which threatened to make a wreck of her health, if
 not to destroy her life.
   Having come with the  full  purpose of having the case  properly in-
 vestigated, both herself and husband readily assented to an examina-
 tion, which revealed a highly inflamed and swollen condition of  the
 neck of the womb, with a small ulcerated patch immediately  around,
. and extending some half  inch within the cavity.  She had for a long
 time  suffered severe  pain at her monthly turns, with great and dis-
 tressing bearing down both before and after her menstrual  flow;  her
 back was weak and painful, making it  impossible  to walk  out of
 doors, or  to stand much upt>n  her feet.   She  had  become nervous
 and much debilitated, and had  pains at times in her chest, her liver,
 her head, and limbs; was distressed by all sorts of disturbances of
 the stomach ; and had become, as  she said, about  as thoroughly  un-
 fitted  for all the useful purposes for which human beings are made,
 as she well could be.
   She had been married five years ; but, as  might be expected from
 the condition of the uterine neck, she had no children.
   Introducing a glass speculum, I took a caustic holder, with a piece
 of stick  nitrate of silver  in it, and  touched the whole  surface of  the
 ulcer in the mouth of the womb as far as it could  be reached.  I di-
 rected her to take one to. two  teaspoonful doses  of the tincture of
 scullcap every night, to quiet the nerves and promote sleep, and re-
 quested her to come to me again in a week.
   At the next visit I reached  the upper part of the ulcer in the uterine
 neck  with a delicate silver  syringe, and threw a fine shower of a
 strong solution of nitrate of silver upon all sides of the ulcer, and
 prescribed, in addition to the scullcap,  pills  of iron, etc. (75), to be
 taken three times a day.
   I directed her to  see  me once a week, which  she did for four
 months.   The improvement, after the second week, was gradual and
 steady, — so much so, that little variation was required  in the treat-
 ment.   At the end of four months, the inflammation and ulceration
 had both  disappeared;  her pains  and  aches had  all silently with-
 drawn ; she  could walk,  ride, and stand upon her feet; and, in brief,
 she has since, to the  delight of herself and husband, borne two chilr
 dren, and enjoyed tolerably good health. 
FEMALE DISEASES.
377
                          Midwifery.

  A stoppage of her courses  is  most commonly the first notice a
woman has of her being in the family way.   This is perceived two
or three weeks after conception, when she begins to experience other
feelings peculiar to the situation.  These feelings are nausea and vom-
iting, or a decided languor, in the morning;  swelled and sometimes
painful breasts; the areola?, or colored rings around the nipples darker
than usual; pain in the lower part of the back;  and, occasionally, a
good deal of spitting of a frothy,  cotton-like substance.
  These symptoms  are more or less severe in different cases, and
under different circumstances, according to the state of the patient's
bowels, and her  habits of exercise.  Ordinarily, she  suffers most
during the second and third months, on account of the

  Sinking  Down  of the Womb, which, from soon  after the period of
conception, is gradually increasing in size and weight.   As it grows
larger and heavier, it  sinks lower in the cavity of the pelvis, until
about the fourth month, when, becoming so large that it cannot longer
be accommodated within the narrow limits of this unyielding box of
bones, it is obliged to  mount higher to find  room in the ampler and
more distensible.belly.   This low  position of  the womb  in the early
months of pregnkncy, occasions many disagreeable  sensations, — as
pain in the lower part of the back, and sickness at the stomach.
                                       •
  The Costiveness, too,  from which  women  suffer so much at this
time, is often caused, in part at least, by  the pressure of the enlarged
womb upon  the  lower  bowel.  Costiveness,  thus  induced, at  length
becomes itself a  cause of serious mischief.   The lower bowel, filled
and  enlarged with its  hardened contents, reacts upon the womb,
crowding it still  lower  in its narrow  quarters, and greatly increasing
its  excitability.   The  enlarged bowel and  womb combined, make
constant pressure, sometimes upon the urethra, or water-pipe, causing
pain and difficulty in making water, and  always upon the ascending
veins, checking the return of blood, and producing congestion  in the
lower bowel, manifested by troublesome piles.

  Treatment of Pregnancy. — When the pregnant woman first recog-
nizes her situation, she  should determine to "observe moderation in
all things."  Let  her avoid violent  and  sudden exertion, and move
about more calmly and  evenly than usual.  By this is not meant that
she should give up  her customary occupation ; but  that she should
pursue it with becoming carefulness, resolved in no case to hazard
over-exertion, and  rather  leaning to the side of indolence.   This
would not be real indolence, for she is doing a great work internally,
and should not unduly withdraw her energies to external affairs.
  Let her not be too  much in  the erect position.  If of delicate
constitution,  and not in vigorous health, she should make it a point
to lie  down  several times  during the day.   The  standing  position,
continued  for a long time, especially if it  be under circumstances 
378
FEMALE DISEASES.
to induce fatigue, greatly favors  the descent of the womb, — while
a frequent rest in a horizontal position, may enable  it to keep its
place.
  All Objection. — It may  be objected by some, that a large majority
of the mothers in the world are working women, and obliged to con-
tribute by their  industry to the  support of their families ;  and that
they cannot afford, therefore, to lie still, and mind directions.
  To this it may be answered, that it is a great advantage to under-
stand the best way, so as to have the  privilege of at least aiming at
it  Much is accomplished, in all  circumstances,  by aiming at  doing
the best  thing;  and few women  are so situated  that they could not
so favor  themselves as to obey the laws of health a little  more per-
fectly, if  they thoroughly understood them.  All can better afford to
avoid sickness,  than  to be  sick.  Many  occupations,  also, unless
money tempt  to excessive  application, become,  when  steadily fol-
lowed, comparatively  easy and unexciting.  Thus, most people  can
go through their usual  round of  duties, because  they  have got used
to it.  Indeed, there is nothing but indolence itself, to which we may
not become accustomed.  The difference between  the laboring and
the privileged classes is  more imaginary than real.  All must  work.
None can escape the primeval decree  —" In  the sweat of thy face
shalt thou eat bread."
  Many  women, when they find  themselves  in the family way, will
observe no cautions,  but  work all the harder, and even use other
means for the purpose of .bringing on abortion, and  preventing an
increase of children.   This unnatural and wicked, but  too prevalent,
disposition, results sometimes from a fear of the  pains of child-birth,
sometimes from a desire to avoid the necessary care and confinement
connected with raising children, but most often from a wish to escape
the expenses which the prevailing fashions and  customs  of society
connect with a. large  family.  The cost of a shattered nervous sys-
tem, and of a body weakened and poisoned by powerful  drugs, is not
considered, because not  understood!   Hence the success of those
quack advertisements, impudently professing to cure female diseases,
but whose chief object is disclosed by the insertion of the hypocritical
caution — " Be careful not to take this medicine during pregnancy, as
it Ibill be sure to produce abortion."
  It seems as if the world would  nAver learn that God loves children,
although  since  Abraham's day he has said so much about them in
his word, — although His Son,  sent into  the world on purpose to
show the disposition  of the  Father, took them  up in  his arms, and
blessed them, — and although He has  implanted a most wonderful
love of them in the soul of man.

  Costiveness and Piles. — Let the pregnant woman  use all proper
means to keep her bowels in order.   She will thus greatly diminish
the distressing nausea,  and  may entirely prevent the accession of
piles.  To accomplish this object, the  saline aperients (7) (5), or, oc-
casionally, other mild cathartics  (10)  (12) (14),  may  be used.  But
more important than either  or all of  these is the  frequent use of  a 
FEMALE DISEASES.                    379
goo4 self-injecting family syringe.   An  injection of half a pint  of
cold water  every morning,  will  do much  towards  regulating  the
bowels, and preventing or curing piles.

  Nausea. — If,  as sometimes happens,  there  should be  persistent
nausea after the  first  three months, it  will need  to be combattecl
by mild tonics and  stimulants, as chamomile tea,  or  clove tea (58)
(114), and by seeking  a  kind of diet which will be  agreeable both
to the  palate and the stomach.   Dr.  Meigs  speaks  of champagne
as  a remedy,  and  mentions  some  serious  cases  entirely relieved
by  it

  The Nipples. — During  the last month, particular attention should
be  paid to  the  nipples.  Untold  misery often  results to  the young
mother from sore nipples; and it is well worth her while to use every
precaution against them.   The nipples are of course in an excitable
state during the whole period of gestation, and at length frequently
become irritable and tender.  Let them  be daily bathed, for three or
four  weeks before confinement, with some astringent and cooling
lotion, as oak-bark decoction, borax water, alum water, or a solution
of tannin (200)  (201) (202) (203).
  The object of treatment, in this case, is to toughen ,them, and  ren-
der them less susceptible, so that they may not be made tender by the
subsequent application of the child's lips.
  When a woman is-peculiarly liable to this trouble, the further  pre-
caution  of having them  gently  drawn, by  some friend,  every day*
during this last month, would be of great service.                   *
  At all events, let no pains  be spared to  guard against this evil; for
sore nipples make sbre breasts; and sore breasts make broken breasts;
and broken breasts are terrible things.   They make the mother sick;
and if the mother is sick,  the child is sure to be sick; and all hands
soon get sick and worried; and the whole business of having children,
and taking care of them, is deprived of its peculiar joys and consola-
tions, and brought into undeserved  disrepute.   Whereas, under wise
and prudent management, there is something delightful to the young
mother in yielding sustenance to her dependent  offspring.  For, when
her  nipples and breasts are  in a healthy state, she can say with the
poet as              .
                " The starting  beverage meets its thirsty lip,
                  'T is joy to yield it, as 'tis joy to sip."

  Swathing. — In advanced pregnancy, much assistance in supporting
the burden is sometimes derived from swathing the bowels.  Healthy;
and vigorous women, however, need no such assistance ; it is chiefly
applicable to cases of debility, either  constitutional, or resulting from
neglect, or from over-exertion during former pregnancies.

  Cramp in the Stomach  is sometimes very severe, and if allowed  to
continue, may kill the child.    The best remedies are warm carmina-
tives  (114)  (115), or anodynes, etc.  (121)  (122), or antispasmodics
(90) (94). 
380                    FEMALE DISEASES.
    Headaches. — These may be relieved by antispasmodics, etc. (90)
  (94), or anodynes (121).

    Palpitation of the Heart  may  prove very distressing to delicate
  women.   The remedies are the antispasmodics, with rest   Some-
  times tonics are useful, such as the muriated tincture  of iron (73).
  The bowels should be carefully regulated.

    Fainting, which occurs before or at the time of quickening, is some-
  times very troublesome.  The  proper treatment  is the avoidance of
  fatigue, and, during the fainting fit, the recumbent posture, cool air,
  application of cold water to the face, and ammonia to the nose.

    Cough is  sometimes present.  It  is caused by the upward pressure
  of the diaphragm against the lungs, by which they are irritated and
  convulsed.  The remedies  may be  selected from the  cough prepara-
  tions among the prescriptions.

   Varicose Veins. — These cannot be removed during pregnancy; but
  they may be relieved by great care of the bowels, and by wearing
  tight bandages, or elastic stockings.

    Swelling of Lower. Limbs  is caused by  pressure of the  enlarged
  womb upon the veins; and may be relieved by care of the bowels,
  and diuretips (130).

    Itching of the Genitals may be much relieved by borax, morphine,
ffetc, (204).

                   Miscarriage.—Abortion*.

    When a woman in  the family way throws off the  contents of her
  womb, or loses her child, during the first six months, the accident is a
  miscarriage, or abortion; when the same thing happens during the
  last three months of  her term, it is a premature labor.

    Symptoms. — If abortion occur during the first month after concep-
  tion, the symptoms may not attract  much attention, or, may  be re-
  garded only as an irregularity of menstruation.  Occuring at later
  periods, it is frequently indicated by some feverishness, coldness of
  the feet and legs, a puffed-up condition of the eye-lids with purplish
  discolorations, shooting pains in the breasts, which become soft, pains
  in the back, bearing-down  pains in  the lower  part  of the bowels,
  wThich come and go, and  at length take the character  of real labor
  pains.   As these pains increase, blood begins to appear, and, sooner
  or later, the bag of water breaks, and the fetus is thrown off.

    Causes. — These are very numerous.  Some of the principal are,
  displacement of the womb; ulceration of its neck ; syphilitic disease
  of the fetus received from the parent; too  much exercise ;  heavy lift-
  ing ; falls, particularly when the woman comes  down upon  the feet,
  and is heavily jarred; emetics; powerful  purges ; and too much nup-
  tial indulgence. 
FEMALE DISEASES.
381
  Treatment. — Where the symptoms are but slight, nothing may be
required more  than  a little caution for a few days, and rest in the
horizontal posture, using cold drinks, and taking for two  or  three
nights, at bedtime, perhaps, a pill composed of one  grain of opium
and two grains of sugar of lead.  Beside these remedies, it may be
well to  put a mustard poultice low down upon the back.
  If, notwithstanding, flooding comes on, and the symptoms of mis-
carriage increase, a  napkin wetted with cold water, or vinegar and
water, or a bladder partly filled with ice, should  be laid upon the ex-
ternal genitals, and  pulverized alum, mixed up with a little honey,
must be given internally, every  half hour; and if. the flooding still
increase, it may be proper in some cases to resort to the tampon or
plug.   To do  this, take either lint, or old  pieces of  calico, or a piece
of  fine sponge, and having soaked it full of a strong  solution  of  alum,
or  tannin, or,  still better, Monsel's persalt of  iron,  one  part  to six
parts of water, — fill the vagina full, and then place  a fold of linen in
the genital fissure, and apply a bandage.   This will generally stop the
flow; but the plug must be removed in from five to  ten hours.
   If the abortion cannot  be prevented, — especially in the  latter
months of gestation, then the case is to be permitted to go on, and to
be  treated the same  as a natural labor.

                      Labor.—Delivery.

   The expulsion, at full term, of the child, the  after-birth, the  mem-
branes, and the fluids, constitutes labor, or delivery.  It is supposed
to  occur about two hundred  and eighty days after the last menstrua-
tion ; but authors reckon it differently; in truth, it is not possible to
fix it exactly, for it evidently varies in different cases.
   When the time of her lying-in arrives, let every woman meet it
with calmness  and undoubting  confidence.  There is every reason to
encourage this state of mind.   Think of the vast multitudes of people
in  the world.   Each  one once existed in the womb of a mother, and
had to pass through  its  narrow portals to be  admitted to  the light
 Successful delivery  is the rule, the world  over; and it should  be the
rule to confidently expect it.                        •
   In the midst of the pains  of labor, nothing does  more to bring a
favorable result  than courage and patience.  Patience is able calmly
to  survey all the. difficulties before her, because  she never attempts to
encounter but one at a time.  There is much philosophy in  the story
of  the  " discontented pendulum," which got discouraged, one  morning,
from reflecting how many millions of times it would  have  to  swing
during succeeding years, but  became reassured  upon considering that
a single stroke cost but a very trifling effort, and that it really had to
make but  one  at a  time.  So it is with  labor; its  pains, which are
really severe and agonizing,  will become  comparatively  tolerable, if
the whole attention  of the woman be confined to  present suffering,
and her whole stock of courage and patience be brought to bear upon
one pang at a time.
   Let  her resist the temptation to a feeling of haste.   Nature will 
382                    FEMALE DISEASES.
  often proceed more evenly, and more speedily, if allowed to take her
  own time.  A hurry to get through is a great obstacle to successful
  delivery; it always puts things back.
    Symptoms.— One  of the  first indications  that  labor is about to
  begin is, that the woman finds herself smaller, — the child having
  sunk down  lower in  the  abdomen, and she  accordingly  breathes
  easier.   The  genital  organs become relaxed  and moist,  and mucus
  escapes, which is called " the shows."  The woman finds  herself dis-
  posed to be nervous and  fidgety, and  perhaps a little depressed in
  spirits.
    When labor  has fully set in, it is marked by lowness of spirits,
■  flashes  of heat and cold, a great desire to empty the  bowels and to
  make water, and  grinding, cutting  pains, which grow stronger and
  more continuous, with intervals of ten or fifteen  minutes'  ease be-
  tween.   Vomiting in the early stages of labor often occurs, and may
  be regarded as favorable, — indicating the softening and  opening of
  the mouth of the womb.
    Treatment of Labor. — When labor begins,  the attention should be
  directed to the state of the bowels and bladder.  The child's head
  begins  early to press  upon the bladder and lower bowel, causing the
  desire to  make water, etc.; and these should be immediately emptied
  to make  room  for the  head to pass more easily. The bowel may be
  freed by  a dose of castor oil (10), if there is time for it to operate,—
  but more surely, and more satisfactorily, by an injection.   Relief in
  the bladder may, perhaps, be obtained by a different  position  of the
  woman in the act of  making water.  It is the pressure of the  child's
  head upon the water-pipe which causes the trouble  ; and to relieve it,
  the woman should get upon her hands and knees, with her shoulders
  lower than the hips, so as to throw the child  upward and forward
  towards the cavity of the  abdomen.  Thus situated,  she may often
  find it easy to make water, when in the ordinary position it would be
  impossible.  If, however, this manoeuvre does  not succeed,  and the
  bladder becomes greatly distended, the catheter must be used.
    The  Bed and Habiliments. — In  the  next  place, fix the  bed, and
  the patient's  Habiliments.    Reject  feather beds;  use the  mattress.
  Cover  this  with a rubber  cloth, if convenient, and  then with  folded
  sheets to  absorb the discharges, and  protect^the bed.  Let the woman
  be arrayed in the same garments she expects to wear  after the com-
  pletion of the labor, and let these be well tucked up  under her arms,
  and let the lower  portion of her body, from the waist downwards,
  be enveloped in a sheet.  This sheet can be easily removed, and the
  clean clothes pulled down without greatly disturbing the patient when
  in the exhausted state which follows labor, and when it would subject
  her to great fatigue to be obliged to sit up in bed to have  her clothes
  changed.   Let her lie upon her left side, with  her body shortened by
  bending forward, so that the muscles may be relaxed;  let her head be
  placed  in the middle of the bed, and  her feet  press against the right
  foot-post.  Around this post a shawl or towel may be fastened, upon
  which she may be allowed to pull during the pains. 
4
                        FEMALE DISEASES.                     383
  The Presentation.— An examination with the finger is to be made
to learn the presentation, — that is, to learn which part of the  child
comes first into the mouth of  the womb.
  Head Presentation. — If the head present, the  labor will probably
go*on without the  need of medical aid. ,  But in  all labors there is a
liability to dangers from unforeseen accidents, which renders the at-
tendance of an intelligent physician highly prudential.
  Breech or Feet Presentation. — If the  feet or breech  present, it is
desirable  to  have  the  first part of the labor  proceed slowly, so that
the passage may become well dilated, and prepared for a more rapid
delivery of the  head.  If the breech  present,  do not  pull down the
feet; let the child come double : it will make more room  for the head.
If the feet present, let  there  be no pulling upon them to  hasten the
birth of the breech.
   After the  feet and breech have  fully cleared the  external orifice,
the delivery may be judiciously hastened for the  purpose of prevent-
ing the death of the child from pressure on the umbilical cord, before
its head is brought to the air,  and the act of breathing thus permitted.
For  after  the  pulsations  of  the  cord cease,  the child  must either
breathe or die.
   In this  kind of  presentation, therefore, the  child's  life is in great
danger.  After the birth of the  lower half of  the  body,  the cord ex-
periences severe  pressure, sufficient to interrupt if not wholly prevent
its pulsations.  It then becomes necessary to hasten the birth of the
upper extremities and head by all prudent means.   Violence is never
in order in midwifery;  but considerable force, skilfully directed, may
sometimes be safely used.  After  the shoulders are delivered, the pas-
sage  of the head may be facilitated  by carefully pulling down the
arms.  Then, as soon as possible, introduce the finger into the mouth
of the child.   This will  serve the  double purpose, perhaps,  of per-
mitting a little air to make its way into the child's lungs,  and of fur-
nishing a hold by which its head may be gently drawn along into the
world.
   If  there is much delay at  this  juncture, perhaps in some cases the
child's life may be  preserved by inserting into its mouth one end of a
male catheter, — thus furnishing an open  tube  for the  passage of air,
until more vigorous pains shall introduce it into the full liberty of the
atmosphere.   While the head is yet undelivered, great care should be
used to  keep the child's body warm  by covering it with flannel, and
also  to keep it in a correct relative position with the head.   If the
body be incautiously turned round, of course the neck will be twisted ;
and the chikfs  subsequent delivery with a broken neck will be the
miserable result, — bringing confusion to the medical attendant, and
unhappiness to all  concerned.
  Arm or  Shoulder Presentation. — If the  arm or shoulder present,
the child  will probably have  to be turned. In  case this  cannot be
effected, its chest must be opened and emptied of its contents, that
there may be room to bring  down the head.  It is barely  possible to
avoid a resort to art in  this presentation. 
384                    FEMALE DISEASES.
  Flooding or Hemorrhage, occurring to an alarming extent, is hap-
pily one of the rare incidents or consequences of labor.  But when it
does occur, it demands the most serious and prompt attention.
  Profuse bleeding from the womb is most  commonly owing to a
partial separation of the  placenta, or after-birth, from  its attachment
to the internal cavity; and it  has recently been observed that the flow
proceeds more rapidly from  the  detached portion of the  after-birth
than from the  corresponding exposed surface of the womb.   A knowl-
edge of this fact has an important practical bearing;  for if, in severe
cases of  flooding,  the  partially detached  after-birth can be entirely
separated, the  bleeding will often  be speedily arrested.
  The most dangerous  floodings occur in cases of placenta previa,
when the after-birth is over the mouth of the womb.   In such cases,
when the labor  commences,  and  the womb begins to open itself, the
after-birth must of course be partially separated.  These cases, unless
promptly relieved  by art,  may prove fatal in a  few minutes.  Yet,
there is ordinarily sufficient time, if it be improved, calmly to choose
and  pursue  the  proper treatment.  If the flooding be immediately
dangerous to  life, the child  must be turned  and delivered, or the
tampon or plug be applied, as directed under the head of abortion.
This expedient is  used when, through rigidity of the mouth of the
womb, the delivery is inadmissible.

  Before Delivery. — In all cases of flooding,  we prescribe  quiet, the
recumbent posture, cold applications to the abdomen and the external
genitals, and the internal  administration of astringents and anodynes
(152).
  After Delivery, our object is to promote contraction of  the womb
by cold applications and frictions externally, or, if necessary, by the
introduction of the hand into the  womb, for the purpose of removing
the after-birth, clearing out clots, or stimulating it to shut itself up for
the expulsion  of the offending substance.   Until this contraction  is
secured, the plug should  not  be used, lest  internal bleeding into the
enlarged and  expanded womb should  be profuse, and fatally exhaust
the patient.

  After the  Child  is Bom, pur first duty is, if possible, to see that  it
breathes.  In  the  vast majority of cases, the  well-known  cry, which
salutes the ear, gives proof that the duty is unnecessary.   But some-
times we fail to  hear this welcome sound.   The umbilical cord may
be once  or  repeatedly wound  around the child's neck, and must be
immediately removed to prevent  strangulation ; or, the child's mouth
may be  filled with phlegm, or some  sticky  mucus, which must be
poked out with the finger, and its exit favored  by turning the  face
downward; or, after tedious labors, the child may be born in a v^ry
feeble  state, and may  need the stimulus  of cold  water thrown sud-
denly, in small quantities, upon its chest and  body, with considerable
rubbing, and perhaps the inflation of its lungs with air blown into its
mouth.
  Tying the Cord.— When breathing is established, a piece of narrow 
                        FEMALE DISEASES.                     385

tape or common twine  is to be tied tight around the  navel-string,
about two inches from the child's navel, and the cord is then to be
cut off, with a pair  of sharp scissors, from half to  three  quarters of
an  inch outside the place where  it is tied.  The child is then to be
.delivered to the nurse.

  Washing the Child. — The child is now, while the physician is  at-
tending to the mother, to be washed and  dressed by the nurse.   Its
skin is at this time covered with a  suet-like  substance, called the
vernix caseosa.  To remove this, it should  be washed  all over gently
with warm water  and castile soap.  It is not material that this coat-
ing should be absolutely all removed at the first washing;  but the
soap and water should be again gently applied in eight or ten hours
from their first use.  It is improper  to use spirits for this cleansing.
All rough rubbing must be avoided as injurious to the delicate skin
of  so tender an infant.   Washing with cold  water  would lower the
temperature  to a dangerous degree, and should in no case be allowed.

   Removal of the After-Birth. — The woman having rested fifteen or
twenty minutes, a little  gentle  soliciting or pulling with the cord will
generally bring away the after-birth.  If, however, any serious obsta-
cle prevent its expulsion, it may be slowly and cautiously taken away
by the hand introduced.

   Cleansing  the Bed, and Applying  the Swathe. — Upon the removal
of  the after-birth, a  cloth is immediately applied to the  external or-
gans, a drink of water or tea is administered, and another rest of an
hour  or  more allowed.   The  woman may then be  conveyed to a
neighboring  bed, sofa, or easy-chair, for the purpose of cleansing the
bed, adjusting her clothes, and  applying the swathe.  This last men-
tioned application may consist of a towel pinned snugly around  the
body, or of a cloth, cut and fitted exactly for the purpose. Its object
is to afford a firm and steady support to the contracting womb.
   If a chair  is occupied  while the bed is being arranged, it should be
well tipped back, and the woman's feet supported on  a high stool, as
it is of great importance, so soon after delivery, to keep her either
entirely or very nearly in the recumbent posture, to avoid dangerous
floodings.

   The Dressings for the Child's Navel should  be so fixed  that  the
navel-string or cord will  not be left in  contact with  the healthy skin.
To effect this, make a hole large  enough  to admit the  cord in  the
centre of a piece of linen  cloth four inches square ;  pull the cord
through this  hole, leaving the cloth lying flat  upon the child's belly ;
then, having bandaged the cord down to the belly, fold the cloth over
it,  and apply the belly-band.   The interposition of these dressings
will thus keep the cord, which is dead and in process of decomposition,
from irritating, and perhaps excoriating the living flesh, with which it
must otherwise be in close contact.

  Nourishment of the Child, etc. — After  being dressed, the child
should be kept  next the body of the mother or nurse, that it may
                               49 
386
FEMALE DISEASES.
 receive the natural warmth thus  to  be derived.   Its nourishment
 should be obtained exclusively  from the mother's breast.   If it is
 hungry, be sure and keep it so.   There is nothing more appropriate
 than a hungry child all ready to take hold and  exhaust the full and
 almost bursting breast on the  third day, when  the milk has come.
 Alas!   How many children have been fed on sweetened water, and
 on milk and water, till they have lost all instinctive idea of, and all
 appetite for, nursing! and how many bowel  complaints and broken
 breasts have  been the  miserable  consequence!  But meddlesome
 friends are afraid the  "little dears" will starve; and therefore they
 must first be  made sick by unnatural diet, and then for their cure be
 treated to that filthy, harsh,  and  indecent substitute for medicine,
 " chamber-lye and molasses."
   But it may  be asked, " must not the child be fed at all, if it is hun-
 gry, and cries  a great deal, and there is nothing in the mother's breast
 for it ? "   Such  cases will be  exceedingly rare, if the  breasts have
 been properly  solicited from the first by a hungry child.   When they
 do occur, being themselves exceptions, their  treatment must be  ex-
 ceptional ; but, even then, only so far as is absolutely necessary.  If
 fed at  all, the child should not  be fed  to  satiety, but as little as the
 circumstances will possibly permit.   The great rule remains: keep the
 child  as hungry as possible till the milk comes.  When it has to be
 fed, imitate the mother's milk as nearly as possible in the preparation
 of the artificial  diet.   A  little  sweet cream, warm water  and sugar,
 should be so  mingled, that in warmth, richness, and sweetness, the
 mixture may closely resemble human milk.

   Diet of the  Mother. — For the first few days after confinement, the
 most  appropriate  diet  for the mother is gruel, cocoa, rice-water, crust
 coffee, or  some  similar liquid nourishment.   Different constitutions,
 however, need somewhat different management.
   A woman naturally robust, and of full habit, should confine herself
 more  strictly,  and for a longer  time, to this light diet, than one who
 is more slender and feeble.  In  some cases,  weakly women  require
 the juice of meat, and even wine or ale, as early as the second or third
 day.    If she be subject to canker, or nursing-sore mouth, a generous
 diet is  particularly serviceable.   After the first week, she may gradu-
 ally return to her customary diet
   Costiveness may be treated  with the usual remedies.  It was an
 did rule to give a dose of castor oil on the third day, when there is a
little increase  of excitement in the system,  from the filling of the
breasts.  This  is not always necessary, and in  most cases an injection
would be far better.

  The  Perpendicular Position.—During the first month, let the woman
 avoid being often or long on her feet  This is a very essential caution
to avoid prolapsus, or falling of the womb, with all its attendant weak-
 nesses  and pains, and  to  ensure a good  " getting up," with a sound
womb, in the right place, and subsequent months of health and enjoy-
ment. 
FEMALE DISEASES.                     387
     Milk  Leg.—Phlegmasia Dolens.— Crural Phlebitis.

  The popular idea is, that in this disease the woman's milk has fallen
into her leg, which has inflamed.  This is of course absurd.   As to
the real nature of the complaint, there are various opinions, — some
holding it to  consist in  inflammation along the sciatic,  crural, and
pubic nerves; others, that it is an inflammation of the lymphatics of
the groin which causes it; others, that it is an inflammation of the
crural veins.   Probably this latter view is  the correct one.
  Symptoms.—.The disease begins in from  two to seven weeks after
delivery, with pain in the lower  bowel, groin, or thigh.  The pain is
more violent when the thigh is extended.   In a day or two, the pain
diminishes, and the limb begins to swell, frequently in the calf of the leg
first, thence extending upward, but generally in the groin, and extend-
ing gradually down.  The skin  becomes  entirely white, smooth, and
glossy, does  not pit when pressed, is painful to the touch, and is hotter
than the skin upon  the other limb.  In  connection with this local
disease, there is general fever, with small and rapid pulse, thirst, etc.

  Treatment. — The patient must lie flat upon  her back, with  the
swelled limb placed upon pillows, or a bolster, raised so that the foot
shall be a little higher than the hip, and  then charged not  to put  her
foot down upon the floor, until she is very nearly well.
  Apply a narrow blister along the course of the crural vein.   When
this is removed take  a large piece of flannel, — Dr. Meigs says an  old
flannel petticoat, with the hem and the gathers cut off, — and dip it in
vinegar and hot water, equal parts; wring it out, and cover the whole
limb with it.   Put a piece of blanket  or oiled silk  over it to keep it
from wetting  the  bed.   Repeat this, and keep it up for  six hours.
When it becomes tedious to the patient, remove  it, and  bathe  the
limb with warm sweet oil, two parts, and  laudanum, one part, and
cover it with flannel.  In two or three hours, return to the first appli-
cation  of hot water and vinegar.  Continue  this for five or six hours,
and then take warm sweet oil and laudanum ; and thus pass from
one to  the other until the inflammation is subdued, or, as Dr. Meigs
says, till the calf of the leg can be shaken.
  If the bowels are  confined, let them be gently moved by some gen-
tle physic (13)  (14) (18) (25) (27) (41).
  In many  cases, diuretics and cathartics  combined will  be  proper
(302), or diuretics only (128) (130).
  While the inflammation lasts, and there is fever, the tincture  of
veratrum viride must not be forgotten.
  If recovery does  not take place after the  active inflammation  has
subsided, the limb should be bandaged from the toes to the groin.

            Child-Bed Fever.—Puerperal Fever.

  Few complaints more justly excite the dread of the practitioner
than this.  It cuts down woman at a time when she  can  least of all 
388                    FEMALE DISEASES.
be spared by her young offspring, and at a moment when she most
excites the love  and sympathy of her whole family.   It is a terrible
disease.
  It consists of inflammation of the peritoneum or lining of the ab-
domen ; also, frequently inflammation  of the ovaries, of  the womb,
of the veins of the womb, or of the absorbent vessels  of the womb.
  Its symptoms have already been described, on page 277, under the
head of inflammation of the peritoneum.  The treatment is, likewise,
there given.   I may mention here, however, that an infusion of cham-
omile flowers is lately spoken of as a powerful means of preventing
suppuration in this complaint.
  There is a diversity of opinion as to whether this disease is conta-
gious, though the best medical testimony seems  now to be on the
affirmative side of the question.  The physician or midwife having a
case of child-bed fever in  charge, should not  for some time attend
cases of midwifery.

                   Nursing Sore Mouth.

  Nursing women sometimes suffer terribly with  this complaint  It
begins with a scalding  sensation upon the tongue, a pink color in the
roof of the mouth, and a  hot, watery discharge from the mouth.
After a few days, small ulcers appear on the tongue, and in the
throat   Costiveness  is generally present; but when the ulceration
extends to the bowels, diarrhoea occurs.  It comes to an end upon
weaning the child.

  Treatment. — To relieve costiveness, give some gentle cathartic (12)
(15) (25)  (34) (36).
  Iron  in some of its forms  and combinations is highly necessary (61)
(71) (73)  (349).
  Gargles* will frequently do much good (227) (229) (230)  (235) (243)
(244) (347) (350).
  The  diet must be simple, nourishing, and digestible, consisting of
stale bread, potatoes, tender beef steak, roast beef, broths, etc.


    Inflammation  of  the Breast.—Broken Breast.
                       Mammary Abscess.

  The mammary gland, or  gland which secretes milk in  the human
breast,  consists of a number of ducts, passing inward from their ter-
mination in the nipple, and  then spreading around like the roots of a
tree, and  terminating  in minute glands.  The  mammillary tubes are
straight ducts, ten or twelve in number, having their mouths at the
centre of the  nipple, dilating  at its base into larger reservoirs, which
extend some distance into the gland.   (Fig. 142.)  •
  When  milk is first formed, after confinement, these tubes and  res-
ervoirs sometimes get so full  and hard that they crowd and compress
each other, making  it difficult to remove the  milk, and  under these
circumstances, the breast will inflame. 
FEMALE DISEASES.
389
  Symptoms. — The inflammation generally  begins  with a chill, fol-
lowed by fever, and pain of a shooting kind, which is much increased
                 by pressure.  An examination will generally reveal
                 a circumscribed, hard, and painful  tumor,  even be-
                 fore  there is any redness on the  surface.   After a
                 time, the swelling spreads,  the  skin  becomes  of a
                 dusky red, is hot and shining, will frequently pit a
                 little on pressure, and soon gives a  sense of fluctua-
                 tion.  Upon  the  formation  of matter,  the  fever is
                 increased, the breast is  enlarged, and there is local
                 tenderness and throbbing pain.
                   This  complaint may be  caused  by taking cold,
                 irregularities in  diet, or by mental  emotion;  but
                 more commonly  it is  caused by  accumulation of
                 milk within the ducts.

                   Treatment. — These  afflictions may generally be
prevented by keeping the breasts  well  drawn.   It is  the duty of a
nurse to look well after this matter, and see that  the breasts  do  not
get hard and distended with milk.
  But when the inflammation has fairly set  in, the  first aim  should
be to prevent, if possible,  the formation of matter.
  Active purging should  be resorted to at once (29)  (32).  Sweating
should  be  encouraged by the tincture  of veratrum viride.   If  the
object be to prevent the  formation of matter, cold lotions, or  cold
water  compresses, should be  used freely; but if two  or three days
have passed before active treatment, the suppuration will go on,  and
it is better to use warm applications.  Dewees says warm vinegar is
the  most beneficial as well as the most  comforting.  Poultices  and
warm fomentations are much used.   Some apply  stimulating  lini-
ments,  made of essential oils, etc.  (195)  (198).  Leeches are often
used with advantage.  They should be applied, not  upon the  breast,
but just below it.
  During the progress of the  disease, especially after the abscess is
opened, the breast should  be supported, and prevented  from hanging
down, by long strips of adhesive plaster  carried below and around it
By this means a gentle pressure is kept up  by which the matter is
more easily evacuated.
  The breast should be opened with a lancet  as soon as the abscess
points,  or  fluctuation  is  discovered.   Should  the ulcer not heal, an
astringent wash, as a weak  solution of nitrate of  silver (211) may be
applied to it once or twice a day.
  During the discharge of matter, the system of the patient  should
be supported by a nourishing diet, and by wine, tonics, etc.


                         Sore Nipples.

  Women suffering from  excoriated nipples are apt to keep the infant
chiefly to the healthy breast, and only to  apply it to the tender  side
for the  purpose of  obtaining  present ease from the pain of over-dis-
 
390                     FEMALE DISEASES.
tension.  In this way the  ducts  remain always full, and  are  apt to
get inflamed.   Sore nipples, therefore, are to be attended to as much
on account of the evils to which they lead, as of the suffering they
directly occasion.
  The excoriation of the  nipples begins  as a chap.  This shows no
tendency to heal; and the child's mouth being often' applied, rubs off
the skin around the crack, and this naked surface soon becomes an
ulcer.   These ulcers are  sometimes only on  the  surface; at other
times they  are profound, going deep into the substance of the nipple.

  Treatment. — These excoriations  and ulcers might be easily healed,
were it not that the newly-formed skin is apt to be continually rubbed
off by the child's mouth in the act of sucking.   Two things are there-
fore to be done, — to favor the healing, and to protect the tender part
from renewed injury.
  For the first object, a strong infusion  of green tea or port wine may
answer very well in ordinary cases.   A little alum or borax, dissolved
in rose water, or water (201) (202), is often used.  A weak solution
of sulphate of zinc, or sulphate of copper, or  nitrate  of silver (209)
(211).  But one of the very best articles is composed of glycerine and
tannin (306).
  To  protect the teat from injury  in the act of sucking, use a shield
made  of India rubber.  When  the infant is not at the  breast,  the
nipple should be covered by a metal shield.

             Whites. — Leucorrhoea. — Fluor Albus.

  Though  leucorrhoea is  only a symptom of  disease, — as  I have
stated on page 353, — yet I think, on further reflection, remedies should
be given for it, and  I accordingly insert them here.
  If the discharge be of a ropy, tenacious character, one  of the best
remedies is a strong solution of nitrate of  silver, used  as  an injection
with a female syringe, once a day (10).  Of  this, not  more than two
teaspoonfuls should be used at a time;  and great care should be ob-
served not to stain the under-clothes with  it.   When the discharge is
eifher  yellow and thick, or lighter  colored and watery, some  one of
the following (200), (202),  (203),  (207),  (209), (220), (230), (232),
(243), (244),  may be  used with advantage  as an injection, twice
a day.  An infusion of the white pond  lily, one ounce to  the  pint of
water, or two drams of the fluid  extract of the same  in  four  ounces
of water, makes a very excellent injection, which may be  used twice
a day.  A  very simple injection,  and sometimes quite effectual, is a
strong infusion of green tea.
  Some one of the above remedies will generally afford some relief;
but if whites exist in a somewhat  aggravated  form, they  furnish  evi-
dence of some  serious disease in  the  vagina, or neck of the  womb,
and the case  ought to be submitted to a competent physician. 
CARE OF  CHILDREN  AND  THEIR  DISEASES.
  Pure Air. — The first want of a child is a plenty of fresh air; and
this want never ceases to the end of life.   Impure air kills thousands
of  infants.   Out of 7,650  born in the lying-in  hospital of Dublin,
2,944 were destroyed by impure air within two weeks after birth.
  Children should be kept in the open air as much as possible, and
in well-ventilated rooms when indoors.  It is wrong, when infants are
sleeping, to cover their faces with bed-clothes, or draw curtains around
their cots, or  to envelop  their  heads in blankets  and shawls  when
carried in the open air.

  The  Shin.— The health of infants requires that their skin should be
kept clean.   Unless this is  done they are liable to suffer much from
cutaneous and other diseases.  The skin of a new-born child is cov-
ered with a white, unctuous matter, called the vernix caseosa.  It is
injurious  to let  this remain for any length of time after birth.  To
remove this, Dr.  Dewees recommends that the child be smeared with
hog's lard, and then washed with soap and water.  Dr.  Eberle says,
smear with yolk of eggs, and then wash with simple warm water.
  The young child should be washed every day with warm water,—
then, after a time, with tepid water, then with temperate, and finally,
after it is some months  okl, with cold water.   This, if persevered in
through childhood and youth, will ward off a thousand ills and sick-
nesses to which the young are liable.                            •

  The  Clothing of Children should  be so adjusted as to give their
limbs ample  play, and should be thick enough to keep  them warm.
They ought to have flannel  next the  skin in winter, and cotton  in
summer.  At the risk of wounding  some  nice  people's feelings, I
must add that the fashion of a child's clothes is not important.

  The  Food. — The natural and proper food of a young  child  is  its
mother's milk.  To this it  should be  confined, unless prohibited  by
imperative circumstances, until a portion of the teeth are  cut  When
the'mother  cannot nurse her child, the  breast of a  suitable  nurse
should, if possible, be* supplied.   If the infant  need  any more food
than is supplied  by the breast, give cow's milk and water, sweetened
with a little loaf sugar.   The sucking-bottle, if used, must  never  be
permitted to get sour. 
392          CARE OF CHILDREN AND THEIR DISEASES.
  Health  of a Nursing Woman. — During nursing the greatest atten-
tion to health is required by the mother or the nurse.  A woman of a
consumptive  constitution should never nurse an infant.  Nourished
at the breast of  such a mother, the child, who has inherited her  con-
stitution, will be the more likely to fall a victim  to her disease.

  Passions of a Nursing Woman. — Let  the woman who  nurses  a
young child be careful of her passions.  An irritable disposition, giv-
ing rise to gusts of violent passion, may so alter the character of the
milk as to throw the child into convulsions.   Grief, envy, hatred,  fear,
jealousy, and peevishness, unfit the milk for nourishing the child, and
often cause the child's stomach to be much disordered.

  The  Diet of the Nurse should receive strict attention.  It should be
plain and wholesome, and the  amount  should never  be excessive.
Her drink should  be simply water.  She  should take gentle daily ex-
ercise in the open  air.

  Weaning. — At  the end of twelve  months,  the first set of teeth are
generally  so far cut that the  child  can manage most kinds of plain
food; and it may  now be taken from  the breast.  Should the teeth
appear  earlier, and the  infant  be healthy, it may be weaned even at
the end of the tenth month.  Never take the child from the breast in
the midst of summer heat    A disordered  state of  the  bowels,  or
cholera infantum,  would be likely to be the result.   The  spring and
the autumn are the proper periods for weaning.
  If for some months, it have been accustomed  to other food beside
the milk  of the mother, it may  be  taken suddenly from  the breast
It must not have any amount of solid food it may crave immediately
after weaning.   It should still be kept, for some  time, upon a simple,
bland, half-fluid  aliment, taken in moderate quantities, an*d at  proper
intervals.  At first, the food should be bread, and  milk, boiled rice and
milk, soft-boiled eggs, roasted potatoes and milk, oat-meal gruel, plain
rice  pudding,  preparations of  arrow-root, tapioca and  sago, simple
meat broths, mixed with crums of bread or grated  crackers, or  in
which  rice or barley has been well boiled.  From  this it may  pass
gradually  to a more  solid diet; though, until the age of puberty, the
principal part of the diet should be milk, the farinaceous articles, and
vegetables.  Sugar has been thought to be injurious to children.  It
is not so.  If taken moderately, at meal times, it is wholesome.
  Whatever be the food allowed  to  children, it should never be taken
in excess;  and to prevent this, they ought not to take their meals alone;
for they have very keen  appetites, and if permitted to do so, they will
generally form habits of gluttony.   Three or  four light meals a day is
enough.
  Their drink should be water simply, — nothing else.
  If parents would observe, these rules, and enforce them strictly, they
would confer blessings upon their children greater than riches.  They
would  send  them  into the world with health and good  constitutions,
and would save  them from untold misery and an early death.   Such
a course would  evince  more  love for their children than those weak 
CARE OF CHILDREN AND THEIR DISEASES.          393
concessions w4iich allow tea and coffee, and all sorts of food, in quan-
tities  to  suit, which  occasion early disorders  of the stomach  and
bowels, and  bring later derangements of the nervous  system, with
all its regrets and  horrors.

  Sleep of Children. — During the first period of its existence, an in-
fant sleeps a large portion of the time.   This is a wise provision of
nature.  It withdraws the young child, for a time, from those outward
exciting  agents, which would too much disturb the nervous system of
so tender a being.  Whenever a young infant is  restless or wakeful
much of the time, we may feel sure it has  had too much food, or is
in some  way disturbed by it, or by tight  clothes, or that some other
cause is  giving it uneasy sensations.
   Its sleep should be the promptings of nature,  and should never,
except in rare instances, be  brought about  by opiates.  It is wrong
and sinful for a mother  or nurse to put an  infant to sleep with an
opiate, merely that she may gain time for  pleasure, or even for other
duties.

   The Infant should  be  kept warm while Sleeping. —  During the first
few weeks it should sleep with its mother, — especially if the weathet
be cold.  After that, it may be in a cradle or cot.  The  covering should
be warm, but light, so as not to press  heavily upon its tender limbs.
If laid upon its back, the fluid of its  mouth and throat may get into
the windpipe, and obstruct the breathing, or  produce coughing.   It is
better, therefore, to lay the infant upon its side,— taking care not to
produce  distortion of the spine or limbs by always laying it upon the
same side.
   Children should not be allowed to sleep either with the aged, 01
with sick persons.  It is not healthful  for them to breathe the exhala-
tions from'the bodies of such.  For a somewhat similar reason, some
kinds of plants, and flowers generally, should be excluded from their
sleeping rooms.  Their beds should be so placed as to  turn their faces
away both from the  sun-light which  comes in  at the windows, and
from the artificial light in the room.
   They  should be taught to retire early at night, and to  rise imme-
diately after waking in the morning.   This habit will  be worth much
to them  through life.   After the meeoneum has passed, the bowels of
an infant  should be opened from two to four times  in twenty-four
hours.   If the stools are less frequent than twice  a day, or, if they are
lumpy, some gentle cathartic  is  called for.  From half a dram to a
dram  of fresh castor oil, or a dessert-spoonful  of mixture  (24)  an-
swers a good purpose.  During childhood, the bowels should be moved
once  or  twice a day.   When a cathartic is required, a table spoonful
of mixture (25), or a teaspoonful of  (17), will be found very excel-
lent.

   Exercise. — During the first few weeks of  an infant's life it requires
but little exercise ; indeed its organization  is not sufficiently settled
and compacted to permit much without injury.   A little gentle rub-
bing  with the hand  over the whole body,  is about all it needs or will 
394          CARE OF CHILDREN AND THEIR DISEASES.
bear.   To dandle and toss it about, and especially to sat it upright, is
injurious and wrong.  Its bones are all  soft, and will not endure to
be much twisted about, and its spine is not stiff enough to bear up
the weight of its head.
  After a few  weeks, riding in a carriage drawn by a careful and
trusty nurse, is  both a healthful and pleasurable exercise  for children.

  Learning to Walk. — At the end of the  ninth or tenth month, a
child may begin to learn to  walk.   It is not safe to teach it this exer-
cise much earlier than this, as  the bones, being soft, may be  bent by
the weight of the body,  and the limbs be permanently deformed.
  As soon as the child has learned to walk alone, it should be allowed
perfect freedom of exercise.  Thenceforward, the open air is its proper
place during the day;  and  such an unrestrained use of its limbs as
its own instincts may dictate, is its proper calling.   For five years
after it has learned to  walk, it should  do little else  than to use its
limbs out of doors, as it pleases.   The  books and the school-room
will be in season after that.   First compact the body, — then bring
out the mind.   The mind is of no use without the body, — the body
must be developed first, or never.

  Moral Treatment. — We charge  upon nature many of the bad pas-
sions which we ourselves implant in children.   The moral treatment
of children is  generally bad.  We are apt to begin by either making
them our masters or our slaves.   Sometimes we do both, — allowing
them to  govern us for  a time, and then, getting into a passion, or a
mood for playing the tyrant, we turn upon, and govern them as if we
were autocrats.   We submit to their whims until we  grow irritable,
and then, by way of retaliation, we compel them to submit to ours.
  This is all wrong.   Children  should be governed always, but with
an even, a gentle, and a  loving hand.  They should early be subjected
to habits of self-control,  and of regularity in eating, and sleeping; and
should be taught absolute and continued obedience.   All this can be
brought about only by firmness, self-control, and  great gentleness on
the part  of  the parents.  If they would  make a child  cheerful and
happy in its disposition, they  must themselves be cheerful, and never
let  it  see  anger, passion,  and fretfulness, marring  their conduct
Nothing  is  more  injurious  to the  health of a child than a peevish,
complaining, and soured disposition ; and these  vices are seldom ac-
quired, unless seen in the lives of parents.


               How to  Nurse  Sick  Children.

   As the education of  the  young, whether religious, moral, or  intel-.
lectual, is more important than that of  adults, so is the care of their
physical  life of more importance.  Death aims to "out-Herod Herod,"
and seeks the life of all infants, male and female, and in fact destroys
one half of  all below the age  of five years.
   But few know how to train and  take care of children.  It is a still
more rare gift to know  how to nurse them when  sick.   No persons 
CARE OF CHILDREN AND THEIR DISEASES.         39o
 can properly nurse sick children who  are  in  feeble health, or  have
 fretful tempers, or are low-spirited; for they can neither endure the
 fatigue, nor  bear  the  trials, nor hear the prattle which such a respon-
 sibility would bring.   Some will manage a well child very well, who
 are not  fit to have the care of a sick one ; for there is a great differ-
 ence between a  child  when  well,  and the same  child when  sick.
 When well, and full of fun, and frolic,  and life, laughing, and jump-
 ing, and shouting aloud for very joy at being alive, it is an easy thing
 for a  person of even a morose temper to  attend upon  them.  But
 when sickness  comes, and the  child's  playfulness is all laid  aside ;
 when it becomes so  fretful that nothing goes right with it; when it
 cries to be laid down, and then cries to  be taken up ;  stretches  out its
 hand  for  drink, and  pushes away  the  cup when it is presented,—
 apparently made  more angry  by your attempts to serve it; — when
 these things are repeated, day  and night, until the nurse is weary and
 exhausted, and even a change  of disease and amendment only brings
 a cross and fractious temper, it is only by possessing peculiar qualifica-
 tions, that the nurse can maintain an even and  unruffled disposition.
   While passing through such scenes, it is hard for the  nurse to re-
 member that sickness does not destroy the little loving heart, but  only
 hides its affection for a short time.

   Signs  of Disease in Children. — It is  important that the nurse of
 sick children should  know what to observe, and the meaning of the
 signs of disease.  A  baby has  only cries to express its sick feelings.
 To one person, these  cries mean no  more than that the baby has some
 sort of illness.  To another, with more experience and better  powers
 of  observation, they point to the head, or chest, or  st#mach,  as the
 disorder.   A baby with the stomach-ache, utters long, loud, and pas-
 sionate cries, and sheds tears plentifully.  Suddenly it stops for a mo-
 ment, and then begins again, — drawing up  its legs  to the stomach,
 and as the pain passes off, stretching them out  again, and with many
 sobs, passing off into  a gentle  sleep.
   If there be inflammation in the  chest, it neither  cries aloud, nor
 sheds tears, but after  every long breath,  or hacking cough, it utters a
 short cry,  which is cutoff before it  is half finished, — apparently be-
 cause crying is painful.
   If the disease be in the head, the cries  will be  sharp,piercing shrieks,
 with low moans and  wails between.  Or, there  will  be quiet dozing,
 interrupted by startling pains.
   When a child is taken ill, whatever the disease which is impending,
 there, is always a change of some sort, which soon attracts attention.
 It either loses its  appetite,  or is fretful, or soon  tired, or sleepy, or
 restless, or thirsty, or has a hot skin, or, rather, has a number of these
 symptoms.  It vomits, or is purged or bound in its bowels.  It loses
its  merry laugh and cheerful look; it no longer watches its mother's
or its  nurse's eye, as  before, but clings  to her  more closely, and will
not be out of her arms a moment   If lulled to sleep in  her arms, it
wakes immediately on being placed in its cot.
  Such symptoms often continue  a day or two  before it can be de- 
396         CARE OF CHILDREN AND THEIR DISEASES.
termined what disease is impending.   An  intelligent nurse may do
much towards solving the question.  It is frequently proper at such
times to place the child in a warm bath.  When stripped for the bath,
it should be carefully examined  to  see if there is any rash upon its
body.  If it be a rash from which it is about to suffer, the bath will
help bring it out. The rash should be looked for at least  every twelve
hours, until the nature of the disease is determined.

  The Appearance of the Different Rashes may be distinguished with
a little care and experience.   Measles has a number of dark red spots,
in many places  running  into each  other, and is generally seen first
about the face, and on the forehead, near the roots of the hair,  and is
preceded by  running at  the  eyes  and  nose, and  all the signs of a
severe cold.   Scarlet fever does not show separate spots,  but  presents
a general bright red color of the skin, much like a boiled lobster.  At
first there is more of it about the neck and  chest than  on the face,
and it is preceded  by a sore throat   Chicken pox is  attended by
fever, but not so much running  at the  nose and eyes as in  measles,
nor is there so much cough.  The spots, too, are smaller, and are not
so much run together; and they come out more over the whole body.
They appear a few hours earlier on  the body than  elsewhere ; and in
a day or two they are found to be enlarged, and turn into little blad-
ders of water as big as the head of  a shawl-pin.

  And now  a few Words as to  what should be Done in the sick-room
of a child.   The room should be kept cool, and its temperature should
be  measured by a thermometer.  This instrument, when  hung away
from  the fire,^hould  show a temperature of about 55°.  That is about
the right degree of warmth.  Sick-rooms are generally kept  too hot.
The room  should be darkened; not made totally dark,  but  its light
shaded down by closing the outside blinds, or  by dropping  the cur-
tains, so as to give a kind of twilight; and the cot should always be so
placed as to turn the little one's face away from the light.  The room
should be kept quiet; and this requires attention in the whole  house,
as well as among the persons in the room.   Those present should
never whisper, but speak  in low and gentle tones, — should not walk
on tip-toe, but move about carefully. There is a. fussy quietness which
disturbs the sick far  more than noise.   The child  must be spoken to,
and roused from its slumbers, and turned from side to side, and raised
for its food or medicine, with a soothing tenderness, and a  delicacy
which never forgets itself.
   In applying leeches or cold  to a child, judgment is needed, to suc-
ceed well.   The leeches should be put  either behind the ear or on top
of the head, so that the child cannot see them.   Cold is  best applied
by means of a couple of bladders half filled with powdered ice, and
wrapped in two large napkins; one of them should be  placed under
the child's head, the  corner of the napkin being  pinned to the pillow-
case  to prevent its being disturbed, while the other  is allowed to rest
upon the head, with the  corner of  the napkin again pinned to the
pillow, to take off the greater part of its weight.  In this way the child 
PARE OF CHILDREN AND THEIR DISEASES.         397
will not be wetted, or irritated, as by the changing of wet  cloths,
nor will the cold applications get displaced by its movements.
   A word should be said respecting the  nursing of children in cases
of lung-inflammation, — an  affection from which they often suffer.
The lungs are much like two large sponges, and the  air enters them
through  the windpipe ; and  passing through  smaller and yet smaller
tubes, it comes at last into tiny cells, so small that they can only be
seen  by  a magnifying glass.  When the lungs are inflamed, some of
the tubes become stopped up;  and the  very  small cells  are  pressed
on by the flow of more blood than natural to the part; and  so the
air enters less easily, and  in smaller quantities, than it  should.  If
now you let the child lie flat, it is not only less able  to draw a deep
breath, and fill  the lungs, but the  blood also  flowing to the inflamed
portion of the lung, returns less easily than if  the child were propped
up in bed.   When a whitlow is on  the finger, if the hand be hung
down, the inflamed  finger will  become  redder, and  will  beat and
throb so  as hardly to be endured, while, if the hand be raised, the
pain will abate.  The same increase of pain does not follow an accu-
mulation of blood in  an inflamed lung, because the lung  is not as
sensitive  as the finger; but the consequences are  very serious.  The
air-cells being more and more pressed upon, the  admission of air is
more and more difficult, until, at length, a large part of the lungs is
rendered useless, and the child dies.
   In this disease, the temperature of  the room needs attention.  The •
air should not be quite so cool as in other diseases.  From 60° to 65°
is about  right
   Of course crying will irritate inflamed lungs, and it is all important
that a child sick with this disease  should  be soothed and quieted as
much as  possible.  Every good nurse knows how to do this better
than any rules can teach her.
   Sometimes  sickness and vomiting, from which  a child may suffer,
are increased by want of judgment in giving food  and drink.   When
there is  nausea, the stomach will bear only very  small quantities of
food at a time, while cold drinks are almost always borne much bet-
ter than  warm.   When there is nausea, it is best for an hour or two,
not to attempt to give any food or drink.   After the stomach has been
thus completely rested, give a  single teaspoonful  of cold water.  If
this is not thrown up,  it may be succeeded, in  ten or fifteen minutes,
by a second or a third.  If this is borne, give  a little water thickened
with  isinglass, or cold barley  water, or  cold milk and water; and
then,  with the  same  precautions, and in  very  small quantities, beef
tea, or chicken  broth, or whatever  else the doctor in attendance may
direct,  The smallness of  quantity, the coldness of the articles, and
the giving it without moving or disturbing the child, if possible, are
the important points to be  attended to.
   It is of great consequence that children suffering  from diarrhoea
should have  their skin kept very clean.   The pores should be kept
well open, so that the  fluid matter which is passing off by the bowels,
and through the mucous membrane or inner skin, may be diverted to
the outer skin.  In this disease, the skin of children is apt to become 
398         CARE OF CHILDREN AND THEIR DISEASES.
irritable, or even sore.  In these cases, soap  and water are quite apt
to increase the soreness, while a little starch, made as  for use upon
clean clothes, though much thinner, will, if used in place of soap, very
much soothe the inflamed skin.
  A child much  exhausted by diarrhoea,  or other disease, should be
moved or lifted out of its cot or cradle as little as possible.-  Suddenly
moving it when very weak, may cause fainting, or even convulsions.
Let it be sponged and cleaned by merely turning it, with great gentle-
ness, from side to side.
  In such cases, too, the child  should  be supported with proper nour-
ishment.  When  worn down  by diarrhoea, its desire for food may be
nearly lost.  Though at one time it cried much, and seemed to suffer,
it will, in this condition, grow quieter, and  doze, and even sleep on
for hours, appearing fretful  only when roused.  If, in such cases, the
child  be allowed  to go without food  because it  does not seek it, or
declines it when  offered, it will sink into  a deeper  and  deeper sleep,
and finally into a stupor which will  end  in death.   To give a little
arrow-root, or wine, or broth, may now require trouble and persever-
ance ; but it must be done, for upon it depends the child's  life.  The
effort to administer food  must not  be abandoned because  once or
twice, or several times unsuccessful, for the food which is refused one
minute, may be accepted five minutes after.
  In  the various  rashes  from which  children  suffer, there is a very
general fear of washing the surface lest the rash be driven in.  There
is no ground for this fear, unless it  be in measles; and even in  this
complaint, there is no danger if luke-warm water be used.  If only a
small part of the body be  sponged at a time, there is nothing to fear
even  from frequent washing;  and the passing of a wet sponge  fre-
quently over the surface is a great comfort when  the  skin is  burning
with  fever.  The same  remark applies to the changing of the linen.
The  same kind of objection, and with no better reason, is often urged
against cold  wat^r in fevers, though it  is most refreshing,  and if
taken in small quantities, and  often, never does harm, but often much
good.
  The Warm Bath. — The best  method  of giving a child a warm
bath  is a matter of importance.  There should  be  as little  parade
about it as possible.  If the child sees the bath prepared, is taken out
of bed, undressed and put into it smoking before  its  eyes, it may be
much alarmed, and cry so passionately as to be  really injured by it.
The  bath should  be prepared out of its sight, and  brought to the bed-
side  with a blanket spread over it  to hide  the  steam.   The child
should then be laid upon  the blanket, and gently let down into the
water, and then set to play with a couple  of corks with feathers stuck
in them.

  Inflammation  of the  Mouth.—Erythematic  Stomatitis.
  This is a  simple inflammation of the mucous membrane of the
mouth ; and is  very common during  infancy.  It may be confined to
the tongue, or spread over the whole mouth.  It is sometimes very 
CARE OF CHILDREN AND THEIR DISEASES.         399
 severe, going down into  the  gullet and stomach, and into the wind-
 pipe.  It occasions redness and pain in the mouth, and fretfulness of
 the  infant, — causing it to quit the  nipple suddenly when sucking.
 A frequent result of this inflammation is the secretion and  exudation
 upon the surface, of a white, matter-like  curd.  It appears in small
 points and patches.  This is  the thrush, or what nurses call children's
 sore mouth.  It is commonly confined to the period of suckling.

   Treatment. — For the simple inflammation  of the  mouth, a wash
 made by infusing the inner bark of slippery elm in water,  answers a
 good purpose ; and in more  severe cases, a wash  made of sugar of
 lead (227) will be found useful.
   In some mild cases of curdy exudation,  this  last wash will do well,
 if united with the daily use of the warm bath, and proper care of the
 diet.  But in the  more  severe  cases, a little  pulverized borax and
 white sugar  or honey (274) (275), placed occasionally on the  infant's
 tongue,  will do good service.  A decoction of equal parts  of blue
 cohosh and  golden seal is a good remedy.  When the curdy patches
 are  large, touch them with a mixture of hydrochloric acid and honey
 (276).  If the exudation have a look as if mortification were  taking
 place, use a wash  of chloride  of lime  (228), or chloride of soda, etc.
 (229), or creosote and mucilage (230), or alcohol and vinegar (231), or
 nitrate of silver (211).  When diarrhoea is present, with acidity, give
 (26).  In the more severe cases, when appearances of mortification
 are seen, quinine (69) should be administered.


     Follicular  Inflammation of the Mouth.—Aptha.

   This disease attacks the little glands of  the  mouth, called follicles,
 and appears about the time of cutting teeth.  Small white specks, a
 little elevated, first show themselves on the lips, insides of the cheeks,
 and under side of the tongue, etc.  The  specks enlarge, a .whitish,
 curdy matter flows out from  their centre, and ulcers' are formed, with
 elevated edges, surrounded by a red, inflamed  circle.   Sometimes,
 instead of curdy matter, a bloody exudation takes place, and dark-
 colored crusts are  formed which  are  mistaken for  mortification.   In
 bad cases,  there is great restlessness, with hot mouth,  dry skin, thirst,
 and diarrhoea, with green stools, and sometimes salivation.

   Treatment. — The  milder  forms of this disease are treated like
 simple inflammation of the mouth.   If there  is thirst, give  several
 times a day,  a spoonful of cold water, with a  little gum arabic dis-
 solved in it.   If the  child be weaned at this time,  its food should  be
 barley or rice-water, sweetened with loaf sugar.  An occasional dose
 of magnesia, with or without a little  rhubarb, will  remove the acid
which abounds in the bowels.   After  ulceration  has  taken  place,
borax (274) will do well.  When watery discharges  from the bowels,
and  griping  pains appear, preparation  (28) should  be used.   If the
strength be reduced, give (69). 
400         CARE OF CHILDREN AND THEIR DISEASES.
          Inflammation  of the Gums.— Gengivitis.

   During the cutting of teeth, the gums are apt to be inflamed, red
 or livid, swelled  and painful.  The child  is languid, with a hot and
 dry  skin, small and quick  pulse, little appetite, much thirst, and a
 tongue covered with a thick, yellowish fur.  When ulceration takes
 place, and is  allowed  to go on,  the teeth  become loose, black, and
 rotten, and often soft and pulpy ; a  flow of fetid spittle  takes place;
 the  breath of the child becomes  offensive, and its countenance  pale
 and sallow.   The gums bleed under the least pressure, and a profuse
 diarrhoea fills up  the list of ills.

   Treatment — In the first  stages, mild washes to the gums, such as
 (227), will do well.  Clear out the bowels once with magnesia and
 rhubarb  (26).  After ulceration has taken place, use oak bark (232),
 or chloride of lime (228), or diluted hydrochloric acid (233).   A daily
 tepid bath.   If the strength be reduced, use an infusion of Peruvian
 bark, or quinine (69).

   Gangrene of the  Mouth.—Canker.— Cancrum Oris.

   This disease attacks weakly children, of a lymphatic temperament
 and having inflamed gums.   It often follows intermittent, remittent,
 or bilious fever, and is also frequently connected with disease of the
 stomach and bowels.

   Symptoms. — It is attended with languor, listlessness, indisposition
 to play or move  about,  thirst, loss  of appetite, peevishness, and  ina-
 bility to  sleep.  The  countenance is pale  and sunken, and there is a
 peculiar  puckering of the cheeks about the  corners  of  the  mouth.
 The breath is  bad, the gums have  the appearance of salivation, the
 teeth become loose and fall  from their sockets, or, if they remain, they
 become covered with a thick coating of a dirty white or ash color.
 A few ash-colored water pimples appear upon the gums, which en-
 large, run together, and finally break, — presenting a black appearance
 of mortification.   The gangrene,  sooner or later, goes to the lips  and
 cheeks.

  Treatment. — When bowel complaints exist, they are to be treated
with  the  usual remedies, such as (70) or  (156).  If there be  active
inflammation  of  the gums,  at first, leeches may  be applied, after
which, the inflammation being subdued, a wash'of oak bark  (232),
will  be in place, with  quinine given internally (69) to ward off the
mortification.   As a wash, too, a strong solution of sulphate of cop-
per (234)  is excellent, — so is white vitriol (235), and nitrate of silver
(219), and creosote (236).
  The diet should be  beef-tea, plain beef or mutton broth, with rice,
milk and rice, tapioca, sago,  and the  like. 
CARE OF CHILDREN AND THEIR DISEASES.         401
                 Difficult  Teeth-Cutting.

  Teeth-cutting generally begins between the ages of five and seven
months.  It is indicated by redness, heat, and tenderness of the gums,
an increase of saliva, and, occasionally, redness of the cheeks, water-
ing of the eyes, thirst and fever, with fretfulness, disturbed s[eep, and
more frequent motions of the bowels, a little more fluid than usual,
and  sometimes of a greenish hue.   As the tooth comes near the sur-
face, the child holds its fingers in its mouth, and presses the gums
harder upon the  nipple when, sucking.   Beside these  milder symp-
toms, there  are sometimes  ulceration of the mouth, gangrene, exten-
sive  and long-continued diseases of the bowels, — and even disorders
of the brain, convulsions, and palsy.
  Treatment. — Watch the gums, and the moment they are swollen
by the teeth pushing them up, lance them at  the elevated points, cut:
ting entirely down  to  the advancing teeth, — so that no tough mem-
brane shall cause pain by impeding their growth.   These incisions
often prevent fatal disease  of the brain,  and  sometimes almost in-
stantly relieve the most threatening symptoms.   Before the teeth are
far enough advanced for lancing, some soothing wash may be applied
to the gums, or a leech or two to  the angle of the jaw. For obsti-
nate diarrhoea, with watery stools and griping, use prescription (157).
If the child be drowsy and starts  from sleep, and has heat and red-
ness, with enlargement of the  blood vessels about the head, put three
or four leeches behind the  ears, and make  cold  applications to the
head.   At  the same  time, open the bowels  with  castor oil  (17).
When there is difficulty of passing the water, give flax-seed tea; and
if the pain be considerable, an opiate (351).


                             Croup.

   This is  one of the  scourges of childhood.  In ten years previous
to 1845, no less than 1150 children were destroyed in Philadelphia by
croup.  During the year 1840, the  large number of 4,336 died of the
same disease in England.
   Croup is an inflammation of the mucous membrane of the larynx
and  windpipe.  It causes to flow out upon the surface  of the mem-
brane, a peculiar fluid, which  stiffens into a membrane, or skin-like
substance,  and adheres to the inner surface, of the wind-pipe, and
sometimes extends  through the whole of the bronchial  tubes.  This
is membranous croup, — the worst and most fatal form of the disease.
Dr. John Ware of  Boston  has shown that there are other forms of
croup, not so fatal,  because not attended by the formation of a mem-
brane upon the mucous surfaces.
  The Symptoms of croup are, difficulty of breathing, hoarseness, and
a peculiarly loud  and ringing cough, with fever.   In the membranous
and worst form of  the disease, the breathing is not, at first, so labo-
rious, and the symptoms generally not so violent and alarming  as in
                              51 
402          CARE OF CHILDREN AND THEIR DISEASES.
the less fatal but more inflammatory type.   This latter kind, though
generally causing great alarm, like a highway robber, by the sudden
fierceness  with which they seize the throat, are yet much less fatal,
and  of course less  to be feared, than the membranous form.  The
disease is pretty much confined to  children between the ages of one
and eight years.
  Treatment.— The old and usual mode of treatment is first to bleed,
and then to place the  patient in a warm bath ; and, after the child is
returned to the bed, to give nauseating doses of tartar emetic (105).
In Boston, this  treatment is now nearly discarded, as being too active,
and  possibly a cause  of evil rather th'an good.   The following is a
safer and more successful treatment
  •Give, every three hours, Dover's powder and calomel (352).  Sponge
the-neck often with water, and apply a liniment (192).   It is  some-
times proper to give  a gentle  emetic, — say, two drams  of wine of
ipecac.  A flax-seed poultice applied to the neck is also excellent.  If
the child be large enough, let it inhale frequently from an old tea-pot,
the vapor of hot water and mullein leaves ;  and if it be too young to
do this, keep the room full  of watery vapor, by throwing water upon
hot bricks.  If the bowels need moving, give a dose of castor oil (17).
In addition to these  measures, a strong solution  of nitrate of silver
(219) should be thrown into  the  throat with one  of my laryngeal
shower syringes, and  repeated  every two hours till  the membrane is
discharged.

      Spasm  of  the  Glottis.—Laryngismus Stridulus.

   This disease consists in  a sudden shutting up of the glottis, or pas-
sage to the windpipe, which creates a feeling of strangulation, and a
difficulty  of  breathing so  great that the drawing  in  of  the  breath
causes a peculiar crowing sound.  There is no fever.  The child, upon
taking food or drink,  or upon being irritated or teased, is taken sud-
denly with an impossibility of drawing in its breath.   After struggling
convulsively for a time, its head thrown back, its nostrils dilated, its
mouth open, its eyes  rolled up, its face pale, its legs and arms stiff,
it begins  to  breathe  with a  shrill  crowing sound.   The disease is
sometimes mistaken  for croup, and for hooping cough.   It is strictly
spasmodic in its nature.
   Treatment. — During the paroxysm, set the child in an upright pos-
ture, with  the  head leaning forward, exposed to a full draft of cool,
fresh air, and sprinkle cool  water upon the face.  Let nothing be tight
about the neck.  Slap the child slightly on the back, and apply fric-
tion along the spine.  If  these means do  not succeed, place  it in a
warm bath ;  while  in the bath, sprinkle cold water on the face.
   When the fit is over, examine the gums.   If they are swollen, lance
them down to the coming  teeth.   The bowels should be moved daily
with some gentle physic, but not irritated by severe purging.   If the
stools  are light colored, use prescription (142), with warm water in-
 jections. 
CARE OF CHILDREN AND THEIR DISEASES.         403
                Hooping Cough. — Purtussis.

  This  is a contagious disease, peculiar to childhood, and occurring
but once in the same individual.  It is characterized by a  convulsive,
paroxysmal cough, which is attended by long-continued  hissing, con-
vulsive  breathing, with rattling in the windpipe, which  is succeeded
by  several short  efferts  to  expel the breath, following each other in
quick succession.  The long, convulsive breathing, attended by the
hooping sound, is immediately repeated ;  and these paroxysms con-
tinue until a quantity of thick, slimy, ropy mucous  is thrown  up, by
expectoration or  vomiting, when the  breathing is again free.  These
paroxysms have all the appearance of impending suffocation, redness
of the face, shedding of tears, sweating about the head and forehead,
and such agitation of the whole body that  the child lays hold of
something for support.  Blood sometimes starts from the nostrils,
and the child involuntarily passes  water, or  evacuates the bowels.
In  spring and autumn, the disease most prevails.  It is not generally
dangerous.

  Treatment. — First  give  an emetic, — say, two drams of wine of
ipecac.   Afterwards, give small doses of ipecac and sulphur  (277).
From six to fifteen grains of sulphur alone, three times a day, is an
excellent remedy. A liniment of olive oil, oil of amber,  etc.  (193),
applied  to the spine,  is useful.  Belladonna (278) is a good remedy.
Prussic  acid (96) is  strongly recommended by many, and is worthy
of a trial.  Lobelia (106) is a valuable  remedy.   Alum  (279)  is well
recommended.  Sulphuric  ether, a little being  spilled in the nurse's
hand and held to the child's  nose, generally shortens the paroxysm,
and frequently abridges the disease.   A solution  of nitric acid in
water, as strong  as lemon juice, and sweetened, is a very valuable
remedy, — breaking up the disease in two or three weeks.   The child
may drink it freely, a  little  further reduced with water.

           Looseness  of the Bowels.—Diarrhoea.

  Infants and chilhren are more liable to diarrhoea than  adults, and
this is  the reason for speaking of  the  disease here as  well as else-
where.   It may be  caused by inflammation of the stomach  and
bowels, by irritation produced by too much or improper food, by cold
and damp weather, or by teething.  The discharges from  the  bowels
may be more or less thin, of a dirty-white color, of  a curdled appear-
ance, and acid smell, or they may be watery, yellow or green in color,
and often  mixed with blood.   Sometimes they  are mixed with  por-
tions of undigested food, are very acid, and when the looseness has
been caused by unripe vegetables and fruit, in a state of fermentation,
like yeast.  At other times, especially while teething, they are a kind
of thick mucus, like jelly.
  If pressure on  the bowels causes  pain, the diarrhoea is the result of
inflammation.  When the disease has become chronic, the  skin is dry, 
404          CARE OF CHILDREN AND THEIR DISEASES.
harsh, and discolored, the face wrinkled, looking yellowish, dirty, and
old.

  Treatment. — First, regulate the diet.  This is very important  In
the case of older children, take away every kind of solid food, as well
as pastry, confectionery, sweetmeats,  and  fresh vegetables.   Give
plain boiled rice and milk, — sometimes boiled milk, — water gruel,
crackers and milk, tapioca, etc.   At the beginning of the attack, give
some mild physic, as castor oil, or syrup of rhubarb.  A warm bath
at this period is excellent.  If the discharges  are very sour, dissolve
a teaspoonful of bicarbonate of soda in half a tumbler of water, and
give a teaspoonful every hour,  or the  same amount of lime water,
mixed with an  equal quantity  of new milk, or prepared chalk and
ipecac (158), some slight astringent being used also  (159).  But bet-
ter  than all other astringents for this complaint, is a  decoction of the
cranesbill or spotted geranium, with milk, or of the bark  from the
root of the common blackberry which is armed with  strong prickles.

The Summer Complaint  of Infants.— Cholera Infantum.

  This is confined to the North American continent.  It occurs in
large cities during the hot  season.  Its subjects are infants between
the  ages  of four  and twenty months, — occurring  most frequently
about the time of cutting the first teeth.  It is one of  the most fatal
diseases of infants.

  Symptoms. — It begins with a profuse diarrhoea, — the stools being
green  or yellow, or more  often light  colored,  and  very thin.  The
stomach soon becomes very irritable, — rejecting everything with vio-
lence.   In some cases, vomiting and purging set it, — the discharges
from the bowels being without color or smell.  The infant rapidly
loses flesh, and is soon reduced to  great languor  and  prostration.
The pulse in the beginning is  quick,  small, and often tense.  The
tongue is covered with a white, slimy mucus.   The  skin  is dry and
harsh.  The head and belly are hot.   The feet and  hands are either
of the natural temperature, or cold.  There is  great  thirst, and  tow-
ards evening, fever.   The belly  is often a little swollen, and tender to
the touch.   Occasionally there is delirium, as indicated by wild and
bloodshot eyes, violent tossing of the head, and attempts to bite and
scratch the nurse.

  Treatment. — If possible, remove the  child at once  from the impure
and  heated air of the city to the cooler  and purer air of the country.
If this cannot be  done, keep  it in as large and dry a room as can be
had, and take it often into the  open air, in clear weather.  Confine
the infant entirely to the breast, or, if weaned, let its  food be tapioca,
pure arrow-root,  rice flour, and milk, and put it daily in a warm or
tepid bath, according as the skin is hot or cold.   Give it  gum-water,
or rennet whey, with  a little gum arabic added to it
  These measures, if used early, will often  cure the  disease, without
medicine.   If the vomiting be obstinate, camphor and sulphuric ether 
CARE OF CHILDREN AND THEIR DISEASES.         405
(280) will generally give  relief.  When everything else fails, in re-
lieving the  sickness, sugar of lead  (160) is generally successful.
When the vomiting is stopped, the most prompt remedy for the dis-
ordered bowels  is  the  compound  syrup  of  rhubarb  and potassa.
When the disease has become chronic,  treat it the same as children's
diarrhoea.   But if the discharges are sour, offensive, and dark colored,
pulverized  charcoal  (42), with tartrate of iron (71), will be suitable
remedies.   Rhubarb, leptandrin, etc. (28),  will often answer a good
purpose.

                              Colic.

   Infants are very much subject to colic, from over-feeding and con-
sequent acidity of the stomach, from giving them  solid food  at too
tender an  age, and  from some improper thing ate or  drunk  by the
mother or nurse.   They often  suffer intensely from  these pains, toss-
ing  their legs up and down, and  screaming  vehemently.   When it
arises from costiveness, the bowels are often hard and swollen.
   Treatment. — When it arises from costiveness, give an injection of
a tablespoonful of castor oil, and an ounce of  warm infusion of pep-
permint or spearmint.  At the same time, administer internally an in-
fusion of one of the same herbs, with a small portion of bicarbonate of
soda dissolved in it, and sweetened with loaf sugar.   Or, if the bowels
need to be acted  upon, the syrup of rhubarb, or the  sweet tincture of
rhubarb, with a little soda in it, will do well.  Paragoric generally
brings relief, but  should not be used, if simple carminatives will an-
swer the purpose.  Children are often relieved by covering them with
a hot flannel, laying them upon the  belly on the  knee, and trotting
them, at the same time  tapping them  gently upon the back.   This
should be  done cautiously ; for if  unsuccessful, it might increase the
suffering ; and the infant has no language  but screams to tell its dis-
tress.

           Falling of  the  Bowel.—Prolapsis Ani.

   In cases of long-continued looseness, the lower  bowel of children
sometimes gets so weakened, that it drops down, and projects through
the  fundament.   Occasionally, only the mucous  membrane which
lines it comes down, in the shape of a small tumor, causing a sense
of bearing down and smarting. These fallings-down occur when the
child goes to stool.  Whether it be the bowel or the lining membrane
which has come down, if  it be allowed to remain long down, inflam-
mation will take place, and to return it  will then be very difficult.

   Treatment.— Place the  child upon his back, and, having smeared
the  thumbs, or fore  fingers, with lard or sweet oil, press them gently
upon the tumor in such direction as shall tend to return it within the
body. If this  does not  succeed, push  the forefinger into the gut, so
as to relax the circular muscle which contracts upon and holds it.  If
the falling is caused by straining at stool, made  necessary by costive- 
4C6          CARE OF CHILDREN AND THEIR DISEASES.
ness, some ripe  fruit stewed in molasses, or rye  hasty-pudding and
molasses, should be given to the child daily, and it should be caused
to empty the bowels  while standing up.   To  strengthen the bowel,
few things are better than cold water, applied to  the fundament sev-
eral times a day.   An astringent wash of oak bark (232), is  also val-
uable.   Should the bowel become so much relaxed that these means
fail, a tight bandage must be applied to support the fundament.  Be
careful that some ignorant pretender does not, — as has happened,—
apply the  ligature or the knife, and cut off the tumor, instead of re-
turning it into the body.


                 Gastric Fever of Infancy.          •   ,

   The  inflammatory affections of  the  bowels, which happen after
teeth-cutting, are  frequently accompanied by  remittent  fever, — the
fever showing itself very distinctly towards evening, and subsiding, or
nearly disappearing, in  the morning.  It is a sympathetic fever, and
is generally the result of a reaction produced  by inflammation of the
stomach, or ileum, or colon.  The attack is sometimes sudden, though
generally gradual.                            ,

   Symptoms. — For several days, the child will be languid and fretful,
with loss of appetite, increased thirst, and* some heat of skin.   Tow-
ards night these symptoms  are more intense; the skin is more hot,
the thirst and restlessness are greater, the  pulse more rapid. In  the
morning, the skin is more  moist  and cool, and the child falls into a
short, disturbed sleep.   Early in  the  attack, the  bowels are consti-
pated,— though there is sometimes diarrhoea, or  a frequent desire to
go to stool without much being passed.   The evacuations are always
unnatural and very offensive.  They are dark-colored, or clay-like, or
of the consistency of tar, — sometimes mixed with  mucus, and  occa-
sionally with blood.  There is  tenderness of the  belly, and pressure
upon it causes pain.  It is also hot to the touch, while the feet" are
cold.   The  face  is  flushed,  and  the  breath  has a decidedly sickly
sanqll.   The stomach is irritable, and  vomiting is frequent   The
tongue, after a time, becomes coated, dry, and pointed.
   In  the  chronic  form  of the disease, there is, frequently, diarrhoea,
the passages being unhealthy and  fetid; the tongue is covered with a
brownish-yellow mucus, the  teeth with  sordes ; the lips  are parched
and cracked; the urine is scanty and high-colored, with a white sedi-
ment ; the skin, dry, harsh, and dirty-looking; the  countenance con-
tracted and wrinkled ; and there is, frequently, a dry, hacking cough.

   Treatment. — Regulate the diet.   This is important.  In recent and
acute cases, withhold all food, except some cold  mucilaginous fluid
as drink,  as rice-water,  gum-water, infusion of slippery-elm bark, or
milk  diluted with barley water.   Give a warm or tepid bath  daily.
Purgatives should be used sparingly.  The bowels,  when costive, had
better, generally, be opened by injections of tepid  water, or thin  gruel.
If any laxative be used, let it be  the  compound  rhubarb powder, or 
t
CARE OF CHILDREN AND THEIR DISEASES.         4^7
either  of  the following,  (28)  (281).   When the  discharges  have
become healthy, and the tongue  clean and moist, some light bitter,
as the infusion  of Peruvian bark, or Colombo, in combination  with
diluted sulphuric or hydrochloric acid, may be' given.   These,  care-
fully given, with the daily tepid  bath, and  exercise  in  the open air,
will, soon restore the strength.

                    Mesenteric  Disease.

   This attacks scrofulous children between the ages of  three and ten
years.   Its symptoms  are a prominent belly and  loss of flesh, — par-
ticularly upon the arms and legs. To be able to feel the enlarged
and hardened glands, through the walls of the belly,  is the surest sign
of this disease.  When the complaint is long-continued, the  child
loses all its flesh, and dies in almost a complete skeleton state.

   Treatment. — If there is inflammation or other  disorder  in the
stomach or bowels, attend  to  this first   Then put the patient on a
generous diet, such as  meat broths,' etc.  Give bicarbonate of potassa,
dissolved  in  the  infusion of columbo or  quassia, and when  there  is
costiveness, add rhubarb to the preparation.  For the enlargement of
the glands, apply, externally, an ointment (184) of the iodide of lead,
or of  the iodide of potassium (185).   Give an ioduretted bath, daily,
which is formed by adding one grain of iodine and two grains of
iodide of potassium to each gallon of warm water.
   The syrup of iodide of iron should be given, internally, three times
a day, in  a little water, or the iodide of potassium, and compound
infusion of gentian.  Daily sponging the  body in salt and water, and
exercise in the open air, are important.

                            Rickets.

   This is also a disease of scrofulous children.  By some bad process
of nutrition in such children, there does not enough phosphate of lime
enter  into the  bones to harden them,.and the weight of the  body, or
the pulling of the muscles, or the pressure of the clothing, bends and
distorts them in all manner of ways.   The  heads of the thigh bones
are pushed nearer together, making the lower belly narrow ; the back
bone is so curved as to lessen the height; the  shoulder blades stand
up like wings when flying is contemplated; and  the shoulders are so
lifted  up that the head seems  only a little higher than  the elevations
on each side.

   Treatment.— A good, generous, wholesome diet, properly regulated;
out door exercise ; the tepid or cold salt water sponge bath, with fric-
tion, and but little medicine.   The hypo-phosphite of lime, in two-
grain  doses, given in a little sweetened water, three times a day, or the
syrup  of the hypo-phosphites, in half-teaspoonful doses, three times a
day, may be given with advantage. 
408          CARE OF CHILDREN AND THEIR DISEASES.
                The Blue Disease.—Cyanosis.

  This disease is  known by a blue, purple, or leaden tinge  over  the
whole  body.  The warmth of the  body is  reduced, there  is difficult
breathing, which is increased by quick motion or by crying.   The
disease is generally fatal.   The blueness is occasioned, either by the
passage between the right and left  side of the heart  remaining open
after birth, so as to let  the blue, venous blood run through and mix
with the red arterial blood, thus making the whole blue, or by  the
obstruction of the pulmonary artery, which withholds the blood from
the lungs, and does  not allow it  to  be arterialized and reddened.
This latter opinion is the more general one now.    4

  Treatment. — Keep the patient, as much as possible, in a state of
rest, so that; the circulation  may not be hurried.  Allow a pure fresh
air, easily-digested food,  and protect the body from cold and damp-
ness.   Hold the infant near the fire, and apply gentle friction over the
head and body with a warm, soft eloth.


                             Fits.

  Most persons have seen  a baby  in fits ;  and it is a sad sight, — its
little face all distorted and livid;  its eyes rolling and  squinting fright-
fully; its hands clenched, and arms bent, and legs drawn up, and body
arched  backward, and limbs twitching violently, — itself insensible,
and unable to see, or swallow, or move.  After & time, the fit ceases,
sometimes by degrees, at other times suddenly, — the child fetching a
deep sigh, and then lying quiet and pale, as if it had fainted.  From
this  state it  passes into a  sleep, and, on waking, some hours after,
seems quite  well.
  Fits may attack a child  which is  apparently well, and kill it im-
mediately, or  it may have fits  daily, or even several times a day,
and linger on for weeks.  A child may have fits  from a  great  vari-
ety of  causes.  Fits, therefore, have a  different meaning in  different
cases.   But  they always show that the brain has in some way been
disturbed.

  Treatment. — As fits are  not  a disease  in  themselves, but only a
symptom of some disease, the treatment must have reference to the
cause.   Sometimes, while the fit lasts, it is wise to do nothing.  But,
if a fit come suddenly, in the case of a child  previously healthy, it is
generally safe to place it  in  a hot bath, and at the same time, to dash
cold water on its face, or to pour  cold water on its head, or  hold  on
it a large sponge dipped in  cold water.  The hot bath will draw the
blood to the skin, and away from the over-loaded brain.  It will quiet
the disturbance of the system,  and if scarlet fever or measles are
about to appear, it will bring them  out 
DISEASES  OF THE  GENERAL SYSTEM.
    Having now treated of those disorders which affect the skin, the
 brain and nerves, the throat, the lungs and their appendages, the heart
 and its covering, the abdominal cavity and its lining membrane, the
 sexual organs, and those complaints peculiar to females and children,
 it remains to speak of those others, — fewer in raumber,— which are
 not  specially developed in any particular part, but disturb the whole
 system.

                              Fever.

   Fever is a disease which affects the system generally, and is char-
 acterized by more or less excitement of the circulation, increased heat,
 diminished strength, and, oftentimes, unnatural thirst   The  degree
 of excitement is measured by the  state of the pulse.  Of this state,
 there are two characteristic indications :  namely, frequency and hard-
 ness.   A pulse  is frequent when its rapidity exceeds that of health;
 it is "hard when its stroke resists the  pressure  of the  finger with
 unusual force.
   In health, the  pulse of an adult  beats from sixty to eighty times in
 a minute; that of children is more frequent  The pulsations of  the
 heart of the unborn infant, as heard through the body of the mother,
 are one hundred and  fifty  in a minute.  After  birth, the pulse varies
 from one  hundred and forty down to the standard of adult age.   To
 appreciate hardness of pulse, experience is absolutely necessary.
   The great activity of the circulation,  in  fever,  is intimately con-
 nected with the heat and thirst, and tends directly to waste the ener-
 gies, and consume the strength of the  patient.    The heat of fever
 lessens or dries up the secretions, or different  fluids of the body,
 which, in a state of health, are separated  from the blood  for various
 purposes.  This is the cause of the dry skin, scanty urine, etc.
   A crisis of fever is that period in  its course when unfavorable symp-
 toms give place  to those of returning health.
   A  course of fever, or, in common language, a run of fever, is dis-
tinguished by a great variety of symptoms, which will be more par-
ticularly spoken of in the pages which follow. 
410            DISEASES OF THE GENERAL SYSTEM.
                       Typhoid Fever.

  Of the different kinds of .fever, this is one of the most common and
widely prevalent.   The name typhoid is from two Greek words which
mean like typhus, or similar to typhus.  The word typhus, from a Greek
word signifying stupor, means stupid, dull, or low ; and, when  applied
to a fever,  implies that it is low,  or characterized  by great  nervous
depression.
  Typhus and typhoid fevers, if not identical, are so similar in history
and treatment as to make unnecessary their consideration under sep-
arate heads.  The following is one of the differences claimed to exist
between  the  two: namely, in typhus fever, the belly is flat; there is
no marked  disease of the "bowels, and generally no diarrhoea until the
second or third week.  In typhoid fever, on the contrary, some  small
glands, called Peyer's glands, situated in the lower part of the  small
intestines, are always inflamed, and sometimes ulcerated; and, con-
sequently,  among the  symptoms most  frequently noticed, are diar-
rhoea, and drum-like swelling of the belly, called tympanites.

  Symptoms.— The disease often  has  precursory  symptoms.   For
several days before its actual beginning, the patient droops.  He may
attend to his various duties, but does not seem  well; he is low-spirited
and  languid; is indisposed to any exertion of body  or mind;  has
pains in the head,  back, and extremities;  loses his  appetite; and
although dull and perhaps drowsy in the day time, his  sleep is  inter-
rupted arid unrefreshing at night.  The immediate harbinger of the
fever is a chill, often so marked as to cause violent shivering.
  The history of  the first week shows increased heat of the surface ;
frequent pulse, ranging  from eighty to one  hundred and twenty;
furred tongue; restlessness and sleeplessness;  headache and  pain in
the back;  sometimes diarrhoea and swelling of the belly; and some-
times nausea and vomiting.
  The second week is frequently  distinguished by an  eruption of
small, rose-colored spots upon the belly, and by a crop of little watery
pimples upon the neck and chest, having the  appearance of minute
drops of sweat standing on the skin, and hence called sudamina, or
sweat drops; the tongue is dry and black, or red and sore ; the teeth
are  foul;  there  may be delirium  and dulness of hearing; and the
symptoms  generally are  more  serious  than  during the  first week.
Occasionally, at this period, the bowels are perforated or ate  through
by ulceration, and the patient suddenly sinks.
  If the disease  proceeds unfavorably into the third  week,  there is
low  muttering and  delirium; great exhaustion ; sliding down of the
patient towards the foot of the bed ; twitching of the muscles ; bleed-
ing from the bowels; and red or purple  spots upon the skin.
  If, on the other hand, recovery takes place, the countenance bright-
ens ;  the pulse  moderates; the tongue cleans, and the discharges
assume the appearance they have in health.
  Treatment. — Give the patient  good air, and frequent  spongings 
DISEASES OF THE GENERAL SYSTEM.            4H
with water, cold or tepid, as shall  be most  agreeable to his feelings.
Keep the bowels  in  order;  by which is meant, be more afraid of
diarrhoea than of  costiveness.   Diarrhoea should be restrained by a
little brandy, or by small and repeated doses of Dover's powder (153).
  For costiveness, give injections, or the mildest aperients (7) (10) (12).
  To lessen  the frequency of the pulse, reduce  the fever, and  pro-
duce perspiration,  give from three to ten-drop doses of the  tincture or
fluid  extract of veratrum viride, every hour.   This remedy has great
power in fever.
  Great wind-swelling of the  bowels may be  relieved by fomenta-
tions, or hot, steaming  applications.  Sometimes the  wind may be
let  off by  introducing into the bowels a long gutta percha tube,—
thus reducing the swelling, and greatly promoting the  patient's com-
fort.
  If pain in  the head be severe and constant, let the hair be cut short,
and the head be frequently bathed with cold water.
  Let the strength be supported  by light nourishment; and in case
of bleeding from the  bowels, or great debility, by broth and wine.
  For foul mouth, the weakest possible infusion of old hyson tea is
valuable.   Good nursing is eminently desirable.
  If the fever runs a low course, the patient being much  prostrated,
quinine, even in large doses, may be given from the beginning.

                  Bilious Remittent  Fever.

  There are three principal varieties of periodical fever, which, though .
varying considerably from each other, in several particulars, are  yet
essentially, in their substance, but one disease.   These are Bilious
Remittent  Fever,  Pernicious  Intermittent or  Congestive  Fever,  and
Ietermittent Fever or  Fever  and Ague.  According to  the custom of
most writers, I shall treat them  separately, beginning with Bilious
Remittent Fever.

  Symptoms. — The  attack  is  generally sudden and  well  marked.
Some writers say it  has no premonitory symptoms ; others, that it
has.  The more general understanding  is, that for a day or two, or
even longer,  before the onset, there is a sense of languor and debility,
slight headache, lack of appetite, furred tongue, bitter taste  in  the
mouth in the morning, pains in the joints, .and general uneasiness.
  The formal onset is nearly always marked by a distinct chill, or rigor,
— sometimes slight and brief;  at other times severe and prolonged.
The chill  may begin at the feet,  or about  the shoulder blades, or in
the back, and thence run like small streams of cold water poured in
every direction through  the  whole body.  There is generally but one
well-marked  chill,  the returns of the paroxysms of fever being seldom,
after the first, preceded by the cold stage.
  At certain periods of the day, there is an  increased intensity in the
symptoms of the disease, occasionally  preceded, though generally not,
by the chill.  ^ Between this  period of severity in the feverish symp-
toms, and a similar period which follows it, there is generally decrease 
412            DISEASES OF THE GENERAL SYSTEM.
in the violence of the symptoms, during which the  fever moderates,
but does not, as in fever and ague, entirely go off; has distinct remis-
sions, but not  complete intermissions.                          ,
   During the  hot stage, the pulse is up to one hundred and twenty, or
one hundred and thirty.  There are pains in the head, back, and limbs,
of a most distressing kind.
   The tongue is generally covered with a yellowish, or a dirty-white
fur; and in bad cases, in  the  advanced stage, is frequently parched,
brown, or nearly black in the centre, and red  at the edges.  There is
no appetite for food, and generally nausea and vomiting; and usu-
ally there is pain and tenderness in the epigastrium.   The bowels are
at first  costive, but afterwards become loose, and there  are frequent
evacuations of dark, offensive matter.

   Causes. — This disease  is  produced by malarial exhalations from
the decomposition of vegetable matter.   It is most  prevalent in  hot
climates, and in the summer and autumn.

   Treatment. — If the fever be in the formative stage, and have  not
fully developed itself, give an emetic (1) (2), and follow it with a mild
cathartic (7) (13).
   If the disease be already developed, sponge the body, all over, sev-
eral times a day, with cold or tepid water, according to  the  feelings
of the patient, and  give cooling drinks (132)  (133) (298) (299).   To
moderate the fever, give three to ten-drop  doses of tincture,  or fluid
extract  of  veratrum viride.   The compound  powder of ipecac and
opium is  a valuable preparation for  the  same purpose.  Give cold
water as drink if desired by the patient, or let him eat ice.
   When the headache is very severe, let wet cups be applied .upon the
temples, or  behind the ears ;♦ and the same remedy to the pit of the
stomach, when there is great tenderness, is often desirable; though a
mustard poultice will sometimes do better.
   During the remissions of the fever, quinine, and other tonics are to
be given, as in fever and ague.

 Congestive  Fever.—Pernicious  Intermittent Fever.

   This is the pernicious, or malignant form of malarious fever.  It is
marked, either in the earlier or later stage, by a rush of blood towards
one or more organs, by which they are crowded full and congested,—
hence its title of congestive fever.

  Symptoms. — It may be  intermittent, or  remittent, — more  com-
monly, it  is the former.  It  may assume  any of the  types  of peri-
odical fever, but it is most frequently quotidian or tertian.
   The first attack does not differ very materially from  a common
attack of simple intermittent.  The first paroxysm is simple, exciting
but little  attention.  The second is always  severe, producing  great
coldness, and  a death-like  hue of the face  and extremities.   The
advancement  of  the disease brings dry, husky, parched, and pun-
gently hot skin, followed,  after a time, by a  cold, clammy sensation. 
DISEASES OF THE GENERAL SYSTEM.            413
 The eyes are dull, watery, and  sometimes glassy; the countenance
 dull, sleepy, distressed; the tongue, at first white, changes to  brown
 or black, and is usually tremulous; the breathing is hurried and diffi-
 cult   Pressure  over the liver, stomach, or bowels,  produces pain.
 The mind is  often disturbed, and falls into lethargy and stupor, or is
 delirious.

   Treatment — This should be very much like  the treatment of  the
 bilious remittent fever.
   While getting up from the fever, the diet must be light  and nutri-
 tious at first, but may be increased in quantity as the strength returns.
 Exercise  out  of doors must  not be omitted.   If recovery be slow,
 some mild tonic, or a little wine, or ale, or brandy, may be taken two
 or three times a day.


         Fever  and Ague.—Intermittent Fever.

   This is a kind of fever in which there is a succession  of attacks
 with equal intervals, and intermissions that are complete  but unequal,
 on account of the uncertain duration of each fit
   An interval is the period of time between the beginning of one fit,
 and the beginning of the next.
   An  intermission is the  period of time between the close of one fit,
 and the beginning of the next.
   The different varieties of  ague take their  designation  from the
 length of the interval in each case.
   The interval of a quotidian, or daily ague, is twenty-four hours.
   The interval of a tertian, or third-day ague, is forty-eight hours.
   The interval of a quartan, or fourth-day ague, is seventy-two  hours.

  Symptoms. — The disease first develops itself by an ague fit.   This
 has  three  stages, the cold,  the  hot,  and the  sweating.   The cold
 stage is very marked.  The patient has a sense of a debility, yawns,
 stretches, has no appetite, and does not wish to move.   The face and
 extremities become pale, the skin shrinks, causing universal horripila-
 tion, or goose-flesh; the patient shakes, and his teeth chatter.
   After a time, these symptoms decline, and the hot  stage  comes on,
 which is characterized by high fever, with its various  uncomfortable
 sensations.
  When this  fever  passes off, it  is followed by the  sweating  stage,
 during which a moisture breaks out which increases, frequently, to a
 profuse sweat; the body returns to its natural temperature, the pains
 and aches disappear, and a feeling of  health comes back.
  During the cold stage, the blood is driven inward from the surface,
 and particularly oppresses the spleen, which, in cases of long standing,
becomes swelled and permanently enlarged.   This swelling may be
plainly felt,  and is often  quite perceptible to the eye.  It is  called
ague cake.
  Ague fits begin at different hours of the day, and generally  termi-
nate in the evening. 
414
DISEASES OF THE GENERAL SYSTEM.
  A quotidian usually begins in the morning; a tertian at noon; and
a quartan in the afternoon.
  The cold stage is shortest  in  the  quotidian, and longest  in  the
quartan.
  Thus the longest fit has the shortest interval, and the shortest cold
stage ; while the shortest fit has the longest interval, and the longest
cold stage.
  There  are  also double tertians  and double quartans, wherein  the
fits repeat themselves, — sometimes the same day, at other times on
alternate days.
  To these varieties, the terms postponing and  anticipating are  ap-
plied, according as the intervals are growing longer or shorter.   When
a person  is recovering from  ague, the interval may  gradually grow
longer, the attack being put  off, or postponed.  But if the disease be
increasing in severity, the attack may anticipate its usual period, mak-
ing the interval shorter.
  Tertians are more common than either quotidians or quartans.
  Agues  are more prevalent in spring and autumn.   Fall agues  are
most severe and dangerous.
  Causes. — Exhalations from  the soil,  called malaria, arising from
decomposition of vegetable matter in new countries,  or from low and
marshy districts in which the land is alternately covered  with  water,
and again left dry and exposed to  the sun.
  In districts where  it prevails, high  hills  are exempt, and even  the
upper stories of  houses are more healthy than the lower.

  Treatment. — First clear the bowels with the fluid  extract of senna
(15), or the preparation (21).  Then, in the cold stage, give hot, and
in some  cases, stimulating drinks.  Administer  hot  foot baths, and,
putting the patient in bed, apply bottles filled with  hot water to  the
feet, sides, and  back, and in every way try to  excite warmth and
comfort.
  In the  hot stage, give cooling drinks, and opium (117)  (118) in  de-
cided doses;  or, what is better, quinine (67) in two teaspoonful doses
every half hour, at the same time  giving five-drop doses of tincture or
fluid extract of veratrum viride every hour.
  During the sweating stage, stop the veratrum, and rub the patient
with dry towels.
  In the  intermission, give quinine (62), in three-grain doses, once in
three or  four hours, and continue it, gradually increasing the dose, a
fortnight  after the cessation of the attacks.  The following is a good
preparation: quinine, one scruple; elixir of vitriol, one  dram;  dis-
solve the quinine in the elixir, and add tincture of black cohosh, four-
teen drams.  Twenty drops  are to be given, in a little water, once an
hour.
   The web of the black spider,  rolled  up into five-grain pills, and
taken, one pill at a time, once in two  hours during the  intermission,
is said to cure many cases.
   It is important, in fever and ague  districts, to avoid the hot sun,
and the damp evening and morning air. 
DISEASES OF THE GENERAL SYSTEM.            415
                        Yellow Fever.

  This disease belongs  to  warm climates, being most prevalent in
Southern cities.   It makes its appearance chiefly in the latter part of
summer, and disappears upon the approach of frosty weather.

  Symptoms. — The complaint begins, generally, with  a chill, which
is sometimes severe, though commonly  moderate, of short duration,
and rarely repeated.
  Following this chill, there is moderate fever, and a little heat of
surface; but this rarely  rises to any considerable  height,  and only
continues  to the  second or third day, when, in fatal cases, it gives
place to coldness  of surface, etc.  In many cases there is sweating.
  The pulse is peculiar, — not easily described, — generally  not rising
above one hundred in a minute, — a kind of bubble under the  finger,
which breaks and vanishes before it can be fairly felt.
  The  tongue is moist  and white in the first and second days, but
red, smooth, shining, and dry,  as the disease advances towards the
close, having a dry, black streak in the middle.
  The most striking symptoms are nausea and vomiting.   The vom-
iting, in fatal cases, is generally very persistent, and towards the ter-
mination, the yellowish or greenish matters thrown  give place to thin
and black  fluid, having a sediment looking like coffee-grounds.   This
is called the black vomit.
  The bowels are generally costive, with frequent  epigastric tender-
ness and distress.  There is generally severe headache, and a pecu-
liar expression of countenance, in which  the lips smile, but the rest
of the face is fixed and sad, sometimes wTild.   The  patient  continues
wakeful, night and  day.   There are discharges of  blood, often, from
the nose, the gums, the ears, the stomach, the bowels, and the urinary
passages.

  Treatment. — First, move the bowels  with some mild physic (40)
(18) (19) (41) (37).
  During  the chill, put the feet in a mustard bath (242), give warm
cordial drinks, and apply hot bottles etc., externally.
  Cups may be applied to the back of the neck, or over the stomach,
according to circumstances.
  During the second stage, or stage  of calm, nothing is to be done
but give some light  stimulants, and  to promote sweating by warm
drinks, and  tincture of veratrum viride ; and also quinine (62).
  The third and severest stage is to be met by stimulants, as brandy,
freely given, with a continuance of the quinine.
  During  the fever stage, and for the vomiting, give creosote, twenty
drops to six ounces of spirits of Mindererus, and  alcohol enough to
dissolve the creosote.   The  dose is half an ounce every two  hours.
Said to be excellent for putting a stop to the retching and vomiting.
  Cleanliness, temperance, and cheerfulness, are essential in warding
off the disease when one is exposed to its cause. 
416            DISEASES OF THE GENERAL SYSTEM.
                        Rheumatism.

  This is an inflammation of a peculiar character, being caused by
acid or poisonous matter in the blood, and  having for  its seat the
fibrous tissue, or  that thready texture which enters  largely into the
composition of the cords and muscles of the  human body.   The
synovial, or lining  membrane  of joints,  is  also  peculiarly subject
to rheumatic inflammation.   Hence  the  terms, fibrous  rheumatism,
and  synovial rheumatism.  There  are also acute and chronic  rheu-
matism.

                    Acute  Rheumatism

  Is a very painful affection.   It  is most frequently brought on by
exposure to wet  and  cold after violent and  fatiguing exercise of the
muscles.

  Symptoms. — Its  principal  characteristics  are, high fever, with a
full, bounding pulse ; furred tongue ; profuse  sweat, which has a sour
smell,  and seems to  increase  the weakness without relieving the
pain; scanty and high-colored  urine,  with brick-dust settlings; and
swelling of the joints, with slight redness, great tenderness, and severe
pain, which is particularly agonizing when the patient  attempts to
move.
  This affection often changes suddenly  from one part of the body to
another, or from one set of joints to another.  This  sudden shifting,
termed metastasis, is peculiarly dangerous ; for sometimes the inflam-
mation, seeming  to regard the  constantly moving heart as a large
central point, suddenly seizes upon its lining membrane, and occasion-
ally proves speedily fatal.

  Treatment. — It is well first to open the  bowels freely with the
compound powder of leptandrin, or the compound powder jalap.
Then give tincture of black cohosh and tincture of veratrum viride
(124), and push the preparation to the extent of producing sweating.
This, if no evil effects seem to result from  it, that is, no prostration or
bad  feelings in the head, may be kept up till the violence of the dis-
ease abates.
  Sometimes opium,  nitrate of potash, etc.  (127), administered one
or more times, will have a good effect.
  The tincture  of black cohosh root, two parts, and the tincture of
colchicum root, one part, and given in doses of forty drops, is a valu-
able remedy.
  For articular  rheumatism, iodide  of potassium, one  dram, and
morphia, one grain, dissolved in one ounce of water, and given three
or four times a  day, in two  teaspoonful doses, are said to have the
power of  shortening the disease.
  It is a valuable treatment, after clearing the bowels with salts and
senna, to  give equal parts of wine of colchicum  and spirits of tur- 
DISEASES OF THE GENERAL SYSTEM.           417
pentine in  doses of ten drops every two or three hours ;  and after a
day or two, to give, in connection with the  above, at intervals of five
hours, tincture of chloride of iron, ten drops, with  ten to twenty drops
of laudanum.
  Fomentations of hops and cicuta,  or stramonium  leaves, placed
upon the inflamed and swollen joints, will  have  a good  effect  in
relieving the pain.   The recent leaves of stramonium, pounded, mixed
with a little water, and laid upon the joints, is  said to  act very
favorably.

                   Chronic Rheumatism.

   The chronic form of rheumatism may follow the acute as its conse-
quence, but is  more often  an independent disease.  It is seldom at-
tended by fever, and in this differs  from the  acute rheumatism.   It
often lasts a long time,  and causes much suffering.

   Symptoms. — These are various, but are generally understood, even
by the common people, to consist of pain, lameness, stiffness, etc., in
the joints and other parts.  The joints are  often  swollen,  but not  as
much as in the acute disease.  It is peculiar to this form of the com-
plaint, that when  the patient remains at rest  for  a time, he will have
pain and stiffness in  the affected part on beginning to move, but as
he grows warm, both will disappear.

   Treatment. — This  complaint  is  often  palliated, and  sometimes
cured, by passing a current of electro-magnetism  through the affected
part.
   The  tincture or the  fluid extract of black cohosh, taken in full
doses, is one of the best remedies.  It  may be taken alone, or mixed
with the tincture  of poke-berries, and a tincture  of prickly-ash bark,
if convenient.
   Opium  and nitre (127) form a valuable  remedy.  Colchicum is
much  used, and has a deservedly high  reputation  (292) (301).
   Liniments often have a good effect (190) (195) (196) (198).  It is
well to wear a piece of  oiled silk over the affected part.   It keeps  up
a gentle perspiration   from  the rheumatic surface, and materially
hastens a cure.
   To bathe the affected joint at bed-time with hot sweet oil, and then
envelop it in  cotton batting, to be Kept on through the night, will
often give  much relief.
   The bowels must be  kept regular, and all exposure to wet feet or
clothes, and to currents of cool air when sweating, must be carefully
shunned.

                              Gout.

   Gout is rheumatism's cousin; the parentage of both belong to the
brotherhood of the acids.
  A very acid state of the blood, or a state favorable to  the forma-
tion of acid, is supposed to be the cause of the inflammation peculiar
                                53 
418            DISEASES OF THE GENERAL SYSTEM.
to both these disorders.   In rheumatism, an acid which exists in sour
milk, and in cider, called lactic acid, is  thought to be the disturbing
element   In gout, lithic or uric acid is known to be uncommonly
abundant, and to form a  principal ingredient of those  concretions,
found in  gouty joints, and familiarly called chalk-stones.
   The larger  joints are most  often affected  by rheumatism;  while
gout prefers the smaller ones.   In rheumatism, the pain is excruciat-
ing; in  gout, it  is intolerable.   There is  truth  in  the humorous
Frenchman's description of the pains of these two complaints, which
is, in substance,  as follows:  Place your joint in a vice;  turn  the
screw till you  can bear it no longer ; that gives you an idea of rheu-
matism ;  now  give the instrument one morfe  turn, and you have
gout.

   Symptoms. — A fit of the gout, as it is called, generally makes its
attack in the  night  Its unsuspecting victim is first awakened, per-
haps an hour or two after midnight, by an intensely burning, wrench-
ing pain  in the ball of the great toe, or some other small joint.  This
pain, with its  accompanying symptoms of fever, continues with little
abatement for twenty-four hours.   There is then a distinct remission,
when the sufferer may get some sleep.   He has a similar experience
during several succeeding days and nights, when the disease, which
has been growing milder, leaves him.
   After a considerable interval, there is  likely to  be  another similar
visitation.  The length of  this interval is inversely as the number of
attacks, — that is, it diminishes in  length as  the  attacks increase in
number; in yet plainer and more homely terms, the  attacks  come
" thicker  and faster;"  the  space between them  gradually shrinking
from three or four years to  one or two months.
   Recovery from  the first attack may be complete, — the skin peeling
off from  the red and swollen joint, and leaving it strong and  supple
as ever.  But, after several  repetitions of the  inflammation, the joint
becomes  stiff', its  motions  being obstructed by the deposit of lithic
acid  concretions,  or chalk-stones.  The limbs are
sometimes actually frosted over with  crystals of
urate of  soda (Fig. 143).   This  form of urate of
soda crystals  differs very materially from Fig. 122.
When these crystals appear upon the  surface, and
deposits  are  made in the  joints, uric  acid is not
secreted  as usual by the kidneys, but  accumulates
in the blood.
   But gout is a disease by no means entirely local
in its character.   It vitiates the blood,  affects the system generally,
and is often betrayed by general symptoms long before the local mis-
chief is indicated by one  of the attacks.  Irritability of temper, un-
pleasant  sensations in the stomach and head, and  various  uncomfort-
able  feelings of body and mind, have been considered as premonitory
of this disorder.  Many other organs also, beside joints, are subject to
the gouty inflammation.   The stomach, heart, lungs, head, and even
the eyes, are known to have been thus affected.
 
DISEASES OF THE GENERAL SYSTEM.            419
  Causes. — Luxury and indolence, — particularly the former, — are
regarded as the principal causes of gout.

  Treatment. — Colchicum is the remedy for gout.   It removes the
disease by exciting the  kidneys to action, so  that the poison is con-
veyed away in the urine.   Perhaps it acts in some other unexplained
way, as an antidote to the  disease.   One teaspoonful of the  wine of
colchicum may be taken two or three times  a day, until relief is ex-
perienced.  It  should then be continued, in ten-drop doses, for a few
days longer, to prevent a relapse.   The colchicum  may be taken in
the form of prescription (301).
   Coffee, drank freely every day, is said to  be a sovereign  remedy
for gout  It is  also declared to be excellent for gravel, — a fact
which 1 forgot to mention when  treating of the  affections of the
kidneys, etc.
   The bowels must be kept in order, but not actually purged (34)
(40).   The diet must be simple and unstimulating.
   Let the  inflamed joint be bathed  often in a saturated solution of
bicarbonate of soda in  soft, warm water.  Cold  applications should
not be made, as there is danger of provoking a sudden change of the
inflammation to some internal organ.
         •

                   Scrofula.—King's  Evil.

   This disease was once thought to be peculiar to  swine, and  hence
derived its name from scrofu, a sow.   It shows itself in various forms,
— as  hip disease, white swelling, rickets, salt-rheum, etc.    Persons
affected  by it are subject to swelling of the glands,  particularly those
of the neck.

   Symptoms. — In the beginning of the disease, small, hard, movable
kernels appear about the neck, just under the skin.   These are  lym-
phatic glands, and the swelling generally takes place long before there
is any soreness, or perceptible redness.  They may be felt  under the
skin ; and, in  the  course of six months or a year, may grow to the
size of a filbert,  or even a hen's  egg.   Sometimes they  are  much
larger even than this, and very hard.  They may appear in  many
other parts beside the neck.
   After a time, though  very slowly, they come to a head, and break,
— discharging a watery fluid, or a mixture like whey and curd.  They
are seldom very sore.  When they heal, they are apt to leave a puck-
ered condition of the skin, and ugly scars.
   The scrofulous humor may  sometimes  affect the eyes,  when the
lids will become red and thick, and  discharge mucus and water; —
the under  lid sometimes  turning  out,  and  presenting a shocking
spectacle.
   The scrofulous condition is generally supposed  to be indicated  by
a white, delicate skin, thick lips, light hair, and a delicate constitu-
tion ;  but these signs are not worthy of much confidence.
   The disease often  attacks the cellular tissue, causing  numerous 
420            DISEASES OF THE GENERAL SYSTEM.
 suppurations  and  abscesses.  It also affects  the  bones,  producing
 caries, necrosis, and other affections.  It shows itself in certain  in-
 flammations of the eyes,  in the  formation of running sores in the
 ears, and in various other ways.

   Causes. — It is contended by some, that  scrofula is in  all cases
 inherited;  that we  receive it from  our progenitors, as we do  their
 other constitutional peculiarities ; that the disease is everywhere, and
 in all time, one and the same, which shows  it to come from within,
 and not from without; that were it dependent on external causes for
 its existence,  it would be  greatly modified  by temperature, climate,
 and the peculiarities of the races affected by it
   They  assert that though  the  causes which are  usually  assigned
 for scrofula, such as living  in cold,  damp, and impure air, and the
 lack of  sufficient food,  connected with  filthy habits, often have a
 powerful effect in  developing scrofula already existing in  the  con-
 stitution, and  of aggravating it when already developed;  it never
 produces it.
   How far these  statements are to be received, I will not undertake
 to judge.  It is certain that the disease is often inherited ; and if we
 admit that the other causes named have some share in its production,
 it is possible  we may not go entirely astray.  Yet my o\vn  strong
 suspicion that scrofula arises from the animal  poison of syphilis, fil-
 tered through the blood of many generations, inclines me to the adop-
 tion of the above views.

   Treatment. — In  olden times  of superstition, this  disease was-be-
 lieved to be cured  by the patient coming into the presence  of the
 king, and  being  touched by his  royal  hand.   The ceremony  was
 called the  "sacred  touch."   It was  from this that  the disease took
 its name of "king's evil."   This superstition reached its height in
 the reign of Charles II.   After the Restoration, the numbers who
 flocked to  Whitehall and Windsor to receive the " touch," are said to
 have  been  immense, — no less  than ninety-two thousand  in twelve
 years ; and the writers of that day declare that none failed to receive
 benefit.
   In modern  times, believing that  the ceremony of the touch  was
 best adapted to the period when kings were thought to have  sacred
 persons, we rely  for the cure of this disease, upon rational medicine
 and hygiene.
   The medical treatment of  it is constitutional and local.
   Iodine is the great  remedy for  scrofula.   Dissolve one  scruple of
iodine and  two scruples of iodide of potassium in seven teaspoonfuls
 of water.  Of this, give ten drops  three  times a day,  in  a little
water, gradually  increasing  the  dose to once and a half or twice
that amount.   The  iodide  of potassium, as in prescription (101), is a
good remedy.
   Where there is considerable debility, the iodide  of iron, in doses
 of twenty-five  or thirty drops, in  water, three times a day, is a good
 preparation. 
DISEASES OF THE GENERAL SYSTEM.
421
   The compound syrup  of yellow dock root, and  the  compound
syrup of stilfingia, taken  sometimes alone, and at other times, with
two to five grains of iodide of potassium in each dose, are both ex-
cellent medicines for scrofula.
   The bowels  must be kept open  by laxative food, or in the failure
of this, by some gentle physic (12).
   Medicinal springs, particularly those containing  iodine,  are  ex-
cellent
   Before  the tumors become very  sore, let them be bathed several
times a day with a solution of muriate of lime, or ammonia, or soda,
two drams to  the oupce  of water.   When  they are inflamed, apply
poultices of ground slippery elm and powdered bayberry, equal parts.
Powdered poke-root, or blue-flag may be substituted for the bayberry.
If these things  are not at hand, use white bread and milk, or flax-seed
poultices.
   When  the tumors have opened, and ulcers have formed, the ulcers
must be washed out with  soap suds, and dressed with salve made of
beeswax and sweet oil; or, when  the ulcers  are indolent, with  the
red iodide of mercury ointment.  Let the dressing  be changed  two
or three times a day.
   Great attention should be paid to the improvement of the general
health.  The diet must be ample and nourishing,—consisting of fresh
meat, poultry, broths, soups, milk, and wholesome vegetables  in such
variety as the season allows.
   The skin must be wTashed daily with cool water and spirit, or water
and saleratus;  and mbbed to redness with a coarse towel, or flesh
brush.  Either  flannel or silk should be  worn next the skin, summer
and winter.
   Exercise must be regular, and cheerfully performed, in the t>pen  air.
If the residence be in a damp and unhealthy air, it should be changed
at once, if possible.   In any case, a change of residence, from time to
time, when travelling is not possible, is much to be desired.


                     Scurvy.—Scorbutus.

   Owing to a better knowledge of this disease, and of  its proper
treatment, it is much less common than in former years.   It chiefly
affects seamen  who make long voyages ;  but is not entirely unknown
on land.

   Symptoms. — Languor,  loss of strength, and  great depression of
mind, are among the first signs of scurvy.   To one  about being  at-
tacked, work and play are alike burdensome.   There  is no  heart even
to move.   The  face, and  the whole skin, look  pale and bloated, and
the breath has  a fetid smell.  The  gums are  swelled, soft, red, and
spongy;  and they bleed upon the  slightest touch, — sometimes  the
blood oozes from them  spontaneously.   The  teeth get loose,  and
often fall out.    The skin becomes covered with bluish   or purple
spots, — looking precisely like bruises.  These  spots  spread and  run
into each other, forming large patches of discoloration. 
422            DISEASES OF THE GENERAL SYSTEM.
  These spots appear to be formed by the bursting of the small capil-
laries of the veins and arteries, which have grown too weak and rot-
ten to hold their contents, and the infiltration of dissolved blood into
the cellular substance under the skin.
  Ulcerous sores break out in various parts of the body, which smell
badly, and discharge a thin matter.   These ulcers are covered with a
crust.  Various  parts of the  body, the bones included, are twinged
with pains.   The pulse is weak and soft.   All the secretions, includ-
ing the urine, have  an offensive  smell, — as  though the whole  body
were approaching putridity.   In truth, the whole  man seems  to be
disintegrating, decaying; the flesh becomes  soft, and dwindles; and
the bones break  easily, — being afflicted with a decay approaching to
rottenness.
  In bad cases, blood is discharged from the bladder, bowels, womb,
nose, and mouth; and the smallest exertion is followed by fainting,
and in many cases,  by sudden death.

  Causes. — The disease is owing to the use of food and drink begin-
ning to be decomposed, and to living  long  at sea without vegetables
containing certain  acids.   Its attacks are likewise encouraged  by
whatever weakens and depresses the nervous system,—as long expos-
ure to a moist,  damp air, particularly when this  is connected with
confinement  on  board a ship, unclean linens, occasional  loss of the
usual rest, and great fatigue, as in storms.  The force of these causes
is increased  by  the loneliness, the sadness, and the despondency of
the sailor's life.

  Treatment. —■■  Sailors are very much  protected  from the disease
now,  by frequent returns to land, during long voyages, to procure
fresh  meats,  vegetables, and water.   This  practice is very generally
adopted, particularly by our whale ships, which make long voyages;
and the result is, very little  scurvy,  and general  health  among the
men.
  One of the best  medicines for  the disease is quinine; it may be
given in from one to two-grain doses twice or three times a day.
Gentian and quassia  are also suitable remedies;  so is the muriatic
tincture of iron  (73).
  But the best of all remedies are fresh and succulent vegetables, and
also fruits.   Spinage, lettuce, dandelion, sorrel, cresses, and the like,
are among the very best things when  they can be had.  Lemon juice
produces the happiest  effects.  Potatoes  are among the very best
remedies, — particularly if scraped and ate raw.   They are also valu-
able when cooked.   Spruce beer is a good antidote; and may be
made at sea from  the essence.   Many kinds of beer may be brewed
at sea, which are valuable.
  When the bowels are  Costive, cream  of tartar, dissolved in water,
and drank freely, wTill be found the best remedy.  If there be  loose-
ness of the bowels, morphine, laudanum, a tea made of logwood, or
geranium, or the tincture of catechu,  will be suitable.
  For the spongy gums, a solution of alum  applied to them will be 
DISEASES OF THE GENERAL SYSTEM.            423
 proper, or a mixture of equal parts of tincture of myrrh, catechu, and
 Peruvian bark; and ulcers may be washed with the same.
   Vinegar, which is an excellent prevention in this disease, may be
 made at sea from molasses and water exposed to the sun.  Two
 ounces of nitre dissolved in a quart of vinegar, and given  in table-
 spoonful doses, three times a day, is said to be an excellent remedy.
   Every ship, on going to sea, should be supplied with  dried fruit, as
 raisins, currants, whortleberries, prunes, etc.; and should  have peas,
 beans, rice, flour, sugar, and molasses.  Beside these, ships should have
 essence of spruce and lemon, and dried  balm, sage, pennyroyal, and
 other herbs.
   Seamen, when down with this disease, should be moved with care,
 as the spark of life may be easily extinguished.


          Purple  Disease. — Purpura Hemorrhagica.

   This has been sometimes  ranked as an affection of the skin; but it
 is not such ; it is rather a disease of the general system.

   Symptoms.—This complaint is known by the appearance  upon the
 skin of two kinds of spots;  the one kind are small, round, bright-red
 points, even with the surface, and changing in a day or two  to a pur-
 ple  or livid  color, which are yellowish brown when about  to disap-
 pear.  This variety of the purples is quite simple, attacking, generally,
 young persons, and in warm weather.  It is sometimes  tedious in its
 course, but never dangerous.   It requires little treatment; — pure air,
 wholesome diet, with quinia and the mineral acids, make up  the chief
 part of it.  It  may be known by the spots  not disappearing when
 pressed upon by the finger.
   The other and more dangerous variety of the  disease is attended,
 generally, by faintness, wandering pains, great debility, and the ap-
 pearance upon the legs, arms, and body, of dark-red spots, and irreg-
 ular,  livid  patches, looking just  like the marks of recent bruises.
 Ihese marks are caused by the effusion of blood in patches under the
 skin ; and in this respect, they are just like bruises, only they are pro-
. duced by different causes.
   In the rapid progress of the disease, dark venous blood frequently
 oozes from the tongue, mucous membrane of the mouth, nose, breath-
 ing tubes, ears, vagina, womb, stomach, etc.  The other symptoms
 vary in different cases very much, but generally indicate great dis-
 turbance of the system.
   It often  runs a  very  rapid course, but  sometimes  remains for
 months.


 (2o^^2)7l5)!e b°WelS  arG t0 ^ kCpt rGgUlar  gentle physic
   Iron is a valuable remedy  (73).
   Astringents  generally have a good effect (156) (159) (279) (305).
 The  best astringent  in this complaint, is gallic acid, taken in five-
gram doses, every three or four hours. 
424            DISEASES OF THE GENERAL SYSTEM.
  The sponge  bath, twice a day, with tepid or cool water, and fol-
lowed with gentle rubbing with a coarse towel, will  do much  tq
restore and equalize the circulation in the skin.
  During the active  stage of the disease, the diet should be very
light, — simple toast-water, rice and arrow-root gruel, and either alum
or wine whey.
  While getting well, the  patient may have a more nourishing diet,
consisting of tender fresh  meat, broths, etc.;  and must take gentle
exercise in the open air. 
SURGICAL  DISEASES.
                        Inflammation.

   Every part of the body, which has vessels and nerves, is  liable  to
 inflammation.   Where there are no nerves, it cannot exist.  Many
 diseases are caused by it   Mechanical injuries, such as cuts, bruises,
 and fractures, produce it.   And many other disorders, not caused by
 or causing it in the beginning, become entangled with it in their pro-
 gress.   It is very important, therefore, to understand the nature and
 management of inflammation.  It is  not always to be looked upon
 as a disease; it is frequently  a  simple  process  of repair,  whereby
 nature restores injured parts to health.

   The Signs of  Inflammation are redness, pain, heat, and  swelling,
 though in some cases, these do not all appear.

   Acute Inflammation. — When the redness, the pain, the heatfand
 the swelling, are clearly marked, and  the  inflammation is so rapid,
 that it either subsides in a few days, or quickly brings on suppuration,
 or ulceration, or mortification, it is said to  be acute.

   Chronic Inflammation. — When it is less painful, and  slower ^n its
 progress, beginning very gradually, and  lingering a long time, it  is
 then chronic.

   Common, or  Simple, or Healthy Inflammation is  that which is not
 mixed up with  any disease, but is established by nature foi some
 salutary purpose.

   Unhealthy Inflammation is that which  has been caused by some
 other disease, and is under its control.

   Specific Inflammation is that which seems to vary from all ordinary
 cases,  being dependent on  a particular  state of the system, on an
 animal poison, or a principle of contagion or infection, and a power
 of propagation from one person to another.
   Some of these produce such permanent effects, that those having
 them are not liable  to a second attack.

  Inflammation  is Primary, or, as the doctors say, idiopathic, when it
is the original disease. 
426                    SURGICAL DISEASES.
    Inflammation is Secondary  or Sympathetic when it is the result of
I some other disorder, which goes before, and produces it.
    It has been explainer! elsewhere that the different parts of the body
 are connected by little threads or nervous strings which run from one
 to the other.   If one part of the body become injured or disordered,
 it uses  these nervous threads, as telegraphic wires, to tell other parts
 of its misfortune; and it sometimes  happens, that when the intelli-
 gence conveyed is of a sad and alarming character, the part receiving
 the news is so excited and distressed as to become inflamed.  Nothing
 can be more proper than to call this sympathetic inflammation:
    When the  inflammation is violent, and is seated upon some impor-
 tant part, the sympathetic action is so great as to disturb the  whole
 constitution; and this general disturbance is sympathetic or symptom-
 atic inflammatory fever.

    The Symptoms are quick and  strong  pulse, dryness and  heat of
 skin, parched mouth, great thirst, scanty and high-colored urine,  cos-
 tiveness, disordered nervous system, loss of appetite, anxiety, restless-
 ness, sleeplessness, headache, wandering and confusion  of mind,  and
 sometimes delirium.  This fever John Hunter called a universal sym-
 pathy of the  body with the disturbed condition of a part of  it
    It is  only  by inflammation that a wound  is  healed, or  a broken
 bone repaired.
    Upon the  surface  of  a wound  nature pours out  a fluid  called
 plastic lymph.  This is composed of fibrine, — the material of which
 flesh  is made, — united with a little of the watery part of the  blood,
 chiefly albumen.   The watery part disappears soon after it is poured
 out, and the fibrine hardens into a kind of membrane.   Through this,
 nature  sends small  nerves, arteries, and  veins, which she uses as
 threads to sew up the wound.   Fibrine being the chief material with
 which nature constructs  our  bodies, she  of course uses it  to repair
 theml^vhen wounded,—just  as a carpenter, who constructs  a floor
 with  planks, uses planks  to mend it when it is broken through.
    In the case  of highly inflamed and swelled tonsils,  nature some-
 times becomes alarmed, and,  for  once making a mistake, she rushes
 in with her  material for repair, and  fills up all  the interspaces with
 fibrine, — thus  hardening the glands, and making their  cure impossi-
 ble without cutting them off.  But in most cases, nature is right,  and
 cures the injury by inflammation.

    Buffy Coat of the Blood. — The effects of inflammation extend to
 the blood.  This fluid, when drawn from the veins of a person suffer-
 ing from an inflammation active enough to disturb the constitution,
 forms a clot in the basin more  slowly than  usual, but the clot is
 harder; and  a layer of fibrine is left upon the surface of a yellowish
 buff color, looking like size or glue, and  called the buffy coat.   The
 clot is  also scooped  out in  the  centre,  and the blood is said to be
 cupped.

    Coin Discs. — It is another peculiarity  of inflamed blood, that if
 a drop of it  be examined under a powerful microscope, its globules, 
SURGICAL DISEASES.                    427
or discs, which are very numerous, will be found  standing on their
edges, and leaning against each  other, like a row of copper or silver
coins.   (Fig. 144.)
  Inflammation may end in one of four different ways.

  I. By Resolution. — Suppose a large splint of wTood be stuck  into
the hand  of a  healthy man.   It  causes redness, heat, swelling,  and
pain; and these, combined, are inflammation.  The splint is  pulled
out, and the hand well done up with  a water dressing, and properly
cared for.   The redness fades, the  heat  declines,  the swelling  sub-
sides, and  the  pain disappears ; the inflammation  is ended, and the
hand  is well.   Coming to a fortunate  end in  this way, inflammation
is said to  be resolved, or  terminated by resolution.

             Fig. 144.                           Fig. 145.
   II. By Suppuration. — It does not always end  so  happily.   The
 splint may be broken off below the skin, and not pulled out; and
 proper means may not be used to subdue the inflammation.  Instead
 of abating, it may increase ;  and the centre of the  injured  part may
 begin to rise up to a point, and grow white on the top.   This shows
 that there is matter formed underneath, which is lifting up  the scarf-
 skin, and seeking to  come through.  Fig. 145 is a microscopic view
 of pus corpuscles.
   The  pain  is  now  very throbbing and pulsating, — keeping time
 with the beats of the heart   When the scarf-skin can hold out no
 longer, it  breaks, and yellow, cream-like  fluid runs out, which  we
 call  pus.   The redness, pain, etc., now subside.  This process we call
 suppuration.
   At this  time, if the  wound have been a  severe one, attended by
 sympathetic fever, and the discharge of pus be now large, there may
 be a change in the  fever, marked  by frequent shiverings and chilli-
 ness, followed by flushes of heat, which  ends in sweating.   We call
 this  hectic fever.                                              ♦

   III. By Ulceration, or the formation of open, running sores.

   IT. By fortification. — If  the wounded part have been so much
injured as  gradually  to destroy its  vitality, it dies.   The  vivid  red of
the inflammation  changes to a purplish, or livid, or black hue.  The
strained condition of the skin ceases, — a bloody  fluid  lifts up  the
 
428                    SURGICAL DISEASES.
cuticle, — the pain and feeling are all gone, — the part is dead and
putrid, and gives  out a peculiarly offensive smell.  This process is
called mortification.
 '  The mortified and dead  part is called a slough ;  and it is separated
from the living parts  by a peculiar vital process which has the name
of ulceration.

   Treatment of Inflammation. — Though  inflammation  sometimes
ends kindly by resolution,  and though it  is  often a salutary process,
yet it is frequently very destructive, — ending in suppuration, ulcera-
tion, and mortification, — thickening, hardening, softening, and  en-
larging parts affected by it;  and doing these things in textures of
great delicacy,  and of vital importance in the economy  of life.   It
calls, therefore, for judicious, and, often, for very active treatment.
   There are two principal  things to be done, — to remove the cause,
if  it be still  active, and to take the  blood away from the inflamed
part.
   If a bullet be lodged in the  flesh, or a thorn, or a splint of wood,
or a piece of glass, it is the exciting cause of the inflammation which
follows, and  little  can be  done  to  advantage, till the offending sub-
stance is extracted.   If inflammation be excited in the bladder by
the irritating presence of  urine, which cannot be passed, this must
be  drawn  off with the  catheter, before relief can be had.   If the
stomach be inflamed  by improper food, or too  much of  it, the  diet
must  cease to  follow appetite, and take reason for  its  master.  If
ladies have excited inflammation in the bowels, or any of the internal
organs, by  a dragging weight of skirts, they must either  put off the
burden, or  hang it upon the shoulders with straps.
   The blood is removed from  the inflamed part in two ways —

  Cupping and Leeching. — It is done directly by cupping and leech-
ing.  These methods take  the blood  out  of  the  small vessels, which
are so full and crowded as to  produce pain.    Cold  water, ice, etc,
applied to the part, cause these little vessels to contract, and squeeze
the blood out of themselves.    These are very  useful applications;
and they are to be pursued as long as there  is any hope of  break-
ing up the inflammation,  or  causing it to end  by resolution. But
when this is no longer to be expected, and it  is found  that it will  go
on  to  suppuration, then apply warm fomentations  and  poultices.
These will mollify and soften the parts, and cause the suppurating,
or, in  common  language, the  rotting process, to go on more rapidly,
and with less pain.

  Counter-Irritation. — The  other method  of  removing  the  blood
from the inflamed part is by what is called counter-irritation.
  People are apt to think it very absurd that inflammation should be
induced in one  place  to relieve or cure it in another.  But it is not
absurd.   It relieves or cures  on the  principle  of sympathy, which 1
have already explained.   We  put croton oil,  or tartar  emetic, or
Spanish flies, or cayenne pepper, or mustard, upon the surface  of the
bowels when the internal parts  are dangerously inflamed, and what 
SURGICAL DISEASES.                    429
is  the result ?  Why, the terrible smarting and pain alarms nature,
and she rushes up to the surface with a large amount  of the blood
around  the inflamed parts, and there, for hours, perhaps  for  days,
struggles to beat down  the new mischief at the surface; and, in the
mean time, the internal parts, relieved by the removal to the surface
of so large a quantity of hot blood, make a long stride towards re-
covery.
   A popular  orator is speaking to a multitude in  a hall which is
thronged to excess, and  a few feeble persons  faint, and are  likely to
be suffocated and trodden upon  in the dense, mass.   A person at the
door, seeing what has happened, cries "fire." »The crowd rush  out;
the fainting persons get  breath, and are saved.   So, when the  thou-
sand streams of blood rush through their channels upon an inflamed
and fainting internal organ, crowding and oppressing it, we set the
skin on fire with some inflammatory substance ;  the  blood rushes to
the new point of  excitement, and  the oppressed and fainting organ
recovers.
   Cupping and leeching, which are often  necessary, are  not to  be
resorted to in very debilitated constitutions.   In some persons, leech-
ing produces erysipelas.
   Costiveness is always produced by the symptomatic fever which
often results from inflammation.  This  should be removed by saline
purgatives, such as rochelle, epsom salts, glauber's salts, salts of tartar,
tartrate of potassa, and the tartrate of soda (9) (7) (12) (14) (18) (20)
(25) (27) (41).  Sometimes more active purgatives are required, and
then the compound extract of  colocynth, etc. (29), will  be  excellent,
or, five  grains of blue pill, at night, followed by (299), may be used.
   As a drink, cream of tartar  (298) will be found cooling and re-
freshing.   In all inflammations, the diet must be light and unstimu-
lating.

                 Suppuration and  Abscess.

   An abscess is the collection of pus or matter in  the  substance of
some part of the  body.  When the matter is poured out from  some
part, the  process  is said to be suppuration; when  it collects  in a
tissue, it is an abscess.   When the matter collecting in  some organ,
comes  towards the  surface, and a place in the. centre rises above the
surrounding skin, and turns white, the abscess is  said to point.  Some
abscesses point and break in a week ; others of  a more chronic char-
acter, will  linger on for months.

   Fluctuation. — Before  an abscess points, a fluctuation may generally
be felt in the  swelling, which is  one of the surest signs that it con-
tains pus.   Sometimes  this fluctuation may be felt even when the
matter  lies very deep in the flesh.   A\id when it is so deep that it
cannot  be  felt, if a sudden cessation of  the symptomatic fever should
occur, and shiverings or rigors  should come on, attended by coldness
in the  affected part, we may reasonably suspect that pus is formed.
It is  not easy, at  times, to say  whether matter is really present; and 
430                    SURGICAL DISEASES.
  great care should  be used  not to plunge  in  a lancet where none
  exists.
     Treatment. — When the abscess is completely formed, and  there is
  no longer  any doubt of the  presence of matter, it should be opened
  at once.   To let out the confined pus alleviates the pain, and lessens
  the inflammation.   If  the matter  lie close to  a bone, the opening
  should be made without delay.  The opening should be large enough
b  to let the matter out freely.   It is a rule to keep the incision open
 • till the cavity of the abscess is so far filled up that another collection
  of pus is not likely to occur.
     If the matter do  not readily get to the surface  through the opening,
  it may burrow itself in the flesh, in a long narrow channel called a
  sinus.  To relieve  this, the opening must be extended in such a way
  as to  give vent to the new collection.
     An abscess is sometimes indisposed to heal at the bottom, and pus
  continues to be formed a long time, and is discharged  through an
  opening  smaller than the  sack which contains  it.  This is a. fistula;
  and the opening to  it should  be enlarged so as to let out the matter
  more  freely.  A little soft lint  may then  be gently pressed into the
  wound to prevent its healing before the cavity below.
     An abscess from  acute inflammation requires to be poulticed for a
  time after it has been opened.   When the swelling and inflammation
  are gone, the poultices  are to  be laid aside, and a bandage put on.
  When the inflammation is gone, let the diet be improved; and if the
  discharge of matter be large, give wine and tonics.

                          Mortification.

     The complete death  of a  part of the body, and its change  into a
  black, stinking, cold, and insensible  mass, with which the other  parts
  of the system have discontinued all organic connection, is what we
  call mortification.   That form of it which is most common, is said to
  be humid, on  account of the moisture of the dead parts.

    Gangrene. — Before  the mortified part is completely dead, and,
  consequently, while its  recovery is  supposed to  be possible, the con-
  dition of the  part is called gangrene.

    Sphacelus is the name given to it after its entire death.

    Sloughing is the process of separating  the dead  matter, and the
  substance separated is a slough.
     The causes of mortification  are quite  numerous.   The most com-
  mon are, stoppage of the circulation by inflammation, by mechanical
  causes which obstruct the passage of the blood, by chemical agents
  and poisons, and by local or general debility.
    In a bad constitution, which  bears disease poorly, mortification is
  very dangerous.

    Treatment.— In treating mortification, three things are to be aimed
  at, — to stop its progress, to promote the separation of the dead from 
SURGICAL DISEASES.
431
the living parts, and to heal the ulcer which is left after the separa-
tion.
  To stop the  progress of mortification, we must remove  its cause.
If it be inflammation, treat that according to the principles laid down;
though leeching, purgatives, etc., should be used sparingly, as mortifi-
cation reduces the constitution so rapidly that it does not bear reduc-
ing as well as usual, and sometimes not at all.   As soon as the in-
flammation has  subsided, particularly  if the  system be weakened,
tonic bitters and a nourishing  diet must be  had.  When there is
fever, with great excitement of the nervous s^tem,. delirium, picking
of the bed-clothes, etc., the patient should  have anodynes  (121) and
antispasmodics (87)  (91)  (90),  with blisters upon the  back of  the
neck, drafts upon the  feet, and  such other, local remedies as the case
may require.
   It is of little use to put  anything upon the mortified part, except   ,
with a view of lessening the stench.  For this purpose,  lay upon  the
part lint soaked in a solution of chloride of lime or soda, or  a solution
of pyroligneous acid, or of creosote.
   Very little can be done  to hasten the separation of the  dead part
from the living; but  while it is taking  place, a common flax-seed
poultice, mixed with a little powdered charcoal, may be  kept on it.
   The  ulcer  left  after  the separation is  to be  treated like other
ulcers.

                   Ulceration and Ulcers.

   When the  small particles composing the  body have been used
awhile, they wear out, and become useless. * Over the whole body
are distributed a multitude of small vessels, called absorbents, whose
business it is to pick up these worn and loosened particles, and carry
them away.
   There  is another class  of small vessels, having just the opposite
 duty, — namely, to bring new  particles  of matter, and put in  the
 places of those taken away.  These are arteries.   They are the natu-
 ral artisans, who construct our  bodies.  The absorbents are the de-
 molishers who pull them down.   Under these two forces, our existence
 is, for a time,  a drawn game between  life and death.   The absorb-
 ents, like myriads of hungry insects,  eat us up, — the  constructing
 arteries, like faithful builders, reconstruct us.   The work of the ab-
 sorbents, is called absorption; that of the constructing arteries nutri-
tion.
   When nutrition partially  ceases, and absorption  continues  una-
bated, we grow thin, or lose flesh.  This happens in  consumption.
If nutrition should stop altogether, absorption going on as usual, our
bodies would  be quickly destroyed.  We should  be wholly devoured
by these little  absorbent vessels.   This  would be ulceration applied to
the whole body.  But it  does  not  appear in so general a form.  It
confines itself  to particular parts.
   When  nutrition entirely ceases in  any portion of the body, the
absorbents devour all the skin, flesh, and vessels of the part,- —leaving^ 
432
SURGICAL DISEASES.
an open cavity.   The process of taking away the flesh, etc., is ulcera-
tion, — the cavity left is an ulcer or sore.

  Natural Surgery. — Ulceration sometimes acts the part of a natural
surgeon.   When a part dies from mortification, it is necessary to
have it removed; so nature  sets up, directly around it, an acute in-
flammation, in.  which all nutrition  stops, and  absorption goes on
rapidly.   In this way, a complete dike is in a short time made around
the dead  mass, and it is as handsomely amputated, or cut off, as any
surgeon could do it.
  When  the ulceration is going on, and the  blood-vessels  are  being
cut off by it, the blood coagulates or curdles in  them for a short dis-
tance back  from the  breach, which prevents bleeding. This is  as
good as tying the arteries.
  Some  textures ulcerate more easily than others, — the skin and
mucous membranes most easily of all.
  Ulcers are divided into healthy, unhealthy, and specific.

  A Healthy ulcer is a simple sore, not showing any  bad symptoms,
but rather a kindly disposition to heal.   It is generally small in size,
of a florid-red color, and has upon its surface, little elevations, pointed
like  cones, called granulations, which are not so apt as in the case of
unhealthy ulcers, to rise above the level of the surrounding skin.

  Unhealthy Ulcers comprise those called irritable, indolent, and pha-
gedenic, etc.

  Indolent Ulcers  are ^numerous.   The edges  of  the skin around  .
them are  generally  thick,  prominent, and rounded.   The granulations
are pale, smooth, large, and flabby, with a peculiar gloss upon  them.
These ulcers  form  most  often on the leg; and the nearer they  are to
the ankle, the  harder they are to cure.

  Phagedenic Ulcers are those which look as though they literally eat
away the parts.   Their surface  has a livid appearance.  The matter
formed is small in quantity, and is frequently tinged with blood.

  Specific Ulcers embrace scrofulous, cancerous, venereal, scorbutic, and
others.   They are  called  specific  because they are  produced by par-
ticular diseases, and states of the system.

  Treatment. — The first thing to be done is to  remove the exciting
cause.  A venereal, or a scrofulous, or a scorbutic ulcer, cannot be
cured, unless we first  lessen the force  of the disease  in the general
system.   If the continuance of a sore depends on bad digestion, we
cannot expect to cure it, till we put the stomach  right.
   Healthy ulcers want  no treatment,  except some simple dressing,
such as  marshmallow or  spermaceti ointment.   It is well, in some
cases, to touch the  granulations near the surface, with lunar caustic.
   Ulcers  upon the legs and ankles  do not heal well if the patient
walks about much, or even allows  the legs to hang down a great
.deal. 
SURGICAL DISEASES.                    433
Fig. 146.
  Indolent ulcers  are to be touched by lunar  caustic stick, or by
diluted  nitric  acid.  The diluted  ointment of the nitrate of mercury
                 is  also often used with benefit.   So is the com-
                 pound tincture of benzoin;  the basilicon ointment,
                 etc.   Or, apply  a bread and milk poultice to the
                (. ulcer, and  keep  the  patient twenty-four  hours in
                 bed.   Then  apply the lunar  caustic stick  to the
                 whole sore, and to the skin  around it.   Afterwards
                 cover the ulcer with sticking plaster, and a bandage.
                    The following is the best plan.  Lay upon the
                 sore a number of pieces of lint, soaked in the ni-
                 tric acid lotion (314), and cover them with a bread
                 and milk poultice.  Change these applications twice
                 a  day, and  continue  them  till the discharge looks
                 healthy, and the granulations begin to appear.
                    If there is  inflammation about the sore, give some
                 of the preparations of salts to purge the bowels, and
                 confine the patient to bed.  When the parts begin
                 to look healthy,  lay some  pieces of lint upon the
                 sore, wet with nitric acid lotion (214), or zinc lotion
                 (215);  and  then apply strips of adhesive plaster,
                 one and one-half inches wide, two-thirds  round the
                 limb, and extending an inch below the ulcer, and an
                 inch  above  it, — at  the  same time, drawing the
                 edges of the sore together  with a gentle force, and
 retaining them there with the plaster.   Put  a compress of soft linen
 over the plaster, and apply a bandage over the  whole, making it tighter
 below, and a little looser above, and extending to the knee.  (Fig. 146).
Boils. — Ferunculus.
   Underneath the skin is a layer of tissue composed chiefly of cells.
From  this tissue there are  small elevations, in the shape  of  cones,
which  rise up into the substance of the true skin.   Like those papillae
of the  skin which become inflamed and produce corns, these  eleva-
tions are subject to an inflammation, which causes boils.
   At first, a tender knot or hardness is felt just under the skin,  which
soon begins to look red.   A painful tumor now begins to show itself,
of a dusky red or  purple color, which acquires the size  of a  pea, a
hazel-nut, or a walnut.   Sometime between the fourth and  eighth
day, it becomes pointed and  white at the  top, when the  scarf-skin'
gives way, and lets out a little pus mixed with blood, and exposes to
view a mass  of dead  matter, called a core, which is too large for the
opening, and is not ready to come away, if it were not.  This core is
a mass of mortified or dead flesh; and nature is cutting a  space
around it, that it may be thrown  off.  In  two or three  more days, it
comes  away, leaving  a cup-like cavity, which gradually fills up, and
the boil is over.
  Some costitutions yield boils in successive crops,   When this hap-
                                55 
434                    SURGICAL DISEASES.
pens they are a terrible affliction.  There are not many Jobs who can
bear them with patience.
                                                   <
  Treatment. — A boil will generally run its  course.   A five-grain
blue pill, taken at bed-time, when the boil is  first showing itself, is
about the only thing I know that will blast it  And yet, my unwil-
lingness to encourage a general use of mercurials, makes me hesitate
to recommend it.   One pill, not-to be repeated, can do no harm, how-
ever, and may safely be taken.
  Boils may sometimes be stopped by  touching them with lunar
caustic.  Water-dressing, if used early, and persevered in, will some-
times prevent their growing larger than  a pea.   After  the bqil has
opened, apply poultices  for a day or two, then some simple, stimu-
lating ointment, as basilicon salve, or Turner's cerate, or nitric acid
lotion (314).   If boils continue to come out in successive crops, give
alterative medicines, or sulphurous mineral waters, or  liquor potassae,
or bicarbonate of soda.


                    Carbuncle.—Anthrax.

   This is like a boil, only much larger, and more painful.  Instead
of one of the little cellular elevations being inflamed, as in the case
of the boil, the carbuncle  begins with the inflammation of several.
Its surface is more  flat than that of a boil; its inflammation  more
violent;  and the constitutional symptoms  excited more severe.   It
has  the  breadth, sometimes, of the top  of a quart bowl.  Like the
boil, it appears most often  upon the neck, the shoulders,  the back, the
buttocks, the thighs, etc.  It goes through the same process as a boil,
and ends in the same way, only discharging a vastly larger core.
   Carbuncles most often appear in  persons above middle age, and
indicate  an impaired and  broken constitution.   They occasion  great
suffering, and sometimes prove fatal.  Upon the head or neck, they
are more dangerous than in other situations.

  Treatment. — Apply, constantly, during the formation of the carbun-
cle, either fomentations  and poultices, or cold water dressing.  I pre-
fer the latter.   To stop both the local and the constitutional disorder,
make  two incisions in the form of a cross, cutting  entirely through
the dead mass.   Then  apply a fermenting poultice, or one of oat-
meal, for two or three days, — after which, use the basilicon salve, or
apply daily a weak solution of lunar  caustic, or the nitric acid lotion
(314).  During recovery, tonics are  useful, such as quinine, tincture
of peruvian bark, and sulphuric acid; and morphine to procure rest,
at every stage when it is required.


                     Malignant  Pustule.

   This is one of the five diseases which man may take from animals.
 The other four are the cow-pox, hydrophobia, glanders, and pestilential
carbuncle.   This last is what  the French call  charbon, — pronounced 
SURGICAL DISEASES.                    435
sharbo.  My own mother and an elder brother came near losing their
lives by it, — having taken it  by handling t£e flesh and tallow of a
dead cow.
  Malignant pustule  begins wTith a water-pimple, not bigger than a
millet seed.   Underneath it is  a hard point, surrounded with redness,
like a  flea-bite.   This  hardness  is soon attacked by mortification,
which spreads on all sides, and kills everything as  it  goes.   Next, in
fatal cases,  come  great restlessness,  fain tings, sunken  countenance,
dry skin, dry brown tongue, despondency, delirium, and death.  It is
supposed  generally not to arise from constitutional causes, but to be
produced  by a specific  poison applied to the skin, or by eating the
flesh of cattle which die of gangrenous diseases.  The  disorder is
probably the same with the pestilential carbuncle.

  Treatment. — Deep incisions, and the application of the most pow-
erful  caustics, as  the caustic  potash, etc., and  tincture  of peruvian
bark, quinine, aromatic  sulphuric  acid, wine,  ether, and  opium.
Probably  the  best treatment is to surround the pustule with a thick
layer of ointment; then to fasten some lint to the end of a stick, wet
it with nitric  acid, and press it upon the pustule.   Now apply cloths,
wet with cold water, and when  the slough comes  off,  dress with
simple ointment, or touch occasionally with weak solution of nitrate
of silver (211).

                     Chemical  Injuries.

  These are of two kinds, produced by causes of an exactly opposite
nature.   The  first are

                     Burns  and Scalds.

  A burn is the effect of concentrated heat acting upon living tissues.
The effects are inflammation, and sometimes complete disorganization
and destruction of the parts.
  A scald is an injury produced by applying hot water or other fluid,
to the skin or mucous membrane.  The natural  temperature of the
human body is ninety-eight degrees ;  that of boiling water, two hun-
dred and twelve degrees.  Bringing  the skin in contact with a fluid
heated so far above it, produces redness and pain ; and when nothing
is done instantly to ward off the injury, the  scarf-skin is raised from
the true skin in the form of a  blister, filled with water.
  The degree of  danger from  a burn  or  scald, depends upon  the ex-
tent of the injured surface, and also upon the depth of the injury.  An
extensive  scald or burn  may prove fatal in a few hours, — the  patient
never rallying from the first  prostration.   These  injuries  are most
dangerous when upon the head, neck, chest, and belly.  Old persons,
and those who are feeble, and  have shattered constitutions, will sink
under burns and scalds, from which robust persons will  suffer but
little.

  Treatment. — For slight burns and scalds, make cold applications. 
436                    SURGICAL DISEASES.
Put the injured part in very cold water, or lay upon it pieces of linen,
or lint, wet with vinegar and water, or rose water and sugar of  lead
(238), or diluted  solution of acetate  of ammonia.   When these are
not to be quickly had, lay on scraped potatoes.  The object is to
reduce  the  inflammation, and  to prevent blistering.   They must,
therefore be put on very soon.  If the scald be extensive, and on the
body, — producing shivering, faintness, paleness, and coldness of the
skin, and a small  pulse, — cold applications  are not proper.  In  such
case we may use warm  fomentations, or, in  the case of a child, the
warm  bath.   A  liniment of spirits of turpentine,  linseed  oil,  etc.
(194), makes an excellent application.
  Raw cotton, spread out thin, and laid upon  a burn, is a good dress-
ing, and one which is much used.   So is  flour sprinkled upon the
injured surface with a dredger.   For loosening the flour  when  it is
to be taken off, poultices are useful.
  Keep the  air from  the wound as much as  possible.   With this
view, do not  remove the dressing often, and when  a  cold  lotion is
used, merely pour it upon the rags, letting them remain undisturbed.


               Effects  of Cold.—Frost-Bite.

  Cold is a relative term.  The same temperature may be called hot
or cold, according as it is  compared with a  hotter or  colder  tempera-
ture.   If we warm one hand by a fire, while we lay the  other upon
ice, and then plunge them both into cold water, the water  will feel
cold to the one which has been by the fire, and warm to the one taken
from the ice.
  The warmth of the body being ninety-eight degrees, any  tempera-
ture below this may be said, in a certain sense, to be cold.  Yet a
temperature  much lower  than this, namely, from sixty to seventy, is
the most agreeable and invigorating, because  it takes away the  heat
just about as fast as it is  produced in a healthy body.
  The first effect of cold  applied to the body is to weaken the circu-
lation  in  the small blood-vessels of the  skin.  When applied  with
some  intensity, the heart and  arteries  in general are weakened; the
blood  is delayed in the  vessels near  the surface, and not being
changed to a red  color in the lungs as fast as  it should be, the fin-
gers, ears,  etc., become blue or livid ;  and, if the cold be continued
sufficiently long, the circulation stops in these parts ; heat ceases to
be evolved, and  mortification  or death is the consequence.  Parts
killed in this way are said to be frost-bitten.
  A free circulation of red blood is  essential to the continuance of
sensibility.   Hence, when  the circulation  is  seriously impeded by
cold, the body becomes numb, — it loses its feeling;  the muscles act
feebly ; a languor and torpor follows ; drowsiness  comes on, followed
by sleep, from which  there is no waking.   Drowsiness, during expos-
ure to  extreme cold, indicates great danger.

  Treatment. — It is a great principle in restoring frost-bitten parts,
and persons  benumbed with  cold, to communicate heat in  the most 
SURGICAL DISEASES.
437
gradual manner.  Mr. Hunter says the degree of external heat should
be in proportion to the quantity of life.  When life is weakened and
nearly  destroyed  by frost,  therefore, the warmth imparted must  be
small, and rise no faster than life returns.
  To restore a frozen limb or part, rub it with  snow, or  place it in
cold water for some time.   When feeling begins to return, still keep it
in cold water, and  let heat be added in a very gradual manner,  by
poring in, now and  then, a  very small quantity of warm water.
  If a  person  be reduced by  cold  to insensibility,  and apparently
frozen to death, take his clothes off, and cover him all over  with snow,
except the mouth and nostrils.  If snow is not to be had, put him in
water  as cold as ice, and  let him lie for some  minutes.   Then rub
him with cloths wet with cold water.  When the body is thus thawed
by degrees,  and the muscles begin to relax, dry the body, and placing
it in a cold bed, rub with the warm hands, only under the clothes.
Continue this for hours.   If signs of life appear, give a small injec-
tion of camphor  and water, and  put a drop of spirits of camphor  on
the tongue.  After a time,  rub with spirit and water, and finally with
spirit, and give tea, or coffee,  or brandy and water.


                    Mechanical Injuries.

  Wounds are divided into several kinds.

  Incised Wounds are very common.   Being made with sharp instru-
ments, they  are cuts, and have no laceration or tearing about them.

  Stabs, or  Punctured Wounds, form another class.   They are made
with pointed  weapons, as bayonets, lances, swords, and daggers.
They are more dangerous than  the former,  because they penetrate
to a greater depth, — injuring blood-vessels, nerves, bowels, and other
organs.

  Contused  and Lacerated  Wounds form still another class.  They
embrace gun-shot wounds, and all those  produced by blunt instru-
ments.   They tear,  and bruise, and mash the flesh.

  Poisoned  Wounds form yet another class.  They  are such as  are
united  with the introduction of some venomous poison into the  in-
cised, or punctured, or contused part.   Stings and bites of venomous
insects and snakes'are of this class, — also the wounds made by poi-
soned arrows.

  Simple Wounds are such as are inflicted on a healthy subject with
a clean sharp instrument.

  Complicated  Wounds are  those  inflicted  when  the state of  the
whole system, or  of the wounded part, is such as to make  it neces-
sary for the surgeon  to deviate from the  treatment needed for a
simple wound, — as, for example, when there is  bleeding,  or nervous
symptoms, or  great pain,  or locked-jaw, or  much contusion, or  ery-
sipelas. 
438
SURGICAL DISEASES.
  Sympathetic Fever. — All large wounds are followed by symptom-
atic fever, which comes on from sixteen to thirty-six  hours after the
accident  This is generally  of  the inflammatory kind, and is indi-
cated by greater warmth  of  the  skin, a  more frequent and stronger
pulse, anxiety,  thirst, and loss  of digestive power.   Where  much
blood is lost, and the constitution is feeble, the pulse is more quick
than strong, and the  fever of a lower and more typhoid type.  In
this case, blood must not be drawn.
  Lacerated wounds are more dangerous than incised ones, because
the parts are stretched and otherwise injured, besides being separated.
  A very small wound upon the  brain, the spinal marrow, the bowels,
or the heart, will often prove fatal, because  the  functions of these
parts are intimately connected with life.
  Wounds of young persons  heal much more rapidly and kindly than
those of old persons.

                      Incised Wounds.

  When the flesh is divided with a cutting instrument, the cut  edges
separate, and the wound has a gaping  appearance.   This drawing
apart happens in consequence of the elasticity of the  skin.  It often
happens that vessels of considerable size  are cut, so that  bleeding is
the principal thing to receive  attention.

  Treatment  of Hemorrhage. —Bleeding  is stopped by the tourniquet,
by the ligature, by compression, by the application of cold  water and
ice, and by astringents and styptics.

  The Tourniquet.— This instrument consists of  a band and buckle,
a pad, and two brass frames, the upper of which is furnished with
two  small  rollers, and the lower
with  four,  over all  of which the
band  plays.  When the handle is
turned to  the  right  or left, the
band  is tightened  or relaxed to
just   the  extent  required.  (Fig.
147.)  The band is  buckled round
the limb in such a manner  that
the pad is placed  exactly over the
artery.  When an artery is cut, it
is known by the blood being very
red, and spirting out in jets; and
in this case, the instrument must
be placed  upon  the  limb above
the wound, or between it  and the
heart

  The Ligature.—When an artery
is  divided, the  surgeon  lays  hold
of the end of it with his forceps, and ties a thread tight around it
This  is called a ligature.  By it, the bleeding is instantly stopped;
 
SURGICAL DISEASES.                    439
 and long before the thread becomes  loose, the  opposite sides of the
 vessel have  grown together,  and  all danger of a renewal of the
 bleeding is over.

   Application of Water  and Ice. — This  is done by saturating with
 cold water several folds of linen rags, or lint pads, and applying them
 to  the wound, remoistening, and  reapplying  them as fast as they be-
 come hot, till the pain and inflammation subside.

   Compression. — When the blood does  not come from  any large
 vessel, but from several  small ones, compression  is sufficient  It con-
 sists in placing the opposite sides of the wound  together, if possible,
 and then laying compresses over, and applying a bandage with mod-
 erate tightness.

   Astringents and  Styptics. — These are  spirits,  tinctures  of myrrh,
 peruvian bark,  diluted mineral acids, solutions  of tannin, alum, sul-
 phate of copper, decoctions of  white oak bark, etc.   These  have the
 power to stop bleeding from small vessels.   Monsel's salt, a remedy
 just coming into use, is said to have more power  than all the above.
 It  is a preparation of iron  and nitric  acid, and  has  been used with
 great success in stopping violent  bleeding at the military hospital of
 Bordeaux.  It is not a caustic or an irritant;  but it acts very power-
 fully upon albumen and blood, — producing with the  latter a large
 clot, absolutely insoluble, which  continues to enlarge for several hours
 after  the  application, and becomes quite  hard and firm, so  that no
 blood can get through.
   Beside these means,  the application of the  lunar  caustic  stick,
 potash, and the hot iron, are used, particularly the first, quite often.


              Union by  the First Intention.

   When the bleeding is stopped, all foreign substances  removed, and
 the wound  properly cleansed, the  next thing  is to bring the opposite
 sides of the  cut evenly  together, ahd  to  keep them  steadily in this
 position till they have healed.   If this method succeeds, the  healing
 takes place without the formation of any pus.  This is called healing
 by. the first intention, or  adhesion.   The cut surfaces grow  together.
 For keeping the surfaces together, straps of adhesive plaster are used,
 putting them^at right angles across the  cut, and leaving spaces be-
 tween them.  'Over the straps should be cold water dressings.

  Sutures. — Incised wounds are sometimes,—though seldom  now,—
 sewed together,  by what  is called  the interrupted suture.   After the
 bleeding is  stopped, a curved needle is threaded, and, the lips of the
 wound  being brought together, is introduced through  the right lip,
 and then, being directed  across  the wound, is pushed through the left
lip, from  within outward.  It  is  now cut off, and  tied  in  a  bow.
 These stitches should be at least  an  inch  from each  other.   The
adhesive plaster is generally better than the suture.
  The first plasters and  dressings  should remain  on the parts at least 
440
SURGICAL DISEASES.
 three or four days, unless very great pain, bleeding, or some other bad
 symptom, should call for their removal.


  Useful Rules for Examining and Dressing Wounds.

   Never give the  patient more pain from the mode of handling and
 dressing the wound than is necessary for his present good, or future
 safety.   Never distress him by probing, squeezing, etc., to find things
 that will be of no use when learned.
   Make all examinations as-soon after the  accident as  possible; for,
 before inflammation and  swelling take place, the probe or finger in-
 flicts much less pain.
   In changing the dressing of a wound, let  all the fresh ones be ready
 before the removing  of the old.   The sponge, warm water, adhesive
 plaster, lint, ointment,  lotions, bandages, etc., should all be at hand,
 and not have to be looked after when the wound is exposed.
   Put the patient in the most easy position, that he may not be need-
 lessly fatigued during the dressing.
   If the bandage, plaster, and other dressings, have become hard, and
 glued together, and to the skin, by blood or matter, soften them with
 warm water, which is to be  pressed out of  a sponge, — a basin being
 held below the part to catch the water as it falls from the dressing.
   The strips of adhesive plaster are to be removed by pulling gently
 at one  end, and then  the  other, — each to  be drawn  towards the
 wound, so as not to pull its lips apart
   In  large wounds, take off one, or  at most, two strips of plaster at
 a  time.  Cleanse, wipe dry, and again support this part of the wound
 with  new strips of plaster, before any more are taken off.  This will
 prevent the wound being torn open by the weight of its parts.
   If the wound be large  and deep,  its sides should be supported by
 an assistant while changing the dressings.
   If there are several wounds, dress but one at a time, that there may
 be no needless exposure to the air.
   Pay the utmost attention to cleanliness.
   The frequency of the dressing must  depend on the  amount  and
 quality of the  discharge, the situation of the injury, the climate  and
 season of the  year, the effect produced by the  dressing, and  by the
 feelings of the patient


           The  Way in which  Wounds Unite.

   When the two surfaces of a wound are brought together, they be-
 come impervious to the blood, but not to coagulable lymph, or  fibrine.
 This, — the material of which all flesh is made, — flows out upon the
two surfaces, and becomes a bond of  union between them.
  Into this layer of fibrine, the  small  blood-vessels, — arteries  and
veins, — which have been  cut asunder, push themselves with open
 mouths, and, meeting in the centre, they inosculate, or grow together,
 and the blood resumes its circulation  through them. 
SURGICAL DISEASES.                   441
  By this method, incised wounds of moderate size are often  healed
in forty-eight hours.  This method of healing by the  first intention
is always to be brought about, if possible.


                     Punctured Wounds.

  These are produced by swords, daggers, etc.
  Great swelling and inflammation, large  abscesses, erysipelas, the
wounding of large arteries, and the consequent extravasation of blood,
symptomatic fever, and  lock-jaw, are the frequent results of punc-
tured wounds.  They are, therefore, more dangerous and hard to cure
than cuts.

  Treatment. — For the first twenty-four hours, use superficial dress-
ings of lint, wet  with a  solution of sugar of lead dissolved in  cold
water, or with cold  water simply, and a loose bandage.   If, after this,
pain  and swelling  should  increase, leeches  may be applied  to the
neighborhood of  the wound, and fomentations, or poultices, be put in
place of the cold  water, — placing a small linen rag, spread with sper-
maceti cerate,  over the wound.  When the pain and inflammation
are great, saline  purgatives (7) (18) (25) (27), and opiates are often
called for.

            Contused  and Lacerated Wounds.

   These are produced by cudgels, stones, bullets, or whatever else of
a blunt nature, tears asunder the muscular fibres, leaving jagged and
uneven surfaces.   They  are  rarely healed without suppuration, and
are frequently  followed  by violent inflammation.  They suppurate
and slough, but theyjdo not bleed much,—not even, sometimes, when
large arteries  are torn asunder.  Whole limbs are occasionally torn
away without hemorrhage.   In warm climates, lock-jaw is a frequent
consequence of them.

   Treatment. — Draw the  edges  of the wound  loosely together, and
retain them with a  few strips of adhesive  plaster.   Sometimes a
suture, here and  there, will be proper.   If a great deal of inflamma-
tion  ensues, take away the adhesive plaster and the stitches, and
apply a poultice, or water dressing; and if  there be much fever, rest-
lessness, or delirium, saline  purgatives (18) (25), opium (118), and
very low diet, will be needed.
   The wound having thrown off its  sloughs, suppurated, become
clean, and formed  granulations, the poultices are to be taken off, and
simple dressings  substituted.   These should be adapted to the condi-
tions of the sore, according to the directions for treating* ulcers.
   When the wound is so severe that extensive mortification will be
sure to  follow, the limb must be immediately taken off, to save the
life of the patient 
442                    SURGICAL DISEASES.
              Granulation and Scarification.

  Suppurating wounds  heal  in  the  same way with  ulcers.   The
chasm is filled up by the appearance of little soft elevations of new
substance, which originate at all points, and meet at the centre, draw-
ing the sides  nearer together, and  raising the bottom  towards the
surface.  This is called granulation, because these elevations look like
grains ; and the result is a new tissue, of a peculiar character, which
constitutes the cicatrix, or scar.

               Reproduction  of Lost Parts.

  Among some of the lower animals,  whole limbs which have been
destroyed, are  easily reproduced.   It is not so  with man ; though cer-
tain parts, when only partially destroyed, are sometimes  regenerated.
Thus, portions of skin, of considerable extent, are often  reproduced;
and so are the whole of some long bones, when destroyed by necrosis.
The same  is  true,  to some extent, of  ligaments.  But portions of
brain, and spinal marrow, and muscle, and mucous membrane, when
once removed, are never regenerated.

                     Gunshot Wounds.

  At a time when fire-arms are so much carried about the person,
and so  often used for purposes of duelling, and murder, it is proper
that every person should know something of the modes of treating
gunshot wounds.
  Treatment. — It is often proper to make a gunshot wound larger at
the orifice.  When  this is done, it is generally pn the side where the
bullet has passed out, if it  has gone  entirely through.  A bullet is
always to be removed, if it can be felt.
  The dressings are at first  to be superficial, light, and unirritating.
The common tepid water dressing, covered with a piece  of oiled silk,
is one of the best   Some use  pledgets of simple ointment, poultices,
and fomentations.  These latter are generally employed during  sup-
puration ;  but during the first two or three  days, cold evaporating
washes, and cold water,  are best, when the wounded part is inflamed
and hot, and the circulation is  vigorous.

                     Poisoned Wounds.

  To the bites of various creatures man is exposed in most climates,
and all seasons of the year.  These may be divided into three classes.
  Bites of Musquitoes and Spiders, and  Stings of Bees and Wasps.—
For these, the best applications are a  solution  of common salt, or
water of ammonia, or sugar of lead (239), or laudanum, or tincture
of iodine.  If none of these are  at hand, at  the moment, cover the
part with wet  earth.   Tincture of arnica (240) is a good  application. 
SURGICAL DISEASES.
443
   Bites of Tenomous Snakes. — Either instantly cut out a piece from
the bitten part, or apply a dry cup, to prevent the absorption of the
poison.   Suction with the mouth will sometimes answer  the same
purpose.  After doing one of these things, touch the part with caustic
potash.  Internally, give Fowler's solution, twenty drops, in a little
water, every two  hours.   Also purgative  injections, — stopping the
arsenic when purging is well established.
   For the bite of the rattle-snake, the only known remedy is alcoholic
drink, taken in large quantities, and immediately.  Gin and whiskey
are believed to be the best  Fill the system full.   When the  poison
has begun to take effect, enormous quantities will be borne,  before in-
toxication can be induced.  Keep the whole person saturated until
the symptoms decline.

                           Fractures.

   The existence of a fracture is to be known by  the symptoms.
 These are, pain, swelling, deformity from the limb bending to one
side, sometimes shortening of the limb, or loss of power to use it, and
a crepitus or grating sound or sensation from the rubbing of the ends
of the broken  bone together.  There are several  kinds of  fractures.
They are

   The Transverse Fracture, which is directly across the bone.

   The Oblique  Fracture, which runs from side to  side, in an oblique
direction.

   The Longitudinal Fracture, which runs lengthwise of  the bone.

   A Simple Fracture is one in which the bone is broken simply, with-
out any wound of the  flesh with it.

   A Compound Fracture consists of a simple fracture, and  of  an ex-
ternal wound in addition, caused by pushing the  end of the broken
bone through the flesh.

   A Complicated Fracture is one in which, beside the breaking of the
bone, there is the dislocation of a joint, the  wounding of an artery,
the extensive tearing of the soft parts, or the wounding of the bowels
or some other internal organ.

   A Comminuted Fracture is one in  which the bone is broken into
several pieces.

   Treatment of Fractures—When a bone is broken, the first thing
to be done is to get the injured person to his home, or to  the nearest
house.   To do this  in a  rough or careless way, might add much to
his sufferings.
   If it be an  arm which  is broken, let it be placed in  a broad sling,
extending from the elbow  to the fingers. -  In this condition- the pa-
tient, if in tolerable  health, and the  distance is not great, will find it
easier to walk home, than to bear the jolting of a carriage. 
444
SURGICAL DISEASES.
    If the leg or the thigh be broken, then a hurdle of some  sorj: (Fig.
 148), must be obtained as soon  as possible, and, being covered with
 straw,  or  blankets, or  gar-                  „   ,   '
 ments,  the  patient  should
 be gently  lifted  upon it by
 just persons enough to raise
 him  easily from  the ground.
 This should now be  carried
 by four persons,  two  at  each  end, moving with great gentleness, and
 keeping exact step with each other.  If these persons take hold of
 the ends of two  poles, laid under the  hurdle, they will find they can
 carry it much more easily.  If no hurdle be at hand, let four poles, two
 long ones, and two short ones, be laid across each other at right angles,
 and fastened together with nails or  strings.  Then lay upon these an
 old door, or some loose  boards; and the injured person may be easily
 carried upon this temporary structure.  A blanket fastened upon four
 pole's, in the manner of a cot-bed, will answer a good purpose.
   Having placed the patient upon the hand carriage, bring the  sound
 limb and the broken one snug together,  and  tie them to each other
 with two or three pocket handkerchiefs;  this will support the broken
 limb, and prevent its being shaken about  and  injured by motion.   In
 doing this, the limb should be laid as near as possible in the natural
 position, so that  the bones may not  get out of place, and their ends
 get pushed through the flesh.

   The Reduction, or Setting of the  Fracture,  is the first thing  to  be
 done.   By this is meant the bringing of the ends of the broken bone
 together, and adjusting  them to  each other in their natural position.
 This is  done by what surgeons  call extension, counter-extension, and
 coaptation.
   Extension  means taking  hold of  the limb  below the fracture and
 pulling from the  body.                                 ,

   Counter-Extension is pulling above the fracture towards the  body.
 These opposite puffings are done at the same time to overcome the
 force of the muscles, which contract, and  draw the ends of the bone
 by each other and shorten the limb.
   Sometimes no  extension or counter-extension is necessary, the ends
 of the broken bone not  being  pulled out of their place.  When  the
 pulling is necessary, it should be gentle and steady.

   Coaptation means adjusting the  ends of the  bone to each other.
   The.  next  thing is  to  provide  for keeping  the  ends of  the broken
 bone  steadily in  contact, so that  nature  may have a fair chance  to
 unite them.
   To secure this object, mechanical contrivances are useo>, which are
 simple,  and  may  always  be had without difficulty.
   They consist of linen  bandages, about  the breadth  of four fingers,
 and from four to  ten yards long ;  and pads, made of old woollen cloth
or blankets lightly quilted together, or pillow-cases filled with tow, or
 chaff, or cut straw, or even leaves ; and of splints, made of clapboards,
 
SURGICAL DISEASES.
                                                     445

 ^the^
 into a piece of cloth to ZZTtht™  n  ?   , \adeI and 1uilted
 splint may be u^^^^ZtT^^  A ^ ™W






 position, and perhaps l&tl/LT^e ^Knlto" i'tota r^nd"
 collar bones are exceptions, and should bJ bound up immediately

 w^^«^&^a piL- "^ -
 theTetterthe aPParatUS * °Dee adJUSted> the kss * * "eddied with



exercise by walking about                 patient to take some

                        Fig. 149.
<£&& %Z SSX^££%*Z'&
Fw. 150.
are also fracture-boxes (Fiff. 150) »nf\ r~„„t
keep  the bed-Cotne, L& ^tZT^^^. 
446
SURGICAL DISEASES.
beds are now brought to great perfection, and one should, if possible,
be procured when the patient is likely to be confined a long time
with a compound fracture.   The  fracture-box, represented  by Fig.
150, may be made from thin boards, by any  carpenter.   It  has a
hinge at the knee to enable it to fulfil the double purpose of a double-
inclined plane and a fracture-box.

        The Way  in which Broken Bones Unite.

  The union of broken bones is much slower than that  of severed
flesh.   The  ends of the bone being kept steadily together, they soon
become surrounded by a swelling of the soft parts, which  change to
a sort of osseous substance, making a kind of bony hoop,  to act as a
splint or support, — nature not being willing to trust the surgeon to
keep  the  fragments  axactly in  their place.   This is called a provis-
ional callus, because it only has a temporary use.

  This First Stage lasts about ten days.  At the end of this time, a
spongy substance appears between the ends of the bone.  This sub-
stance is not bone, but in the swelling around the fracture specks of
bone  begin  to  be deposited; the fibrine  here poured out becoming
first cartilage, and then receiving into  itself phosphate of lime, it be-
comes bone.  A similar work is going on within, in the part called
the medullary membrane.

  This Second  Stage lasts from the tenth to the twenty-fifth day.

  Then Begins the Third Stage, which goes  to the end of the sixth
or eighth week.  During this period,  the  external, swelling, and the
internal  medullary membrane,  become completely ossified and firm;
though the ends of the bone are not yet grown together.

  The Fourth Stage goes to the  end of  the  fifth  or  sixth month.
During this time, the external swelling, or provisional callus, becomes
covered with a periosteum, and the ends of the  bones themselves are
fastened together by a bony union.

  The Fifth Stage extends from the fifth or sixth to the twelfth
month.  During this time,  the ends of the bone  become grown to-
gether  so strongly that the bony ring,  or provisional callus, is no
longer wanted, and it becomes  absorbed, and disappears, — in other
words, having  no further use for it, nature takes off her splint.  The
 place where the fracture was, is now as strong as any other part.

               Union  in Compound Fractures.

   The union  of compound fractures takes  place in a different way
 from that of the simple fracture, just described.  In this case there is
 suppuration, and. the bones  remain disunited several weeks, and there
 is  no provisional callus formed.  But after some weeks, the ends of
 the bone soften and granulate; and when  the production of pus de-
 clines, these granulations are gradually changed into bone. 
SURGICAL DISEASES.                   447
      Time  Required for Uniting Different Bones.

   Fractures of the arms unite sooner than those of the legs.
   The ribs and collar bone unite with  tolerable firmness in about a
month ; those of the arm in six weeks ; of the thigh and leg in eight
weeks.  I only mean the firmness derived from the  provisional callus.
   A broken bone will unite much sooner in a healthy person than in
an unhealthy one ; much sooner in a young than in an old person.
   As a general rule, the apparatus should  be kept  on thirty days in
the case of children;  forty days in "that of adults ;  and much longer
in that of aged persons.

                         False Joint.

   The union of a broken bone is sometimes prevented  by a frequent
moving of the limb.   The ends of the bone having  failed to grow to-
gether, will sometimes become rounded and smoothed, uniting only
by a kind of ligament, and  acquire the habit  of sliding upon each
other, and thus form what is called a false or artificial joint, — the
limb  being permanently capable  of bending, to some  extent, at the
place of the fracture.

                  Fractures of the Skull.

   These  are always  dangerous in  their nature, and the  aid to be
derived from  surgery much less than in other fractures.  If  a fracture
*of the skull produce deep  sleep,  and  snoring,  and the patient  does
not show any symptoms of pain when  pinched, etc., we are to  infer
that a piece of bone is pressed down upon or into the brain.
   In  this case, if the position of the  blow be known, a cut is to be
made through the skin, two or three inches long, down to  the bone.
If arteries bleed, they must be taken hold of with a pair of *forceps,
and tied with a silk thread, the ends of which are to be cut off.  The
bone  being well exposed by  one or  two incisions, the piece which is
pressed down upon the brain is to  be raised with a chisel, or some
similar instrument, to a level with the other  bones.  The surface
must then be cleaned with a sponge, the hair around shaved off, the
skin brought  together, and the cut edges  reunited by sticking plaster.
   When the inflammation appears, twenty-four hours after, it is to be
kept down by doses of from five to ten drops of tincture of veratrum
viride, given every one or two hours.

          Fractures  of the Bones of the Nose.

  Injuries of this kind may generally be rectified by passing a strong
probe up the nostril, and pressing out the bones  to their natural place,
at the same time using the fingers  on the outside to  prevent their
being pressed out too far.   Inflammation  must be  kept  down by
cloths wet in  cold water and laid on, and by light diet. 
448                   SURGICAL DISEASES.
Fracture  ef the Lower" Jaw.
Fig. 151.
 • This usually takes place near the chin.  It may occur also near the
angles of the jaw.   It may be simple or compound, and is known by
the pain, the swelling,  the inability to move the jaw, the indentation
felt  by the  finger, the  irregularity of the teeth, and the grating sensa-
tion  felt while moving the jaw with  the  hand placed on the back
fragment
  Treatment. — Let one or both thumbs be introduced  into the mouth.
With these, keep the  back  part of the jaw stationary, and pull for-
ward the fore  part with the fingers on  the
outside.  In this  way the  fracture can
soon be put right.   This done, shut  the
mouth  firmly, and  place a thick compress
of lint over the broken part; over this put
a piece of pasteboard, wetted so  as to
bend easily to the parts,  and over this a
strong bandage of muslin, two and a half
inches  wide, with  a small bag to fit and
hold the chin ; all which is represented in
Fig. 151.
  For a fortnight the patient  must feed on gruel, broth, arrow-root,
and milk, that  the jaw may not be displaced by chewing.
       Fracture  of the  Collar Bone, or Clavicle.
                                                              k
  This  accident generally occurs  about the  middle of the bone, and
is generally caused by falls on the  arm and shoulder.
Fig. 152.
Fig. 153.
  Symptoms. — Pain and tenderness  at the place of the injury, and
inability to lift the arm ; a small bunch or prominence at the point of 
SURGICAL DISEASES.
449
the fracture; the distance from the point of the shoulder to the breast-
bone shorter than on the other  side; #and  the dropping downwards,
forwards, and inwards of the shoulder.   To make the case sure, com-
pare the two bones, and see whether they agree.

  Treatment. — Place the knee between  the shoulder-blades, and
grasping the round ends of the shoulders with the two hands, draw
them gently back till the ends of the bone come to their proper place;
or, place the elbow of the patient  close  to the body, and a little for-
ward, and then push it upward.
   To retain the shoulders in  this upward and backward position  for
some weeks, pass  a flannel  bandage, four inches wide, around the
front of one shoulder, under the  arm-pit,  across the back, over the
opposite shoulder, under the  other arm-pit,  and again across the back,
in the form of the  figure go.   To  prevent  the bandage from  cutting
the skin, put pads under the  arms.  (Figs.  152 and 153.)

            Fracture of the  Shoulder-Blade.

   When  this  accident  happens, the body of the bone is generally
broken  across  by some great direct violence.   In a few instances, the
end next to the collar-bone is broken.

   Symptoms. — Great pain in moving the  shoulder, and  the grating
sensation which may be  felt  by placing one hand on the  upper end
of the bone, and moving the lower portion  with the other.

  Treatment. — A  bandage must  be passed  round the chest,  and a
few  turns be made around  the upper arm, so as to fasten it to the
side, and prevent all motion.   Purging, low, diet, and the tincture of
veratrum viride will be required to  keep down inflammation.

   Fracture of the Acromion, or  the end  of the scapula which  unites
with the collar-bone, may be known by the flattening of the shoulder,
— the broken  part being drawn down by the action  of the deltoid
muscle.

   Treatment. — It  must be supported by the  same bandages  as are
used for a fracture of the  collar-bone; and the elbow must be well
raised, so that  the head of the upper-arm  bone may be lifted against
the upper portion of the scapula, and act as a prop to keep it in  place.
No pad should be put in the arm-pit, for this would push the broken
part too much outward.

           Fracture  of  the Upper-Arm  Bone.

   The  bone of the upper-arm  is  most  frequently broken near the
centre, though it may be fractured near the ends.   It may be known
by taking hold of the arm above and below the suspected fracture,
and attempting to move  the  ends of the  upper and lower fragments
upon each other.  If there be a fracture, the grating  of the broken
ends against each  other will either be  heard or felt.  The arm will
                              57 
450                   SURGICAL DISEASES.
also be bent and helpless;  and if the ends of the bone be slipped by
each other, it will be shortened..
  Treatment. — Let a powerful man take hold of the arm and pull
gently and  gradually, but with considerable  force, till the  arm is
brought to its natural  length, — another man taking  hold of the body
of the patient,  and pulling in an  opposite direction.  In the mean
time, the  surgeon is to adjust the  ends  of the bone to each other,
and  apply a bandage, but not very tightly, from the elbow to the
shoulder,"and over this, four  splints, with pads under them; one in
front, reaching from the shoulder to the  bend of
the elbow, with a few turns of the  bandage over
it;  another behind, reaching from  the  shoulder
to the point of the elbow,  with a few turns of the
bandage around  it, also;  another  on the inside,
extending from the arm-pit to the inner projection
of the bone at  the elbow, also secured by a few
turns of the bandage; and the fourth one on the
outside, reaching  from the shoulder to the outside
knob at the elbow.  The  whole is now to be se-
cured either by a bandage  or tape.  (Fig. 154.)
The arm  is to  be confined to the side, and the hand and fore-arm
placed in a sling.   In  from seven to ten days, the dressing should be
taken, off to see if all is right.

                  Fracture of the  Elbow.

  This may be known by  the patient being able to bend the arm, but
not straighten it, and by the grating which may be heard or felt when
the arm is moved back and  forth by the operator, and also by the
severe pain felt in the  fractured part.

  Treatment. — First apply leeches and evaporating  lotions to reduce
the inflammation.  When  this is effected,  straighten the limb, and ap-
ply a bandage snugly from the fingers to the  elbow. The  broken
end of the bone must now be brought to its place, and the bandage
continued over it, and for a few inches above it.  Secure it here, and
bring it back, — carrying  it above  and below the elbow for  several
times ; and then extend it  up to the shoulder.   A splint must now be
applied to the inner side of the arm to prevent its being bent,—ex-
tending from the hand nearly  to the shoulder, and  another, of similar
shape, to the outside.   The joint should be kept quiet for four or five
weeks, — during which  time, the splints  may be  taken off three or
four times, to see if there is any chafing  of the skin, or any disturb-
ance of the bones.

       Fractures Between  the Elbow  and Wrist.

  The part of the arm between the elbow and wrist, called the fore-
arm, has two bones, — one extending from the elbow on the inside to
the wrist at the root of the little finger, called the ulna, and the other,
 
SURGICAL DISEASES.
451
 on the  side next the thumb, a shorter and a smaller bone, and called
 the radius.
   When both these bones are broken at the same time, the fracture
 may be easily discovered; when only one, the sound bone keeps the
 other in place, and the injury is not so easily made out.
                                 ••
   Treatment. — Relax the muscles by bending the  elbow, and  then,
 by extension  and counter-extension, put  the  ends of the  bones in
 proper place, and then place  two splints thickly padded in the centre,
 one upon the front of the hand and fore-arm, and the other upon the
 back of the hand and fore-arm, — the palm of ihe hand being turned,
 not towards the chest, but downwards.  They are to be covered with
 a bandage from the fingers to the elbow.   The whole  arm and  hand
 should  be placed in a sling, and  remain in this position four or five
 weeks.

      Fractures of the  Wrist,  Hands,  and Fingers.

   The  setting of fractured bones in  these  parts is to be done by ex-
 tension and counter-extension, as in the case of other bones.
   If  the wrist be broken, a splint  should be applied in front and one
 behind, and a bandage bound tightly from the hand half way to the
 elbow.
   In  fracture of the  bones of the  hand, a pad  or compress must be
 put upon the palm of the hand, and a splint placed  over this, with
 a bandage  extending  from  the wrist to  near  the  ends of  the fin-
 gers.
   If one finger only be broken, apply narrow paste-board splints on
 four sides, and cover them with a narrow bandage; and then bandage
 the whole hand.
   In  a'll these fractures, place the hand in a sling.  About three weeks
 will be  required for the bones to unite properly, and several weeks for
 the parts to acquire their natural usefulness.

                   Fracture  of the  Ribs.

   This accident occurs either by blows, or by being crushed between
 two opposing forces.   One, two, or  more ribs may be  broken  at a
 time, according to circumstances.

   Symptoms. —A fixed, piercing  pain,  made   worse  by breathing,
 coughing, or any other motion, and  also a grating sensation during
 the taking of a long breath, the hand  being laid upon the injured part
 at the time.

   Treatment*— The ribs are to be held steadily in their place by pres-
 sure.  To effect this, request the patient to  draw in  a long breath,
 and hold it.   While the ribs  are  swelled  out  in this way, and the
 broken  ends are thus  brought to their proper place, pass a woollen
 bandage, five  or six inches  wide, several  times tightly around the
chest, from the arm-pits to the pit of  the  stomach.  This will confine 
452                   SURGICAL DISEASES.
  the muscles of the chest, and the breathing will have to be done with
  the muscles  of the belly, and  the ribs will thus be kept still, and
  have a chance to grow together.
     If the pleura be wounded, and inflammation follow  from this or
  other cause, the patient  must be confined in bed, kept on a low diet,
  and his  pulse be  kept down by tincture of veratrum viride.   The
  bowels  should be  emptied by recipes  18, or 20, or 27, or 41, both to
  subdue  inflammation, and to give the diaphragm a chance to drop
  down freely.

                Fracture of the Breast-Bone.

     Symptoms.— The injured part is frequently either sunk down or
  raised up; there is difficult breathing, cough, spitting of blood, pain,
  inability to lie on the back, and a grating noise  caused by breathing.

     Treatment.— The same as that for broken ribs.   Should the broken
  part be  pressed down upon the lung, so as to' cause serious difficulty
  of breathing, an incision may be made, and the  broken piece raised
  up with a chisel, or stiff case knife, or some similar instrument.

         Fracture of the Haunch Bones, or Pelvis.

     These fractures are dangerous, — being often connected with some
  other injury,  as tearing of the  bladder, lower bowel, or great veins or
  arteries.  Fortunately, however, they are  only caused by some  great
  violence, and do not often occur.

     Treatment, — Place the patient in the easiest  possible  position, and   jj
  keep him entirely at rest.   Generally a catheter should be kept in the   jj
  bladder, that the  water may pass off easily; and the whole  hips   j
  should  be bound  round tightly with a flannel or calico bandage, and   :■
|  made as firm and fixed as possible, to keep the broken bones  together,   jj
  The most perfect rest must be ordered  for six weeks or two months.
     If the extreme lower end of the sacrum, the os coccygis (Figs. 8 — 3)   :j
  be broken, the separated portion must be put in its place by introduc-   ;|
  ing the finger into the rectum ;  and the bowels  must be kept loose by   'j
  gentle, physic, that the broken bone may not be pushed from its place   |j
  by the pressure against it of hard stools.

                 Fracture of the Thigh-Bone.                 ||

     The  points where this bone are broken  arc at its upper portion or   ;i
  neck, and near  its middle.  The break  at  this latter place  may be   jj
  straight across, or  oblique, — partially lengthwise.  When^oblique, the
  point of the bone may  stick  into one of the  large muscles, and be   |i
  made fast by it.                                                    J

     Symptoms.— The fracture in the middle of the bone,  if it be trans-
  verse, may be known by some  swelling or irregularity discovered by
  running the  hand  along the thigh, and  grasping it here and there; 
SURGICAL DISEASES.
453
and if it be  oblique, the ends of the bone  will be  drawn by each
other, and the limb will be shortened.

  Treatment, — Place the patient on his back, and let two strong men
use extension, — one taking hold near the hip, and the other grasping
the limb at the knee and pulling steadily and strongly till the limb is
of the proper length, and the ends of the bone are in their place. £Fhe
man who takes hold of the  upper end of the limb may hold it more
firmly and with less fatigue by passing a folded sheet around the groin.
   The extending  force being still continued, the operator is now to
apply the splints, which are  to be four  in  number, — one in front,
reaching from the knee-pan to the groin; one behind; one  on  the
inside, from  the upper part of the thigh to the inside  of  the knee ;
and a fourth one, about  four inches wide, reaching from the arm-pit
to  a distance  of two or three  inches  beyond  the  sole of the foot.
 Cotton must be placed under these splints to prevent their injuring
the  skin, and they must be of a width to nearly, but not quite, touch
each other.   These being properly adjusted, and the extension still
continued if the fracture is oblique, the bandage is now to  be firmly
applied from the foot to the upper  part of the thigh,  and then passed
a few times around the body.   This fracture is sometimes treated
without splints, as represented in Fig. 155.

           Fig. 155.                              Fig 156
  Six or seven weeks will be required for the bones to grow together,'
during which time the patient will need to lie upon his back.  But
the dressing may now and then be taken off and put on again.
 
454                    SURGICAL DISEASES.
  Sometimes only a single long splint is used ; sometimes no splint;
in still other cases, four splints, — the outside one being short, and the
limb resting on a double inclined plain.
  Fracture at  the IVech of the Bone. — When the bone is broken at
the  neck, close to the hip joint, the injury is known by the knee and
foot turning outward, and  by the limb  being  an inch or two shorter
than the other (Fig. 156).   This is an accident to which old persons
are  particularly liable.  When the bone is broken here, it  seldom
grows  together again.  The union which is formed is generally by a
ligament.
  Treatment. — This requires a very long splint, reaching from the
armpit to beyond the sole of the foot, and bound firmly with a band-
age, as in fracture in the middle of the thigh.  The limb should be
kept extended, and  the injured one must be bound to the other by a
bandage, keeping both legs straight and immovable.  A broad leather
strap, bound firmly round the hips and  thighs, will be serviceable.
  Two or  three months  will be required for the injury to become
repaired, so that the limb may be used.   The  patient must get up
cautiously, and be careful not to use the limb much so long as pain
is produced.

                Fracture of the  Knee-Pan.

  The knee-pan (patella) may be broken up and down, or across; —
the  latter fracture is the more common.  It is  a troublesome fracture,
and is very apt to leave a stiff knee.

  Symptoms. — When the bone is  broken across, the patient cannot
stand upon the limb; the leg may be flexed or crooked, but cannot
be straightened; the upper part of the knee-pan is  drawn  up away
from the lower portion, leaving a  wide gap, into which the fingers
may be laid, — at the top  and bottom  of which the rough  edges of
the  movable bones may be felt.

  Treatment. — First, reduce the inflammation by tincture of arnica,
leeches, etc.  Then  straighten the limb, and put a well-padded splint
behind, to  keep the  knee  motionless;  place the patient's  body in a
half-sitting posture,  and  raise the foot considerably above a level.
Put a bandage  over the splint, beginning  half way up the thigh, and
extending down to  the knee-pan, and being made  very  tight just
above the broken bone, so that it  cannot easily slip under it.  The
broken bones  must  now be brought  together,  and the bandage be
passed below  and  again  above the knee  several times in the form of
a figure 8, to keep the bones from parting.
  The bandage, generally, may not be removed for a fortnight.  After
this period, if everything  has gone  on well, the limb may be carefully
bent a little every day, to avoid a stiff knee. 
SURGICAL DISEASES.                   455
                    Fracture  of the  Leg.

   The leg is that part of the limb between the .knee and ankle.   It
 has  two bones; the  smaller on  the outside, called the fibula; the
 larger on the inner and front side, called the tibia, or shin bone.
   One or both of these may be  broken at the same time.   If both
 •are  broken, it is impossible to walk upon the limb ;  there is a change
 in its shape ; it may be bent; and the grating of the broken ends of
 bone may be felt or heard.

   Treatment. — First,  adjust the  bones by means of extension and
 counter-extension, as in other fractures.  Then apply two splints, one
                          on the outside  from the knee to the sole
                          of the foot;  the other  upon the inside.
                          Over  these a bandage is to be firmly ap-
                          plied,  reaching from the toes to the knee.
                          The  leg may  rest upon  the side or the
                          back,  as the comfort of the patient may
                          require.  Upon the side is generally the
                          easiest  position, with the  knee a  little
                          bent (Fig. 157).
                            The dressing may be removed in six or
 seven days, to see that the bones  are in their proper place.  Five or
 six weeks will be required  for recovery; and at the end of this time,
 the  dressing may be laid aside.   But the  patient must use  his leg
 very gradually.
   One of the simplest methods of treating a fractured leg is to place
 it in a fracture-box.   A pillow is to be placed in this, and the leg, the
 bones being put in place, is to be  placed in the box, and the foot to
 be secured to the foot-board by a bandage, and the sides of the box,
 movable upon hinges, are to be brought close enough to the limb to
 keep the bones in place, — compresses, etc., being placed around the
 limb as  required.   Bran may be placed  in  the box in place of a
 pillow.

           Fractures of the  Bones of the Foot.

   These are to be treated in the  same manner  with fractures of the
 hand.  They are often attended with much other mischief, as lacera-
 tion of the flesh, ligaments, etc.   Hence, cutting off the foot, or  a
 part of it, is often necessary.  Paste-board splints are frequently used
 in these fractures.  If matter forms, it must be let out by opening the
 parts.

                    Compound  Fractures. #

  When, in connection with a broken bone, there is a wound of the
flesh, which leads to, and communicates with the space between the
broken ends of the bone, the whole injury is called a compound frac-
 
456                    SURGICAL DISEASES.
ture.  The wound in the flesh  may be caused  by the same force
which breaks the bone, as a bullet  from a gun, or a cart-wheel, or
some machinery in which the limb  is entangled.   Quite often  the
flesh wound is caused by one  of the ends of the bone being forced
through the flesh and skin.
  But, however caused, a compound fracture is of a  much more
serious nature than a simple one ; and  it is particularly dangerous
when a joint is involved.  It is more serious above the  knee and
elbow than below, and  more to be  dreaded in the lower limbs than
in the upper.

  Treatment. — An attempt should  generally be made to preserve
the limb;  it should not be cut off, unless  the compound fracture is of
the worst kind.   But if there be no hope of saving the limb,  the
amputation should be performed  at once, while the constitution is
tranquil, and before it has been shocked and injured by the sympa-
thetic fever, suppuration, abscesses, and hectic, which are almost sure
to follow such grave injuries.
  But, suppose it  be  determined not to  cut the limb off, — as it gen-
erally should be, — the first thing is,  after the bone is  set, to close the
wound against all entrance of air, and to cause it to heal by the first
intention,  that is, without suppuration.   To flo this, one method is to
cover the wound with lint dipped in blood ; but the more usual mode
is, to bring the sides  of the wound  together, and secure them very
carefully by strips of adhesive plaster, in the same way as in common
cuts.  The. bandage should be kept wet with cold water, by squeez-
ing a sponge over it, or by sprinkling cold water upon it as fast as it
becomes dry.
  It will be necessary, in this case, to keep the bed-clothes, away from
the limb while it is thus wet, which  may be done by cutting a barrel
hoop in two, and nailing it to two pieces of lath.  There  should  be
air circulating under the sheet, that the heat of the inflammation may
not keep the limb in a steam-bath.
  Should  the wound heal by the first intention, the danger will soon
be  over, and  the  treatment may be  the  same as for simple fracture.
But this, unfortunately, does not often occur.
  It more often happens, that after three or four days, the patient
grows restless, has very short and disturbed sleep, is hot and thirsty,
has headache and shivering  fits, is more  ill towards evening, wanders
in his mind, or becomes delirious,  and perhaps  dies in ten days or a
fortnight from these  constitutional  disturbances.  If the  symptoms
are a little less severe, the wound will at  first discharge a small quan-
tity of dirty, bloody matter,  which,  if everything goes well, will, by
degrees, change to healthy matter, without smell, of a  straw color,
and about as thick as cream.
   The fever, and other bad symptoms, will now subside ; the sleep
and appetite come back, and a new process begins, that of healing by
granulation, or the formation of new flesh to fill  up the gap made by
the wound.   >
   For old persons, or those whose health has been broken, this stage 
SURGICAL DISEASES.
457
is  full of danger, and is apt to result in death, if the lower limb be
the injured part.
   If the constitution proves unable to bear up  against this stage of
the injury, alternate heat and sweating set in, the face is flushed with
a pink color, the pulse becomes weak and quick, the body wastes, the
appetite disappears, the tongue becomes dry and brown, restlessness,
wandering,  and  delirium, follow in quick  succession, and all are
speedily terminated by death.   With the setting in of these  symp-
toms, the wound stops discharging, or throws out only a thin, watery
and stinking matter.   Quite often the skin and other parts mortify,
and if there be  strength enough to throw off the  dead  parts, the
broken ends of the bone stick out, looking dead and white.
   When the constitutional symptoms begin, apply poultices, to set
up, if  possible, the formation of good matter; for  if this can be
•brought about, the  symptoms may be regarded as  favorable.   The
poultice must  be continued till  the  wound is  filled with  new flesh
nearly to the surface.

   In the First Stage," the medical treatment must  have reference to
checking the  inflammatory condition.  This  may be done by full
doses of tincture of veratrum  viride.  Should the  symptoms take a
typhoid type, and the powers  of life seem to sink, then quinine, and
iron, and bitters will be needed.

   In the Second Stage, whatever inflammation there is depends on
exhaustion, and everything fitted to prop and fortify the constitution,
as brandy, wine, broth, and easily digested, nourishing food, must be
freely given.

                  Dislocations.—Luxations.

   The surfaces where two bones meet and glide upon each  other for
the purposes of a joint, are called articular surfaces, and the union is
said  to be  an articulation.  These surfaces are covered by a smooth
cartilage, to render their play upon each  other easy.
   The joints are held together by cartilaginous straps and ligaments,  %
which  serve as pullies; by the aid of these, the joints turn back and
forth, as a  door opens and shuts upon its hinges.
   When by some external violence, or the weakening of  these liga-
ments, these surfaces are suddenly separated, or forced apart, there is
said to be dislocation or luxation.
   Joints are divided into two kinds, the ball and socket (orbicular)
which  has a rotatory motion, as the shoulder, hip, thumb, —■- and the
angular, or pump-handle  (ginglymoid), as the elbow and knee.
   The ball and socket joints have a  greater diversity of motion, and
are more exposed to dislocation.  They are likewise more easily put
in their place.
   In a Primary Dislocation, the bone is thrown  at once into the place
where the surgeon finds it.
   The Secondary Dislocation is one  in which the muscles pull the 
458                    SURGICAL DISEASES.
 head of the bone  still further  from its  natural  place  than it  was
 thrown by the first shock of violence.
   A Dislocation is  Simple  when there is  no wound  penetrating the
 synovial membrane.
   It is Compound when attended by such a wound.
   A Dislocation is  Complete when the articular surfaces are entirely
 separated.
 '  It is Incomplete  when the separation is only partial.
   Recent Dislocations are rectified with comparative ease.
   Old Dislocations  are  hard to be repaired, and sometimes cannot he
 reduced at all.

   The Symptoms of Dislocation are, inability to  use  the joint; the
 head of the bone being felt in an unnatural place;  the limb shortened,
 lengthened, or distorted ; a change in the shape of the joint, etc.
   Simple dislocations are  generally trivial.  Compound dislocations
 often render amputation necessary, and are always perilous.
   Aged persons are less liable to dislocations than the young.
   When a dislocation and a fracture occur at the  same time, the dis-
 location is to receive attention first
   A dislocation is to be reduced by a gradual and continuous extend-
 ing force.  The reduction is known by the limb recovering its natural
 length, shape and direction, and  by its being able  to perform certain
 motions which are not possible while in a dislocated state.   The pain
 is immediately  reduced upon reduction taking place;  In  shoulder
 and hip dislocations, the head of the bone makes a loud noise when
 it slips into its place.

              Dislocation  of the Lower  Jaw.

   Gaping very wide is the  usual cause of this.  It has been known
 to result from a mere yawn.  One or both sides may be disjointed.

   Symptoms. — If but one side is dislocated, the chin is twisted to one
 side, and immovable, and  the  jaws are partially open; if both  sides,
 the mouth is wide open, the chin project's, there is a hollow in front
 of each ear, great  pain, inability to speak,  and dribbling of spittle
 from  the mouth.

   Treatment. — To effect a reduction, cover the thumbs with a towel
 or a piece of wash-leather to prevent their being injured  by  a sudden
 snapping  together  of the  jaws, and then,  standing in front of  the
 patient, introduce them  into the  mouth, press them upon the crown
 of the back lower teeth, at the  same time lifting the chin with the
fingers.
   After the jaw is  set, it should be kept bandaged for a few days,—
the bandage being merely passed once or twice over the top of the
head, and under the chin.   No  solid food reauiring chewing should
be taken for a short time. 
SURGICAL DISEASES.                   459
             Dislocation of the  Collar-Bone.

  This may take place by the  end attached  to the breast-bone slip-
ping over or under that bone, or by the other end slipping above or
below the bone to which it is attached.  When the first named end
of the bone slips over the breast-bone, it is said to be a. forward dis-
location ; when it slips under the breast-bone, it is backward.   In this
latter form of dislocation, the end of the collar-bone sometimes presses
upon the gullet, and prevents swallowing.
  Symptoms. — In the forward  dislocation of the  inner end  of the
bone, a bunch may be felt by the hand at the top of the breast-bone;
in the backward dislocation, a depression or hollow.  The upward dis-
location of the outer  end  of the collar-bone, may be  known  by the
flattened and sunken condition of the shoulder.
  Treatment.— To put the  bone in its place in the first of these ac-
cidents, draw the  shoulders back, by which means the collar-bone
(clavicle) is drawn away from  the breast bone (sternum), and  easily
slips into its place.  To reduce the dislocation at the other end of the
bone, place the knee between the patient's  shoulder-blades (scapulae),
and draw his shoulders backwards and upwards.  After the  reduction,
support the arm in a sling.

           Dislocation  of the Shoulder-Joint.

  The head of the long bone of the arm (humerus)  may be displaced
in three different directions, — downward,  into the arm-pit (axilla);
forward, under the muscles of the breast; and backward, upon the
back of the shoulder-blade.
                             Fig. 158.
  It is recognized by the shoulder losing its roundness, and becoming
flat; by the lengthening of the arm; by the head of the bone  being
felt in the arm-pit; and by severe pain. 
460                    SURGICAL DISEASES.
  To effect the  reduction in the first  form of displacement, put the
patient on  a bed,  or upon the floor.   Put one heel in the arm-pit,
against the  head of the bone.  Then, taking hold of the arm above
the elbow,  or at the wrist, pull steadily,  and push  with the heel.
(Fig. 158.)   The extension may be more steady  and powerful by a
double towel around the surgeon's neck.
  If the  reduction cannot be  effected, relax the muscles by a warm
bath, or by  nauseating doses of tartar emetic.
  After the reduction,  a sling will be required, and three weeks' or a
month's rest.

            Dislocations of the  Elbow Joint.

  Of these there  are six  varieties.  In the first, both bones of the
fore-arm  (radius and ulna) are thrown backwards; in the second, both
are drawn  backwards  and inwards; in the  third,  both  are  thrown
backwards and outwards;  in the fourth, the ulna alone is forced  back-
wards ; in  the fifth, the radius is forced forwards ; and in the  sixth,
the radius is thrown backwards.
  In general, these dislocations are all easily set   In the  first four,
the knee is to  be  placed at the bend of the  elbow, and the fore-arm
bent upon  it, the  surgeon grasping fhe upper arm with one  hand,
and the  fore-arm with the other.  In  the  dislocations of the radius,
the upper arm  is  to be put  in a.'fixed condition, while the surgeon
takes hold of the hand and pulls, at the same time throwing the bone
forward.   If the luxation  be backwards, there must be the same ex-
tension and counter-extension, while the fore-arm is bent.

  Treatment. — The fore-arm must be placed in a half-bent position,
and a splint  should be bandaged upon the front of the whole  limb,
compresses  being  placed  upon  the head of the  bones opposite the
direction of  the dislocation.   This confinement  must be  continued
three weeks.

                Dislocations  of the  Wrist.

   These are caused by falls  upon the hand.  Both  the  radius and
ulna may  be thrown backwards or forwards upon the  wrist,  caus-
                   FlG 159                  ing a projection either in
                                          front  or  behind.   (Fig.
                                          159.)   The bones are to
                                          be  set by  pulling in
                                          opposite  directions upon
                                          the hand and the fore-
                                          arm, and  pressing later-
ally, if the displacement be at the side of the wrist.

  Treatment. — Put a straight splint on the front, and another on the
back of the fore-arm and  hand, with compresses on both sides of the
wrist, and a bandage over the whole.  Support the fore-arm in a sling,
and keep down inflammation by cold water, cooling lotions, etc.
 
SURGICAL DISEASES.                  461
        Dislocations  of the Bones of the Hand.

  Some one of the carpel bones may be pushed  up out of its place,
so as to form a projection on the back of  the hand.  To put it in its
place, press upon it simply, and then put compresses on the front and
back, with straight splints upon these and a bandage over all.  Put
the hand in a sling.
  Dislocations of the finger joints may generally be replaced by bend-
ing the displaced phalanx over the head  of the bone from which it
has been disjoined.  Sometimes a good deal of extension  and counter-
extension are required, for which purpose a piece of cord may be
wound  around the finger, — the skin being protected by covering it
with a piece of wetted buck-skin.

              Dislocations  of the Hip-Joint.

   These are four in number, — upwards,  downwards, backwards and
upwards, forwards and upwards.
   To reduce these, a greater amount of power is needed than in the
dislocations of any other bone, — owing to the greater power of the
muscles which are to be overcome.

            Fig. 160.                            Fig. 161.
  Dislocations of this joint are often confounded with fracture of the
head and neck of the thigh  bone.   This latter may be distinguished
 
462                    SURGICAL DISEASES.
from the luxation by the grating sound to be heard, by the possibility
of pulling the limb  out to its natural length, and by its being short-
ened up again by the action of the muscles the moment  the  pulling
is given up.

  The Upward Dislocation of the head of this boneupon the back of
the haunch,bone, is known  by the shortening of the limb, and by the
knee and foot turning inward, — the  foot lapping over the opposite
foot, and the great toe resting upon the other instep.   (Fig. 160.)

  The  Dislocation Downward is known  by the lengthening of the
limb, the projection of the knee, the turning of the foot and knee out-
ward, and the bending of the body forward.   (Fig. 161.)

  The  Dislocation Backward and Upward  is  distinguished by  the
inclining of the foot  and knee inward, the drawing up of the heel,
and the resting of the great toe against the ball of the great toe of
the other foot.  (Fig. 162.)

           Fig. 162.                                Fig. 163.
  The Dislocation  Upward and Forward is known by the shortening
of the  limb,  and the turning of the foot and knee outward.  (Fig.
163.)
  For replacing the bone, put the patient upon a tablfe, on his back.
Draw a sheet between his thighs, and, extending it up by the side of
his body, let it be fastened to a staple.   Put a padded belt, with rings
 
SURGICAL DISEASES                    463
attached, around the injured limb, just above the knee.  To  these
rings, fasten one block of a pulley, and attach the other to a post,
giving the pulley-rope to an assistant.   The surgeon  now  standing
on the injured side, directs gradual  extension to be made, while he,
by his hands, or by a band passing around the injured thigh  and over
his  own  shoulders, lifts the head of the bone, and guides it into its
socket.

  Treatment. — Keep  the patient in bed for two weeks or more, with
his  knees tied together by a strip of muslin, and a broad  belt around
his  hips.

       Dislocations  of the Enee-Pan  or Patella.

  This bone may be thrown outward, causing a great projection on
the outside, and an inability to bend the knee.
  It may be thrown inward, causing the same  impossibility to bend
the knee, and a projection on the inside.
  To restore the bone to its place, put  the  heel of the patient  upon
the shoulder of an assistant; then press down the edge of the knee-
pan which is farthest from the centre of the joint,  thus  tilting up the
other edge of the bone, when the muscles, aided by a lateral pressure,
will draw it to its place.

  Treatment. — Put a straight  splint upon the  back of the limb, and
make moderate pressure  upon the knee by a bandage.   Cold water,
or cooling washes, should generally be applied.  Keep the patient in
bed two weeks.


             Dislocations of  the  Knee-Joint.

  There are four of these,—forward, backward, inward, and out-
ward.
  They are  readily corrected by extension and counter-extension from
the ankle and thigh,  and pressure upon the  head of the displaced
bone.
  Treatment much the same as for displacement of the knee-pan.


                Dislocations  of the Ankle.

  These may occur in a forward, backward,^>utward,  and inward
direction.  (Figs. 164 and 165.)
  To rectify it, bend the limb, so as to relax the muscles  on the back
of the leg;  then, while extension  and  counter-extension are made
upon  the foot and thigh, press firmly on the dislocated bone, and thus
force it to its place.

  Treatment—Confine the foot and  leg  in splints  made  of thick
paste-board, soaked in hot water, and moulded to the shape of the
limb, with a foot-piece at right angles.   Keep the patient in bed five 
464
SURGICAL DISEASES.
or six weeks, and when he begins to walk, support the ankle with a
roller bandage, or a laced gaiter.
Fig. 164.
Fig. 165.
                    Contusions.—Bruises.

  When any blunt, hard substance comes in violent collision with
the soft  parts  of  the  body, without breaking  the  skin, the  injury
received  is called  a bruise.  One of these accidents  generally rup-
tures  a great number of the very smallest  blood-vessels, which let
out blood under the skin, producing "black  and blue" or livid spots
(ecchymosis).  What fist-fighters call a black eye is an example.

  Treatment. — Cold applications at first  to  prevent the blood run-
ning out of the small vessels under the skin.   After the inflammation
has subsided, stimulating applications, as vinegar and water, alcohol,
camphorated liniment, ammonise and alcohol, equal parts, and some-
times bandages.

                            Sprains.

  A sprain  is a forcible  wrenching and  twisting ol  a joint to  such a
degree as to stretch and more or less lacerate  the  ligaments  of the
part, and sometimes to  break a tendon,  but without entirely displac-
ing a bone.   Its symptoms are, violent pain, swelling, and  discolora-
tion of the parts from the blood running into the cells under the skin.
In elderly persons, the effects of sprains are very tedious,  disabling
them for many weeks, or even months.

  Treatment. — Elevate  the limb, keep  the joint  perfectly quiet, and
apply cold lotions, or fomentations.  When  the inflammation is all 
SURGICAL DISEASES.                  465  '
past, apply stimulating liniments, and bandages, or shower  the part
with cold water.

                   Ruptures  of Tendons.

   These accidents are known by a  sudden snap, followed  by pain,
loss of motion in the part, and swelling and discoloration.

   Treatment.— Place the part in such a position as to relax the broken
tendon, the ends of which must  be brought together, and  retained in
contact till they grow together.

                   Diseases of the Bones.

   The bones are supplied with blood-vessels and nerves; and as they
live and grow like other parts of the body, so they become  diseased
and die in like  manner.

               Ulceration of Bones.— Caries.

   Bones, like the soft parts, when attacked  by violent  inflammation,
may ulcerate, discharge matter, and heal by granulation ; or, having
lost a portion of their substance, may sink under entire disorganiza-
tion and death.  This disease passes in some parts of the  country,
under the name of " fever sore."

   Treatment. — Apply splints, and keep the part in a  state  of abso-
lute rest  Subdue the local inflammation  by  the usual means.  If
the disease arise from scrofula or syphilis, use  the remedies for those
diseases.

              Death  of the  Bones.—Necrosis.

   This is like mortification of the soft parts.  It occurs from injuries
and inflammation of the periosteum.
   It is known by dull, deep-seated—sometimes acute — pain ;  and is
followed by increase of size, from the formation of new bone around
the old, — the old  being gradually broken into pieces, and  discharged •
through external openings.

   Treatment. — Poultices and quieting fomentations.


         Unnatural Growth  of Bones.—Exostosis.

   This disease consists either of a tumor of a bony nature, growing
upon  and arising from  a bone,  or an enlargement of a bone.  It
springs from  the periosteum, or from the surface of a bone, or from
its spongy  texture.  The enlargement or the tumor may be white
and hard, hke  ivory, or dark-colored and spongy, or a mixture of the
two.
                             59 
 466                   SURGICAL DISEASES.

   At first, a tumor of#this kind is not  attended with pain or incon-
 venience.  It comes  on slowly, and sometimes remains  nearly sta-
 tionary for several years.

   Treatment. — If the  tumor be large  and inconvenient, remove it
 with the knife.  If not, use local pressure with pads and bandages;
 also leech, blister, and restrict the patient to a spare diet

                   Diseases of the Joints.

   Some of these diseases begin in the cartilages, some in the svnovial
 membrane, and others in the heads of the bones.


           Disease of the  Hip-Joint.— Coxalgia.

   This generally consists in inflammation of the synovial membrane
 and capsular ligament of the hip-joint, ending frequently in ulceration
 and destruction of the head and neck of the thigh bone.
   The symptoms are fulness in  the groin; pain, which is increased
 by motion ; aggravated when the limb hangs without touching the
 ground;  is more felt in the knee than in  the hip itself; and shoots
 down along the inside of the leg, as far as  the  instep.  The thigh
 inclines forward, and the limb has the appearance of being longer
 than the other, — though in the latter stages, it is really shorter.

   Treatment. — Before suppuration takes  place,  apply leeches and
 blisters, and enjoin perfect rest.  After  suppuration, keep  the patient
 upon his back, on a mattress, and mould to the parts thick paste-
 board splints, with pads, and give tonics.  Keep the bowels open with
 senna and bicarbonate of potash, and  rub the parts with iodide of
 potassium  ointment, or with  preparations (282)  (283) (195).  The
 disease being scrofulous, the iodide of potassium (140) may be taken
 with advantage internally.

       White  Swelling.—Synovial Degenerations.

    There are several diseases of the knee-joint, characterized by swell-
' ing  and white  color from tension of the skin, wmich have passed
 under the  common  name of  white-swelling.   The diseases are hot  ^
 strictly the same, but as they all  affect  the knee, and have symptoms
 to some extent  in common, it is well enough to group  them under
 the same title, — especially as one treatment is adapted to all.
    One is a pulpy disease of the  synovial membrane.   It begins with
 a trifling stiffness, and a slight swelling.   The swelling increases by
 degrees,  and on touching the part, there is a sensation as if it con-
 tained fluid.   By and by the  cartilages ulcerate.  The disease is in-
 curable, as the synovial  membrane is  finally converted into a pulpy
 substance, and the limb has to be amputated.
    Another of these  is inflammation of the synovial  membrane, be-
 ginning with ulceration of the cartilages.  It begins with  pain  in the 
SURGICAL DISEASES.
467
 joint, which is  severe at one point, and attains its height in a week.
 In a day or two, the joint is swollen from a collection of water.

   Treatment.— Splints and entire  rest, as in all chronic diseases  of
 the joints.  Also a generous diet, and whatever is calculated to build
 up the health.

                            Bunions.

   This  is an inflammation, enlargement, and hardening on the inside
 of the ball of the great toe.  It is frequently connected with a distor-
 tion of  the toe, which seems partially  out of joint.  The projection
 of the joint exposes it to  great irritation from the  shoe, and to re-
 peated attacks of inflammation.  It occasions great suffering.

   Treatment. — Remove the pressure from the part, and  when there
 is inflammation, keep the foot quiet and elevated upon a chair, apply-
 ing leeches, poultices, etc.  Another method is to cover the bunion
 with soap plaster, spread  on thick, soft leather, or, put the  toe in a
 separate apartment of the stocking, like  the finger of a glove.  Then
 enclose  it in a separate part of the  shoe, which is contrived by fixing
                                     a piece of firm sole-leather  in
                                     the bottom of the shoe, so  as
                                     to make a separate  compart-
                                     ment for the toe. 'By  this
                                     means  the  pressure   against
                                     the side is  removed.   Stick-
                                     ing plaster may be spread on
 wash-leather, and a piece cut out the size of the bunion.  This  will
 take off a portion  of the  pressure of the  shoe, and will hasten the
 cure.
   Fig. 166 represents a ganglion or tumor  formed upon the  synovial
 sheath of the tendon which bends the finger.


               Whitlow.—Felon.—Paronychia.

   This is an abscess of the fingers, of which there are three kinds,—
 the first situated upon the surface of the  skin, the second under the
 skin, the third within the  sheath which contains the tendons of the
 fingers, and sometimes involving the covering of the bone.
   The latter form of the disease is the most terrible, and begins with
 redness,  swelling, and a deep-seated  and throbbing pain, which grad-
 ually becomes so excruciating as to banish all sleep, and nearly drive
 the patient to distraction.   Finally, matter forms and burrows in the
 deeper parts of the finger, and  at length finds an opening, which
 brings relief.

   Treatment. — Carry the hand in a sling;  apply a leech or two, and
use poultices.   A poultice made of  equal parts of powdered slippery-
elm  bark, poke  root, ground flax-seed and lobelia seeds, mixed  with
hot ley, and changed twice a day, is an admirable application.
 
468
SURGICAL DISEASES.
  When these methods  fail to  stop the progress of the abscess, the
finger should be laid open with the scalpel, cutting down to the bone.
This will give vent to the  matter, and the wound may  be dressed
with poultices, until the inflammation is  subdued, and the healing
process is well established, when some simple salve may be applied.

                          Chilblains.

  This complaint  should have  been spoken  of immediately  after
" frost-bite," but it  was forgotten.  It is caused  by exposure to cold,
and affects the fingers, toes, and particularly the heels, with a painful
inflammatory swelling, of a red, purple,  or bluish color.   The skin
may be  red  in patches,  and slightly swelled, with itching, tingling,
pain, and lameness; or there may be blisters, around  which the skin
is blue or purple;  or, worse yet, there may be ulceration and slough-
ing.
  Treatment.— Stimulating  liniments are the  remedies usually em-
ployed for this complaint   One of the best consists of six parts of
soap liniment and  one part  of tincture of Spanish flies ; and another
excellent one is prescription  (307).  If  there is ulceration, use Turner's
cerate, or the resin  ointment.

                   Stiff Joint.—Anchylosis.

  This is of two kinds, complete and incomplete,—complete when the
bones  of the joint  have  become firmly united by bony matter, and
incomplete when the motions of the J3int are very much interrupted,
but not  entirely  destroyed.   The first is the result of ulcerations of
the cartilages of the joints, and of the heads of the bones ; the latter,
of  fractures, sprains, bruises, thickening  of the  synovial membrane,
and weakening of  the muscles.

  Treatment.—No treatment is of much use in the first-named form of
the disease.   By sawing through the bone, and then daily moving the
limb back and Ibrth, a false  joint may be  made,  but it is apt to grow
together again, and finally defeat the.purpose of the surgeon.  When,
however, stiffness arises from the weakening of the muscles, and some
other  causes involving  the  ligaments and tendons, something may
be  done by daily  frictions  with stimulating liniments, champooing,
and warm fomentations; and by gently bending the joint  back and
forth,  several times every day, as much as  can be done without pain.

                            Tumors.

    A  tumor is a swelling  which  consists of  a new production,  not
constituting  any portion  of  the original structure of the body.  There
are several  kinds  of tumors; but  it  is sufficient for  my purpose to
follow Mr. Ferguson, and  divide them into the  malignant and nortr
malignant. 
SURGICAL DISEASES.                    469
Cancer.
Fig. 167.
  This belongs to the class of malignant tumors.  It has two stages.
The first is that of induration  or  scirrhus, — during which  it has,
under the finger, the feeling of stony hardness.  The second stage is
that of ulceration or open cancer.
  Cancer most  often attacks the female breast  the skin, the mucous
membranes, the  tongue, the stomach, the neck of the womb, the lips,
etc.  It rarely occurs in subjects under thirty years of age, and not
often in persons under forty-five.

  The  Symptoms of Cancer,  when  it  appears in the breast, are,  a
puckered condition, and dull, leaden color of the  skin ;■ a hard,  knotty,
and uneven  feel ;  and occasional  sharp
pains.   When it attacks the skin and mu-
cous membranes, there is a  hard,  warty
lump, which ulcerates,  after a time, pro-
ducing  an open sore, with a hard base.
(Fig. 167.)
  The sore of  a cancer discharges  an
irritating, excoriating matter,  wmich has
a peculiarly fetid odor, so offensive and
so different from any other smell, that it
is  seldom  forgotten.    The bones  of  a
cancerous person break with great ease.
Unmarried females  are much more liable to the disease than the  mar-
ried.  The cancerous growth is composed, in part, of cells, rounded
or caudate, containing, as  seen under the microscope, nuclei, younger
cells, and granules.  (Fig. 168.)
Fig. 168.
Fig. 169.
Fig. 170.
  The difference between these cells and those of common pus glob-
ules may be seen by comparing Fig. 168 with 169, — the latter being
pus corpuscles highly magnified by a powerful microscope.  Fig. 170
represents pus globules not so much magnified.

  Treatment.— There are but two methods of treatment which prom-
ise  any success.   The first is to extirpate the tumor by  a  surgical
operation before the  disease has so far invaded the constitution as to
be sure of returning.  The other is that adopted by Dr. J. W. Fell, 
470                    SURGICAL DISEASES.
an American  physician, who was permitted to try his remedies in
one of the English hospitals, and who  drew from the surgeons in
charge of it a favorable report of the results.
  Dr. Fell's remedies are mainly blood-root and  chloride of zinc (336)
made into a paste.  The skin over the tumor is first destroyed, and
this paste, spread upon strips  of linen,  is applied.  This causes an
eschar, into which incisions are made, half an inch apart, taking  care
to avoid the living tissue.  The same  paste spread in a like manner
is then daily inserted into the furrows.   By this  means, which is orig-
inal with Dr. Fell, the  effect  of the  caustic penetrates  through all
parts of the tumor, causing the whole diseased mass to  fall off', and
leave a healthy, granulating surface.
  In incipient cancer, where the disease has not  made much progress,
Dr. Fell uses the above, which he calls a brown ointment (336), and
in connection with it an ointment of  the iodide of lead (337), using
each twelve hours.  With  these, he claims that he cures incipient
cancers, with great readiness.   He also employs, internally, half-grain
doses of  pulverized blood-root (143), with arsenic and cicuta.
  Dr. Fell claims that with these preparations, he has often cured
lupus, and has been very successful with them in treating  indolent
ulcers.

              Soft Cancer.—Bleeding Cancer.

   Medullary Cancer.—Encephaloid Tumor.—Fungus  Hematodes.

  This varies in  size  from a  nutmeg to a child's head.  Its color
varies  from white to deep  red.   At times, it is soft  and elastic at
first;  at other times, it  is firm  and tense.  The patient is wan  and
pale  from the beginning.  The parts  do not ulcerate, as in scirrhus;
but after the skin is broken, a spongy bleeding tumor protrudes.

  Treatment. -~ Dr. Fell's method.


                  Black Cancer.—Melanosis.

  This is an  organic disease,  in which  the  tissue of the disordered
part  is converted  into  a black, hard  substance, which is converted
into ulcerous  cavities.    This often appears in  the lungs, and is  met
with in the liver and other parts.
  Its  symptoms are, a sallow complexion, great debility, and dropsi-
cal swelling of the limbs before the termination.

  Treatment.— When  it appears externally, Dr.  Fell's treatment is
worth a trial.  When in the lungs, the inhalation of tincture of blood-
root  and  solution of chloride of soda (241)  should  be used. Two
teaspoonfuls may be put in Warren's  Vapor  Inhaler, — the  instru-
ment being filled  half full of hot water, — and  inhaled ten  minutes,
three times a day ; the  blood-root pills (143) being taken at the same
time. 
SURGICAL DISEASES.                   471
             Fatty Tumor.—Adipous Sarcoma.

  This is the most common of all the forms of tumor.   These bodies
generally have a soft and doughy feel, or as if filled with wool.  They
are the least inclined to become malignant, and consequently the least
dangerous, of all the tumors.   Whatever  pain  there is, is caused  by
their size, weight, and pressure.  They are occasionally found a little
below the point of the shoulder, in the deltoid muscle of females, and
are caused by the unreasonable pressure of the dress at that point.

   Treatment.— They should  be  removed by  an operation, which is
easily  performed,  as they separate  very readily from  surrounding
parts.

                           Ptlypus.

   The  polypi constitute  a class of tumors  growing from  mucous
membranes.   They  are of two  kinds, — the  soft, jelly-like polypus,
and the fleshy or fibrous polypus.

   The  Soft Polypus, which grows from the nose, has  not much feel-
ing, and is not particularly disposed to bleed.

   The  Fleshy Polypus is firmer  and  harder than the  preceding, and
most generally connects itself with the womb.

   Treatment. — Both kinds of polypi are either twisted off with a
pair  of» forceps, or  strangled  by putting  a string,  called a ligature,
around their neck, which will  cause them  to fall off in a short time.


                   Wens.—Encysted Tumors.

   The most common situation of these is under the skin of the head.
A wen is simply a sac full of  various matters, which, when examined
with a microscope, are found to be oil globules, epithelial cells, and
crystals  of stearine.  These  contents  are  secreted by  the  internal
surface of the sac.  They  sometimes look like curd  or rice, sometimes
like  suet, and sometimes like honey.  In other instances, they are
mere  water, and  they  have been known to consist of hair  or  horn.
These  tumors are round, elastic, and movable, and are without pain.
They grow slowly, but steadily.

   Treatment.— The attempt to excite inflammation and consequently
absorption, by punctures, seatons, or injections, are dangerous, and
ought not to be resorted to.   If the tumor is  small, its opening, indi-
cated by a small black spot, may be found, a probe be introduced
into it, and the contents of the sac be squeezed out; and this may be
repeated as often as necessary.   But  the proper and only real remedy
for these tumors is their removal by a surgical operation. 
472                    SURGICAL DISEASES
                         Aneurisms.

  An aneurism  is a tumor formed by arterial blood, and communi-
cating with an artery.   A true aneurism is formed by the coats of an
artery getting weakened by some cause, and swelling out so as to
form a pouch or sac.   (Fig.  171.)  There are other  kinds of aneu-
risms, which need not  be described.

                              Fig. 171.
  Symptoms. — An aneurism may be  felt as a tumor somewhere
along the course of an artery, and it beats  under the finger like the
pulse.   The beating is caused by a fresh quantity of blood being
pushed into this  sac  with every stroke  of  the heart   If it be small,
pressure on the artery above it will so far shut off the blood from it,
that it  will  feel flaccid or soft.   The patient will often say that the
tumor began to  appear after some  violent strain,  when  something
appeared to give way.   In the chest, aneurism will produce an un-
natural pulsation felt by the patient  In the belly, it may generally
be felt as a tumor through the abdominal walls.

  Distinction. — Tumors which lie directly over arteries  are lifted up
every time the blood is driven along  under them, and hence they
pulsate like aneurisms; but  they do not pulsate when small, whereas
aneurisms do from the beginning of their growth.    Aneurisms are
soft at first, and hard afterwards;  whereas tumors are generally hard
at first, and finally soft.

  Treatment. — In some few fortunate cases, aneurisms get well spon-
taneously.  If the flow of  blood through them can be stopped, that
which  is within them will coagulate, forming a hard tumor, which
will  gradually waste away.  To cure them, therefore, we  must stop
the circulation through them; and this  may be done, in some cases,
by compression.  The pressure upon the  artery must of course be
above  the tumor, and should not be so great as to  stop the blood
altogether, but only very materially to  diminish its  flow.  The  pres-
sure  is applied by an  instrument  having two pads,  an arc of steel, a
joint in the middle, and a screw by which the padded extremities are
pressed together.   (Fig. 172.)
  When this mode of treatment is  not practicable, the artery must
be tied between the aneurism and the heart.  The patient should be
placed in bed, with the limb wrapped up to preserve its temperature, 
SURGICAL DISEASES.
473
and placed in an  easy  position.   Nothing  cold  should  be applied
to it.
  The force of the circulation should be reduced by the tincture of
veratrum.
Fig. 172.                           Fig. 173.
Bronchocele.—Derbyshire  Neck. — Goitre.
   ^ronchocele is what is called an endemic disease; which means,
 a disease which prevails in certain localities.   This complaint is prev-
 alent in  Nottingham and Derbyshire, England, among the Alps, and
 especially in the Tyrol  and valley of the Rhone.  It is thought to be
 produced by the use of  melted snow, and water impregnated with
 lime and earthy  matter.

   Symptoms. — A prominent, soft, elastic tumor, occupying  the front
 of the throat, in the situation of the thyroid gland, and like it in shape.
 It is  not tender, and the skin is not discolored.  In old cases,  the
 tumor becomes  hard.   In Fig. 173, th^  tumor is so large as to have
 pushed the gullet to one.side.

   Treatment. — The usual and perhaps the  best remedy for this dis-
 ease is iodine.  It may be given as iodide of potassium, with a bitter
 or some other article (138) (145) (101).  An  iodine ointment may be
 applied to the tumor (185).
   The patient should  move away from the  infected district, and re-
 side, if possible, upon the sea coast.


            Water in  the  Scrotum.—Hydrocele.

  As the name shows, this is a collection of water in the  scrotum  or
bag which holds the testicles.

  Symptoms. — It presents a swelling, shaped like a pear, smooth on 
474
SURGICAL DISEASES.
its surface, fluctuating if pressed, without  pain, but causing a little
uneasiness by its weight.  On placing a lighted candle on one side
of the scrotum, the light may be seen through it.

  Distinction.— This complaint may be distinguished front a solid
enlargement of the testicle by its not being  so heavy, solid, or painful,
and  by its fluctuating and  being transparent; from rupture, by its
forming slowly instead of suddenly, by the  swelling  beginning at the
lower part of  the scrotum instead of the upper, a^nd by the enlarge-
ment not being increased by coughing as it is in rupture.

  Treatment. — In children, strong scattering washes (353) are some-
times successful.  But most commonly, a number of punctures'are
made with a large needle, to  cause  the  fluid to escape into the  cell
tissue of the scrotum, whence it is removed by absorption.
  To effect a radical cure in grown  persons, the surgeon is to  grasp
the tumor behind, and introduce a  trocar and canula into the sac,—
being careful  to point the  instrument upwards, so as not to wound
the testicle.   The trocar is  then withdrawn, — the  canula  being at
the same time pushed well into the sac, so that none of the fluid may
get into the cell tissue outside the sac.   The fluid runs off through
the canula.  When  this has all  escaped, some stimulating fluid, as
common lime-water, or, still better, tincture of iodine, is to be injected
through the canula into the  emptied sac.   After  retaining this from
two to five minutes; it is permitted to flow out.   Inflammation fol-
lows, which breaks up the secretion of water, and effects  a cure in
two or three weeks.  The amount of fluid thrown in, should be  about
one or two teaspoonfuls of a mixture of one part of tincture  of iodine
and two parts of water.  If the first operation does not effect a com-
plete cure, it may be repeated.


            Blood  in the  Scrotum.—Hematocele.

   This is a collection of blood in the scrotum from some injury.

  Treatment. — If the quantity of blood effused be small, cold appli-
cations may cause it to be absorbed.  If it be large, make a  puncture,
and apply a poultice for the blood to ooze into.


        Acute  Inflammation  of Veins. — Phlebitis.

   The veins are subject to attacks of acute inflammation,  which
constitutes a very dangerous, and often fatal, disease.

   Symptoms. — Fits of shivering, or perhaps fainting, a rapid  pulse,
anxiety of countenance, lowness of spirits, catching pains  about the
heart, and swelling, redness, tenderness, and hardness along  the  course
of the affected veins.   Sometimes the tongue is furred brown or black,
the  skin is sallow, there is bilious vomiting, low delirium, and  death.
 In cases less rapid, there are great swelling and redness over the  dis- 
SURGICAL DISEASES.                    475
eased veins, and abscesses form, which, when opened, reveal clots of
blood, mixed with pus.   Or, the patient, while remaining low, with a
sallow countenance, and a yellow tongue, will  complain suddenly of
intense pain in some joint, as the knee or  shoulder, — in which there
will be a rapid formation of pus; a similar suppuration will follow
in other joints as well as in the lungs, etc., until the patient sinks, and
dies of exhaustion.

   Treatment. — Apply leeches  freely over the inflamed veins, — also
fomentations.   Every abscess should be  opened early.   Keep the
bowels  moderately open with some preparation  of salts, and allay
pain and restlessness by  morphia.  Support the strength by beef tea,
etc.; and, if the pulse be feeble, give wine or quinine.
   The suppuration  may be checked, in this as in other  complaints,
by drinking freely of chamomile tea.   The  power to  control sup-
puraton  has  recently been  discovered as  belonging  to chamomile
flowers.

                      Chronic Phlebitis.

   This is a far less serious disease than the preceding.  It generally
affects the veins of the legs.

   Symptoms. — Tenderness and  hardness of the affected  vein,  with
swelling around it, and of the parts below ; a general  painfulness of
the limb.  After the inflammation has subsided, the vein  feels hard,
like a cord, because the inflammation causes the blood within to co-
agulate, and harden, so that nothing can pass through the vessel.

   Treatment. — Leeches, fomentations, or cold lotions,  as  the patient
may choose, purgatives, and rest, with the  limb elevated.   Subse-
quently, when the inflammation  seems completely subdued, friction
with camphorated oil, and bandages.


          Enlarged or Varicose  Veins.—Varix.

 .  The veins which lie near the surface, especially those of the  legs,
are apt,  by exhausting labor upon  the feet, and by  strains, to get
weakened, so that their valves lose their tone, and their sides  stretch
and give way in certain  places, letting the blood bulge out, and form
purple bunches.  These bags of blood, lying along upon the surface
of the limb, form knotty tumors, looking like blood-boils.  They oc-
casion a kind of distress, but no sharp pain.
   Persons of weak, soft, and relaxed muscles and  blood* vessels are
particularly liable to this complaint.  It often attacks women in the
family way.   .

  Treatment. — Where  only a few  veins  are  affected,  it may be
sufficient, in some cases, to apply firmly  over  them a few strips of
leather, spread with soap  plaster.  But generally it is  better to  sup-
port the whole limb with a good calico bandage, or with a laced stock- 
476                    SURGICAL DISEASES.
ing, which should be applied in the morning before the patient is up.
It is generally well, also, to use friction, with some liniment, or iodine
ointment.  Lead water, or alum water, or an infusion of white oak
bark, may be used with advantage.  Burdock and plantain  leaves,
bound upon  the  skin, and removed before they  are dry, are  useful.
Showering with cold water strengthens  the veins.     •


                      Rupture.—Hernia.

   Hernia signifies a protrusion of any internal organ from the cavity
where it  belongs; but the term  is generally restricted so as to mean
no more than a protrusion of the bowel through the walls of the belly.
   When  the abdominal walls are weak, from  any cause, no  matter
what, — lifting, straining, or making violent muscular exertion  of any
kind, will then often  cause  the  bowel to force itself through at the
most debilitated spot;  and pushing the lining of the belly, the peri-
toneum, along before it, a bag or sac is formed, in which the project-
ing bowel is enclosed, forming an external tumor.
   Divisions of Hernia. — Rupture may  occur in several  different
places, and has accordingly received different names.     ,
   Umbilical Hernia is a protrusion  of the bowel  at the  umbilicus
or navel.   This is most common in children soon  after birth; and
women who are often pregnant are liable to it.
   Ventral Hernia is that which occurs at any part of the belly where
other forms of rupture do not appear.
   Inguinal Hernia is that in which the bowel protrudes at the  groins,
or through the abdominal rings.
   Scrotal  Hernia  is that in which the bowel descends into the  bag or
scrotum.

   Femoral Hernia is the dropping down  of the bowel behind what
is  called Poupart's ligament, and appearing as a tumor at the upper
part of the thigh.

  Reducible Hernia. — Rupture is said to be reducible, when the
bowel may be put back into the cavity from which it came.

  Irreducible Hernia. — Hernia  is called  irreducible when  the pro-
truding bowel cannot be returned into the  belly.
  Strangulated Hernia is that form of the complaint in which the
bowel is so .pressed upon at the point  where it passes through the
walls of the belly  that it is strangled or constricted so that its contents
cannot pass through.

  Symptoms of Hernia. — A soft tumor, which may be  compressed,
appears somewhere about the belly; and is  increased in size when
the patient stands up.   It also swells when he coughs, or makes any
exertion;  and grows smaller, or  entirely disappears, when he  lies
down. 
SURGICAL DISEASES.                    477
   Treatment.— In  a case of reducible  hernia, the first thing to be
done is to put the bowel back in its place, which is accomplished by
gently pressing and kneading the tumor, and swaying it-back  and
forth, — being  careful to use no violence, — until it can be  pushed
within the abdominal walls.  It is then to be kept in its place by the
use of a truss, made expressly to fit the case.  This instrument should
be constantly worn by day, and by night, too, if not too irksome ;  but
if worn by day only, it should always be applied before rising in the
morning.
   Irreducible Hernia may be palliated by wearing a truss with a  hol-
low pad, which will so evenly and firmly embrace the tumor as  neither
to irritate it, fior permit any further protrusion or enlargement,
   Strangulated  Hernia. — If a  person have worn a  truss for some
time, and, suddenly leaving it off, makes some violent exertion, either
the  bowel or omentum  is liable to be suddenly forced through a nar-
row aperture, and to become strangled.  In such case, the patient has
flatulence, colicky pains, a sense of tightness across  the belly, and a
desire to go to stool, but no ability to pass anything.   Then follows
vomiting, first the  contents of  the  stomach,  then  mucous and bile,
and, lastly, the fecal matters from the bowels, which are not permitted
to pass on to their natural outlet.  The  neck of the hernial sac now
becomes swelled, tender, and painful, the countenance is anxious, and
the pulse small, hard, and wiry; and, after a time, the tumor  begins
to mortify, the patient expresses himself free from all pain, and soon
after dies.
   In the treatment, the  bowel is to be returned if possible.   To do
this, the bladder should first be emptied with a catheter, and  the
patient should  lie down with his shoulders raised, and both his thighs
bent  towards the belly,  and placed close to each other, so as to relax
all the  ligaments and muscles of the belly.   The  surgeon may now
work gently for half an hour, if necessary, trying to put the  bowel
back, but must be  very careful not to excite inflammation by any
violence.
   If he does not succeed, efforts are next to be made still further to
relax the muscles, as well as to reduce the force of the heart's  action,
and to diminish the size of the tumor.  With the tincture or fluid
extract of veratrum viride, the  heart's action and force of the circula-
tion may be  reduced to  any desirable extent.   The  muscles  may be
relaxed by injections of tobacco, made  by steeping one dram  of to-
bacco in  one  pint of water for ten  minutes.   This, however, is  a
somewhat dangerous remedy, and should give place to the compound
lobelia injection.  Two grains of tartrate of antimony in one pint of
tepid water, make a suitable injection.
   To reduce  the tumor, apply pounded ice  in a  bag, or a freezing
mixture  (354).  If the pain be acute, give large" doses of opium or
morphia.
   If all these remedies fail, there is then no hope but in relieving the
stricture by a surgical operation.
   General Directions. — Rupture is an exceedingly  common affection. 
478                    SURGICAL DISEASES.
 Perhaps every third  or  fourth person  suffers  from it  more or less.
 Females,wfrom motives of delicacy, are apt to conceal the misfortune,
 and not seek  advice.   This exposes them to danger.   Queen Caro-
 line, wife of George II., lost her life by such concealment.
   A swelling coming on suddenly in the groin or at the navel, after
 considerable  exertion, may be taken to be  a rupture without much
 fear of  mistake.
   The complaint being discovered, the  bowel  should  be put  back
 in its place, and  a truss be put on at  once.   In  the case of young
 persons, a truss may frequently effect a cure, but, that it may do this,
 it should not be taken off", night or day, except to cleanup it, and then
 only when the wearer is in bed.
   Those who  can afford it, should have two  trusses of the same size
 and strength,  so that if one get out of order, the  other may take its
 place while it is  being repaired; for, an hour's absence of the truss
 n^ight occasion a mischief which it would require months to repair.
   Persons having a rupture must be very careful to keep costiveness
 at a distance ; for straining at stool is highly injurious.

                   Varicocele.—Cirsocele.

   This is an  enlargement or varicose  state of the spermatic veins,
 and may be mistaken for hernia, inasmuch as standing  and coughing
 increase it.  But it feels like a bag of worms; and  by this peculiarity,
 may be distinguished  from rupture..

   Treatment. — Wear a suspensary bandage.

       Deformities and Irritations  of the Spine.

   Lateral Curvature. — There are several varieties  of curvature of the
 spine.   Some  of them are caused by the destruction of  some portion
 of the spinal column by disease.  It will not be necessary for me to
 treat of these forms of curvature, as they can only be investigated and
 treated by the most skilful surgeons.  Those who will use this book
 chiefly, would hardly think of meddling with them.
   The curvature  which arises from debility of the bones, ligaments,
 and muscles,  and which  is very common  among females,  has the
following

   Symptoms. — At first there is a projection of one collar-bone, or one
side of  the  chest, or one  shoulder is considerably elevated, and is
popularly thought to  be "growing out."   On examination, the right
shoulder and  the right side of  the chest will be found, generally, to
be rounded and lifted  up, while the other is sunk down  and  concave.
 At the  same  time, the left hip sticks out, and the loins on the right
side have an inward curve.  The spinal column will have a curve, as
in Fig. 174.

   Causes. — This affection is caused by occupations which keep the
body in  a laterally distorted position, and tax  one side of the body 
SURGICAL DISEASES.
479
 more than the other.   It is produced in children who study their
 lessons  at school  with one elbow  resting  on a  high desk.   The
 muscles, too,  get  so weakened  in  many          FlG 174 •
 females of luxurious, sedentary, and indo-
 lent habits, that they cannot hold the bony
 frame of the body in an  upright position,
 and the jointed column  of bones,  called
 the  spine, sags down  to  one side,  and
 draws the whole skeleton of the trunk out
 of shape.

   Treatment. — The first thing  to be done
 is to learn what particular  attitude of the
 body has  occasioned the  distortion.   This
 discovered, every possible, effort is  to be
 made to  break up the habit, whatever it
 may be.  If it be standing on one foot, or
 sleeping on one side, or  reading or writ-
 ing with  the elbow  high, keep a constant
 watch and strict rule over the patient.
   Exercise in  the  open air should be free,
 and  taken daily.   The use of the  dumb
 bells is  excellent for both sexes;  but girls
 should, in  addition, have all the variety of elegant exercise furnished
 by calisthenics.  Wealthy parents, whose daughters are tenderly bred,
 should never let them grow up  without the invigoration which these
 exercises impart.
  ^ When the curvature is marked, and the debility considerable, these
 vigorous exercises  should be taken for a time with moderation, and
 the patient should lie down and rest immediately after taking them.
   In many cases considerable benefit is derived from the mechanical
 support  afforded by supporters of various kinds.  These  are now con-
 structed  and adapted to the body, with  considerable skill,  by those
 who make their construction a study  and a business.

   Spinal Irritation. — The spinal  column is liable at certain points,
 to become  congested, and consequently sore and irritable.

   Symptoms. — The  symptoms of this  state of things are very varia-
 ble and  numerous, as all  sorts  of sensation of the  skin, from utter
 numbness  and  insensibility up to the  most acute  sensitiveness, des-
 cribed as creeping, shooting, coldness,  tingling, and the crawling of
 ants.   There may  be neuralgic pains, spasm,  cramp, trembling, or
 palsy of the voluntary muscles;  or  a  fixed pain and tenderness in
 some joint or other  part; or palpitation of the heart, dizziness, and
 wind and pain  in the stomach.
   When any of these symptoms appear, and cannot be traced to any
other cause, we are to suspect some irritability of the spinal column,
and  to search,  accordingly, in that direction.  The proper method of
search is, to make  firm pressure  on each of the projections  of the
spine, and  to pass over  the  projections a  sponge wrung out  of hot
 
480                    SURGICAL DISEASES.
water.   If there be trouble here, the patient will  now be likely to
complain of severe pain at some one  point.  Or, the tender place
will  generally be  found sooner, by tapping with the ends of the fin-
gers, with quick and sharp strokes along upon the projecting bones
of the  spine.  The patient  will be  pretty sure to wince  when the
tender  point is reached.

  Treatment. — Apply leeches, and  follow  them with a blister,  or
stimulating  liniment,  or  some strong,  slightly  irritating plaster, and
the tenderness will be very likely to disappear, as if  by magic.


                Wry Neck.— Caput Obstipum.

  In this complaint, the head is drawn over towards one of the shoul-
ders, with the face generally turned towards the opposite  side.   This
is caused by the  rigid contraction of a particular muscle.   In some
instances, however, other muscles are affected,  and  the head may be
drawn  in other  directions, or be twitched about in various ways.
  I had a  singular case from New Hampshire, which, though not
exactly wry neck, was a kindred disease, and is worthy of being men-
tioned.  The subject of it was a young lady of good physical develop-
ment, but inclined to nervous complaints. Her head was chiefly drawn
over backwards, sometimes so as to lie for a short time flat upon the
back, with  no power  to  raise  it  She was  obliged, ordinarily, to let
her head lean a little to one side, and rest upon the  hand, in order to
keep it steady.  When walking, with  the head erect, without this
support, it was  every few moments jerked over backward and a little
to one  side, the chin being thrown up in a most unseemly way.   The
case partook of the nature of chorea.

  Treatment. — For the  genuine wry neck, where the  muscle which
draws  the  head to one side  is rigid  and  inflamed,  the  treatment
should consist of leeches, poultices, purgatives, blisters, and alteratives.
When  the  muscles causing the distortion are not rigid, electro-mag-
netism, or the shower bath may have a good effect.  In some cases,
strychnine will  do well.
  The peculiar case mentioned above, completely recovered, under the
uses of the extract of St. Ignatius's  bean (95),  one  pill three times a
day, and gradually increased to nine  pills a day.  She also took iron,
and  was put  upon  a most energetic  system  of out-door exercise.
Considering the  stubborn  and severe  nature of the  complaint, her
complete recovery was  as  unexpected to her friends as it was grati-
fying-

                Foreign Bodies in the Eye.

  When a person complains of  some substance in the  eye, the inside
of the  lower eyelid, and lower portion of the ball, should first  be ex-
amined, the person being directed at the same time to look up.   If
nothing be discovered there, the  patient is then to be directed to  look 
SURGICAL DISEASES.                   481
downward.  This will expose to view the upper part of the globe.
At the same time, the eyelashes should be taken  between the thumb
and finger, and the lid turned upward over some round smooth thing,
as a bodkin, which will turn the lid wrong side out, and bring to view
whatever is on the inner surface.  Any foreign body discovered may
be removed by wiping it off with the head  of a pin, having a silk
handkerchief turned over it.   If this fails to detach it, it may be care-
fully picked up by running under it the point of a lancet, tooth-pick,
or pen-knife.

                      Stye.—Hordeolum.

  A stye is nothing more nor  less than a small painful boil at the
edge of the eyelid.

  Treatment. — In severe cases, apply a poultice; and open it as soon
as it begins to point.  After it has discharged all  it is likely to, apply,
on going to bed, for  two or three nights, a little diluted nitrate of
mercury ointment.  Tonics and  alteratives are frequently required to
break up the formation of styes.


       Inflammation of the Edge of  the  Eyelids.

                        Ophthalmia Tarsi.

  This inflammation often involves  the  Meibomian glands, which
then secrete a sticky  mucus, which, not being wiped away during
sleep, glues  the lids together, so that, on waking in the morning, the
patient cannot get his eyes open.  The complaint is  generally chronic
and obstinate, lasting  a long time.  Weakly persons, with disordered
digestion, are most subject to it.   In some cases the lids ulcerate; and
the lashes fall out  Generally the lids are considerably inflamed for
a few days, and then,  the inflammation  subsiding, branny scales,
which may be brushed off, form along the borders of the lids, at the
roots of the lashes.

  Treatment. — The health being generally disordered, needs first to
be improved by all possible means, as by alteratives, tonics, bathing,
exercise in the open air, travelling if practicable, and  a generous diet
  While the lids are inflamed, they should be bathed by a wash com-
posed of sulphate of zinc, twelve grains;  laudanum, two drams; and
soft water, twelve ounces.  The redness and heat  having  subsided,
and the bowels  being opened by a gentle  dose of physic, an astrin-
gent wash  should be applied once  or twice during the day  (208)
(209), and a small piece of the diluted nitrate of mercury  ointment
be rubbed along the  borders of the  lid, with a pencil-brush  at night
This will generally effect an immediate improvement,  and in time
will bring about a cure.
                               61 
482
SURGICAL DISEASES.
                  Disorder of the Lashes.

  Trichiasis. — This signifies a growing inward of the eyelashes.

  Dystrichiasis. — This is a double row  of eyelashes, one of which
grows inward.
  Treatment. — Pull  out  the  misplaced hairs, and continue to do so
as fast as they appear.

                            Ptosis.

  This is a falling down of the upper eyelid, from palsy of the third
nerve.  It is  sometimes attended with headache, and dizziness, and
may be the forerunner of  apoplexy.

  Treatment. — Begin the treatment with purgatives, and then use
every means to improve the health, especially exercise out of doors.


     Chronic Inflammation of  the Lachrymal Sac.

  When the mucous lining  of the nasal duct  gets thickened and
obstructed, the patient complains of great  weakness of the eye, which
is constantly weeping, — the nostril on the same side  having a corres-
ponding dryness.   The tears not passing down through the obstructed
duct, collect in the lachrymal sac, and form a small tumor by the side
of the  nose.   By pressing the finger upon this, the tears may be
squeezed out through the upward passage, and  glairy  mucus along
with them.   There is generally tenderness of the  sac, and sometimes
redness of the skin.  There is commonly inflammation of the mucous
membrane lining the  eyelids, etc.

  Treatment. — The  acute inflammation of the sac  must be treated
by leeches, purgatives, and cold washes.
  Chronic inflammation of the sac requires a special attention to the
general health.  The diet should be carefully regulated, and the alka-
line sponge bath used every day, with  brisk  rubbing  after it.   When
the sac gets very  full, the patient should try gently to force the con-
tents down into the nose by pressing upon the upper side  of the
tumor; and he may promote the same object by  strongly drawing in
his breath often with his mouth and nostrils both tightly shut.   The
diluted nitrate of mercury ointment may be applied to the eyelids at
bed-time, and a little of prescription (211) may be dropped once dur-
ing the day into the inner corner of the eye.


       Purulent Ophthalmia.—Egyptian  Ophthalmia.

  Owing to the  glaring  sunshine, and  the  particles of sand with
which  the air is loaded, this disease is endemic in Egypt.  Hence its
name Egyptian opthalmia. 
SURGICAL DISEASES.
483
  Symptoms. — It  begins with  stiffness, itching, and watering of the
eyes, and a feeling as if there were dust  in them.   The  lids are a
little swelled, and  become glued together during sleep.  The mucous
membrane which lines the  lids and covers the ball, is  intensely red
and swollen, and  discharges a  copious  quantity of pus.  There is a
severe burning pain extending to the cheek  and temple, with head-
ache and fever.   The eyes cannot be opened.   It is both contagious
and infectious.

   Treatment. — At the very beginning, apply a nitrate of silver wash
 (211), twice a day.   With this  application, a  low diet, and  Ave to
ten-drop doses of fluid extract or tincture of veratrum viride, every
 hour, this terrible  complaint may often be broken up.
   If the disease have reached its height, and there is great fever and
 headache,  the  patient may be freely purged (31), and the  pain  be
 allayed by full doses of Dover's powder.
   The patient must  be kept in  bed, in a dark room, with the  head
 elevated.
   The eyes should be frequently washed out gently with warm water,
 or a decoction of poppies, containing one grain of alum to an ounce.
 This must be done  with  a piece of fine sponge, or  with  a small
syringe.   Once or twice a day, a few drops of solution of nitrate of
silver, two  grains to the ounce  of soft water, may be dropped in
the eyes from a camel's-hair pencil.   As soon  as  the disease begins
to give way, the  alum in  the  poppy decoction may be increased a
little.

            Purulent Ophthalmia  of Children.

   This always begins within  a short  time  after birth, — generally
on  the third day.

   Symptoms. — The edges of the lids  at first become red, and glued
together, and  the  membrane lining them is red and rough.  The eye
remains closed.   The conjunctiva or membrane  which  covers the
globe, next becomes intensely scarlet, and so much swelled, at times,
that the lids  turn out; and it discharges a thick purulent matter.
The child is feverish and restless.

  Causes. — Exposure to  cold  and damp, bad nursing, omitting to
wash away from the  eyes  the  cheesy secretions of the  skin, and the
contact of gonorrhoeal and leucorrhoeal secretions of the  vagina  at
birth.                                                     s

  Treatment. — Wash out  the eye  frequently, and gently,  with  a
weak astringent wash (207) (203), or put between the lids once a
day, a large drop, with a  camel's-hair  pencil, of prescription (208).
When the disease is  declining, apply to the lids, with a camel's-hair
pencil, diluted nitrate  of mercury ointment. 
484                    SURGICAL DISEASES.
                  Catarrhal Ophthalmia.

  Symptoms. — In this complaint, the  white of  the eye becomes in-
flamed and very red, the redness being superficial, so that the vessel
can be moved by pulling the eyelids; generally there is a thin mucous
discharge, which, in severe cases, becomes thick  and purulent.  It is
caused by cold and damp.

  Treatment. — If there be considerable pain and headache, give pur-
gatives (31) (19), and continue them, once a day, till the symptoms
of active  inflammation subside.   Apply to the  eyes  a poultice of
slippery elm, and bathe them frequently with a decoction of poppy
leaves, lukewarm  or  cold, according to the  choice of the  patient
Smear the edges of the lids at night with fresh lard;  and when the
inflammation begins to decline, use  dilute'd nitrate of mercury oint-
ment instead.  Keep  the  eyes  well protected from the light with a
shade.  A large drop of a solution  of nitrate of silver, two  to  four
grains to the ounce of water, may be put into the eye  two or three
times a day.  Sometimes  sulphate of zinc, four  grains  to the ounce
of water, will do well.
  When the disease reaches the chronic stage, — the pain and head-
ache  having passed  off, — some astringent applications will be re-
quired, as a very weak solution of nitrate of  silver  (208), or a dram
each of powdered witch hazel leaves  and golden seal, steeped for ten
minutes in a gill of boiling water, and  strained when cold.


                  Scrofulous  Ophthalmia.

  This disease is chiefly confined to  children under eight years of
age.

  Symptoms. — Entire inability to  bear light;  the lids  are spasmodi-
cally closed, and the head constantly turned away from the light.  The
blood vessels of  the  conjunctiva are not  particularly injected, with
the exception of one or two large ones which run towards the cornea,
and terminate  in one or more small  opaque pimples.  The cornea
frequently ulcerates,  and the  complaint is very obstinate, — being
liable often to recur.

  Treatment. — As in all scrofulous  complaints, it is  important  in
this to look after the general  health.   No more physic  is required
than  to keep the bowels open ; and  even this, if  costiveness exist,
had better  be done by  bread made from unbolted wheat flour, by
injections of cool or tepid water, and by exercise.  The health must
be supported by iron, sarsaparilla,  stillingia, and  quinine.
  The eye is to be strengthened by cold water applied to the lids, the
forehead,  and the temples.   The eyes  may be bathed likewise with a
warm decoction of poppies, or of chamomile flowers.
  But one of the best applications  is a solution of nitrate of silver,
one or two grains to the  ounce of water, a few drops being put into 
SURGICAL DISEASES.
485
the eye once or twice a day.  Occasionally a solution of sulphate of
copper, of the same strength, may be used with decided advantage.
  Both eyes should be protected by a shade.


         Inflammation  of the  Cornea.— Corneitis.

  Symptoms. — The cornea is rough, red, opaque, and generally prom-
inent.  There is some pain and inability to bear light, but  not great.
The pulse is frequent, an4 the skin dry.
  Treatment — If the inflammation be acute, use  leeches,  emetics,
purgatives,  tincture of veratrum.   Apply  fomentations, and smear
belladonna ointment on the eyebrows.
   For the chronic form, give quinine and other bitters, and put blis-
ters upon the nape of the neck, and behind  the ears.   The wine of
opium, and the diluted nitrate of mercury ointment,  must be applied
to the lids.

             Inflammation of the Iris.—Iritis.

   The iris  is covered with a serous membrane, and is very liable to
adhesive inflammation.
   Symptoms. — In the first stage, the iris changes its color, and the
pupil is contracted. . In the next stage, lymph is poured out upon the
surface in a thin layer, sometimes, which  looks rusty, and  sometimes
in larger quantities, filling the whole cavity  of the aqueous humor.
   Causes. — Injuries, or overworking the eye, but more frequently a
taint of the system from gout or syphilis.
   Treatment. — If there be considerable  inflammation, apply leeches
to  the temples,  and keep down the circulation by  tincture of  vera-
trum.  To  relieve pain, if any,  give  Dover's powder, or morphia.
 The  strength is generally to  be supported  by quinine;  and in many
instances, iodide of potassium is to be given as an alterative.   A little
solution of  atropia, one grain to the ounce of water, is to be dropped
into  the eye once or twice a day,  and a warm  infusion of slippery
elm bark, or of marshmallow, to be  used  as a wash.   The bowels to
 be kept open by gentle physic.


           Weakness of Sight.—Muscce Volitantes.

   This is an affection to which persons of  weakly constitution  are
liable, and those who write much, or examine very small objects.
   Symptoms. — Dimness of sight; uneasiness on exposure to a strong
light; and specks floating before the eyes, — often looking like flies.
   Treatment.— The  complaint  depends  on  debility, natural or  ac-
quired ; and tonics, as quinine and iron, and the shower or sponge
bath, and out-door exercise, are the proper remedies. 
486                    SURGICAL DISEASES.
               Imperfect  Vision.—Amaurosis.

  The complaint  here referred  to  is dependent on some change in
the optic nerve or the brain, — most commonly the former.
  Symptoms. — In some  cases the  sight becomes suddenly dim, and
is perhaps soon lost altogether; but more often it is impaired by slow
degrees, — being only defective at intervals, as when the stomach is
out of order, or the eyes have been  fatigued.  At  one time, it  will
begin with  objects  appearing  dim; at  another,  with  their  being
double;  at  still another, with the ability  to see  only one half of
objects.   In some instances, the complaint begins with a crooked,
or disfigured,  or discolored appearance of things looked at.  Again
it will begin as near-sightedness, or  far-sightedness;  or the patient
cannot measure distances, and  will miss his aim  in  pouring water
into a glass, or in putting a match to the wick of a lamp.  The flame
of a lamp will appear split   At times the eye  does not bear light;
at other times it longs for it, and  objects do not appear illuminated
enough.
  Distinction. — Amaurosis may be distinguished  from  cataract by
there  being no opaque body to be seen behind the pupil; and by the
light  of a candle appearing  discolored, split, or lengthened, or iride-
scent, whereas in cataract, vision is only clouded, and a lighted candle
looks as if surrounded with a mist
  Chances of Cure. — These are generally not very favorable, unless
the remedies employed very soon produce good effects.
  Treatment. — Electro-galvanism is one of the most promising reme-
dies.  Bayberry root, dried and reduced to an impalpable power,  and
taken as a snuff, is occasionally useful.   Cayenne,  steeped in water,
one grain to one  ounce  of water, and a little of it dropped into the
eye, may stimulate the palsied nerve,  and in some cases restore sight
  Blisters may be applied behind  the ears, or a seton may be tried
upon the back of the neck, with some promise of success.
  But probably nothing will  do better than  cold  bathing, — a shower
bath if it can be borne, — out-door exercise vigorously pursued,  and
an adherence  for a long  time, — perhaps a year, — to a strictly vege-
table, diet, — at the same time using nervine tonics, etc. (316).


                   Short  and Long Sight.

  Short Sight, called myopia, depends on too great a convexity of the
cornea,  or crystaline lens, or vitreous humor, — one or all, — and the
consequent  formation of the image of the object inspected a little in
front of the optic nerve, or retina, — as at a, Fig. 173, instead of at b,
where it should be formed.   The rays of  light are brought to a focus
before they reach the retina.
   Children  are either born with this defect, or it is  brought on by too
close study, or by long application of the eyes to minute objects. 
SURGICAL DISEASES.
487
  It may be remedied frequently by exercising the eyes in looking at
distant objects.   Children afflicted in  this way  should have  their
studies abridged, and their exercise in the open air increased.  While
studying they should have  some apparatus applied  to  them which
ehall keep the chin elevated, so that the head cannot be  dropped too
low, and the eyes brought too  near the book.   And the book should
t ach day be placed a very little further from the eyes.

                             Fig. 173.
   Glasses worn by  persons having this defect of vision should  be
concave, as at c.

  Long Sight, or presbyopia, depends on the humors of the eye not
being convex enough.  In this case, the image of the inspected object
is formed beyond the optic nerve, as at d,  Fig. 174.  This is one of the
earliest signs of  advancing age.

                             •Fig. 174.
   This defect is to be remedied by glasses which are convex, e.   Per-
 sons in the early autumn of life, must not resort to glasses too hastily,
 or, indeed, until they are compelled to, nor should they change  those
 first used  too  soon.  Glasses should make objects  look distinct and
 bright, but not larger than natural.

                    Squinting.—Strabismus.

   In strabismus, the eyes are  not  parallel in their  position and mo-
 tion.    ,
   It is supposed that one  eye may become  weaker than the other, or
 that the visual axis of the two may not be adjusted alike, so that one
 eye, —perhaps the more  defective  one, —turns aside to escape the
 distorted vision, or possibly the injury  to  itself which would follow
 the attempt to make eyes of unequal power work  evenly together.
 Ihe opposing  muscles  lose their counterbalancing force, and the in-
ternal  rectus, gaining the preponderance, draws the eye inward, — for
the squint  is  more  often convergent than divergent; that is, the eye
turns m more often than out.   Both eyes sometimes squint. 
488                    SURGICAL DISEASES.
  Treatment. — In recent cases, there  is some chance of curing this
complaint without a surgical operation.  The patient should not be in
the society of other squinting persons,  so as to learn it by imitation.
  In the first place  care should be taken that the bowels are kept in
good condition, and that the general health  is well fortified by bath-
ing, tonics, and  exercise.   The patient  should be  made to stand
before  a glass, and  while  he closes the sound  eye, look steadily at
some object with the squinting eye.   Let him do this till the eye is a
little tired ; then let him open the sound eye, when  the squinting one
will turn  aside.  But by compelling it, in  this  way, several times a
day, to work in a straight line, it may, perhaps,  be  taught to  remain
parallel with the other.
  Nervine tonics, as  strychnine  (86)  (94) (95) (316), will  sometimes
do  good;  service; and electro-galvanism has been found useful in
many cases.
  But in old and obstinate cases, the only cure  is  found in dividing
the muscle which pulls the eye to one side, — the  internal rectus, if
the eye is drawn in, — the external rectus, if it is drawn out.


                   Affections  of  the  Ear.

  These  are  so  common, that, in almost every family,  they  require
attention, at one time or another.  % And deafness,  which so  often
results from  these disorders, is  so serious  a  misfortune, that every
affection of the ear should receive early attention.

  Examination of the Meatus.—-For examining the meatus, or ex-
ternal  passage of the ear, there is perhaps no better instrument than
a simple  silver or glass tube, of the size          fig. 175.
and shape represented in Fig. 175.
  To make the examination properly, place
the patient either in a sitting, kneeling, or
standing posture, as may be most conven-
ient, with  the ear  directly under  a good
stream of gas, or lamp, or sun-light   Then  take hold of  the ear with
the thumb and finger, and gently draw it outward and backward, and
with the other hand  introduce the small end of the  tube or speculum,
and carry it forward as far as  it will go  without producing  pain.
Then by gently swaying the large end of the tube  back  and forth, a
stream of light may be made to  illuminate all sides of  the passage.
If the lining of this passage is smooth, dry, pearly-white,  and shining,
and is without wax, it may be regarded as healthy.   At the close  of
the  passage, the tympanum may be seen, and should be semi-trans-
parent, dry, and grayish-white.   Within this, may be seen the handle
of the  malleus, coming from above downward and forward.   This
bone runs about half way across the tympanum, and divides it into an
upper front, and a lower back part  This lower back portion, when
viewed through the  speculum, is more glistening than the upper and
front part, and a bright spot of light  is seen on  its most rounded
portion, which is just below and behind the point  of the malleus.
% 
SURGICAL DISEASES.                  .  489
Inflammation  causes  this innermost part of the meatus to become
thickened, vascular, or  granular, — like  the  conjunctiva  of the  eye
when it is  inflamed;  it also causes it to  secrete and  discharge
matter.

        Inflammation  of the Meatus.—Otorrhoea.

   This is quite a common  complaint  among delicate children ; and
may occur as the result of scarlet fever, or be excited by currents of
cold air, by rotten teeth, or by deranged stomach and bowels.

   Symptoms.— Fever, headache, intense pain in the ear, and swelling
of the glands of  the neck.   After a time, a reddish, watery discharge
comes on, which  soon  grows thicker and mattery.   The fever dis-
appears with  the  appearance of the thick matter.  An examination
with  the speculum shows  the whole meatus to be swollen, vascular,
and covered with a slimy matter.
   Unless  great attention be given to  cleanliness, the discharge  be-
comes very  abundant and  fetid,  and lasts for a long time ; and if
neglected, will be likely to lead  to  very  serious consequences, even
the decay of some of  the bones of the head.

   Treatment.— While the  inflammation is acute, and there is fever
and pain, the diet should be confined to mere liquids, — as rice-water,
gruel, etc., and the bowels should be opened with some preparation of
salts, — the ear being  gently syringed, occasionally, with warm water,
or decoction of poppies, and being covered with a warm  poultice of
flax-seed, or bread and milk.   In place of  a poultice, a soft linen bag,
filled  with bran, and  dipped in  hot water, may be kept on the ear.
If there be great pain and headache, put leeches behind the ear."
   The pain and fever being gone, and the mattery discharge having
come on, the case is  to be  treated like other chronic diseases of mu-
cous  membranes  in  scrofulous  constitutions, by  tonics,  alteratives,
warm baths, and out-door exercise.
   The ear may now be gently  syringed out with castile soap and
water, and immediately after  with a weak solution of alum, or sul-
phate of zinc, one grain to a dram.  This may be done twice a day.
Or, a little of a mixture of two drams of solution of sugar of lead
and half a pint of water, may be dropped*into the meatus, and, after
remaining two or three  minutes, be allowed to run out.   If the dis-
charge be very fetid, two drams of solution of chloride of lime, with
half a pint of water, will make a suitable wash with which to syringe
it, — applying, once a day,  a solution of nitrate of silver, five grains
to the ounce of water.
   Should  the  discharge stop at  any time, and pain and fever come
on, lay aside these astringent applications, and go back at once to  the
leeches, purgatives, poultices, and fomentations. 
490                    SURGICAL DISEASES.
                       Wax  in the Ear.

  The ear  sometimes  becomes completely  filled with  wax, mixed
with hairs and flakes of scarf-skin.

  Treatment. — Let the ear be  gently syringed  from time  to time
with warm  soap suds, so as thoroughly to clear  out the whole mass
of matter.   The water may be quite warm, and a little cotton should
be loosely inserted after the syringing.


                      Earache. — Otalgia.

  Symptoms.— This is simply neuralgia of the* ear, and comes on in
fits of excruciating pain,  which shoots over the  head and face.  It
may be distinguished from inflammation  of the  ear, by the  sudden-
ness and intensity of the  pain ;  by its not throbbing, not increasing
in intensity, not being attended by fever,  and not coming and going
without apparent cause.

  Treatment. — Fill or  remove all rotten  teeth, which  may  be  sus-
pected as the cause  of the suffering.  Give  iron,  particularly the
citrate combined with strychnine (316).


  Inflammation of the Tympanum.—Deafness.—Otitis.

  Symptoms. — In the acute form of the disease, there is violent pain,
ringing noises in the ear, and delirium.  When the suppuration takes
place, there is a chill, and a heavy, tensive  pain.
  In the chronic form of the complaint, the lining membrane of the
tympanic cavity, has  its vessels a little enlarged, with  blood some-
times effused into its substance, or lymph  upon its surface, or the
membrane  is thickened, and  sometimes  covered with  tuberculous
concretions,  or there  are fibrous bands occupying nearly the whole
of the cavity.

  Symptoms. — These are slight, — the first perceptible change being,
generally, deafness in one or both ears.  There may  be a woolly sen-
sation, with  noises or  ringing, and slight aching pains.

  Treatment.— As the deafness in these cases generally depends on a
chronic inflammation of the tympanic membrane, the best remedies are
those which improve the condition of the  digestive organs and gen-
eral health, as regular diet, bathing, pure air, and e*ercise, with tonics
and alteratives.  Occasionally, a leech or two, or a blister behind the
ear, will be serviceable.  But generally dry cupping behind and in
front of the  ear will answer the purpose for  calling  the blood away
from the thickened membrane.
  If the inflammation be acute, it  must be combatted with purging,
blisters, poultices, and fomentations. 
SURGICAL DISEASES.                   ' 491
   When deafness is caused by inflammation in the eustachian tubes,
 or from enlargement of the tonsils, etc., the tonsils  must be  cut off,
 and a solution of nitrate of silver, twenty grains to the ounce, must
 be thrown upon the mouths of the tubes with a shower syringe.

           Bleeding from the Nose.—Epistaxis.

   Treatment. — In  full-blooded persons, with redness of face, and sub-
 ject to  headache, and dizziness, bleeding from the nose may be salu-
 tary, and necessary to ward off apoplexy, and should not be too sud-
 denly stopped.
   When the bleeding is such  as to require  to have it arrested, plug
 the nostrils with the scraping from a fur  hat, or with lint, dipped in a
 strong  solution of  alum, or tannin, or Monsel's  persalt of  iron, one
 part to ten parts of water.

                    Ingrowing  Toe-Nail.

   To most persons, the above words  will suggest some unpleasant
 associations, for there are few but  have had some painful experience
 with this affection.   It is generally, like corns and some other trouble-
 some things, the penalty inflicted  for wearing tight shoes.   It gener-
 ally appears upon the great  toe.   The  constant pressure of  a narrow
 boot  or shoe  against the  side of the toe, causes the edge of the nail
 to sink into the flesh, and cause inflammation  and pain, and finally
 ulceration.  Nature, attempting to repair the mis-       FlQ 176
 chief, sends out granulations, which, being perpet-     \ «       ;
 ually irritated, shoot up into unhealthy growths,     )        /
 called proud flesh.  Thenceforward, the  sufferings    (        V
 of the patient become  incessant; and he  cannot     ]         /
 now even compromise, as he would be glad to do,    /        (
 by putting on shoes  of ample dimensions, but is    /          \
 obliged to negotiate a peace by putting  away the   /          \
 shoe altogether, or by cutting a hole through it to   /            \
 take  off the pressure.   At the risk of giving the  /   ^  \  \\\
 reader a few dismal twinges every  time he looks /iJ^|M  I \ ^
 upon this page, we place here, in  Fig. 176, a good (^^ijfe] °*P
 representation  of this tormenting  disorder,  as a ^mm^0^^  •
 suitable warning against the folly of giving  the toes narrow  quarters.
  Treatment. — Make a lye by putting  half a pint of hard-wood ashes
 into a quart of hot  water; bathe the toe in  this, while warm, twenty
 minutes, every day.   Immediately after each  bathing apply a  poultice,
 made of ground slippery  elm and  weak lye, changing the poultice
 twice a day.   As fast as the inflammation is subdued by this, press a
 little fine lint gently under the edge  of the nail.   At each subsequent
 dressing, cut  off as much of the nail" as is  raised out of the  tender
flesh, with the keen point of a penknife.  Continue to do this till the
whole offending portion is cut away.
  If the above treatment does not reduce the inflammation and great 
492                    SURGICAL DISEASES.
tenderness, spread some  extract of belladonna upon  lint, — lay this
upon the diseased part, and put a poultice over it.
  When the disorder begins to make its appearance, it is *a good plan
to scrape the nail very thin on top; this will cause it to grow upon
the  upper surface, and to give way at the tender part, so as to obvi-
ate, sometimes, the necessity of any other treatment.
  The following is the best treatment  Wash the toe  in warm water,
and  make the parts dry with cotton w^ool.   Then gently press cotton
wool in between the toe nail and  the tender projecting flesh, and ex-
tend it along the groove  back between the skin and nail.  Next, wet
the end of a piece of nitrate of silver, and rub it thoroughly upon the
nail, close to the cotton, not allowing it to touch the  tender flesh;
then put on a thin layer of cotton wool, and, in two or three hours, a
poultice around the toe.
  In two days, the nail will be  perfectly black, and, as far as the ni-
trate was well applied, will be separated from the parts underneath, and
may be taken off without pain.
  If the nail is very thick, scrape off the black and deadened part in
two  days, and apply the  nitrate again.   This treatment is a vast im-
provement on the old and cruel practice of tearing off the live nail.

                 Chafing and Excoriation.

  When the neck, arm-pits, thighs, etc., of children, get chafed  or
excoriated, a remedy may be found by keeping  the parts clean, and
by dusting them with powdered  slippery elm, starch,  or hair-powder.
If this does not effect a cure, apply Turner's cerate, or wash the parts
with a solution of sulphate of zinc, or nitrate of silver, five grains  to
the ounce of soft water.
  Grown persons may treat these troubles very much in the  same
way, or by wearing cotton between parts which rub together.

            Foreign Substances in the Nose.

  When any  foreign substance  gets lodged  in the  nose,  close the
mouth and the opposite nostril, and then blow forcibly through the
obstructed side.  If this is not successful, press the thumb against the
npse above the obstructing body, and  then make a hook of a piece
of wire or knitting needle, and pressing it up over the offending sub-
stance, pull it down.

             Foreign  Substances in  the  Ear.

  If flies and other insects get into the ear, fill the  ear with sweet
oil, and then syringe it out with  warm Water.   Sometimes it will be
sufficient to hold the head down on one side, and have the  ear filled
with water, — remaining quiet in this position for a short time, when
the insect will rise to the surface.   If any hard substance be got into
the ear, lie down quietly upon  the  affected side, and send for a phy-
sician. 
SURGICAL DISEASES.                   493
           Foreign Substances  in the Gullet.

  If the substance have not gone beyond the reach of the thumb and
finger, thrust them down as far as possible, and try to pull it out; or,
a small curved pair of forceps will reach still lower  than the fingers.
Or, this failing, let some one place one  hand firmly on the chest of
the choking person, and give him a smart blow or two between the
shoulders with the other hand.  If the substance be down some way
in the  gullet, it may be pushed  along  into  the stomach by  some
smooth, blunt instrument.

            Foreign Bodies in the Windpipe.

   Sometimes foreign bodies will remain a long time in the windpipe,
and will only create some inflammation and cough, but not any im-
mediately dangerous symptoms.   When the body has gone entirely
below  the epiglottis, but little can be done,  except to give a pinch of
snuff to cause sneezing, and to direct the patient to  expel the air ex-
plosively from the lungs by a few energetic and sudden coughs.  This
may drive the offending body out.

                  Bleeding from  Wounds.

   If bleeding occur from any part where a bone lies near the surface,
as the  head or  face, it may generally  be stopped by pressing firmly
against the bone with a finger,  or a piece of cork, or by binding on
tightly a hard pad.  If this does not succeed, lift up each edge of the
wound, and examine carefully to  see if any small stream of blood is
spouting out in jets.  If so, an artery  is wounded, and the  point of
small forceps or tweezers  must be dipped  in where the jets  come
from ;  the  spouting mouth  taken hold  of  and drawn out ;  and a
strong silk thread passed around it, and tied below the forceps.   The
white and gaping mouth of the vessel  may then be seen.
   If the bleeding be profuse from  an arm, the whole current of  blood
to that limb must be cut off, which  may be done by some person
pressing a thumb firmly into the neck behind the middle of the collar-
bone.  This will dam up the blood in the great artery of the arm, as
it comes out of the chest.  The  handle  of a door-key, wrapped in
several folds of linen, may be pressed  upon  this place for a long time
until medical assistance can be had.
   Dangerous bleeding from the thigh or leg, may often be stopped by
pressing the great artery just below the crease of the groin.
   If the  bleeding  be below the middle of the upper arm, or middle
of the  thigh, pass a handkerchief  once or twice around the limb, as
far above  the wound as possible, and  tie it tightly.   Slip a stiff stick
under this, and turn it round, like the handle of an auger, until the
handkerchief becomes so tight as to stop the bleeding.  This arrange-
ment is called a stick-tourniquet, and is intended to answer the same
purpose with the instrument represented by  Fig. 146. 
494                   SURGICAL DISEASES.
        Apparent  Death from  Noxious Vapors.

  When persons become insensible from breathing foul air in a deep
well or other place where it collects, let them be immediately exposed
to the open air, and  cold water be sprinkled upon the face and head,
and strong vinegar be rubbed about the nostrils.  As soon as there is
ability to swallow, give some drinks, as lemonade, or a few drops of
aromatic sulphuric  acid, dropped  into a  tumblerful of water,  and
slightly sweetened.   A stimulating injection (246) may be given.

       Apparent  Death from Burning Charcoal.

  Some persons very thoughtlessly attempt to warm their sleeping or
sitting rooms with a portable furnace, or open  pan filled with burning
charcoal, or live coals from a wood fire.  This is very wrong, as such
coals while burning  throw off large quantities of carbonic acid gas, a
deadly poison.  This being  heavier than atmospheric air, falls to the
bottom of the room, and  for a time may do no damage; but, if there
be no chimney-draught, or  open door or  window, it will rise above
the heads of those in the room, and bring on asphyxia and death.
  Let such cases be treated the same as the preceding, with the addi-
tional measure of attempting to excite breathing, as in the  case of
persons apparently dead from drowning.

      To Recover Persons  Apparently Drowned.

  Drowning persons  die by what is called asphyxia.  The air being
shut off from the lungs, breathing stops, and the immediate accumu-
lation of carbonic acid in the blood, paralyzes the nervous system, and
insensibility immediately follows.   The heart  continues  to beat, how-
ever, from five to twenty minutes after the occurrence of insensibility
and apparent death.
  Recovery  may take place at any time before the heart ceases to
beat, and  has been brought about in some cases even after this organ
has become still.  It has taken place, in some few instances, as late as
half an hour after being under water, but it can scarcely be expected,
even under the  best treatment, later than twenty minutes from the
time of submersion; and even  as late as  this, the chances are much
against restoration.
  Treatment. — The best treatment is  that recommended by Dr. Mar-
shall Hall.
  Treat the patient instantly, on the spot, in the open air, and, except
in severe weather, expose the face and chest to the breeze.
  Then, to Clear the Throat, place the patient  gently on the face, with
one wrist under the forehead.   All the fluids,  and the tongue now
fall forward, leaving the passage to the windpipe free.  If there be
breathing, wait and  watch.   If there be no breathing, or, if there have
been, and it has failed, 
SURGICAL DISEASES.
495
   Then, to Excite Breathing, turn the patient well and instantly on
 his side, and excite the nostrils with snuff, or the throat with a feather,
 and dash cold water on the face, previously rubbed warm.  If there
 be no success, lose not a moment, but, instantly,

   Next, to Imitate Breathing, replace the patient on his face, raising
 and supporting the chest  well on  a folded  coat or other article of
 dress.   Now very gently turn the body  on the  side, and a little be-
 yond, and then quickly back upon the face, and repeat  these turnings,
 back and forth, deliberately, efficiently, and perseveringly, fifteen times
 in a minute, occasionally varying the side.  These motions will cause
 a kind of artificial breathing;  for  while the patient rests upon the
 breast, the weight of the body compresses this  cavity,  and expels the
 air, which is the same as  the outgoing  breath, or expiration ; when
 he is turned on the side, the pressure is  removed, and  the  air rushes
 in as in natural inspiration, or the ingoing of the breath.   When the
 patient is on the face, make even and efficient pressure along up the
 back of the chest, discontinuing it immediately before turning  the
 body upon the side.  This upward gliding pressure helps expel  the
 air.  Of course it must be  stopped  the moment the body is in a posi-
 tion upon the  side to let it  in.  The result of these  movements is
 breathing, and, if not too late, life.

  Then, to Induce Circulation and Warmth, rub the limbs upwards
 (and of  course this should be  done during  the previous  measures)
 with firm  grasping pressure, and with energy,  using  handkerchiefs,
 and warm soft flannels if at hand. *  This pushes the blood along up
 towards  the heart through the veins.   In this way, too, the limbs are
 warmed and dried, and may be now clothed, — the  bystanders sup-
 plying the garments.   Avoid the  continuous  warm  bath, and  the
 position  on or inclined to the  back.   Beside the  above, pour into  the
 nostrils a teaspoonful  of aromatic  spirit of  ammonia, and thrust a
 feather  into the nostrils, dipped in water of ammonia.  Give also a
 stimulating injection, composed of a pint of water with a tablespoon-
 ful of ground mustard, and a teaspoonful of pulverized cayenne, and
 put a mustard poultice upon the perineum and anus.


            Apparent Death from Lightning.

   A stroke of lightning w?U frequently produce asphyxia  by par-
 alyzing the muscles of resp. ation.  In  such case,  the same means
 for recovery should be used as in apparent death  from drowning.  Or,
 the apparently dead person may be placed in a current of fresh  air,
 and  cold water dashed upon the face, neck, and breast, and warm
 friction  be applied if the body is cold.

             Apparent  Death  from  Hanging.

  Persons found hanging, who have committed suicide, are to be  cut
down instantly, and the same means employed to reestablish breath- 
496
SURGICAL DISEASES.
ing as in cases of drowning.  It may help to restore the breathing, to
bathe the forehead and face with vinegar, or tincture of camphor, and
to pass hartshorn frequently under the nostrils.

                  Clothes Catching  Fire.

   It is  perhaps  unreasonable to look for presence of mind when this
frightful accident occurs, yet it is never more needed than at such a
time.
   The instant a  lady perceives her clothes to be on fire, and in a blaze,
she should seize  the nearest large rug, cloak, blanket, coverlet, or any
equivalent article, and, wrapping it tight around her, throw herself
flat upon the floor, taking care to keep the protecting covering close
to her until the fire is completely smothered.  If she  does this with
energy, and effectually, she will put out the fire instantly.
   If  she continue on her feet, the blaze will rapidly ascend, and burn
her vital parts.  If she run to seek  relief from others not present, the
motion of the air will fan the  flame into  a swifter work of destruc-
tion.
   If  it be a child that is  on fire, let any person present* treat it as
above.  If it be badly burned  before the fire  is extinguished, put it
instantly into a  tub of cold water, or darh cold water upon it, to
prevent the b*urn from becoming deep.

                 Accidents  on the  Water.

   If upset in a boat, or otherwise thrown into the water, and are not
able to swim, draw the breath in well, and keep the mouth shut tight.
Do not struggle  and throw the arms  up ;  but  yield quietly to the
water, hold the head  well up, and  stretch  out the hands only below
the water.   To throw the hands or the  feet up, will  pitch the head
down, and cause  the  whole person to  go immediately  under water.
Keep the head above, and everything else  under water.

     Poisoning Accidents.—Antidotes of Poisons.

   Accidents  from poisons are  of such  common occurrence, that
every person  should  know the proper remedies, and not be obliged to
wait the  arrival of a physician  before the proper corrective is applied.
The  most common remedies,  with  the  methods of applying them,
will be  given under the  proper heads below.  The mineral  poisons
will be spoken of first.

                  Poisoning by Ammonia.

   Water of ammonia, or hartshorn, if taken  in an undiluted state,
acts as a violent poison.
   When this  accident happens, give vinegar instantly, mixed with a
little water.   Vinegar is an acid, and ammonia is an alkali; and acids
and alkalies neutralize each other. 
SURGICAL DISEASES.                  497
                 Poisoning by Antimony.

  Tartar emetic, and  wine of antimony, are  sometimes taken by
accident in large doses, so as to act as poisons, and cause dangerous
vomiting and prostration.
  Give a tea of slippery elm, flax-seed, marshmallow, etc.; also syrup
of poppies, paragoric, or laudanum  in twenty-drop doses.   To neu-
tralize the poison, give  a strong solution of tannin, or an infusion of
oak bark, or nutgalls.


                  Poisoning  by Arsenic.       »

  Use the stomach pump instantly, if one is to be had; if not, give
twenty  grains of sulphate of zinc  (white witriol)  in  a little warm
water; and  promote the vomiting by filling the stomach with large
draughts of warm or cold milk,  sweetened water, or flax-seed tea.
Or, vomiting may be induced  still  more quickly, by giving a large
tablespoonful of strong ground-mustard, mixed with a teacupful of
water.
  But the best antidote for arsenic is hydrated sesquioxide of iron.
Mix a tablespoonful of this with water,  and give this  amount every
five or ten minutes, until half a dozen doses are  taken.
  Treat the inflammation of the stomach which follows, by blisters,
a bland  liquid diet, mucilaginous drinks, etc.


    Poisoning by Verdigris, or  Acetate  of Copper.

  Cooking utensils made of copper never ought to be tolerated ; yet
they are used; and it is from the verdigris which forms upon them
that most of the cases of poisoning  by copper happen.
  Give  an emetic instantly, and then two teaspoonfuls of carbonate
of soda (bread soda) in a  tumblerful of  water, to be repeated in ten
minutes.  White of eggs, diffused in water, and mucilaginous drinks
are proper.

           Poisoning by Corrosive  Sublimate.

    This is the  common  bed-bug poison, and is often taken by
mistake.
  Mix up quickly the whites of a dozen eggs, with  two pints of cold
water, and give a glassful of the mixture every two minutes till the
stomach can contain no more.  If there  are not  eggs enough at hand,
take what there are, and  make up the deficiency with  milk.  •Wheat
flour, mixed with water, is a good remedy.  Use the stomach pump,
if it is at hand.  Treat the resulting inflammation with leeches and
fomentations.
                              63 
498                   SURGICAL DISEASES.
  Poisoning  by  Sugar  of Lead, or Acetate  of Lead.

  Give a ground-mustard, or a sulphate of zinc emetic; then, give
diluted sulphuric acid, or, either epsom or glauber's salts.


                Poisoning  by Strong Lye.

  Strong lye is sometimes swallowed  by children.   The  remedy is
vinegar, or oil.   Vinegar will convert the  lye into acetate of potash,
and any of the oils will unite with it,  and form soap; and neither
the acetate^jf potash, nor soap, will materially injure the stomach.


  Poisoning by Nitric, Muriatic,  or  Sulphuric Acid.

  When either one of these acids is swallowed, not a moment of
time is to be lost.   Fill the  patient full of calcined magnesia stirred
up in water.   This is the  best remedy; but if it is not to  be had,
give  half an ounce of  soap in a  pint of water.  If neither are at
hand,  give chalk, or whiting, in water, or even pound fine some of the
plastering of the room, and give it  in water.


 Poisoning by Nitrate of Potash,  called  Nitre,  or Saltpetre.

  Induce vomiting by luke-warm  w^ter, and by tickling the throat
with a feather; but avoid  irritating the stomach with the ordinary
emetics.

               Poisoning by White Vitriol.

  Provoke vomiting by warm drinks, and by tickling the throat, and
give freely carbonate of soda, in water.


               Poisoning by  Oxalic Acid.

  This resembles epsom salts, and is liable to  be taken for salts by
mistake.   The two  can always be distinguished by touching a little
to the tongue.  Epsom salts taste bitter; oxalic acid, very sour.
  In cases of  poison from  oxalic acid, give magnesia in water as
quickly as possible.   When this is not at hand, give chalk,  or lime,
or saleratus.   Use the stomach pump, if it is to be had.


      •             Vegetable Poisons.

  The vegetable  poisons are  quite  numerous,  and  many of them
quite as virulent and rapid as any in the mineral kingdom. 
1
SURGICAL DISEASES.                  499
                   Poisoning by Aconite.

    Give an emetic of ground-mustard or sulphate of zinc, or use  the
  stomach pump, instantly, and then give stimulants, as brandy, gin,
,  whiskey, rum, etc.

     Poisoning by Opium, Morphine, and Laudanum.

    Use  the stomach pump, if  at hand; if not, a powerful emetic of
  sulphate of zinc, or sulphate of copper; or, if these are not at hand,
•  a tablespoonful  of ground-mustard in a teacupful of warm water.
  If vomiting is not induced at once, tickle the throat with a feather, or
  with the finger.  If sleep is impending, take the patient into the open
  air, and keep him walking;  dash water upon his face, etc.  If he
  still falls into sleep, and appears to  be near dying, apply means for
  artificial breathing as for persons apparently dead  from drowning.


   Poisoning from  Belladonna, Hyoscyamus, Stramo-
                       nium, and Conium.

    These are all narcotics, and when accidentally taken in poisonous
  doses, the treatment  is to be  the same  as  for poisoning  by opium.
  Strong coffee is said to counteract the eff'ect of these articles.


              Poisoning  by Dogwood, Ivy, etc.

    Give some of the salts as a  cathartic, and apply a solution of sugar
  of lead, or, still better, a decoction of witchhazel bark.


                Poisoning  by Spanish Flies.

    Give large draughts of sweet oil, sugar and water, milk, or flax-
  seed tea.  For the inflammation of the bladder, which is produced
  by it, apply leeches, and a liniment composed of camphor  and sweet
  oil.   To relieve the strangury or scalding of the water, give camphor
  internally.

                 Poisoning  by  Prussic Acid.

    This is the most  deadly of all  known poisons.  One drop of the
  pure acid will cause  immediate death.  Give water of ammonia or
  hartshorn, one part diluted with six parts of water, freely.  .


                  Poisoning by Strychnine.

    The  same treatment as  for poisoning by  opium, excepting  that
  sweet milk  should be freely  administered.   This has been recom- 
500                    SURGICAL DISEASES.
mended by one respectable physician, at least, who says he has found
it to be  a  specific.  Camphor, two ounces dissolved in a quart of
whiskey, and given freely, is also said to be an antidote.


                     Care of the Teeth.

  A decay and loss of the teeth is common even among the young.
Few persons at the age of twenty have sound teeth.


              Rotting  of the  Teeth. — Caries.

  This is  not confined  to any age, temperament,  or  condition of
society.         •
  The teeth become diseased, die,  and drop away, while all the other
organs are  sound and active.
  The Creator doubtless intended that  ail the members of the same
body should  be  equally durable; but certain laws of nature, violated
by us habitually, turn upon us, as it were, in anger, and  smite us full
in the  face, breaking our teeth,  and robbing us of the means of pre-
serving the health which we do not appear to prize.
  When rotting begins in the  teeth, its progress is more or less rapid,
and  their  destruction is  certain,  unless it is  arrested by  artificial
means.
  The enamel is nature's fortification to protect the teeth  against ex-
ternal injuries.  When this is broken, or worn away, the bone of the
tooth becomes exposed, and rotting  begins immediately.  Whatever
has a tendency to crack, break up, or destroy the enamel, therefore, is
to be carefully avoided.
  Hot  Drinks, or hot food, coming suddenly in contact with  the en-
amel, are liable to crack it, and expose the bony substance of the
tooth.  The enamel is exceedingly  brittle, much like glass in its struc-
ture, and is easily cracked when exposed to  sudden  transitions from
heat to cold, and from  cold to  heat.
  Luxurious  Living  often  deranges  the  general  health, and causes
acid and unhealthy secretions in  the mouth, which act  injuriously
upon the enamel.
  Acids  are injurious  to the enamel; and when taken as medicine,
should be well diluted, and in some cases, drank through a tube, so
as not to come in contact with the teeth.   Sugar is not directly inju-
rious to the teeth, as many suppose; but if allowed  to  reman about
and between them, it  may generate an acid which is destructive to
the enamel.
  A Crowded Condition of the teeth in the  mouth causes the  enamel
to wear  away, and  leads to rotting; in which  case, early attention
and advice from a dentist, is quite  important
  Food Lodged Between the Teeth, and in their depressions, is a cause
of extensive  decay.   Animal  and  vegetable matter, when exposed to 
w
SURGICAL DISEASES.                    501
warmth and moisture, soon generate an acid which corrodes the en-
amel.  The  teeth, consequently, often begin to decay in parts where
one presses upon an other, and in  depressions, where  food  lodges and
remains.  This shows the necessity of cleansing the mouth and teeth  •
often, — particularly after meals.
  Mercury, when  taken to  the  extent of salivation, — whether it be
calomel, corrosive sublimate, blue pill, or any other form of it,—
causes inflammation of  the membranes  about the teeth, and indi-
rectly produces caries.
  Acidity pf the stomach, the  contact of decaying teeth and dead
stumps with sound ones, diseased and ulcerated gums,  and, above
all, a filthy, unclean, and unwholesome condition of  the  mouth, are
active causes of diseased teeth.
  Improper Tooth Powders, as  those containing  gritty particles, are
to be avoided.
  Tobacco, by deranging the general health, may be  indirectly inju-
rious to the teeth.  Smoking blackens the teeth ; and though chewing
may be useful in deadening the sensibility of the nerve of  a decaying
tooth,  this alone is not a sufficient reason  for so uncleanly and disa-
greeable a habit, while so many agents may be found to produce the
same effect.                               t
  Tartar. — This is derived from the saliva, and is  found, when ex-
amined  by  the microscope, to be composed  of  myriads of living
animals.  When  first deposited around the teeth,  it is in a soft state ;
but, when  not brushed away,  it  soon hardens, and  changes from a
yellow to a brown, and sometimes  to a black color; and often in
children, it  becomes a dark green.   It  destroys  the beauty of the
teeth,  giving them a filthy and  revolting look; the setting of  the
teeth in their sockets  is weakened; their appearance is  elongated;
the periosteum or covering  of the fang becomes inflamed and tender;
and, if the proper remedy be not applied, the teeth will become loos-
ened, and finally fall from  their sockets.   It causes  the gums to be-
come  inflamed, swollen, tender, and  ulcerated,  and loads  the breath
with a disagreeable fetor.   Its direct  influence on the teeth is not
great; but it  vitiates all the secretions of the  mouth, and is thus a
very efficient, though  an indirect cause  of decaying teeth.   In all
cases,  it should be immediately  and  carefully removed,  and  some
astringent  wash, made  from  peruvian  or oak bark, be  applied to
reduce the inflammation and swelling of the gums.


                         Tooth-Ache.

  This is generally caused by an exposure of the nerve  which fills
the internal cavity of the tooth.   This exposure  is caused by a frac-
ture, or, more  commonly, by the rotting away of  a part of the tooth.
This  nerve  is extremely sensitive; and,  by coming in  contact with
the air and  acrimonious  substances, inflammation  is  excited, and
tooth-ache  is the consequence. 
*
502                    SURGICAL DISEASES.
    Teeth sometimes  ache when  they are,  to  appearance, perfectly
  sound.  This may be caused by bony enlargements of the  ends of
  the fangs, inflammation of the periosteum, a peculiar irritability and
t ague of the face, which excite neuralgia, etc.
    Pain of a sound  tooth is sometimes caused by sympathy with a
  decaying  one, by a disordered stomach, or by scurvy, pregnancy, tar-
  tar, or whatever excites painful sympathetic action  in  the nerves of
  the face.

    Treatment.— Tooth-ache  may be quieted by placing a drop of oil
  of cloves, or cajeput, or a drop  of creosote upon a piece, of cotton,
  and inserting it into the cavity of the tooth,  and bringing it into con-
  tact with the exposed nerve.
    Pains of the face and jaw, when  not  the consequence of rotten
  teeth,  may be relieved by  holding brandy, or whiskey, or  rum, or
  diluted tincture of cayenne, or  hot water, in the mouth, and by ex-
  ternal applications of laudanum, Oliver's  plaster, a mustard  plaster,
  or hops steeped in alcohol, or a blister behind the ear.  But for teeth
  too much decayed to be saved by filling, there is no remedy so proper
  as extraction.


                        %  Filling Teeth.

     There  is no operation of the dentist of more  real and lasting
  benefit to the patient than that of filling rotten teeth.
     A tooth that is well filled before its nerve is exposed, is as servicea-
  ble as a sound one, and nearly as durable,   Its preservation for many
  years is perfect and  complete.
     It is necessary, in  the performance of this operation, to  remove
  very carefully all rotten  and foreign matter lodged in the cavity; to
  make the cavity of a dovetail shape, so as to retain the filling;  to wipe
  it perfectly dry; and to press the gold in so as  to  make the cavity
  perfectly water  and air tight.  A tooth filled in this way may be  pre-^
  served many years, and in many cases, during life.
     When  decay has gone so far as to expose the  nerve and render a
  tooth  painful, the nerve, in all cases, should be destroyed before the
  cavity is filled; otherwise there may be soreness, and sometimes ex-
  treme pain, making the extraction of the tooth absolutely necessary.
     A tooth filled after the nerve is destroyed is not as good as if filled
  before the nerve was exposed; the walls of the cavity are thinner and
  weaker, and consequently are more liable to break and crumble away
  when brought into contact with  hard substances ; and the filling will
  be more  likely to be loosened.    There is  likewise some danger of
  ulceration and absorption at the root of a tooth, when filled in this
  condition, which makes  it  very important that teeth should be filled
  early.
      Gold foil is preferable  to all other substances for filling teeth.   If it
  is properly pressed and polished, it will remain  in the mouth for many
   years without any sensible loss of its substance. 
SURGICAL DISEASES.
503
                      The  First Teeth.

   It is an imperative duty of parents to see that their children's teeth  .
 have early and careful attention.
   The health  and durability  of the permanent teeth  depend materi-
 ally on the healthy condition, regularity, and durability of the tempo-
 rary ones.   It may seem strange that diseases of the first set of teeth
 should influence the set which is to follow;  but when we consider that
 the rudiments of the second set already exist when the first are cut,
 it is not unreasonable to suppose they may inherit disease from their
 predecessors.

                     Cleaning the Teeth.

   The most important rule to be observed in the preservation of the
 teeth, is to keep them perfectly clean, and  never to alloW any foreign
 substance to  remain  on or about them.   A decaying tooth should
 never be allowed to remain in the mouth ; it causes others to decay.
   If tartar  have  been allowed to  collect,  have it removed  immedi-
 ately.   The teeth should be  carefully and  thoroughly brushed daily
 with warm water, and the  occasional use of a detifrice that is impal-
 pably fine, and that contains  no acid.

   A Brush has no bad effect upon the teeth, as some suppose, for the
 parts of the teeth most  exposed to  the friction of a brush are never
 the first to begin to decay.  This beginning of decay takes  place in
 their depressed surfaces, and where they touch each other.  A soft
 brush is better for the teeth than a stiff one,  because the  latter is
 apt to  fret  the  gums, and cause  them  to recede, which gives  the
 teeth a lengthened appearance,
   Teeth in  a crowded condition should never be filed, unless they
 begin to decay.

   Tooth-Picks, made of quill, or wood, or ivory, should be used after
 meals, and all particles of food lodged between the teeth should be
 removed.

   In Sickness, the rules  for cleanliness of the teeth should be more
 rigidly enforced than  at  any other  time, as then they are more  ex-
 posed to destructive agents,  md are liable to participate in the gen-
 eral debility and disease of  the system.


    Influence  of Dis'eased Teeth upon the Health.

   The bad effects of a diseased and unclean mouth upon the general
health, are of  more serious consequence than most people  are aware.
In twenty-four hours, we breathe twenty thousand times; and what
must be the effect upon the delicate  structure of the lungs, when, for
days, months and years, the air we breathe is drawn through a depos- 
504
SURGICAL DISEASES.
itory of filth, and is  poisoned by being mixed with effluvia arising
from decayed and diseased matter in the mouth.
   The intermittent fevers of the West are caused by the effluvia aris-
ing  from  the decaying matter of low grounds  and  marshes, which
can  hardly  be more  pernicious than the effluvia from the impurity
anjd  corruption generated in an unclean mouth,  filled  with decaying
teeth.  Dr. Hays says " no species of animal matter is so offensive to
the  health and vitality of the adjoining substance, whether nerve, or
membrane,  or any part or portion  of  the living body, as decaying
bone."

Fumigation of Infected Chambers and  Other Places.

   Nitric Acid Fumigation. — The efficiency of nitric acid in the form
of gas,  in arresting contagion, and in cleansing infected rooms, ships,
and  other places, ;s well established.   To obtain the gas, pour one
ounce of sulphuric acid upon  two ounces of nitrate of potash in a
large tea cup,—the cup being placed in a basin containing hot water.
The gas or vapor will be immediately disengaged.
   This  quantity  will thoroughly cleanse a small apartment, but if
used in a sick room, should  be placed at some distance from the
patient  In a large room, two cups will be required ; and if a whole
house is to be fumigated, let several  be placed in various apartments,
and  the doors and windows be closed for half an  hour.

   Chloride of Zinc.— A solution of the chloride of zinc has great
power in  arresting contagion, and in cleansing  infected places.  A
small quantity of it will, in a few minutes, cleanse the most offensive
apartments.

  Chloride of Lime. —This is one of the most powerful disinfecting
or cleansing agents known.  To prepare it for use, add four gallons
of water to a pound  of the chloride of lime; stir the mixture well,
and  after  allowing it to settle for a short time, pour off the clear
solution, and keep it in well-corked bottles.

  Chloride of Soda.—This, in  disinfecting power, is about equal to
the chloride  of lime.   In order that it may retain its properties, it
must be kept from the light,  in a well-stopped glass bottle.  When
used, it  must be  mixed in the proportion of one ounce, or two large
spoonfuls, to the pint of water.  It is excellent for  cleansing car-
buncles, gangrenous sores, bad ulcers, ulcerated sore throat, and fetid
discharges of every kind.   A weak solution should be frequently ap-
plied.

  Uses  of Chlorides of Lime and Soda. — These articles almost in-
stantly destroy every bad smell, and  all effluvia arising from animal
and  vegetable  decomposition, and entirely prevent their  bad influ-
ence.
  While infectious or contagious diseases  prevail in  large towns or
cities, the rooms  should  be sprinkled, morning and  evening, with 
SURGICAL DISEASES.                    505
some of one of these  solutions.   Some of it should  be placed in the
different  rooms, in shallow dishes, — the small bed-rooms being par-
ticularly remembered.
  In houses where there are typhoid and putrid fevers, and infectious
complaints,  it  is highly proper to  sprinkle the solution  'about the
rooms, and occasionally upon  the  bed-linen ; and the air of the  room
should be frequently renewed.  A wineglassful added to the chamber-
vessel or the bed-pan will prevent all smell.
  Before  sending the  bed and other linen  to the wash, let it be im-
mersed, five or six minutes, in one of these solutions, diluted, as mere
washing will not always remove the infection.  But  the linen should
be immediately rinsed in pure water after the immersion ;  to allow it
to dry without such rinsing might injure it.
  By pouring a quart of one of these  mixtures, added to a pailful of
water, into  drains, sewers, or cesspools, and repeating the application
as may be required, will destroy all their offensive effluvia.
  Meat will keep for some time, without any taint, and without the
molestation of flies, if immersed in one of  these solutions for an in-
stant,  and hung up; and  all tainted  meat, fish,  game, etc., will be
rendered sweet by a little sprinkling of the same.
  To purify water  in  cisterns, and destroy the animalcules in it, add
to every one hundred gallons,  about a pint of one of the solutions.
  The washing of  bedsteads  with one of the solutions, and  putting
it into all the crevices, will destroy bugs.
  A room just painted may be slept in safely, if one of the mixtures
be sprinkled about,  and left in shallow dishes.
  Stables, slaughter-houses, hog-styes, privies, and  all places  from
which offensive smells arise, may be  thoroughly purified by  these
mixtures.
  Being guardians  of the public health of such wide application, and
of so great utility, it is surprizing that they are not more used.

                     Freezing Mixtures.

  In treating wounds, inflammations, etc., it is often quite important
to have  ice, which  is  not  to  be obtained without manufacturing it.
Accordingly, I give here a few directions for its immediate production.
   The salts used should be in a crystalized  state, with as much water
in them as possible without  being damp.  They should be coarsely
pulverized at  the time of using, and put into the  water contained in
a basin, or other suitable vessel.   The water to be  frozen should be
inclosed in a thin vessel, and immersed in the freezing mixture.  To
obtain extreme degrees of cold, the ingredients  and the vessel should
be cooled by one mixture, before being mixed for another.
  To five drams of pulverized hydrpchlorate of ammonia,  and five
drams of pulverized nitrate  of potash (nitre), add two  ounces of
water, in a tin, stone-ware, or glass vessel, and you may freeze water,
sea-water, milk, vinegar, or oil of turpentine.  It will cause the ther-
mometer  to sink from 50° above zero,  to  10°  above; that is, forty
degrees. 
506
SURGICAL DISEASES.
  A mixture of five drams of sulphate of soda, and four drams of
diluted sulphuric acid, will sink the thermometer seven  degrees lower
than the above, namely, down to 3° above zero, or twenty-nine degrees
below the freezing point.
  If six drams of sulphate of soda, four drams of hydrochlorate of
ammonia, two drams of nitrate of potash, and four drams of diluted
nitric acid be put together, the mixture will lower the thermometer
60°; that is, to 10° below zero, or 42°  below the freezing point.
  Beside the above, the following combinations may be used :
  Muriate of ammonia, five ounces;  nitrate of potash, five ounces;
water, sixteen ounces.  Mix.
  Nitrate  of ammonia, four ounces;  crystalized carbonate of soda,
four ounces ; water, four ounces.  Mix.
  Nitrate  of  ammonia and water, equal parts.  Mix.
  Nitrate  of ammonia, and nitrate of potash,  five parts each;  sul-
phate of soda, eight parts ;  and water, sixteen parts.  Mix.
  Phosphate of soda, nine parts ; diluted nitric acid, four parts.  Mix.
  Sulphate of soda, eight parts ; muriatic acid, five parts.   Mix.
  Sulphate of  soda, six parts;  nitrate of  ammonia, five parts; di-
luted nitric acid, four parts.  Mix.

  Freezing Mixtures  with  Ice. — Snow or  pounded ice, two parts;
salt, one part.   Mix.  This will sink the thermometer to 5° below
zero.
  Snow or pounded ice, four parts ;  salt, two parts ; muriate of am-
monia, one part.   In  this  mixture the thermometer will go down to
12° below zero.                                             •
  Snow or pounded  ice, twenty-four parts ; common salt, ten parts;
muriate of ammonia, five parts; nitrate of potassa, five parts.  Mix.
Gives 18° below zero.
  Snow or pounded ice, twelve parts; common salt, five parts; nitrate
of ammonia, five parts.  Mix.   Gives 25° below zero.
  Snow, eight parts; muriatic acid, five parts. Mix.  Gives 27° below
zero.
  Snow, seven parts; diluted nitric acid, four parts.  Mix.  Gives 30°
below zero.  *
  Snow, four parts; chloride of calcium, five parts.  Mix.   Gives 40°
below zero.
  Snow, three  parts;  potassa, four parts.   Mix.   Gives 51° below
zero, or 83° below the freezing  point.

      Dr.  Ira Warren's Paracentesic Instrument.

  Puncturing the chest for drawing off water  in extensive pleuritic
effusion, as practised of late,  has proved one of  the most valuable
operations  in modern surgery.   Like  most new operations, however,
it has been embarrassed by imperfect instruments.
  The annexed cut represents an improved instrument which I have
just invented, by which this operation is made  extremely simple and
easy.  At the right hand  is the puncturing instrument, including the 
SURGICAL DISEASES.                    507
external canula, and the trochar inserted in it   At the letter i is a slid-
ing guard which moves back and forth, and may be set at the point of
desired depth to  which it is desirable to  puncture, and made fast by
a screw.  By this arrangement it may be  driven home to the desired
depth, without any fear of going too far, or of falling short  of the
mark.   The  guard also  serves in a measure to keep the instrument
«teady during the operation, and to prevent inflicting pain by having
it  oscillate about   At b is a tubular attachment, opening into the
canula ; to this an India-rubber hose is attached, which connects, at
the other end, with the cock, a, upon the exhausted receiver, o.   To a
cock, c, on the other side of the receiver,  another  rubber hose is fast-
ened, which connects at the other end with an air-pump.
                               Fio. 177.
  The mode of operating is exceedingly simple.   First, exhaust the
receiver; then quickly, yet gently, plunge in the instrument, and, leav-
ing the canula, withdraw  the trocar till the point passes the connect-
ing tube at b, when the water will immediately flow, in a full stream,
into the exhausted receiver, o.   The working of the apparatus is ex-
tremely beautiful.   Five pints of water may be taken away with it in
five  minutes*, — an amount which cannot be got with the old instru-
ment in much less than half an hour.  If the patient cannot bear to
have it drawn so rapidly, the stream  may be  wholly  or partially ar-
rested, at any moment, by entirely or partly closing the cock,  a.
  The reader will see that the apparatus is so arranged that the ad-
mission of air into the chest is entirely impossible.
  The artist, in making the drawing for me, has inserted the instru-
ment much further forward than the point usually selected.
  My apparatus has a second puncturing instrument, a little larger in
size, for-the purpose of operating in ascites, or dropsy of the belly. 
HOMOEOPATHIC  REMEDIES.
   Though not a believer in the Homoeopathic system of practice, or
in the efficiency of infinitesimal doses,yet I have no prejudices against
the system ; and I introduce its remedies here as a matter of interest
to all, and for the gratification of those sincere disciples of its doc-
trines who (and I hope there wTill be  many of them) may consult
these pages.   Every system  which wins to its  support numerous,
sincere, and caparole minds, must have a fraction of truth in it, and
is entitled to  a respectful  and civil hearing.   Whatever the system
may be, to claim that all its followers are dishonest, and governed by
bad motives, is to evince both injustice and unreasoning bigotry.
   With these  views, I give the  remedies used in the. Homoeopathic
practice, not in their fulness of detail, but to such extent as my limits
will  allow.  In doing this, I have followed the " Manual of Homoeo-
pathic Practice," by A. E. Small, M. D., Professor in the Homoeopathic
Medical  College of  Pennsylvania.   This is one of the clearest and
best arranged  manuals of this practice I have seen, and is now enjoy-
ing an extensive popularity.

   List  of Remedies.—Principle  of Applying Them.

   Professor  Small says:  " The  following list  comprises all the
medicines used in this work.   It is remarked that every  medicine
has a certain range of action in the body.  Some will act upon one
kind of organs in a  particular way, and some  on others; — or some
medicines will always direct their energies to one locality, and others
to another ; therefore, it must first be ascertained bow a remedy will
affect the healthy system, and this will determine the locality of its
action, or in other words, it will manifest the symptoms of its effect;
it is the record of these symptoms that gives us an idea of the range
of a medicine.
   " In  the following list, we shall only place such medicines as have
been thus tried, and  their range of use ascertained.

                        LIST OF REMEDIES.

                                             9. Belladonna,
                                            10. Bromine,
                                            11. Bryonia alba,
                                            12. Calcarea cart).,
]. Aconitum napellus,
2. Alumina,
3. Ammonium carb.,
4. Antimonium crud.,
 5. Apis melifica,
 6. Arnica montana,
 7. Arsenicum album,
jjb Aurum metallicum, 
HOMOEOPATHIC REMEDIES.                   509
13. Cannabis sativa,
14. Cantharis,
15. Carbo vegetabilis,
16. Causticum,
17. Chamomilla,
18. China officinalis,
19. Cina,
20. Cocculus,
21. Coffea cruda,
22. Colchicum,
23. Colocynthis,
24. Conium maculatum,
25. Crocus sativus,
26. Cuprum metallicum,
27. Digitalis purpuera,
28. Drosera rotundifolia,
29. Dulcamara,
30. Eupatorium,
31. Euphrasia of£,
32. Ferrum metallicum,
33. Graphites,
34. Helleborus,
35. Heper sulph. calc,     57.
36. Hyoscyamus niger,     58.
37. Hamamelis,           59.
38. Ignatia amara,         60.
39. Iodine,              .61.
40. Ipecacuanha,          62.
41. Kali carbonicum,       63.
42. Kali bicromicum,       64.
43. Lachesis,             65.
44. Lycopodium,          66.
45. Mercurius subl. corn,   67.
46. Mercurius vivus,       68.
47. Mezereum,            69.
48. Moschus,             70.
49. Natriftn muriaticum,    71.
50. Nitric acid,            72.
51. Nux vomica,          73.
52. Opium,              74.
53. Petroleum,            75.
54. Phosphorus,           76.
55. Phosphoric acid,       77.
56. Platina,              78.
79. Arnica,
80. Calendula,
81. Cantharis,
TINCTURES FOR  EXTERNAL USE.

   82. Causticum,           85.
   83. Hypericum,           86.
   84. Ruta graveolens,
Pulsatilla,
Rheum,
Rhus toxicodendron,
Ruta graveolens,
Sabina,
Sambucus nigra,
Sanguinaria,
Secale cornutum,
Senega,
Sepia succus,
Sihcia,
Spigelia anthelmin.,
Spongia marina tosta,
Stannum,
Staphysagria,
Stramonium,
Sulphur,
Sulphuric acid,
Tartarus emeticus,
Uva ursi,
Veratrum album,
Zincum metallicum.
Stapnysagria,
Urtica urens.
Medicines  the  Best  Adapted  to the Different Temperaments,
                               Habits, etc.

   1.  For the Sanguine Temperament.— Aeon., Arm, Bell., Bry., Calc,
Hep., Merc, Cham., Nux v., Phos., etc.
   2.  Bilious Temperament. — Bry., Nux v., Ars.,  Sulph., Merc, Cob-
culus, etc
  •8.  Nervous Temperament. — Sepia,  Coff,  Platina,  Ignatia,  Puis.,
Nux v., Cham., etc.

   4.  Lymphatic Temperament. — Ant, Arm, Nit. Acid, Calc,  Puis.,
Sulph., Con., Clematis.

   5.  Melancholic Temperament. — Aurum,  Ars., Nux v., Verat, Ipec,
Chin., etc.

   6.  For Plethoric Habit—Aeon., Bell, Calc, Puis., Merc, Sep., etc.

   7.  Debilitated Habit.—Ars.,  Chin., Bry., Lachesis, Arn.

   8.  Lean Habit. — Sil., Lach., Graph.

   9.  Melancholy Disposition—Ars., Verat, Aurum, Puis., Aeon., Bry.

   10. Mild Disposition. —Puis., Sep., Calc, Ignag.

   11. Sensitive  Disposition—Calc, Ignat, Plat,  Bell., Bry., Graph-
ites. 
510                 HOMCEOPATHIC REMEDIES.
  Rules for the Administration and  Repetition of Remedies.

  1. In acute diseases", a remedy, if well chosen, may be. repeated at
intervals of one or two hours, until some amelioration or aggravation
of the malady becomes manifest; in either case, it would be well to
discontinue the remedy for a while, to await the result.
  2. If the aggravation is persistent without reaction, there is reason
for  change of remedy, and another should be chosen, according to
indications.
  3. If convalescence follow the administration of a remedy, it need
not be  repeated unless the  patient ceases to improve before he is
quite recovered; an<J the same rule will apply, in cases of ameliora-
tion, after an aggravation of symptoms.
  4. When the improvement in a patient becomes interrupted, with-
out a change of symptoms, recourse may be had to the same remedy
as at first; but  if such arrest is accompanied by a  development of
other symptoms, a more appropriate remedy must be  sought for.
  5. In obstinate  cases, a change of remedy is  admissible, when
the continuance of  one has been  so long as to render its action
doubtful.
  6. In chronic  cases, a well-chosen  remedy  need not be  repeated
oftener than once in one, two, or three days*
  7. In the selection of a remedy, great care should be exercised, that
no symptoms of the disease should be uncovered by the characteristic
symptoms of the remedy.


 The Form  of Medicines  Designed for Domestic Use.

  The only forms, in which homoeopathic  medicines are prepared,
may be comprised under the head of tinctures, triturations, dilutions,
and globules.  The last two are the only forms requisite  for general
use, the two former  being only the primary or preparatory stages of
the  two latter.  Therefore, either the  dilutions, or globules saturated
with them, are the only forms of medicines accompanying this work.
  When either of  the forms is  administered in water, contained in a
tumbler or  other open vessel, it  should be well covered between the
periods of  administration, and kept in a dark place, away from any
corrupting  odor; — and all other medicines, teas or odors, are strictly
prohibited  during its  administration.  External  applications of  any-
thing in the form of poultices, washes, lotions,  such as camphor, lini-
ments, cologne,  mustard-plasters, medicated  poultices, onions,  bur-
docks, or anything containing any medicinal property whatever, must
be strictly avoided when taking the medicine.


        Of Preserving the  Purity of  Medicines.

  1.  The medicines should  be kept in a chest constructed for the
purpose. 
HOMOEOPATHIC REMEDIES.
511
  2. The chest should be kept closed, and in a cool place, or if in a
warm climate, as much so as possible.
  3. In uncorking a phial, be careful to replace the  identical cork, or
a new one, if the first should get broken or unfit for use.
  4. Do not change the corks of different remedies, nor put medicine
of one kind into a phial that has contained another kind.
  5. It is better to destroy empty phials, than to put any medicine in
them, other than that which  they originally contained.
  6. Every medicine should  be carefully labelled or numbered.
  7. Do not prepare a solution without first being  assured that the
glass and spoon  are perfectly clean ; and if it be necessary  to prepare
two at  a time, use separate  spoons for each, and be careful to keep
them apart.

           Antidotes, and Changing  Medicines.

   When any medicine produces aggravation of suffering, that cannot
well be endured by  the  patient, the administration of  one  drop of
camphor in a spoonful of water,  will generally  antidote its  effect.
And when it is thought requisite to change a remedy, avoid doing  it
suddenly.  A period from two, to  four  or  six hours should elapse,
before a remedy  should follow one that has  been  given ; a teaspoon-
ful of coffee, or a few drops  of wine, may also  be employed  as anti-
dotes to an unfavorable medicinal action.


                  External  Applications.

   When it is desired  to  hasten  suppuration, a piece of lint saturated
with cold water, and kept constantly moist, with a dry bandage on the
outside, so  as to  exclude the  air, will be found one of the  simplest and
best applications that can be used.
   It is doubtful whether cold applications to local irritations  or ten-
sion of parts, are  of any use;  warm applications, either of warm
water or non-medicinal fomentations are better, as they  may palliate
suffering during  the administration of internal remedies.   Cold appli-
cations  to the head, to counteract heat in that region, more frequently
prove injurious  than beneficial.   Moderately hot water, applied  by
means of saturating a flannel, is by far the most preferable.
   The same remedies, prescribed internally for local affections, may
be  applied externally as a lotion, by dissolving them in water, and
applying them to the affected part.


         Remedies  Suitable to Follow Others.

  8. In the treatment of diseases,  it has been observed  that some
remedies act very beneficially, after  others have been  employed, and
the following list may be referred to as a partial guide ; — only, let it
be understood, that the remedy must be selected, hymoeopathic to the
case. 
512                  HOMOEOPATHIC REMEDIES.
  Aconitum Napellus, may be often followed by Calc, Petr., Puis., Sulph.
  Alumina, by Bryonia, if indicated.                          •
  Antimonium Crud., by Puis, and Merc, if either appear to be indicated.
  Arnica Mont., by Aeon., Ipec, Rhus., Sulph., etc., if either be indicated.
  Arsenicum  Album, by Chin., Ipec, Nux  vom., Sulph., Verat., if specifically in-
dicated.
  Belladonna, by Chin., Ipec, Hep., Rhus., and Seneg.,—either if indicated.
  Bryonia, by Alum, and Rhus., — according to indication.
  Calc. Cars., by Lye, Sit, Phos., and Nit ac, provided  any one  of them is indi-
cated.
  Carbo. Veg., by Ars. and Merc, according to indication.
  China Off., by Ars., Verat., and Puis., if suitable.
  Cuprum Met., by Calc. and Verat.,        "
  Hep. Sulph., by Bell., Merc, and Spong.,   "
  Ipec, by Am., Are., Chin., and Nux.,       "
  Lachesis, by Alum., Ars., Bell., Con., and Nux vom., if suitable.
  Lycopodium, by Graph.,  Phos., and Sil.,                "
  Mercurius, by Bell., Dulc, Puis., and Sil.,              "
  Nux Vom., by Bry., Puis., and Sulph.,                  «
  Opium, by Calc, Petr., and Puis.,                      "
  Phosphor., by Petr., Rhus., and Sulph.,                 "
  Pulsatilla, by Asa., Bryon., and Sep.,                "
  Rhus Tox., by Are., Bry., Calc, Con.,                  "
  Sepia Sue, by Carbo v., and Sulph.,                   u
  Silicea, by Hep., Lach., Lye, and Sep.,                "
  Spongia, by Hep. Sulph.,                            "
  Sulphur, by Aeon., Bell., Calc, and Puis.,              "
  Tart. Emetic, Ipec, Puis., and Sep.,                 _ "
  Veratrum Album, Are., Am., Chin., Cuprum, and Ipec, if suitable.

  Dilutions and Globules being the only forms in which  Homoeopathic
medicines are used in  Professor Small's work, he, in most cases, dis-
solves one drop of the dilution, or six  globules, in water, — from two
tablespoonfuls to half a tumblerful, — and gives  from one teaspoonful
to one tablespoonful of this every one, two, three, or four hours, until
a change occurs.

  Simple Fever. — Aconitum.

  Inflammatory  Fever. — Aconitum, Belladonna, Bryonia,  Cantharis,
Chamomilla.

  Typhoid Fever.— Aeon., Ars., Am., Bell., Bry.,  Chin., Cocc, Camph.,
Calc. c, Carbo. veg., Dig., Hyos., Hellb., Lye, Lack., Nux v., Nit. acid,
Nat.  Mur., Opium, Puis., Phosph., Phos. acid, Rhus., Stram., Sulph.,
and Verat.

  Bilious Fever.—Remittent  Fever.— Aeon., Ars., Bell., Bry., Cham.,
Cocc, Coloc, China, Digitalis, Ipec, Mercurius  viv., Nux vom., Puis.,
Rhus tox., Tart, emet

  Intermittent Fever. — Arn.,  Ars.,  Bell.,  Bry., Carb.  veg., Cham.,
China, Cocc, Ipec, Ign.,  Merc, Nux.  vom., Nat. mur.,  Opium,  Puis.,
Sep., Sulph., Rhus., Veratrum.

  Yellow Fever. — Aeon., Ars., Bell., Bry., Chin., Canth., Carbo. veg.,
Ipec,  Lachesis, Mercurius,  Nux vom., Rhus., Sulphur, and  Veratrum.

  Nettle Rash. — Aeon., Calcarea, Cham., Bryonia, Dulcamara, Ipec,
Mercurius, Nux vom., Nit acid, Pulsatilla, Rhus and Sulphur. 
HOMOEOPATHIC REMEDIES.                 513
   Scarlet Rash. — Aconite, Belladonna, Bryonia, Coffea, Ipecac, and
 Opium.

   Scarlet Fever.— Aeon., Arsenicum, Belladonna, Bryonia, Calc. carb.,
 Chamomilla, Digitalis,  Dulcamara,  Helleborus  nig.,  Hepar  Sulph.,
 Kali carb., Lycopodium, Mercurius,  Nitric acid, Nux vom., Opium,
 Phosphorus, Phosph. acid, Pulsatilla, Rhus tox., Sulphur, Silicea.

   Measles. — Aconite, Arsenicum, Arnica, Belladonna, Bryonia, Cham.,
 Calc. c, Carbo. veg., China, Conium, Drosea, Dulcamara, Hyoscyamus,
 Hepar sulph., Ignatia, Ipecac, Lachesis, Mercurius, Nux vom., Phos-
 phorus, Pulsatilla, Sepia, Sulphur.

   Erysipelas. — Aconite, Arsenicum, Belladonna, Bryonia,  Lachesis,
 Rhus tox.

   Chicken Pox. — Aconite, Belladonna, Coffea, Cantharides, and Ig-
 natia.
   Varioloid. — The treatment to be the same as for

   Small  Pox, for which  the remedies are, Aconite, Belladonna, Bryo-
 nia, Chamomilla, Coffea, Opium, Pulsatilla,  Rhus tox., Stramonium,
 and Vaccinin.

   Gout. — Aconite, Arnica, Arsenicum, Belladonna, Bryonia, China,
 Causticum,  Colocynthis, Ferrum,  Mercurius,  Nux  vom.,  Pulsatilla,
 Rhus tox.

   Inflammatory Rheumatism. — Aconite, Arnica, Belladonna, Bryo-
 nia, Cham., Chin., Hepar sulph., Lachesis, Mercurius viv., Nux vom.,
 Puis., Rhus tox., Sulphur.

   Chronic Rheumatism. — Aconite,  Bryonia, Calc.  carb., Causticum,
 Dulcamara, Hepar sulph., Lachesis, Lycopodium, Phosphorus* Rhus
 tox., Sulphur, Silicea, Veratrum.

   Lumbago.— Aconite,  Bryonia, Belladonna,  Mercurius,  Nux vom.,
 Pulsatilla, and Rhus  tox.        •

   Sciatica.— Aconite, Chamomilla,  Colocynthis,  Ignatia,  Nux vom.,
 and Rhus tox.

   Tooth-Ache.—Aconite, Arnica, Arsenicum, Belladonna, Chamomilla,
 Mercurius, Nux vom., Pulsatilla, Sulphur.

   Inflammation of Tonsils—Aconite, Belladonna, Bryonia, Canthar-
 ides, Chamomilla, fulcamara, Hepar sulph.,  Ignatia, Lachesis, Mer-
 curius viv., Nux vom., Nitric acid, Sulphur.

   Putrid Sore Throat. — Aconite, Arsenicum,  Belladonna,  Conium,
 Lachesis, Mercurius, Nitric  acid, Pulsatilla,  Rhus, Secale, and Sul-
phur.

   Canker of the Mouth—Arsenicum, Carbo. veg., Dulcamara, Hepar
sulph., Mercurius, Natrum muriaticum, and Sepia.
                             65 
514                 HOMOEOPATHIC REMEDIES.
  Inflammation of the Tongue. — Aconite, Arnica, Arsenicum, Bella-
donna, Lachesis, Mercurius, Phosphoric acid.

  Mumps. — Belladonna, Carbo. veg., Hyoscyamus, Mercurius.

  Indigestion. — Aconite, Ant Crudum, Arsenicum, Belladonna, Bry-
onia, Ipecac, Tart, emet, and Veratrum.

  Bilious Headache. — Antimonium crud., Arnica, Belladonna, Bryo-
nia, Chamomilla, China, Hepar sulph., Ipecacuanha, Ignatia, Lachesis,
Nux vomica, Pulsatilla, Sulphur, Tartar emetic.
  Further indications for the use of remedies in dyspepsia from dif-
ferent causes, may be found in the following leading considerations:
  When everything taken causes suffering on account of the weakness
of digestion, Carb. veg., Chin., Nux vom., and Sulph.
  From cold water, if it should be found  to disagree,  Ars., Cham.,
Chin., Ferrum, Nux vom., Puis., and Veratrum.
  If caused by beer, Bell., Colocynth., Rhus, and Sep.
  When produced by milk, Bry., Calc, Nux vom., and Sulph.
  From animal food, Ferrum, Ruta, Silicea, and Sulphur.
  When caused by fat or gravies, Nat Mur., Puis., Sep., and Sulphur
  For different ages and constitutions. — Children suffering from dys-
pepsia require chiefly  Calc, Ipecac, Nux vom., Hyos., and Sulphur,
according as the symptoms  may indicate.   Old people require Cicuta,
Ant cr., Carbo veg., China, and Nux vom.
  Hypochondriacal persons  require for the  most part Nux vom. and
Sulphur.
  Hysterical females require Puis., Sep., Sulph., Veratrum and others.
  Wlien brought on  by sedentary habits, Bry., Calc,  Nux vom., Sep.,
Sulphur.
  When  by prolonged watching, Arn., Carb. veg., Cocc, Nux vom.,
Puis., yerat
  When by excessive study, Arn.,  Calc,  Lachesis, Nux vom., Puis.,
and Sulphur.
  When by debilitating losses, as in diarrhoea, dysentery, vomiting or
bleeding, China, Ferrum.         •
  When by sexual excesses,  Calc, Merc, Nux vom., Phos. ac, Staphy-
sagria.
  When the disease is in persons of the lymphatic temperament, Cnni.,
Puis., Sulph.
  When in persons of sanguine temperament, Bry., Nux vom., Bell.,
Phos.
  When in persons of bilious  temperament, Cham., Cocculus, China,
Sulph.                                        *
  When in those of melancholic temperament, Aurum, Ars., Nux vom.,
Puis., Sep.
  When in nervous temperaments,  Coffea, Ignatia, Sulph., etc
  Heartburn.—Waterbrash. — Nux vom., Cham., Pulsatilla, China,
Carbo. veg., and Belladonna.
  CardiaMa.—Gastrakria. — Belladonna, Bryonia, Calcarea, Carbo, 
HOMOEOPATHIC REMEDIES.
515
veg.,  Chamomilla, China, Cocculus, Coffea, Ignatia,  Nux  vomica,
Pulsatilla.

   Sea-Sickness. — Cocculus, Colchicum, Sepia, and Staphysagria.

   Vomiting of Mucus. — Ipecacuanha, Rheum, and Veratrum.

   Vomiting of Blood. — Aconite, Arnica, Arsenicum, China, Ipecac,
Nux vomica, Pulsatilla, and Sulphur.

   Costiveness. — Alumina,  Antim. crud.,  Bryonia,  China,  Calcarea
carb., Cocculus,  Lycopodium, Lachesis, Nux vomica, Opium, Pulsa-
tilla, Plumbum,  Sepia, Sulphur, and Veratrum.

   Diarrhoea. —  Arsenicum,  Antimonium  crud.,  Bryonia,  Calcarea
carb., Chamomilla, China,  Colocynthis,  Dulcamara, Ipecac, Mercu-
rius, Nux vomica, Phosphoric acid, Pulsatilla, Rhus tox., Secale, Sul-
phur, and Veratrum.                             *
   Dysentery. —  Aconite, Arnica,  Arsenicum,  Belladonna,  Bryonia,
Chamomilla, China, Colocynth,  Mercurius corro., Nux vom., Pulsa-
tilla, and Sulphur.

   Cholera Morbus.—Arsenicum, Chamomilla, China, Cuprum, Ipecac,
Nax vomica, Veratrum.

   Asiatic Cholera.—Arsenicum, Carbo. lig., Camphor, Cuprum, Ipecac,
Phosphorus, Phosphoric acid,  Sulphur, and Veratrum.

   Painter's Colic —Aconite, Belladonna, Chamomilla, China, Coccu-
lus, Colocynthis, Ignatia, Mercurius viv., Nux vomica, Pulsatilla, and
Sulphur.

   Flatulency. — China, Nux vomica, Pulsatilla, Sulphur.

   Inflammation of the Stomach. — Aconite, Arnica, Arsenicum, Bel-
ladonna, Bryonia,  Chamomilla,  China,  Hyoscyamus,  Ipecacuanha,
Mercurius viv., Nux vomica, Pulsatilla, Sulphur, and Veratrum.

   Inflammation of the Bowels. — Aconite,  Arsenicum, Arnica, Bella-
donna, Bryonia, Chamomilla, China,  Cantharis, Colocynth, Colchi-
cum, Lachesis, Nux vomica, Nitric acid, Pulsatilla, Rhus tox., Silicea,
Sulphur, Tartar emetic, and Veratrum.

   Chronic Inflammation of the Bowels. — Nitric acid, Sulphur, Arse-
nicum, Silicea, Phosphorus.

   Inflammation of the Peritoneum. — Aconite,  Arnica,  Belladonna,
Bryonia, Cantharides,  Chamomilla, Colocynthis, Lycopodium, Nux
vomica, and Rhus.

   Worms. — Aconite, Belladonna,  Carb. veg.,  Chamomilla, China,
Cina, Calcarea carb., Ipec, Lachesis, Mercurius  viv., Nux vomica,
Pulsatilla, Sulphur, Silicea.               •

  Itching of the Anus. — If caused by worms,  Aconite, Nux  vomica,
Sulphur, and Silicea ; if caused by blind piles, or bleeding, or liquor,
etc., Nux vomica, China, Sulphur, or Ipecacuanha. 
516                 HOMOEOPATHIC REMEDIES.
   Piles. — Aconite,  Antimonium  crud., Arnica,  Belladonna,  Carbo.
 veg., Chamomilla, Colocynthis, China, Hamamelis, Ignatia, Mercu-
 rius viv., Nux vomica, Pulsatilla, and Sulphur.

   Protrusion of the Intestine. — Calcarea, Ignatia,  Mercurius,  Nux
 vomica, Lycopodium, Sepia and Sulphur.

   Acute Inflammation of the Liver. — Aconite, Bryonia, Belladonna,
 Chamomilla, China, Mercurius viv., Nux vomica and Lachesis.

   Chronic Inflammation of the Liver. — Aurum,  Alumina,  Calcarea
 carb., China, Lycopodium,  Nux vomica, Silicea and Sulphur.

   Jaundice. — Aconite,  Belladonna,  Chamomilla,  China, Digitalis,
 Mercurius viv., Nux  vomica, Pulsatilla and sulphur.

   Inflammation  of the Spleen. — Aconite, Arnica, Arsenicum, Baryta
 carb., Bryonia, China, Calcarea carb., Carbo. veg., Ferrum,  Lycopo-
 dium, Nux vomica, Plumbum, Platina, Rhus tox., Stannum and  Sul-
 phur.                                                »

   Inflammation  of the Kidneys.—Aconite, Arnica, Belladonna, Can-
 nabis,  Cantharides,  Cocculus,  Colchicum, Hepar  sulph.,  Mercurius,
 Nux vomica, and Pulsatilla.

   Inflammation  of the Bladder. — Aconite, Cantharides, Arsenicum,
 Digitalis, Hyoscyamus, Nux vomica, and Pulsatilla.

   Chronic Inflammation  of the Bladder. — Dulcamara, Pulsatilla and
 Sulphur.

   Gravel. — Cantharides, Calcarea  carb., Cannabis, Nux vomica,  Nit.
 acid, Lycopodium, Phosphorus and Sarsaparilla.

   Retention of Trine.— Aconite, Belladonna, Arnica, Camphora, Ar-
 senicum, Sulphur,  Pulsatilla,  Cantharides, Dulcamara, Nux  vomica,
 Opium, Staphysagria, Phosphorus.

   Strangury. — Aconite,  Belladonna,  Hepar  sulph.,  Mercurius viv.,
 Nux vomica, Pulsatilla and Sulphur.

   Suppression of Urine. — Aconite, Camphor, Cantharides, Nux vom.,
 Pulsatilla, Belladonna, Opium, Lycopodium and Sulphur.

   Incontinence of Urine. — China,  Nux vomica,  Opium, Calcarea
 carb., Sulphur, and others.

   Wetting the Bed at Night. — Carbo.  animalis, Cina,  Causticum,
 Belladonna and  Sulphur.

   Diabetes. — Kali carbo., Muriatic acid,  Mercurius, Veratrum, and
 Staphysagria.

   Blood Passed with the •Urine. — The  same remedies as for reten-
tion of urine or gravel.

   Clap.—Gleet. — Aconite,  Cannabis, Mercurius viv., Sulphur, Can-
tharides. 
HOMOEOPATHIC REMEDIES.                 517
  Inflammation of the Testicles. — Aconite,  Arnica,  Aurum, China,
Graphites, Lycopodinm, Mercurius viv., Nux vomica, Pulsatilla and
Sulphur.
  Dropsy of the Scrotum. — Pulsatilla,  Sulphur and Silicea.
  Syphilis. — Mercurius vivus and  Mercurius corrosivus, Nitric acid,
Arsenicum, and Sulphur.
  Boils. — Arnica, Aconite, Belladonna, Hepar sulph., Mercurius and
Sulphur.

  Carbuncle.— Arsenicum, Hepar sulph., Lachesis, and Silicea.

  Chilblains. — For internal use, Arsenicum, Chamomilla, Nux vom.,
Pulsatilla, Phosphorus and Sulphur.   For external use,  Tinct.  of
Cantharides, Tinct. of Arnica, Rhus tox., and Tinct. of  Causticum.

  Corns. — Antimonium crud., Ammonium carb., Bryonia, Calcarea,
Ignatia, Lycopodium, Phosphorus, Sepia, Silicea and Sulphur.  For
external treatment, Tinct. of Arnica.
  Abscess. — For the acute abscess, Calcarea carb.,  Hepar sulph., La-
chesis, Mercurius,  Phosphorus, and Silicea; for  the  chronic  abscess,
Mercurius viv.,  Hepar sulph., Silicea, Calcarea and  Sulphur.
  Itch. — Sulphur, Calcarea, Heper sulph., Lycopodium, Sepia, Sulph.
acidum, Stramonium and Rhus tox.

  Whitlow.— Mercurius, Hepar sulph., Rhus tox., Lachesis, Silicea,
and Sulphur.

  Itching  of the Skin — Prurigo. — Sulphur, Conium, Ignatia, Mer-
curius, Pulsatilla, Rhus tox., Hepar sulph., and Nux vomica.
  Ring Worm. — Sepia, Natrum muriaticum, Nux vomica, Calcarea
carb., Rhus tox., and Sulphur.

  Ring Worm of the Scalp. — Arsenicum, Hepar sulph., Ducamara,
Bryonia, Rhus tox., and Staphysagria.

  Ulcers. — Arsenicum,  Carbo. veg., Lachesis, Lycopodium, Mercu-
rius viv., Silicea, Sulphur, Sepia and Nitric acid.

  Varicose Ulcers. — Arnica,  Pulsatilla, Lachesis, Sulphur, Silicea,
Arsenicum,  Carbo. veg.

  Hives. — Chamomilla, Ipecacuanha, and Bryonia.
  Catarrh in the Head. — Aconite, Arsenicum, Belladonna, Bryonia,
Chamomilla, Causticum, Euphrasia, Hepar sulph., Lycopodium, Mer-
curius viv., Nitric acid, Nux vomica, Phosphorus, Pulsatilla, Rhus tox.,
Sambucus, Silicea and Sulphur.

  Cold. — Influenza. — Aconite,  Arsenicum, Bryonia,  Belladonna,
Chamomilla, Camphor,  Conium,  Causticum,  Dulcamara,  Hepar
sulph., Mercurius viv.,  Phosphorus, Pulsatilla, and Rhus tox.

  Cough. — Aconite,  Antimonium  crud.,  Arsenicum,  Belladonna,
Bryonia, Chamomilla,  Causticum, Carbo. veg., Calcarea carb,, Dul- 
518                 HOMOEOPATHIC REMEDIES.
 camara, Drosera, Hepar sulph., Hyoscyamus, Ignatia, Lachesis, Lyco-
 podium, Mercurius  viv., Nux vomica,  Pulsatilla, Rhus tox., Sepia,
 Silicea and Sulphur.
   Hoarseness.— Arsenicum,  Belladonna,  Causticum, Cuprum, Cap-
 sicum,  Hepar sulph., lodium, Kali carb., Lachesis, Mercurius vivus,
 Pulsatilla,  Rhus tox., Sulphur, Silicea, Stannum.

   Laryngitis. — Camphor, Aconite, Hepar sulph., Spongia, Lachesis,
 Antimonium crud., Arsenicum, Belladonna, Cantharis, lodium, Mer-
 curius cor., Phosphorus, Rhus tox.
   Croup. — Antimonium crud.,  Arsenicum,  Belladonna,  Bryonia,
 Cantharis,  lodium, Kali carb., Phosphorus, Tart, emetic, Sambucus.

   Spasmodic Croup. — Aconite, Belladonna, and Sambucus.

   Chronic  Laryngitis. — Argentum,  Arsenicum, Belladonna,  Carbo.
 veg., Calcarea carb.,  Hepar sulph., Lachesis, Nitric acid, Phosphorus,
 Sanguinaria, Spongia, Silicea, Sulphur.
   Pharyngitis. — Aconite, Chamomilla, Belladonna, Mercurius viv.,
 Nux vomica, Sulphur.
   Quinsy. — Aconite, Arsenicum,  Aurum, Belladonna,  Chamomilla,
 Hepar sulph., Lachesis, Mercurius viv., Nitric acid, Pulsatilla, Rhus
 tox., Silicea, Sulphur.
   Chronic  Pharyngitis. — Arsenicum,  Antimonium  crud., Bryonia,
 Calcarea carb.,  Causticum, Graphites, Hepar sulph., Kali carb., Phos-
 phorus, Rhus tox., Silicea, Sulphur.
   Hooping  Cough.— In the forming, or feverish stage, Aconite, Bella-:
 donna,  Bryonia,  Ipecacuanha, Nux  vomica, Phosphorus,  Pulsatilla,
 Tartar emetic;  in the second, or nervous stage, Carbo. veg., Cuprum,
 Drosera, Opium and Veratrum.

   Bronchitis. — Aconite,  Belladonna, Bryonia and  Phosphorus ; and,
 next to these, Lachesis, Mercurius vivus, Pulsatilla, Nux vomica, Rhus
tox., and Spongia.

   Lung Fever. — Aconite, Belladonna,  Bryonia,  Phosphorus, Rhus
tox., Tartar emetic, and Sulphur.
   Typhoid  Pneumonia. — Arnica,  Arsenicum,  Opium,  Phosphorus,
Rhus tox., and Veratrum.

   Pleurisy. — Aconite,  Arnica,   Arsenicum,  Bryonia,  Belladonna.
Phosphorus, Rhus tqx., and Sulphur.

   Asthma. — Aconite, Arsenicum,  Belladonna,  Bryonia,  Cuprum,
Ipecacuanha, Lachesis, Moschus, Nux vomica, Pulsatilla, Sambucus,
 Tartar emetic, and Veratrum.

   Bleeding from  the Lungs. — Aconite, Arnica,  Arsenicum,  Bella-
donna, China, Ferrum, Ipecacuanha, Opium, Pulsatilla, Phosphorus,
and Rhus tox.

   Consumption.— Aconite, Arsenicum,  Belladonna, Calcarea carb., 
HOMOEOPATHIC REMEDIES.                 519
China, Kali carb., Lycopodium,  Phosphorus,  Pulsatilla, Sepia, Stan-
num, Sulphur.
  Neuralgia of the Heart. — Aconite, Arnica, Arsenicum, Belladonna,
Bryonia, Digitalis, Ipecacuanha,  Lachesis, Phosphoric acid,  Sulphur
and Veratrum.
  Acute  Pericarditis. — Aconite,  Arnica,  Arsenicum,  Belladonna,
Bryonia, Cannabis, Lachesis,  Spigelia, and Sulphur.
  Chronic Pericarditis.—The same remedies as for acute pericarditis,
with the addition of Aurum muriat, Calcarea carb., Phosphorus, Ly-
copodium,  Silicea, Colchicum, and Ledum.
  Endocarditis. — Aconite, Arsenicum,  Belladonna, Digitalis,  Nux
vomica, Pulsatilla, Spigelia, and  Veratrum.
  Carditis.— Arsenicum, Bismuth, Nux vomica, Pulsatilla, Phospho-
rus, and Graphites.
  Dilatation  of the Cavities of the Heart. — Arsenicum, Aconite, Ar-
nica, Belladonna, Digitalis, Lachesis, Pulsatilla, and Spigelia.
  Diseases of the Valves of the Heart. — Assafcetida, Arsenicum, Bel-
ladonna, Croton, Digitalis, Graphites, Lachesis, Phosphorus, Pulsatilla,
Rhus and Spigelia.
  Aneurism of the Aorta. — Arsenicum, Arnica,  Belladonna, Croton,
Digitalis, Lachesis, Rhus tox., Zincum.

           Diseases of the  Brain and Nerves.

  Rush of Blood to the Head.— Aconite, Arnica, Belladonna, Coffea,
Chamomilla, Ignatia,  Mercurius  viv., Nux vomica, Opium, Pulsatilla.
  Brain Fever. — Aconite, Belladonna, Bryonia, Cuprum met, Hyos-
cyamus, Opium, Stramonium and Zincum.
  Apoplexy.— Aconite, Belladonna, Ignatia,  Lachesis, Nux vomica
and Pulsatilla.
  Acute Inflammation of the Spinal Cord. — Aconite,  Belladonna,
Bryonia, Hyoscyamus, Stramonium, and Sulphur.
  Palsy.— Arnica, Bryonia and  Sulphur.
  Lockjaw. — Arnica,  Belladonna,  Hyoscyamus, Lachesis,  Stramo-
nium, Opium, Rhus tox., Mercurius viv.
  Delirium Tremens. — Aconite, Belladonna,  Calcarea, Nux vomica,
Opium, Hyoscyamus, Lachesis, and Sulphur.
  Epilepsy. — Belladonna, Cuprum,  Hyoscyamus, Ignatia,  Lachesis,
Nux vomica, Opium and Stramonium. *

  Neuralgia.— Arsenicum, Belladonna, China,  Colocynjth,  Lycopo-
dium, Platina, Spigelia.
  St.  Vitus's  Dance. — Belladonna,  Pulsatilla, Stramonium, Hyoscya-
mus,  Nux  vomica, and Sulphur. 
520                HOMOEOPATHIC REMEDIES.
  Stammering. — Belladonna, Hyoscyamus, Sulphur, Causticum, and
Calcarea.
  Headache. — Belladonna, Bryonia,  Rhus tox., Nux vomica, Pulsa-
tilla,  Sepia,  Chamomilla,  Sulphur,  Calcarea,  Arsenicum,  Aurum,
China, Lachesis, Mercurius, and Veratrum.
  In the treatment of headaches, much advantage is to be derived
from a knowledge of the causes which produce them ; we will there-
fore state concisely:
  1.  Headache  from determination of blood to the head, Aconite,
Belladonna, Pulsatilla, etc.
  2.  Headache  from cold in the head or catarrh, Aconite, Arsenicum,
China.
  3.  Headache from rheumatism, Bryonia,  Chamomilla, Nux vomica,
Pulsatilla, etc.
  Headache from disordered bowels, Ignatia, Ipecacuanha, Nux vom.,
Veratrum.
  5.  Headache from constipation, Bryonia, Lycopodium, Nux vomica,
Opium, etc.
  6.  Headache  arising from affection of the nerves  (Nervous Head-
ache), Aconite, Bryonia, Coffea, Nux vomica, Pulsatilla, Sepia, Sul-
phur, etc
  7.  Headache  caused by suppression  of eruptions, Belladona, Cal-
carea, and Sulphur.
  Giddiness. —  Aconite, Arnica,  Chamomilla, Nux vomica,  Pulsa-
tilla.
  Loss of Memory. — China, Arnica, Nux vomica, Ignatia.


       Diseases of Various Organs and Regions.

  Inflammation of the Psoas  Muscle. — Aconite, Belladonna,  Colo-
cynth, Hepar  sulph., Silicea, and Staphysagria.

  Coxalgia. — Aconite, Arsenicum, Belladonna, Chamomilla,  Colo-
cynth, Hepar  sulphur, Pulsatilla and Rhus tox.

  Affections of the Knee. — Silicea, Aurum, Calcarea, Lycopodium,
Nitric acid, Phosphoric acid,  Sulphur, Bryonia, China, Nux vomica,
Rhus tox., and Sulphur.
  Inflammation  of the Eye-lids. — Aconite,  Chamomilla, China, Eu-
phrasia, Hepar sulph., Nux vomica, Mercurius and Rhus tox.
  Stye. — Pulsatilla, Staphysagria, and Sepia.
  Iritis.— Aconite, Belladonna, Chamomilla, Euphrasia, Ignatia, Nux
vomica, Pulsatilla, Rhus tox., and Veratrum.
  Scrofulous Ophthalmia. — Arsenicum, Belladonna, Calcarea, China,
Dulcamara, Hepar sulph., Mercurius and Sulphur.
  Syphilitic Sore Eyes. — Mercurius;  if the patient  have been previ-
ously treated  with mercury, Nitric acid, Aurum, Sulphur. 
HOMOEOPATHIC REMEDIES.                521
  Gonorrhoea!  Inflammation of the Eyes. — Pulsatilla,  Arnica  and
Sulphur
  Cataract. — Conium, Phosphorus, Cannabis, Sulphur.
  Specs on the Cornea. — Belladonna, Euphrasia,  Sulphur and  Cal-
carea.
  Squinting. — Hyoscyamus, Belladonna.
  Watery Eyes. — Petroleum, Stramonium, Calcarea,  Pulsatilla,  Sul-
phur, Lachesis.
  Bloodshot Eyes. — The external use of Arnica, or, internally, Bella-
donna, Chamomilla, Nux vomica.
  Short Sightedness.— Pulsatilla,  Sulphur,  Carbo. veg., Phosphoric
acid, Petroleum.
  Inflammation of the Ear. — Belladonna, Pulsatilla.
  Ear-Ache. — Arnica, Calcarea,  China, Mercurius,  Nux  vomica,
Chamomilla, Dulcamara,  Hepar  sulph., Phosphoric acid,  Pulsatilla,
Platinum, and Sulphur.
  Running of the Ears. — Belladonna,  Calcarea,  Mercurius, Pulsa-
tilla and Sulphur.
  Deafness. — Calcarea,   Mercurius,  Nitric  acid, Phosphoric  acid,
Phosphorus, Pulsatilla and Sulphur.
  Deafness from Congestion.— Belladonna, Hyoscyamus, Phosphorus,
Sulphur.
  Nervous Deafness. — Causticum and Phosphoric acid.
  Rheumatic Deafness. — Arsenicum, Calcarea, Mercurius, Nitric acid,
Pulsatilla.
  Deafness from Suppressed Eruptions. — Causticum, Graphites, Sul-
phur.
  Deafness from Measles, Carbo.  veg., Pulsatilla; from  scarlet fever,
Belladonna, Hepar  Sulph.; from small-pox,  Mercurius viv., and  Sul-
phur ; from abuse of mercury, Aurum and Nitric  acid ; from  enlarge-
ment of tonsils, Aurum, Mercurius, Nitric acid; from suddenly checked-
discharges from nose or ears, Hepar sulph., Lachesis, Pulsatilla; as a
sequel of fevers and other disorders, Phosphorus, Phosphoric acid and
Veratrum.
  Bleeding at the Nose.—Aconite, Arnica, Belladonna, Bryonia, Cina,
China, Nux vomica, Pulsatilla, Rhus tox., and Sulphur.

  Ozcena. — Pulsatilla, Sulphur, Calcarea, Lycopodium  and  Natrum
muriaticum.
  Polypus of the Nose. — Calcarea, Sanguinaria,  Sepia and  Staphy-
sagria.
  Baldness. — When the hair falls from debility, China and Ferrum.
  When it falls in consequence of perspiration, Mercurius. 
522
HOMOEOPATHIC REMEDIES.
  If from the use of quinine, Belladonna.
  If from the abuse of mercury, Carbo. vegetabilis.
  If from grief and trouble, Phosphoric acid and Staphysagria.
  If after inflammatory diseases and nervous fevers, Calcarea, Hepar
sulph., and Silicea.
  Dandruff. — Lycopodium.
  Offensive Breath. — Chamomilla, Nux  vomica, Pulsatilla, and Sul-
phur.
  Cramps in the Legs. — Veratrum,  Colocynth,  Sulphur,  Rhus tox.,
Sepia, Nitric acid,  Lycopodium, Nux vomica, and  Calcarea.

  Goitre. — Iodine and Spongia, in recent cases; and Calcarea, Carbo.
veg., and Sepia, in those of long standing.
  Sweating Feet. — Silicea  and Rhus tox.
  Sleeplessness. — Nux vomica, Pulsatilla, Coffea, Phosphoric acid,
Sepia, Sulphur, Lycopodium,  Lachesis, Stannum,  Secale,  and Nitric
acid.
  Nightmare. — Aconite,  Nux  vomica, Pulsatilla, Opium,  Sulphur
and Silicea.
  Rupture. — For  old  cases, trusses; for recent cases, Aconite, Nux
vomica, Veratrum, Opium, Arsenicum  and Lachesis.
  Fainting. — Aconite, Coffea,  Hepar  sulph., Lachesis, Nux vomica,
and Veratrum.
  Pain in the  Loins. — Calcarea, Nux vomica, Rhus tox., and Sul-
phur.
  Cell Dropsy.—Anasarca. — Arsenicum, Bryonia,  China, Helleborus,
Mercurius and Phosphorus,
  Dropsy of the Belly. — Helleborus, Arsenicum and China.
  Dropsy of the Chest. — Apis melifica,  Arsenicum, Colchicum, Dul-
camara, Spigelia.
  Dropsy of the Brain. — Aconite,  Belladonna, Bryonia, Hyoscya-
mus,  Helleborus, Mercurius vivus,  Opium,  Stramonium, Sulphur,
Zincum metallicum.


                     Surgical Diseases.

  Concussion of the  Brain. — Arnica,
  Concussion of the  Chest. — Aconite, Arnica, Pulsatilla,  Mercurius,
Nux vomica, China, Bryonia, Opium, Chamomilla.

  Sprains. — Arnica, both internally, and externally as a lotion, Rhus
tox., Bryonia, Pulsatilla, and Ruta.

  Hemorrhage from  Wounds. — Arnica  and  Calendula,  both exter-
nally and internally,  China. 
HOMOEOPATHIC REMEDIES.                523
  "Lacerated Wounds. — Chamomilla, Hepar sulph., Silicea and  Sul-
phur.
  Contused Wounds and Bruises. — Ten drops of tincture of arnica
in half a tumbler of water, to  be applied as a  lotion; internally,
Rhus  tox., Ruta, Arnica, China, Lachesis,  Arsenicum, Aconite, Cal-
endula, Hepar, Silicea.
  Punctured Wounds. — Aconite,  Belladonna,  Mercurius,  Hepar,
Chamomilla, Rhus tox., »Cicuta, Arnica.

  Gunshot Wounds. — Hepar sulph., Silicea, Sulphur and Aconite.

  Bite of a Serpent.— Arsenicum, Belladonna, Phosphoric acid, Mer-
curius, Senega.
  Dislocations. — Arnica, Aconite.
  Fractures. — Arnica, Ruta.
  Burns and Scalds. — Arnica,  Carbo. veg.,  Coffea,  Hepar  sulph.,
China,  Aconite,  Opium, Arsenicum, Nitric acid.
  Stings of Insects. — Internally,  Aconite, Arnica, Belladonna, Mer-
curius viv.; externally, Lemon juice and Arnica lotion.
  Hydrophobia. — Dry or radiating heat,  Belladonna, Cantharides,
Hyoscyamus, Lachesis, and  Stramonium.
  Mental Emotions. — For affections brought on  by fright, terror, or
horror, Aconite and Ignatia; if there be fever and heat of head from
these  causes, Aconite; for extreme nervous excitement, Belladonna;
for  disease caused by suppressed emotions, Ignatia; for sufferings
arising  from vexation, Chamomilla;  for those arising from sudden
fits of passion, Nux vomica; for  those arising from anger for just
cause, Staphysagria;  for great weakness and prostration from  a  fit
of passion, Arsenicum; for  coldness and shivering,  loss of  appetite,
nausea and vomiting, brought on by  a fit of passion, Bryonia; for
the ill effects of excessive joy, Coffea; for the injurious effects of jeal-
ousy, or disappointed love,  Hyoscyamus;  for  sufferings from unre-
quited affections, Ignatio and phosphoric acid ; for the effects of mor-
tification, Pulsatilla, Belladonna and Platina.


                     Diseases  of Women.

  Obstructed Menstruation. — Pulsatilla and Bryonia.
  Chlorosis. — Bryonia, Calcarea carb., Ferrum, Natrum muriaticum,
Plumbum, Pulsatilla,  Sepia  and Sulphur.
  Tardy Menstruation. — Arsenicum, Bryonia, Belladonna, Cocculus,
Cuprum, Lachesis, Lycopodium,  Phosphorus,  Pulsatilla, Sulph. acid,
Sepia and Veratrum.
  Suppression of the  Menses---Aconite, Pulsatilla, Belladonna, Bry-
onia,  China, Graphites,  Kali carbonicurn, Sepia,  Sulphur, and Vera-
trum.        . 
524                 HOMOEOPATHIC REMEDIES.
  Too Frequent Menstruation. — Belladonna, Calcarea carb., Ipecacu-
anha, Natrum mur., Nux vomica, Platina, and Sulphur.
  Menstruation  too Profuse. — Calcarea  carb.,  China,  Chamomilla,
Crocus, Ignatia, Ipecacuanha, Nux vomica, Platina, Sabina and Sul-
phur.
  Painful Menstruation. — Belladonna,  Chamomilla,  Pulsatilla,  Nux
vomica, Lachesis, Coffea,  Cocculus, Causticum, and Veratrum.

  Change of Life. — Pulsatilla, Lachesis,  Aconite, Apis melifica, Ar-
senicum, Bryonia, Cocculus, Ipecacuanha, Ignatia,  Sepia and  Sul-
phur.
  Hysterics. — Coffea, Cocculus, Cuprum, Ignatia, Lachesis, Platina,
Pulsatilla, Assafoetida,  Aurum, Belladonna, Conium, Moschus,  Nux
moschata, Secale, Veratrum.
  Whites. — Calcarea carb.,  Causticum, Cocculus, Natrum mur., Pul-
satilla, Sepia and Sulphur.
  Falling of the Womb.— Aurum, Arnica, Belladonna, Calcarea carb.,
Nux vomica, Sepia, Creosote, Mercurius, Platina, Conium, and Stan-
num.'
  Dropsy of the Womb. — Aconite, Apis  mel., Arsenicum, Bryonia,
China, Calcarea, Ignatia,  Nux  vomica,  Pulsatilla, Secale, Sepia and
Sulphur.
  Inflammation of the  Ovaries. — Apis  melifica,  Antimonium crud.,
Arsenicum,  Belladonna,  Cantharis,  Cannabis,  Cocculus, Conium,
Graphites, Hepar sulph., lodium, Kali carbonica, Lachesis, Nux vom.,
Phosphorus, Pulsatilla, Sepia and Sulphur.
  Dropsy of the Ovaries. — The same as  the  remedies for dropsy of
the womb.
  Inflammation of the Vagina,  etc. — Arnica, Rhus  tox.,  Mercurius,
Belladonna.
  States  of Mind, etc., during Pregnancy. — For  despondency, with
hot skin  and quick pulse, Aconite ;  for inquietude  and fear  of the
future, Bryonia; for excessive dejection  and great lassitude, Calcarea
carbonica;  for melancholy,  with  weeping, Natrum muriaticum; for
morning  sickness, constipation,  and fretfulness, Nux vomica ;  for low
spirits during the nursing period, when the energies of the mother are
too much taxed, China,  Aurum,* Lachesis, or Pulsatilla.

  Menstruation continued  during  Pregnancy.— Calcarea carb.,  China,
Chamomilla, Ignatia, Ipecac, Nux vomica, Platina, Sabina, Sulphur,
Cocculus, Crocus, Phosphorus.

  Dizziness  and Headache during Pregnancy. — Aconite, Belladonna,
Nux vomica, Opium, Platina, Pulsatilla and Sulphur.

  Itching of the Genitals. — Mercurius, Rhus tox., and Sulphur.

  Tooth-Ache. — Chamomilla, Mercurius, Nux vomica and Pulsatilla. 
HOMOEOPATHIC REMEDIES.                 525
  Cramps during Pregnancy. — For cramps  of the legs,  Calcarea
carbonica,  Chamomilla,  Colocynth,  Graphites,  Hyoscyamus,  Nux
vomica, and  Sulphur; for  those  of the back, Ignatia, Opium and
Rhus toxicodendron ; and  for  those  of the  abdomen, Belladonna,
Colocynthis, Hyoscyamus, Nux vomica and Pulsatilla.
  Incontinence of Urine in Pregnancy.—Pulsatilla, Belladonna, China,
Silicea or Stramonium.
  Piles during Pregnancy.— Aconite,  Arnica, Belladonna, Hamame-
lis virg., Sulphur and China.
  Varicose Veins in Pregnancy.—Arnica, Hamamelis virg., Nux vom.,
Pulsatilla, Apis mel., Arsenicum, Lachesis, and Lycopodium.
  Flooding. — Arnica, Bryonia, Belladonna, Chamomilla, China, Cro-
cus, Ferrum, Hyoscyamus,  Hamamelis virg., Ipecacuanha and Pla-
tina.

  Miscarriage.— Arnica, Belladonna,  Bryonia,  Chamomilla,  China,
Crocus, Ferrum metallicum, Hyoscyamus,  Ipecacuanha, Nux vomica,
Platina, Sabina and Secale.

  Care of Breast, etc., before Confinement. — If there be tenderness or
excoriation, apply a weak dilution of Tincture of Arnica; for shoot-
ing pains in the breasts, take internally, Aconite, Belladonna, Bryonia,
Chamomilla, and Rhus tox.; for swelling, burning, itching, cracks and
eruptions, Bryonia, Graphites, Lycopodium, Mercurius, Hepar sulph.,
Rhus tox., and Sulphur.

  False Pains. — Aconite,  Bryonia,  Belladonna,  Dulcamara,  Nux
vomica, and Pulsatilla.

  Childbirth.—Protracted Labors.— Aconite, Belladonna, Chamomilla,
Coffea, Nux vomica, Opium, Pulsatilla and Secale.
  Childbirth  Cramps and Convulsions, —  Belladonna,  Chamomilla,
Cocculus, Hyoscyamus, Ignatia, Ipicacuanha, and Stramonium.
  Flooding after Delivery. — Belladonna,  Chamomilla, China,  Cin«
namon tincture, Crocus, Hamamelis virg., Platina and Sabina.
  The Lochia. — If it continue  too long, or is too  profuse, Aconite,
Belladonna, Bryonia, Crocus, Carbo. animalis, Calcarea carb., Dulca-
mara, Opium, Platina and Pulsatilla.

  Milk Fever. — Aconite, Arnica,  Bryonia, Belladonna, Chamomilla,
Pulsatilla, Rhus toxicodendron.

  Suppression of Milk. — Pulsatilla, Aconite, Coffea.
  Sore Nipples. — Calcarea  carb.,  Graphites, Lycopodium, Mercurius,
Nux vomica, Sepia, Silicea and Sulphur.

  Broken Breasts. — Bryonia, Belladonna,  Hepar sulph.,  Mercurius,
Phosphorus and  Sulphur. 
526                 HOMOEOPATHIC REMEDIES.
            Diseases of Infants and  Children.

  The Meconium. — Should this be delayed for  an unusually long
time, Nux vomica, Sulphur, Bryonia, Lycopodium, Opium, or Silicea,
may be useful.
  Mother's Marks. — Calcarea carb., Silicea,  and Sulphur.

  Blue Disease. — Sulphur, Calcarea carb., Digitalis.

  Sleeplessness. — Stramonium, Hyoscyamus, Opium.

  Regurgitation of Milk. —  Ipecacuanha,   Pulsatilla,  Antimonium
crud., Chamomilla, Bryonia, or Nux vomica.

  Thrush. — Wash the mouth with a weak solution of borax ; if this
do not succeed, give Mercurius, Sulphur, Sulphuric  acid,  Arsenicum,
or Nitric acid.
  Excoriations. — Internally,  give   Chamomilla,  Pulsatilla, Ignatia,
Mercurius, Sulphur, Carbo. veg., Lycopodium, Sepia, or Silicea, and
apply a weak solution of Arnica externally.
  The Gum. — Aconite, Rhus toxicodendron, and  Sulphur.
  Prickly Heat. — Aconite, Chamomilla, Rhus tox., Arsenicum and
Sulphur.
  Scurf on the  Head. — Sulphur, and Rhus tox.

  Soreness behind the Ears. — Graphites, Arsenicum, Calcarea  carb.,
and Baryta carb.
  Milk  Crust. — Aconite, Arsenicum, Hepar sulph., Rhus tox., and
Sulphur, are the  principal  remedies.   Also  Belladonna,  Euphrasia,
Graphites, Lycopodium, Staphysagria, Sambucus, and Viola tricolor.

  Erysipelas. — Aconite, Arsenicum, Belladonna,  Hepar  sulph., La-
chesis, Nux vomica, Rhus tox., Silicea and Sulphur.

  Running from the Ears. — Belladonna, Chamomilla,  Calcarea car-
bonica, Mercurius, Pulsatilla, Rhus toxicodendron  and Sulphur.

  Wetting the Bed. — Pulsatilla, Silicea, Rhus tox., Sulphur,  Cina,
Causticum, Carbo. veg., lodium, Calcarea carb., and Natrum mur.
                             *
  Constipation. — Bryonia,  Nux  vomica, Opium, Sulphur, Lycopo-
dium, Alumina, or Natrum  mur.
  Diarrhoea. — Aconite,  Belladonna, Chamomilla,  Ipecacuanha, JVter-
curius and Rheum.
  Cholera Infantum. — Antimonium crud., Arsenicum, Bryonia, Carbo.
veg., Dulcamara, Ipecacuanha, Mercurius, Nux vomica, Veratrum and
Sulphur.
  Colic. — Chamomilla,  China, Ipecacuanha, Nux vomica, and Pul-
satilla. 
HOMOEOPATHIC REMEDIES.               527
  Convulsions. — Belladonna,  Chamomilla, Coffea,  Cina,  Hyoscya-
mus,  Ignatia,  Ipecacuanha,  Mercurius,  Opium,  Stramonium,  and
Sulphur.
  Hiccough. — Nux vomica, Moschus, Ipecacuanha, and Sambucus.
  Marasmus. — Sulphur, followed by Calcarea carb., or Arsenicum.
  Dentition. — When medicines are required, the following are to be
used: Aconite, Belladonna, Chamomilla, Calcarea, Carbonica, Coffea,
Cuprum, Mercurius, Nux vomica, Sulphur and Zincum. 
PROCESSES  OF  THE  HYDROPATHIC TREATMENT.
  For the description of the hydropathic appliances contained in the
following pages, I am indebted, in substance, to the " Hydropathic
Family Physician," by Joel Shew, M. D., author of several popular
works  upon the principles  and practice of hydropathy.   I have  not
uniformly adopted his exact language, which is  not always the best
he might have chosen to express his thoughts.
  Priessnitz is admitted to have been the originator of the hydro-
pathic  modes of treating diseases.  He was an unlearned man, though
he had original powers of  mind; and, imperfect as the treatment is,
he benefited his race by conferring it upon the world.
  At first, and for some time, baths were  made  too  cold, and were
continued too long; the result was, much  injury to the patient in
many cases.  Time and experience have brought a better adaptation
of the  temperature and continuance of the water appliances to  the
symptoms, constitution, and temperament of each patient  Formerly,
weak, exhausted, and nervous persons, not less than the  full-blooded
and  strong,  were put into  the wet-sheet pack, and reduced near to
death's door;  and there, is reason to believe that in some cases where
the practice  is in ignorant hands, this barbarity is not wholly discon-
tinued.  The  practice, however, is now mainly in better hands; and
although I by no means admit its sufficiency as a system of remedial
agencies, I am persuaded it is doing some good.   Used in connection
with the ancient system of regular medicine, which is the joint pro-
duct of time,  science, and  experience, the water treatment, moulded
and modified to the circumstances- and strength of the patient, is an
auxiliary of no mean power.   As such, I accept it.  As  such, it is re-
ceived by hundreds and thousands of regular practitioners throughout
the world.   Further than this, it never can or will be  generally re-
ceived. By pushing it beyond this, its rightful and honored sphere,
its friends only limit its progress, and injure its influence.
   The following is the substance of Dr. Shew's description of hydro-
pathic appliance,

                    The  Wet-Sheet Pack.

   In this process a coarse linen or cotton  sheet is used, long enough
to reach from the patient's head  to the soles of his  feet, and about
two yards in width.  The bed is  stripped of all its covering, one or 
PROCESSES OF THE HYDROPATHIC TREATMENT.       529
two pillows only being left for the head.  One or two comforters are
then spread upon it, and over these  the  same number  of woollen
blankets, which are less  injured by  wet than  cotton  comfortables.
The sheet having been pretty well wrung out of cold water,— always
pure and soft, if such can be had,—is then spread out smoothly upon
the blanket.   The  patient, being undressed, lays himself upon the
sheet, and, his  arms being held up, an assistant laps  one side  of it
over the body and lower limbs; when, the arms being dropped at the '
side, the other part of  the sheet is, in  like manner, lapped over.  The
blankets are then, one  by one, brought over    .     FlG 178
the person in the  same  way, and tucked
under  from  head  to  foot.    Comfortables
may be added, if necessary.   (Fig.  178.)
   It is always best to place a wet towel,
covered  with a dry one, on the  patient's
head  while he is  packed.    If too  much
chill is not produced,  the dry one  may be
left off.
   This is the ordinary  way of taking a pack
in chronic disease.
   The wet sheet is one of the most soothing and agreeable of all the
water appliances.   Hence it  is that it is so often misused.  It  is so
delightful, and tends so much to produce slumber, that  the  patient
never feels ready to get out of it. But  this slumber, — so profound and
sweet as it often is, — he should remember, may be only an apoplectic
stupor, which  leaves him with a swimming head, attended with faint-
ness, perhaps, and ending in  a severe  headache ; giving him, in short,
a congestion of the brain.  All this happens in consequence of robbing
the skin too long  of the air it should breathe.
   There has been  a notion  at  some of the establishments that the
wet sheet is to be used for sweating;  and to this end, the  patient has
been literally  stewed hour after hour, in  some cases, even four, five,
and six hours  in succession,  with  the view of sweating him.   All
such practice  is hurtful.  If the patient gets better under it, it ft in
consequence of the good effects of water used in other ways, coupled
with the  ever-important  adjuncts,  air, exercise, and diet.  In  later
times, Priessnitz never sweat patients at all, much less in wet sheets.
If a man must sweat, leave off the wet sheet assuredly, as that only
hinders the operation.  Use the blanket pack, or the vapor bath.

  How  Long shall the Pack  Continue? — Here, too, there has been,
and still is, much  error in hydropathic practice.  " Stay in the  pack
till you get warm," has been the old  doctrine.  But some get warm
at first, and afterward get cold ; — so  at least they feel.   What  is to
be done ?
   One of Priessnitz's improvements was, to give short packs.  " Re-
main enveloped for fifteen or twenty minutes only," he said.   " If you
are not able to bear the pack in that way, take the rubbing wet sheet
and the lighter processes until you are."  In some cases he gave two
or three of these short  packs in succession, the patient rising between
                               67
 
530       PROCESSES OF THE HYDROPATHIC TREATMENT.
each to take an airing, a rubbing wet sheet, or other bath, and then
returning to the pack.
  Thus far the wet sheet has been spoken of as used in chronic dis-
eases.   In  acute  attacks it is managed differently, according to the
case.   If the object be to abstract caloric from the body, we cover the
sheet but little, — with a single dry sheet, or a blanket or two, or, per-
haps, with none of these.
  We  know that if we keep a towel about a  keg of water in a hot
day, the water will be made cooler by evaporation.  In the same way,
when a patient is  hot and feverish, we keep one, or, still better, two
wet sheets around him, without other covering,  and thus bring  down
the heat and circulation to any desirable degree.   We sprinkle  water
upon the sheets, or rewet them  as often  as  is  necessary, — in some
extreme, cases of fever continuing them a whole week or more.  Ex-
perience teaches that the continuous application of the wet linen is,
in such cases, a most  serviceable application, and one that tends most
powerfully  to induce in the  dermoid structure its natural and health-
ful state.

  The  Wet Sheet Acts by Absorption. — It draws morbific matter out
of the  body, as any.one may see who  applies the sheet for a short
time, and then washes it.   Observe, too, what an odor comes  from
the sheet when a diseased  patient has been packed.   At the  same
time, it absorbs the pure water into its finest tissues on a large scale,
thus supplying that fluid which of all  substances, the system,  under
such circumstances, most  needs.   This moist  warmth of the sheet
also acts as a most soothing poultice.

                       The Wet  Dress.

  A modification of  the wet sheet, and in some respects an improve-
ment, is the " wet dress,"so called.
  A coarse linen or cotton dress is made with large arms, so  that one
raag take the application without help.  The dress being wet and ap-
plied, the patient lays himself upon blankets, in which he wraps himself
just sufficiently to become comfortable.  Or, he may have dry flannel
dresses to  put on over the wet  one, and  then lie in a common bed.
In this application, the air is not excluded from the surface to any-
thing like the same extent as in the common tight pack.   Hence, a
patient may remain  in  it a half, or  the  whole of the night, if he
chooses, — being  careful to become neither  too warm  nor too cold.
Rewetting  once or twice in the night will be of service.  Often in a
single  night a bad cold may be thrown off in this simple way*


                        The Half  Pack.

   Many patients  have so  little  reactive  energy, that while  they can
bear a half pack, so called, the entire sheet would abstract so  much
caloric from the  body as to injure them.  In such cases, the sheet is
to be applied so as to extend only from the arm-pits, or at most, from 
PROCESSES OF THE HYDROPATHIC TREATMENT.      53]
the neck to the hips, leaving the lower extremities, as it were, in the
dry pack.   Sometimes the sheet  is allowed to extend to the ankles,
not including the feet.   Packing the trunk of the body in wet towels,
acts upon the same principle as the partial or half pack, and is, in
many cases a valuable preliminary measure.  It is well to take these
preparatory steps when a patient who has  suffered  long  from chronic
disease, is beginning with the envelopment.


                  The  Folded Wet Sheet.

   In domestic  practice, a modification of  the wet  sheet may be had
by folding four-double  a common  coarse sheet,  for enclosing  the
trunk from  the  armpits  down.  Two  thicknesses  of this are wet in
cold water, to come next the body.
   This is a valuable application in  a host of  ailments, as pleurisy,
inflammation of the lungs, inflammation of the  bowels, colic, cholera^
cholera morbus, rheumatism,  painful menstruation, after pains,  etcfl
This remedy, which can be applied in five  minutes, will  often  soothe
a patient  quietly to  sleep, whose lot, without it, would be a night of
agony.  One advantage of this application is, that if a patient is too
weak to rise, the sheet may be opened in front, so that fresh water
may, when needed,  be  sprinkled upon it, and wet towels may  be
added under it, upon the abdomen, if necessary.
   In all the methods of  applying the wet sheet,  there can be no  pos-
sible objection  to using  warm bricks, bottles, etc., for the  feet when
cold.

   Bath after the Pack. — It  is the practice generally to  take some
form of the bath after the pack.  If the  patient is too feeble to rise,
an ablution is performed while he is in bed.  In  other  cases, a  wet-
sheet rubbing, shallow, plunge, towel, or other bath is resorted to, but
not strictly of necessity.   It is better, however, as a rule, to make the
process a compound one, that is, to take some form of bath  after the
pack.  This should  also be followed by exercise in the open air, if it
can possibly be taken.   A pack, followed by a faithful turn at work,
or by exercise in the open air, is  always worth much more than when
followed by rest within doors.

                  The  Rubbing Wet  Sheet.

   The rubbing wet sheet, too little appreciated, and too seldom used,
is  one of the most valuable of all the  hydropathic resources.  There
is  probably no other single application of water, in all the multiform
modes of  hydropathic medication, that can be made, on  the whole, as
useful as this.  It is  a tonic, a stimulant, a sedative, an antispasmodic,
a  derivative, or  a febrifuge,  according to the circumstances under
which it is applied.                                         *
   We take a coarse linen sheet,— although cotton answers a very
good purpose, — large enough to throw around the body like an In-
dian's blanket.   It is wrung more or less, according to  the demands 
5S2       PROCESSES OF THE HYDROPATHIC TREATMENT.
Fig. 179.
WB'
of the case.   Thereupon, it is thrown quickly around the patient's
body, who, if strong enough, is in the standing posture; and then,
both patient and assistant set vigorously to
work, rubbing over the sheet, not with it,
as some do,  three, four, or more minutes,
until the surface becomes thoroughlv warm
(Fig. 179).
  If there is  fever, less friction is required.
After the wet sheet,  comes a dry one, to
be used in the same  manner.  Those who
have sufficient reactive energy, — and most
have, — may dry the body simply by fan-
ning it with the dry  sheet, the windows at
the same time being open.  This sort of
air-bath  exerts a highly pleasurable effect
upon the skin.   Instead  of giving one  a
f^bld, it helps greatly to ward it off.   This method of drying the body
was one of Priessnitz's later improvements.
   The rubbing wet sheet, it should  be remembered, is not a single
application, capable  of producing only one effect.   It is used in three
different gradations, and  to produce very different  results.  It is well
wrung, or only moderately wrung, or left quite wet and dripping.  If
a person is fatigued, or has a low degree of reactive energy, the first
form is the one to adopt;  if there is not much fatigue, and good re-
active energy, the second; and if the  patient  is feverish,  and the
object is to abstract heat simply, we use the sheet quite wet and drip-
ping ; and we repeat it as many times in succession as  the case may
need.  One great advantage is, that we  give it before or after a wet
pack, when no bath  is at hand; we also give it in connection with
any other bath we may choose.
   See how admirable a remedy the rubbing wet sheet  is, when  prop-
erly understood !   A patient, — a child, perhaps, — is so feeble  in the
reactive  power, that almost any form  of bath we can give it sends the
blood from  the  surface, making the lips  and nails pale or blue, and
the extremities  cold, showing  congestion of the internal organs.
When a bath produces such effects", it is very apt,  to say the least, to
do more harm than good.  But we can apply the rubbing wet sheet
in such  a way as to cause none of these ill effects; besides, it may
be repeated many times in the day, so as to  give the patient the ad-
vantage of a strong treatment;  for a light  treatment,  which can be
easily borne, is made a strong one by the frequency of its repetition.
   A  wet sheet,  well wrung, holds perhaps  a pint of water; or, at
most, a  quart.  Now, it  must appear plain,  that a pint  or quart of
cold water, spread over so large a surface as  the whole skin, must be-
come very easily warmed  by the  body's heat.  Besides, if there is
great delicacy of constitution, we may wring the sheet out of water
at  seventy, eighty, or even ninety degrees,  gradually lowering it as
the patient can bear it
   The domestic availability of this application is also to be spoken of.
 In every dwelling, however humble, there is the coarse  sheet, and the 
PROCESSES OF THE HYDROPATHIC TREATMENT.       5'6S
bucket of water.  How useful, therefore, as a resort, in home  prac-
tice !
   The rubbing wet  sheet appears a trifling application, — one which
is not capable of producing any great result.  But when we remem-
ber the myriads of  nerves of animal life, spread over  the skin, and
derived from the brain and spinal  cord, it  need not surprize us  that
its application should so invigorate the body, take off bodily and
mental  depression, remove languor and fatigue, expel flatus from the
bowels, remove  thirst, give appetite, and cause a feeling of calmness
and relief which can be appreciated only by those who  experience it
A minister, for example, preaches  three times on a Sunday, and gets
his brain so excited  that he cannot sleep.  A cold bath would be too
powerful, and opiates would only act as stimulants, making the  mat-
ter worse.  Two  or three successful applications of the rubbing wet
sheet, with powerful friction, bring the blood so much to the surface,
that  his brain becomes relieved, and he very soon falls into a sound
and refreshing sleep.  So, too, when a man  has  been  long wet and,
drenched  on a rainy day, and'comes home, with the surface and ex-
tremities cold, and the blood pressing hard upon the brain  and other
internal organs, — the well-wrung rubbing sheet is applied, with  plen-
tiful friction, and at once the oppressed organs are set free;
   In  using  the  rubbing wet  sheet, as  in all other forms of general
bath,  it is well to wash the hands and face in cold water, both before
and after it.  There  is no  need of throwing it over the head, as some
have  thought it necessary to do.   A patient needs to breathe freely
when he takes a bath.
   This  application is not always the most pleasant one.   It does, in
fact, require a good degree of moral courage to enable one to endure
the first shock.   The sensations produced by it are worse, if possible,
than those from a plunge into cold water; I mean the  first touch of
the sheet to the  body.   Nervous ladies sometimes tell us they cannot
take the rubbing wet  sheet, when, at  the  same time,  they take the
cold plunge, which is far more  powerful, and perhaps too powerful for
their case.   This unpleasant feeling does no harm, for it vanishes in a
moment or two after the sheet touches the body.

                     The  Douche  Bath.

   This  is the most powerful, but not the most useful, of all the hydro-
pathic appliances.  A common douche consists of a stream of water
from  one  to two inches in diameter,  with a fall of ten,  fifteen, or
twenty feet.  But douches may be arranged of any desirable size and
height.  (Fig. 180.)
  This  remedy is useful in paralysis,  stiff joints, gout, rheumatism,
tumors,  arfd old  swellings of  various kinds.  Those  who have weak
lungs, stomach, or other abdominal organs, should not resort to the
douche without the best of medical advice.
• 
534       PROCESSES OF THE HYDROPATHIC TREATMENT.
                     The Shower Bath.

  This  is also  one of the more powerful of the  hydropathic appli-
ances, and needs judgment in its use.   It consists, in fact, of a vast
number of small streams or douches, and hence is a powerful refrig-
erant, as well as excitant, to  the system.   It is  useful to commence
this bath, for a time at first, only upon the limbs.

                    The Cataract  Bath.

  This  also is one of the more powerful of the hydropathic processes,
and is to be classed with the two preceding baths.  Like them it may
be said to be stimulant, tonic, and alterative, while it is also highly
sedative as far as animal heat is concerned.

                       The  Hose  Bath.

  Through the modern improvements in India-rubber, gutta peTcha,
leather,  etc., it is easy, whenever there is a small  fall or head of water,
to arrange' what is called a  hose-bath.   It is in principle a  douche,
with the additional advantage that it can be made to act upon any
part of  the body, and from whatever direction  we choose.   Rightly
applied, the hose bath is a valuable remedy.  (Fig. 181.)
Fig. 180.                               Fig. 181.
                     The  Pail Douche.

  The process which passes under this name is taken  thus: The
patient seats himself in an empty, shallow, or other bathing tub, and
crosses his hands over his chest.  As many pails of water as are or-
dered are then dashed over him  suddenly, one after another, before
and behind alternately, — not poured, but thrown with some force, by
first a backward and then a forward motion of  the pail.
  A better methoiuof using it is, for the patient to stand in an empty 
PROCESSES OF THE HYDROPATHIC TREATMENT.      535
bathing tub, while an^assistant takes two pails of water, one ten de-
grees warmer than the other, and empties the warmer half upon the
chest and half upon the back, and then bestows the colder pailful in
the same manner;  then dries with friction.

                The  Wave or Sluice  Bath.

   This is taken at the sluice-way of an undershot mill-wheel, or in
any similar place.  The patient takes hold of a rope, or something by
which  he can maintain his position, and then, lying down, subjects
his body to the^iction of the water.  This is, on the whole, a pleasant
and agreeable bath, and in its effects somewhat resembles the douche,
being, however,  milder and safer.

                       The Half Bath.

   This bath may be used  as one of the mildest of the water-cure
processes, or as one of the most powerful.  An ordinary bathing tub is
a very good apparatus for the purpose.   A  good sized  washing tub
will answer very well, if there is nothing else at hand.  The water
should generally be quite shallow in this bath, — from three, to six
inches.   Priessnitz's half-baths were made of wood, four or five feet
long, about two and a half feet wide, and twenty inches deep.   This
simple contrivance is one of his most  powerful  remedial  means,—
that by which some of his highest triumphs  are achieved.
   The water  is generally used of moderate temperature, at sixty to
seventy degrees Fahr., and, when long continued, is changed, as it
becomes warm from the heat of  the body.
   This bath may be used,
   First, as a means of cooling the" mass of the circulation in the hot
stages of fever, and in inflammatory attacks of every kind;
   Secondly, as a revulsive, or means of drawing blood in congestions
or inflammations  of the  nobler organs, the brain, lungs,  stomach,
liver, etc.
   Thirdly, as a  means  of resuscitation  in the shock of serious  acci-
dents, sun-stroke, and before, during, or after apoplectic  and other fits.
 In drunkenness and  delirium tremens, the  half  bath is a sovereign
remedy;
   Fourthly, as a middle means,  and preparatory  to the general bath
in weak constitutions.
   In the latter of these indications, the bath is generally used  but for
a few  minutes after the wet sheet, or at other times, as may be de-
sired.  In the former, much practical knowledge is necessary in order
to proceed always with safety, and to obtain the  best results.   Thus,
six, or even nine  hours may be  required, with the greatest persever-
ance, the patient being thoroughly rubbed over the whole surface, and
this to be kept up  constantly by relays of assistants, the  patient's head
and shoulders, meanwhile, being supported. 
536       PROCESSES OF THE HYDROPATHIC TREATMENT.
                          The Plunge  Bath."

      In sea,  river, and lake,  as well  as  by artificial means, and  as a
    matter of luxury, religious observance, purification, and the preven-
    tion  and cure of disease, the plunge bath has, in all periods of time,
    and in all parts of the world, been  a favorite resort.  So efficacious,
    indeed, has this simple means  proved  in healing the sick, that not a
    little superstition has been mingled  with it.  Springs and wells have
    often been supposed to possess some mysterious power, and for that
    reason  been named  after some patron  saint.   In this respect, the
    world has  loved mystery and marvellousness rather thfcn the  pure and
    simple truth.
      In hydropathic  practice,  the plunge  is much used; but many pa-
    tients are not able to bear it.  Those who are not sufficiently strong
    for it at first,  should practise the rubbing wet sheet, the half-bath,
^   drinking, exercise, etc., until the plunge  can be borne.  It is a favorite
    remedy at all the establishments, to  be taken directly on coming from
    the wet sheet pack.

                          The  Head Bath.

      From time immemorial, cooling applications to the head have been
    much depended upon in that violent and dangerous disease, inflam-
    mation of  the  brain.  All other known means failing, certain obsti-
    nate affections of the head  have  been known to give way to affusion
    of cold water  upon  the  part.  In  headache,  drunkenness,  delirium
    tremens, the delirium of fever, epilepsy, rheumatism of the head, dis-
    eases of the eye, earache, deafness, loss of smell  and taste, and in
    nose-bleed, this highly energetic remedy is brought to bear. In taking
    it, the patient lies down, placing the back of his head  in a shallow
    dish, fille*d  only an inch or two with  water.  (Fig. 182.)
Fig. 182.                              Fig. 183.
                        The Leg Bath.

  This is useful in cases  of ulcers, swellings, eruptions, gout, rheu-
matism, sprains, wounds, etc., of the leg or thigh.   The relief and 
PROCESSES OF THE HYDROPATHIC TREATMENT.      537
strength obtained, often by a single application of this remedy, is truly
wonderful.#  A variety of apparatus may be contrived for administer-
ing the leg bath.  A common wooden tub, contrived  for the purpose,
like that represented in Fig. 183, answers a good purpose.   In such a
vessel, he  covers the inflamed limb introduced, and  cools the blood
flowing to it.

                       The  Sitz-Bath.

   Convenient  tubs, wooden or metallic, are constructed for this bath;
but an ordinary wash-tub answers very well.   The vessel should be
large  enough to permit the motion of the arms in rubbing the abdo-
men,  sides, and hips, first with  one hand, and then  with the other.
Water enough  should generally be used  to pretty nearly cover the
belly.  The more movement and friction while in this bath, the better.
It is more conveniently administered when the tub is  elevated two or
three  inches  from the floor.  Some undress the patient completely,
and place a blanket or sheet over the upper part of the body; but
oftener, only those  parts are uncovered which are to be exposed to
the water.  (Fig. 184.)
   In  a variety  of ailments, this  bath is highly valuable.  It may be
made one of  the most powerful of all  the  hydropathic modes.   Like
all other  powerful applications, it should  be taken only when diges-
tion is nearly or quite completed.
  As  a tonic to the stomach, liver, bowels, womb,  spine, etc.,  this
bath is highly useful.  In constipation, and other irregularities, it is
famous.  Those of sedentary habits will find its use  of rare service.
For the tonic effect, ten, twenty, twenty-five, or thirty minutes.  If
continued for some length of time, the water is to be changed  once
or more, as it would otherwise become too warm.
Fig. 184.                              Fig. 185.
                    The Wash-Tub  Bath.

  Under a great variety of circumstances, the wash-tub bath is  as
invaluable remedy.  For example, a patient is feverish; by setting 
—
  538      PROCESSES OF THE HYDROPATHIC TREATMENT.
  him in a wash-tub half filled with water, and, at the same time, if we
  choose, putting his feet in a pail of water, cold or warm, according to
  the  case, we may give him any desirable  amount of cooling.  We
  cannot, indeed, too highly prize this  simple contrivance  for using
  water, — a means which every family possesses.  (Fig. 185.)
    The water, as a general  rule, should  be tepid, ranging from 72° to
  90°, and may be prolonged from two to fifteen minutes, according to
  the strength of the patient.   It should never be carried to the  extent
  of producing blueness of the nails.   The patient should be dried with
  towels, or the dry rubbing sheet.
    This bath is useful in the treatment of eruptive fevers, bilious  re-
  mittents,  the hot stage of intermittents, and in hectic and typhoid
  fevers.  It is often used after the  wet sheet pack, in  chronic affec-
  tions, and may then have  a little cooler  temperature, or else be fol-
  lowed by pouring a pail of cooler water over  the shoulders, to tone
  up the skin.

                         The Affusion.

    The patient stands in a wash-tub, bathing-tub, or other convenient
  place, when, by means of a pail, pitcher, or basin, the assistant pours
  water upon the head, neck, etc., either upon  the whole of the body or
  only upon a part.  The water is used in quantity and temperature
  according to the  necessities of the case.  The affusion is one of the
  best of hydropathic modes.
    Fifty years ago, Dr. Currie, of England, performed great cures  in
  fever by the affusion, sometimes tepid, at others  cold, according to the
  strength  and heat of the patient.   If there  was great heat, the water
  was used cold; if not, the reverse.  In a variety of febrile  diseases,
  such as typhus fever,  scarlet  fever,  small-pox, measles, tetanus, con-
  vulsions, etc., he used this remedy with remarkable success.

                   Towel and  Sponge  Bath.

   With one or two coarse towels and a quart or two of water we
  may take a  very good bath  almost anywhere, even in  a  carpeted
  room, at a hotel, or wherever we  may be, without spilling a drop of
  the water.   After a person becomes accustomed to this form of ablu-
  tion, none but the most indolent will  be willing  to do without  it,
  unless they can have some other form  of bath.  A daily towel ablu-
  tion, thoroughly performed, is an excellent prevention against  colds,
f helps the  appetite and digestion, and is a good means of preventing
  constipation.
   Some  are  in the habit of sitting in  a half-bath or a sitz-tub, and
  with a large sponge making the water pass freely upon the head, neck,
  shoulders, and other parts of the body.  At the same time, the bather
  may pour water  from a cup, basin, or  pitcher, upon the head, neck,
  etc.  This is a mild affusion, and stronger  in effect  than the towel-
  bath.
A.
n 
PROCESSES OF THE HYDROPATHIC TREATMENT.       539
                         Wash-Down.

   The process to which this name is given by Dr. Edward Johnson,
%is practised as follows: " The patient stands in an empty sitting or
 wash tub, beside which stands a pail of cold water with two coarse
 towels soaking in it.  The bath attendant, taking his place behind  the
 patient, lifts one of the towels,  all loaded with  water, and  lays it
 quickly on  the  patient's  head.   The  patient immediately seizes it,
 removes it from his head, and rubs himself rapidly with it,— his face,
 his throat, shoulders, arms, chest, stomach, bowels, thighs,  and legs.
 Having gone rapidly over the whole body once,  he drops  his towel
 into the pail again, which the bath-man presses  down  to the  bottom
 of the wate,r, then  lifts it out, and places  it on his head again.   As
 before, the patient seizes it, and goes all over  the  same  ground once
 more, and  then, drops it  into  the  water again, when the  bath-man
 again lifts it and places it on the head to be a third time removed by
 the patient, and applied as before, rapidly, actively, and energetically,
 all over  his  body in front.   The  bath-man is industriously occupied
 all the time behind in the same manner, from the back of the  neck to
 the back of the legs, wetting his own towel as often as he wets that
 used by the patient, yiz., three times.  This is called a wash-down of
 three towels.  The patient is then dried in a dry sheet.  It is a more
 powerful bath than the common towel-bath, but not in all respects so
 convenient to take.

                    The Cold  Foot-Bath.

  • One of the first things  people who are troubled  with cold feet do, is
 to plunge  them into cold water.  Nor is  the assertion, put forth in
 some of the  hydropathic works, that the cold foot-bath was prescribed
 by Priessnitz for the same  purpose that the faculty order warm ones,
 correct.  When the feet are already cold, neither Priessnitz nor any
 one in his sober reason  would prescribe cold water, which can only
 make the parts  colder.  To obtain the good  effect of the  cold foot-
 bath, so far as the feet are concerned, they should be warm whenever
 it is taken.   For a tendency to coldness of the feet, — a very common
 symptom in these days of so-called luxury and refinement, and one
 that  indicates a state of things in the system incomparably more to
 be dreaded than the mere coldness of the  feet, — this  is the remedy.
 It may be  taken  at  any convenient time; just before  the morning
 walk is  a very suitable occasion, the parts being usually warm early
 in the day.
   At other times, if cold, they should, if at all practicable, be warmed
 by exercise and friction, before subjecting them to the action of cold
 water.   But in cases of old  age, great  debility, etc., the warm foot-
 bath, and other warm applications may be resorted to  before the cold.
 Thus with cold, exercise, and friction, accustoming the feet daily and
 frequently to cold water, will beget  in them a  habit of  remaining
 Warm.  In a great variety of ailments, such as toothache,  rush of 
C40       PROCESSES OF THE HYDROPATHIC TREATMENT.
'   blood to the head, headache, earache, inflammation of the eyes, gout,
   rheumatism, hemorrhages, etc., the cold foot-bath is a valuable remedy.
   It is ordered deep or shallow, and of duration according to the nature
   of the case.

                       Wading  Foot-Baths.
j
:     I have often directed patients to wade in water in some convenient
   place, as a means of hardening the system and of giving tone to the
   nerves.  Delicate ladies who were not able, as they supposed,  to en-
   dure cold water applied to the feet, have by degrees, wetting the feet
   but little at first, become so accustomed to the coldest water, that in a
   few weeks they could bear as much as any one would desire.   Caution
   and perseverance should be the rule.                   ,
     It is partly by sympathy and partly by the abstraction of heat, that
   foot-baths and wetting the feet act in so beneficial, or deleterious a
   manner  as we know them to do.  The principle of sympathy is an old
   one in the medical art, but none the worse for that.

              The Warm Foot-Bath.—Pediluvium.

     I am  aware that some who consider themselves genuinely hydro-
   pathic, object to  the use of this remedy.   Having truth for my object,
   however, I care not for such objections so far as myself am concerned,
   and without stopping here to argue the question, I simply remark that
   warmth  under some circumstances is as natural an application for the
   living body, as  cold under other circumstances.  I have already  re-
!   marked,  under the head of the cold foot-bath, that putting the feet into
   warm water is often a good preparatory process to that  bath.  It  is
   good also, now and then, for soothing divers aches and pains, and also
   for. warming the feet of old  and weakly people, who cannot exercise
   sufficiently.

         •                The  Nose-Bath.

     In a variety of nasal ailments, catarrh, colds in the head, inflamma-
   tion and ulceration of the nasal passages, nose-bleed, etc., the  nose-
j   bath is a salutary remedy.  The water is used either  tepid or cold,
   according to the case.  It should be drawn back if possible, so that it
   is ejected by the mouth.   Those who have injured the  nasal cavities
   by much snuff-taking, will find advantage from sniffing water freely
   into the  nostrils.  If one is determined to  leave off snuff, as every one
   addicted to it, if he regards either health or bodily comfort, ought,
   he will find it useful often to take cold water, instead of the abomina-
   ble weed. *

                    The  Eye and Ear Bath.

     Various contrivances may be brought to bear in applying  water to
   the eye and ear.   Light, ascending douches and showers#are useful in 
PROCESSES OF THE HYDROPATHIC TREATMENT.      541
varioustliseases of the parts.  There should not be much force used
in this way.  Immersing them  also in water is often  useful.   The
water should not, in general, be very cold, tepid  or warm being^pften
the best.

                   Mputh, or  Oral Bath.

   For inflammation of the gums, mouth, throat, and palate, in slimy
secretions from the throat and' stomach, in toothache, catarrh, colds,
and chronic hoarseness, garglings and baths for the mouth are of great  .
service.  Pauley,  a  merchant of Vienna, has been  thought singular
for his zeal in recommending this bath.   Clergymen and others who
suffer hoarseness  by much speaking, will find that  holding very cold
water in  the mouth until it begins to grow warm, and then ejecting it,
and by frequently repeating the process, much benefit will be obtained.
Coughs  and tightness of the chest may often be essentially relieved
by this bath.  In  mucous secretions from the throat and stomach, by
ejecting  the water a number of  times, it will surprise those who have
not witnessed the remedy to see the amount of slimy secretion thrown
off.

                      Division of  Baths.

   On no one subject connected  with hydropathy has there been more
"confusion of tongues," than concerning the temperature of baths.
Both in  books  and  in popular language, among physicians as well as
laymen, have words been used, sometimes confusedly, and  at other
times without any meaning whatever.  Orthodox medical works, as
well as the  zmorthodox, come under the same category of error.  A
few simple explanations oh this head, properly made, will be sufficient
for all practical as well as scientific purposes.
   The simplest and most natural division of baths is into cold, tepid,
warm, and hot.   These are  all  terms of every-day life, and are fully
sufficient to guide us  in the selection of any and all the multiform
uses of water  which hydropathy  teaches.   I admit, however, that
when we wish to be  especially explicit, the actual thermometrical
temperature should be mentioned.  Hot baths, I maintain,  have no
proper place in  hydropathic practice.  He who resorts to them either
does not at all understand the true  principles  of  the  Water-Cure,
or is guided merely by the  whims  or caprices of those  who employ
him.
  But whatever wrords we use to designate the  different baths, there
is one objection, which is, that all such terms are  necessarily arbitrary
in a greater or less degree.   What appears to one  person cold, may
to another appear tepid, or warm, or even  hot.   Thus it is said that
on a road over  the  Andes, at about half way between the foot  and
the summit, there is a cottage in which the ascending and descending
travellers meet.   The former, who have just quitted  the sultry valleys
at the base, are so relaxed, that the sudden diminution of temperature
produces  in them  a feeling of intense cold;  while the latter, who left 
542       PROCESSES OF THE HYDROPATHIC TREATMENT.
the frozen summit of the mountain, are overcome by distressing sen-
sations of extreme heat   If on a cold winter's morning we go from a
warn* bed to a bath of sixty to seventy degrees  Fahr., the water ap-
pears cold.   If we then plunge immediately into water which is at
about the freezing point, and then return again to the water at sixty
to seventy degrees Fahr., it appears warm.  When the temperature
of the atmosphere is at fifty-five degrees Fahr" in November or Octo-
ber, in this latitude, and the body of a comfortable degree of warmth,
and we take three basins of water at  sixty, seventy, and eighty de-
grees Fahr., placing one hand in the water at sixty degrees, the other
in that at eighty degrees, letting them remain thirty seconds in each,
and then immerse them both in the water at seventy degrees, it ap-
pears to one cold, to the other warm.
   But we can arrive at rules which approximate  so nearly to the ac-
tual truth, that they will serve us, as before remarked, for  guides in
all practical and scientific purposes.

   The Cold-Bath. — With a majority of persons, and  at most seasons
of the year, water at from seventy to eighty degrees Fahr. downward,
gives, when immersed in it, a sensation of coldness.  The spring water
of all countries  furnishes what  may therefore  be called a cold-bath,
although there will be a range of many degrees variation in what we
term cold.

   The Tepid-Bath. — The word  tepid is from the Latin tepeo, to be
warm.   The true English meaning of the term however is, according
to Mr. Webster, moderately warm, or lukewarm ; in other words, water
which, when  a person is immersed in it, gives a kind of indefinable
sensation, one which, coming properly under the neither cold nor warm,
is said to be tepid.  This temperature will be found to range at from
eighty to ninety-two degrees Fahr.

   The Warm-Bath. — The. term warm is generally well understood.
It means that temperature of water which is peculiarly agreeable  to
the sensations.  Fresh-drawn milk or blood we say are warm.   The
temperature  of  water which will cause  this sensation, varies from
ninety-two to ninety-eight degrees Fahr.

   The Vapor-Bath. — The temperature  of the vapor  of simple water
varies from about ninety degrees Fahr. upward, according to the heat
of the water, and the space through which the vapor  passes.

   The Hot-Bath.— The  term hot is also  expressive of its proper mean-
ing.  If the body is immersed in water above blood-heat, it causes an
uncomfortable sensation, which we designate as hot.  Hot water is a
disturber of the  vital functions, particularly if the whole body is im-
mersed in it.  Hot-baths, therefore, should  be used, if ever, only in a
most urgent necessity.   Hot water, in no  form whatever, entered into
any part of  Priessnitz's  treatment
   Having thus  explained the temperatures of the  different divisions
of the bath, it is proper to state them in a tabular form, the better to
aid the memory.  They are as follows : 
PROCESSES OF THE HYDROPATHIC TREATMENT.       543
          Cold-bath from freezing point,   .    .    32 to 85° F.
          Tepid ".......80 to 92°
          Warm"......92 to 98°
          Vapor".......90° and upward.
          Hot  "......above 98°

  I now propose to explain somewhat minutely, and at the same time
with a  due  regard  to the needs of the non-professional reader, the
physiological effects of each of the several kinds of bath, and I here
respectfully premise that any one who attempts to practise the water
treatment without having in his mind clear notions upon this subject
is, to say the least, as much a " groper in  the dark" as  he who attempts
the practice of drugs of which he knows  nothing, upon the living body
of which he knows less.   How can a man be trusted in water treat-
ment if he cannot tell beforehand what effect a bath is to have ; and
this he cannot, if he  does not fully understand the  meaning of the
terms which I have here explained.

   Effects of the Cold-Bath.—The effects of the cold-bath are properly
spoken of under two heads, the primary and the secondary.  The
terms  are  sufficiently expressive of  their meaning.   The first are
those which  take place  at the time of the immersion; the second,
those that occur  later, constituting what we understand by the term
reaction.
   Immediately on immersion in cold water,  the bather experiences
some acceleration of respiration  and the heart's  action, although the
pulse becomes at the same time smaller and weaker.  Very soon,
however, the panting, if I  may so call it, passes off; the temperature
of the body is found diminished, the surface  paler than natural, the
skin taking on  that form of appearance  known as " goose-flesh."
   The  first effect of  cold water applied to the  body, generally, is to
abstract a certain amount of heat from  the surface, to constringe the
capillary vessels, and  to  force the blood inward.  Now, as the living
body possesses the  remarkable property of maintaining its tempera-
ture at very nearly the same point, whether it is in a colder or hotter
medium than itself, the  vitals at once  set to work in restoring the
caloric  abstracted by the contact of the water;  and as the functions
of  circulation  and calorification go necessarily together, the vital
power,  acting through the heart and blood-vessels, attempts a return
of  the  blood  that had been  forced  inward  by the  coldness  of the
water.
   This is  what we  call reaction.   If  the  individual is sufficiently
strong  and well stocked  with vitality,  the blood is  quickly returned
to the surface and to the extremities (which are always most liable
to  become cold, being farthest from the  heart), constituting what  is
termed good, or vigorous reaction.  But if the surface and extremities
continue to remain un warmed by this return  of the blood to them, as
happens in  the case  of feeble persons,  there is said to be poor, or in-
sufficient reaction.
   Effects of the Tepid-Bath. — The tepid-bath, which we  have seen
ranges from eighty to ninety-two degrees Fahr., produces effects anal- 
544       PROCESSES OF THE HYDROPATHIC TREATMENT.
ogous to those of the cold-bath, only not so lasting and permanent.
It is especially useful in the treatment of infants and children, and in
all cases where the reactive  energy is feeble.  If in any case we are
in doubt as to whether the cold bath is admissible, the tepid form will
be a milder measure, and at  the  same time serve as a test in ventur-
ing upon the  cold.  The tepid bath  may be continued longer at a
time, which in some cases will be found an advantage.

  Effects of the Warm-Bath.  — There  is  among  hydropathic  physi-
cians, if  I am not mistaken, too great a fear of wrarm applications on
the part of some, while  others go to the opposite extreme.  Mark, I
speak of warm applications.  Hot, as before remarked, have no proper
place in hydropathy, — a rule to which the exceptions are few.
  The warm-bath, as before remarked, ranges  from ninety-two  to
ninety-eight degrees Fahr.   It is not the  most useful of the hydro-
pathic resources, but one of the most useful, as I shall endeavor here-
after to show.
  Among the ancient Romans the warm-bath was not considered as a
means of luxurious indulgence that tended to weaken the vital powers,
but a means  of refreshment  for the wearied traveller, and of prepar-
ing him for the repast and the enjoyment of other rites of hospitality.
The effect of the warm-bath is not one of debility, as many suppose,
but, on  the contrary, it is a sedative, lowering the heart's action and
the circulation, and tending to repose rather than excitement.

  Effects of the Hot-Bath. — The hot-bath, before remarked, is one
which  is above the temperature of the blood, ninety-eight degrees
Fahr.  It was laid down as a precept by Hippocrates, that a bath en-
feebles when the heat exceeds that of  the  body immersed in it.  The
truth of this precept has often been verified in practice.
  I do not wish to be understood as  affirming that hot applications
caii  never be made with benefit to the body; on the contrary, heat
applied to a part locally may be of service, 'although I am inclined to
believe  that even in those cases where heat acts in a beneficial way,
some other form of hydropathic appliance  can be used  more benefi-
cially.   I make, it will  be  remembered, a  broad distinction between
the terms hot and warm.

                         Sea-Bathing.

  As regards temperature, sea-bathing comes under the general head
of cold-baths.   Sea water, however, at those seasons of the year when
sea-bathing is  resorted  to, is of but a  moderate  degree of coldness,
varying in this latitude  not much from seventy degrees Fahr.
  In order to appreciate fully the effects of sea-bathing upon the sys-
tem, a number of things are  to be considered.
  Sea water differs in its effects from common water by its possessing
greater density.  This  circumstance, however, is not of so great im-
portance as that of the  stimulating nature of the mineral it contains.
The saline ingredient is a powerful stimulant and even irritant of the
skin. On account of this property, it is found that an exposure to the 
PROCESSES OF THE HYDROPATHIC TREATMENT       545
 action of salt water is not so liable to cause ill effects as that to fresh.
 The salt causing a degree of heat upon the surface  somewhat higher
 than that of the natural state, the system is for the time shielded from
 the action of  cold.  It does not follow from this, however, that a per-
 son could live longer immersed in sea than  in common water, any
 more than it follows that because alcohol for a time increases the
 animal  temperature, life  can, under circumstances of great  exposure
 to cold, be the longer preserved.  This it is now well known is not
 the case.
   An advantage of sea-bathing in  the hot season  is, that the air at
 the sea-shore  is cooler than on land.   That our climate in summer is
 too hot for the most favorable  development of health is proved by
 the great  increase of mortality, not only  in  our cities, but in other
 parts, during the hot  season.  The European cities, with  all their
 numbers of inhabitants, dampness, narrow streets, intemperance, pau-
 perism,  etc., would naturally be  expected  to  show a higher  range of
 mortality than our  American  cities, but such is not the fact.  Even
 New York, with all its natural  advantages, is as sickly, probably, as
 any of  the British  or European cities.   This, it  is  agreed on all
 hands, must be owing in great part to the great heat of our summer
 months.
   The  manner of taking the salt-water bath has some peculiarities
 which are favorable to health.   It is, in the  first place, in the open
 air, which, if the weather is favorable, that  is, neither too  hot nor
 cold, is always a great advantage.   Other things being equal, a bath
 in the open air is always attended with a better reaction and a greater
 degree of invigoration than one within doors.
   In the second place, sea-bathing  is  usually and almost necessarily
 connected  with exercise both before and after  the bath, circumstances
 which  are always highly favorable to the action  of cold water.  So
 beneficial, indeed, is exercise taken in this way, that  it would be diffi-
 cult to  determine which of the two, — the exercise or the bathing,—
 is the more beneficial.   In connection, the  two act reciprocally upon
 each other, each rendering the other doubly beneficial.
                                     w

                          Injections.

   The term injection  implies the act of throwing a fluid into some
 cavity of the body.
   In Water-Cure we  inject water more frequently into the bowels
 than any other cavity.   This kind of injection is also called enema, or
 clyster.
   Most  people have so little  confidence  in simple  water, that if a
clyster is administered to them, they have no idea that it cart operate
in so effectual a way as it usually does. . Years ago, when the water
treatment was much less known than at the present time, I have been
suspected of  having secretly put some cathartic substance in the
water, " for," said the patients, « how is it possible for water to act in
this way ? "
   A great variety of injection-instruments have been invented.  Some
                                69 
546       PROCESSES OF THE HYDROPATHIC TREATMENT.
of these are very convenient and useful;  others are got up on mere
speculation, and are  but little worth.  Every family, at least, ought
to have a  good force-pump injection-instrument, if they  can obtain
such a one.  A lady's toilet is  never complete without it.   A good
article is either manufactured or  sold by most  surgical-instrument
makers, and druggists often  have a good article.  But  beware of im-
position.  It is better  to get along with a  common bladder and goose-
quill, as we may in an emergency, than to pay for a good-for-nothing
syringe.

                Modus Operandi of Water.

  It is  often objected to hydropathy that  water, being but one agent,
cannot be made useful in all diseases. I  propose here to make some
remarks on the modus operandi of water, in which I shall endeavor to
explain, not only to the scientific scholar, but to the ordinary reader,
that water  is capable  of being made available as a remedy, — and that
powerfully  too, — in a great variety of ways.   It then acts :

  1. By its Presence. — Water, as we have seen elsewhere, composes
the larger part of the living body; and that without its presence in a
large proportion in the living system, the vital processes cannot for a
moment go on.

  2. By its Coldness. — Cold, within proper limits, preserves and aug-
ments life, while heat tends to debility and decay.  In proportion as
the animal heat is diminished in the  different classes of animals, the
less  is the  want of air felt.  If in  a puppy the  eighth  pair of nerves
be divided, producing a closure of the. glottis so that no air can enter
its lungs, the animal dies in half  an hour, if kept at an ordinary tem-
perature.   But if the  animal is benumbed with cold  it survives the
operation for a whole day.  Frogs, in the  summer, when the tempera-
ture of  water is elevated, are obliged to come often to the surface  for
air.  But in winter, when the water is colder, they live  almost entirely
under its surface.  A cholera.patient in collapse, a person who has
been stifled by foul gases, one in the sinking stage of a fever, or faint-
ing from loss of blood,  or  in any way asphyxiated,  desires always
coldness rather than  heat   It may  not  be possible  in  the  present
state of science to explain these phenomena; but undeniably we have
the facts.

  3. By Endosmose and Exosmose. — Animal membranes  have the
power of absorbing liquids, — called  endosmose, or imbibition, and of
throwing them out, exosmose, or transudation.
  If we take a portion of the intestine of a chicken, tie one end,
nearly fill it  with milk, then tie the  other end, and lastly immerse it
in a tumbler  or other vessel of pure water, we find that in a short
time the milk passes out of the intestine into the water, and the water
inwardly mingling with the milk.   This process goes on till the fluid
within and without the intestine becomes one and the  same.  This is
a familiar illustration of the principle in question. 
PROCESSES OF THE HYDROPATHIC TREATMENT.      547
  4. By Dilution. — Water is the greatest  diluent in nature.  There
is  no substance which is at all comparable to it for penetrating the
myriads upon  myriads of capillaries  that  exist in all  parts  of the
living structure. When the fluids become thick, viscid, and filled with
impure matters, as is usually the case to a greater or less  extent, in
disease, it is an important  object to dilute these matters.   For this
purpose water is the only available remedy.

   5. By its  Tonic  Effect. — Water is the greatest  of all tonics, and
possesses the valuable property, not of wearing out, but of increasing
in its good effects.

   6. By its  Excitant  or  Electrical  Power. — A  man  feels  dull and
stupid from excessive bodily or mental labor, from excessive alimenta-
tion, or spirit, or tea and coffee drinking, with the blood all crowding
up into his head.   We  apply the well-wrung rubbing wet sheet one,
two, or three times, to his surface, according as  he  may need, and  he
at once perceives a most wonderful change for the better.  Or a man
feels of a morning dull  and stupid, with his  muscles sore;  he has
the  rubbing wet sheet, the plunge, shower, or douche, and  instantly
his troubles banish.  Or he may have a lumbar abscess which has
run him down so low that when he wakes in the morning he  finds
he cannot walk.   Two or three gallons of  cold water are poured over
him, upon  which  he walks readily.   Now these  effects  of water,
remarkable  as they are, arise simply from its excitant  or  electrical
power.

   7. By its Temperature. — In acute disease, in all fevers and  inflam-
mations, of whatever name or  grade, the  great power  of  water to
regulate  the temperature of the  body is one of the most striking of
all the phenomena cognizable by man.  By the use of cold water we
can always  vary the heat of the body and the  velocity of the  heart's
action to any desirable extent.

   8. By Purifying the Blood. — Water accomplishes one thing which
no drug, no other  substance in nature can.   It purifies the  blood.  It
does this  because it  penetrates every lane and alley of the system,
however minute.   No capillary is so delicate that it does  not pene-
trate its smallest possible part.  It purifies the blood, because  as long
as the vital  principle lasts, the tendency of nature  is to preserve the
vital fluid in a healthy state; and penetrating every tissue of the body
as water does, it assists nature in the purifying process as no other
substance can.

   9. By Augmenting  the Vital Force. — No fact in science is better
established than that water possesses the power of actually increasing
the  amount of vitality in  the system.   This is, in fact, the prime
effect of water.   It aids the system  in throwing  off disease in the
same way that increasing a merchant's capital aids him in throwing
off debt.
   The foregoing  propositions are submitted as elucidating some of
the leading  principles concerned in the action of water upon the living 
548       PROCESSES OF THE HYDROPATHIC TREATMENT.
body.  I do  not  claim, however, that the whole of the philosophy of
the effects of water  is yet understood by any one.   Doubtless those
who know most about it have yet much to learn.

                  Rules for Using Water.

  The Time  of Day. — In general,  the  more powerful applications
should be made in the early part of the day.   At this time the calor-
ific powers and the  circulation are more vigorous, and, consequently,
the body more  able to  resist powerful applications of whatever kind.

  The Meals.— Ordinarily, no powerful bath should be taken within
three to  four hours  after a meal.   A full stomach and cold water do
not at all agree.  But  in certain ^diseased conditions,, as feverishness,
inflammation, colic, cramp in the stomach, cholera morbus, and other
sudden attacks, water  appliances are to be commenced without refer-
ence to hours or meals.  The symptoms then are our only guide.

  The Lighter  Baths. — If there is doubt as to which application to
make, the well-wrung  rubbing wet sheet, the tepid shallow-bath, or a
warm-bath should first be taken.
  Reaction. — Within  a reasonable time  after a bath, the  body in all
its  parts should become naturally warm.   If the feet and hands re-
main cold, and the nails and lips blue, the bath has, to say the least,
done no good.  In some cases of fevers and  other inflammatory dis-
eases, it is better to keep  the  body chilly than to allow it to become
too warm.
  Ulceration. — If any part of the  body, as  the extremities, lungs,
bowels, etc.,  is undergoing  any  considerable ulceration,  very cold
baths are inadmissible.
  Nervousness. — With some persons who  are highly  nervous, and
particularly with nervous females, much cold bathing, although it ap-
pears to agree well, and to be the best for a time, is in the end harm-
ful, rendering the nervousness and general debility worse.

  Exercise. — For the  douche, plunge, cold  sitz, and foot baths, and
all others that abstract a large amount of caloric from the system, the
body should  be fully warm, and the circulation somewhat accelerated
by exercise.  Exercise should also be taken after the bath, until the
heat and circulation  are fully restored.  But if exercise is impractica-
ble either before or  after the bath, friction should be made  to take its
place.
  Increased  Heat. — Elevation of temperature constitutes no objec-
tion to bathing, provided the  body is not excessively fatigued.  The
reason why overheated persons sometimes lose their lives by plunging
into or drinking largely of cold water is, that the vital force has been
too much exhausted.  Mere heat is an advantage.'

   Perspiration. — Neither does this constitute an objection  to bathing
or water-drinking, if the foregoing rules are observed. 
PROCESSES OF THE HYDROPATHIC TREATMENT.      549
  The Air. — Bathing in the open air is always preferable to in-doors,
provided the extremes of heat and cold are avoided.
  The Head. — It is well always to wet the head with  cold water,
both before and after a bath.  Douches and the shower should never
be taken on this part Simple pouring or affusion is the only mechan-
ical force of water that should be allowed on the head.
  Pregnancy. — This, as abundant experience proves, forms no objec-
tion  to  bathing, or any form of  properly regulated water treatment
Cold bathing and water drinking are of the greatest service during
this period.
  The Season. — If the lungs are not extensively diseased, and if there
is no considerable ulceration going on in any part of the system, the
cool and cold seasons are preferable  for a course of bathing.  With
right management a patient gains  two or three times  as much in a
given time during the cold months as he does in the hot.
  Days  of Rest. — One day in seven water  treatment should be  dis-
continued, with the  exception  of a simple  ablution in  the morning-
Six days' treatment in the week is worth more than  seven, because it
is a law of nature that, if a remedy  is continued steadily and without
change,  it loses much of its good effect.  This is  as true of water as
of any other agent   Those who  do  wisely will omit the treatment on
Sunday, whatever their religious  convictions may be.
  Internal Use of Water. — The same general rules apply here as in
the external applications.  Thirst should for the  most  part be grati-
fied  whenever it  is experienced.  As a rule, the less water drank at
meals the better.    For the  tonic effect, it  is to be taken while the
stomach is empty, and it is better that exercise should  accompany it
From six to twelve tumblers per diem is a fair allowance for average
patients.
  Quality  of  Water. — For all remedial as  well as hygienic purposes
water should be  as pure and soft as can be obtained.   With proper
care and ingenuity in the construction of  cisterns, filters, etc.,  this
desirable end can  be everywhere  accomplished.  Lead, and lead
pipes, should be  avoided, except where the water runs freely  and
constantly.
  The Sweating Process. — Formerly it was much in vogue to sweat
patients in the blanket pack, but latterly the practice has quite gone
into  disrepute.  For several years  of the latter  part of Priessnitz's
career he was very averse to using the  process.   It was a remark of
his, that the cures by sweating were not permanent.

          Wet  Bandages  and Compresses, etc.

   These,  as  we have already seen under the head of wounds and in-
juries, are of great value in water treatment.  They are  used of any
desirable size, upon any part of the  body, and produce different effects
accordingly as they are used.   Cooling wet compresses  are such  as 
550       PROCESSES OF THE HYDROPATHIC TREATMENT.
are changed or rewet frequently, and for the most  are left uncovered.
The warming or stimulating are covered and left upon the part until
it  becomes as  warm or warmer  than natural.   Warm fomentations
are useful in certain cases, but the hot should, as a rule, be discarded.
   The wet girdle is one of the most useful of all medical appliances.
Two and a half or three yards of good toweling, with tapes arranged
at one end, the corners of which have been turned over and sewed so
as to form a point, forms a good girdle.   It should pass usually three
times about the body, one half having been wet.   This brings two
thicknesses of  wet on  the  abdomen and one  upon the back.  At
Graefenberg  this application was worn by  every patient, and, as a
rule, all of the  time.  It is useful in a great variety of ailments, both
acute and chronic.   The same form of application  is also useful for
the arms, legs, etc., the.tapes being used in preference to pins.   ■
   The wet jacket, or chest wrapper, is also a valuable resort in diseases
of the chest.  Oiled silk and other similar articles, as  I have elsewhere
observed, are not to be used upon these local applications. 
DOMESTIC MANAGEMENT  OF THE  SICK-ROOM.*
               Choice  of the  Sick-room,  etc.

   Sleeping Apartment. — In every case of disease, however slight its
 nature, the sleeping apartment of the sick should be airy and well
 ventilated ; but, when Providence visits any member of a family with
 disease of a  serious and protracted  description, all other considera-
 tions giving way to the necessity of the case, an apartment should be
 chosen  and arranged in a special manner for the reception of the in-
 valid.   It should be one calculated  to administer to his  temporary
 comfort, as well as  to aid^ his recovery.  It is  not  time, when the
 alarm is sounded and the  danger is already urgent, to think of such
 arrangements ;  forethought must  be put in  requisition ; every want
 anticipated ; and whatever is  likely  to be required should not only
 be provided, but so arranged that  it can be instantly found when it is
 needed.
   The sick-room should be large,  lofty, and, if possible, with a north-
 ern aspect, in order to avoid the heat of the mid-day or the afternoon
 sun: the windows  should  be  capable of being  opened by drawing
 down the uppermost sash; an advantage,  however, which  cannot
 always  be obtained, as this mode of opening windows is  too gener-
 ally neglected in the construction of modern houses.  No room, how-
 ever large, should be used  as  a sick-room, unless it has a chimney;
 but neither the  chimney-board nor  the soot-board of the  apartment
 should be put up, even in summer.   No article of unnecessary furni-
 ture should be permitted to remain in the room  ; and that which is
 left in it should be of a description fitted to administer to the conven-
 ience of the invalid.
   Two  tables are sufficient.   One of them  may be small, to stand
 near the bed, for the immediate use of the patient:  namely, to hold
 his jug  of barley-water, or  toast-water, or  other beverage ; — a small
 tea-pot, or, what is  preferable, a  half-covered cup with a spout, to
 enable fluids to be administered without raising the sufferer in bed; —
his medicines for the day ; — and  any other thing which he may fre-
quently require.
  The  other table should be large, for the accommodation of medi-
cines not in immediate use, and  also for spare glasses, jugs, cups,

            * Thompson, On the  Management of the Sick-Room. 
552        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
 spoons, both large and small, and other necessary articles.  This table
 should have one drawer, at least, which ought to  be furnished with
 the following articles : broad and narrow tape;  two or three half-worn
 ribbons ;  a bundle of old, soft linen; a sponge; a few ounces of lint;
 scissors, large and small; a bone spatula for spreading ointment;  a
 couple of rolls of muslin, and the same  quantity of flannel bandage
 two inches broad; a pin-cushion well supplied with  pins; needles and
 thread ; and about half a yard of simple adhesive plaster.

   A Sofa or Reclining Chair.— A sofa, if the apartment be sufficiently
 large to admit of it, is a very important piece of furniture in the sick-
 room ; the erect or  the  sitting  posture being injurious in  many dis-
 eases ; and, when the sick-bed requires to be made, a sofa affords the
 means of removing  the  patient  from the bed with  as little inconven-
 ience to him as  possible.
   If there is not space for a sofa, there should be an invalid or reclin-
 ing chair; and,  when circumstances will  permit, it  should  be of that
 kind  which is susceptible of a  variety of changes,  so as to vary, at
 pleasure, the position of the patient.   There should not be  more than
 two other chairs in the room.  If there is  a looking-glass in the apart-
 ment, in a situation which admits of the  patient seeing himself in it
 as he  lies in  bed, its  place should be  changed, or it should be  alto-
 gether removed  from the room.   A chest of  drawers is essential; but
 none of the drawers should be appropriated  for the reception of dirty
 linen, which  ought  never to be  allowed to remain  a moment  in the
 sick-room.  One drawer should be specially allotted for towels, of
 which an ample supply is, in every  case, necessary.   The washing-
 stand will require two additional  basins ; an additional water bottle
 and  a tumbler;  and a large, supernumerary water  jug, under  the
 table, always full of  water.
  IVo Cooking in Sick-room. — There should be  no  kettle, nor any
 implement of cooking, in the sick-room ;  even in winter, and when a
 fire is required.  In general, a fire in  the  sick-room  is only necessary
 for the comfort of the attendants ; but  nurses too frequently take ad-
 vantage of it to boil the water for their own  tea, and to prepare the
 slops for the invalid; a  custom which cannot be too severely repro-
 bated.   The  lamp termed a Night-nurse, consisting of  a water-bath
 placed over a lamp in a wire-worked cylinder; a  small  tin. kettle
which  enters the top  of the cylinder; and  a covered  earthen-ware
vessel which fits it into the water-bath ; are useful for keeping fluids
warm, and at the same time for preserving a light in the room, when
an unshaded lamp or a candle would be hurtful.
  In continued fevers, the sense  of hearing is often so  morbidly acute,
 that ordinary sounds become causes of pain.   In this case, if the floor
 of the sick-room be not wholly carpeted, every precaution to  lessen
the intensity  of  sound should be taken.  One of the most effectual is
to have a couple or  more pairs of large  list  shoes  outside  the  door,
 into which the  feet, even  of the doctors,  may  be  advantageously
 thrust, when  their shoes make a creeking noise, or  when a visitor or
 nurse treads  with a  heavy foot.   On the same account, when  more 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        553
   than one nurse or attendant is required to be in the room at the same
   time, no conversation, although it  may  be carried on in  a  whisper,
   should be permitted.   Whispering, indeed, is  apt  to  excite delirium,
   and to augment it when it is already present.

     Beds and Bedding.— The French beds, without curtains, are those
   best  adapted  for the sick-room.   When four-posted bedsteads, sur-
   rounded by curtains, were more in use than at the present time, the
   mischief arising from  excluding the free air, by drawing the curtains
   close around  the bed, was  frequent and serious.   In every case of
   disease, indeed, especially when it is attended  by fever, the patient
   should be  kept cool, and the most perfect freedom  be  given  to the
   breathing: the mattress  should be placed over  the feather  bed, and
   the pillows be firm and  elastic.  The Marseilles coverlets, which are
   spread upon beds during the  day,'and  often retained at night, are
   heavy, and calculated rather to increase than to  subdue fever:  conse-
   quently they should be wholly discarded from the sick-bed.  Indeed,
   when the disease is fever, and when it is accompanied with great rest-
   lessness owing to the evening exacerbation, if the  bed-room  be suffi-
   ciently large, two beds should  be  placed in it; or if two adjoining
   bed-chambers  can  be obtained, a bed ought to be put in each, so that
   the patient  can be moved from one  bed to the other every  morning
   and evening.  This both  aids sleep, and it also tends greatly to insure
   the personal cleanliness of the patient  The bed-clothes of the bed
   from which  the patient is moved should, on his removal, be  immedi-
   ately turned down and fully exposed to  the air; a precaution which
   will set aside the necessity of so frequent a change of linen, as  would
   be, otherwise, required.   When there is only one bed, and when the
   disease  is fever #(unless  the  patient is too ill  to  permit  his being
   moved), the sheets which have been used at night should be  replaced
   by others in the morning, and hung up in the free air during the day,
   to be again used at night.   But, when it  can conveniently  be done,
   in every case of continued fever, especially of  an infectious kind, the
   sheets should be changed once in twenty-four hours; a practice which
   is likely to prevent the fumes of infection from being  communicated
   to the blankets, or to any of the furnitute of the room.
     Ventilation is always  of  primary  importance;  and  that period,
   happily, is  gone by, in which air  was carefully excluded from the
   chambers of the sick,  even  when  they were  suffering under  febrile
   disease.
     Ventilation  is particularly demanded in those fevers in which mil-
   iary  eruptions  display themselves ; under  no circumstances is it so
   essential as in  febrile diseases of an infectious kind.  It may, however,
1   be consolatory to those whose duty it is to attend such cases, to know
   that  infection,  communicated through the air, rarely extends above a
   few feet from the body of the patient; and even in the  most  malig-
   nant diseases,  with the exception of confluent small  pox, and  malig-
   nant scarlet fever of the worst  kind, its influence  does not exceed a
   few yards,  if the  room be well-ventilated.  On the contrary, if ven-
:   tilation  be  neglected, the power  of infection becomes  greatly aug- 
554        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
mented from  its concentration in confined and quiescent air; it even
settles upon the clothes of the attendants, and on the furniture of the
room; and these imbibe it most readily when their texture is wool,
fur, or cotton, or any loose or downy substance capable of receiving
and readily retaining the air.   Smooth and  polished surfaces do not
easily receive or retain  infectious matter;  consequently the  nurses
and  attendants, in cases of infectious diseases,  should have  glazed
gowns, and aprons of oiled silk.
  In  no infectious diseases are these rules"'more essentially necessary
than in small pox and scarlet fever.   It is well known that, if the bed-
clothes of a patient laboring under either scarlet fever or»small pox be
closely folded up, they will retain the  infectious matter, and  commu-
nicate the disease  at a  great distance of time ; but  the influence of
free ventilation is so great, that medical practitioners who are attend-
ing small pox patients,  and who go from them into the open  air, do
not spread the. disease.   Indeed,, all infection is weakened by dilution
with  air.   The  danger of infection  is  augmented, if, along with bad
ventilation, the atmosphere of the room be moist  from any cause.
  It is further consolatory to know that  the  infectious matter, even
of the most virulent description,  is not poisonous to every one who is
placed within the  sphere  of  its  influence.  A predisposition  of the
body  to receive  the infection  must exist before it  can be communi-
cated ; a condition which is augmented by fatigue  and watching, de-
fective nourishment, mental depression, or anything which can lower
the vital powers.  The necessity, therefore, of maintaining these pow-
ers  by attention to rest, a sufficient quantity of good  and generous
diet, and cheerfulness of mind, need not be insisted upon.
  In every case of  infectious  disease, the attendants, even in the best
ventilated rooms, should stand on the windward, o* on that side of
the sick-bed  from which the  current of air comes ; as, by neglect of
this rule, and by standing  in  the current which has  passed over the
patient, the infectious exhalations are blown  upon  them in  a direct
stream from  the body of the  patient.  The attendants should never
lean over the sick, nor should they receive their  breath.  The  health
also of the nurses should always be supported by nutritious and gen-
erous diet; but not by brandy, nor any other ardent spirit
  The term   infection in its most  extensive signification, implies
some deleterious matter, originating from any source, and transmitted
through the air, which is capable of causing  diseases in the human
body.  When  this matter is emanated from  the diseased bodies  of
men,  the term is frequently regarded as synonymous with contagion;
but, in strictness of language, the latter refers  only to the communi-
cation of  disease by contact.   Whatever may be the matter of infec-
tion, it may enter the body through the  medium of the lungs, which
is the most ready inlet, or by  the saliva, or even through the surface,
if the skin be  abraded, or if any ulceration be present.   The influence
of infectious matter is evidently exerted on the  nervous  system, dis-
playing itself by debility, inertness, dislike to  motion, great suscepti-
bility  of cold, irritability and despondency  of mind, and by the pro-
duction of a disease similar to  that  of  the person from  whom the
» 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        555
infectious matter has proceeded.  The infection may be supposed to
have taken effect, and to have produced the actual disease, when the
person who has been exposed to its influence is attacked with giddi-
ness, pain of the head, irregular heat and chills,  nausea,  and, if the •
infectious disease  be small pox, convulsions.   These symptoms are
Sufficient to denote the necessity for immediate medical advice.

  Temperature. — Next to ventilation  nothing is of more importance
than the regulation of the temperature of the sick-room, avoiding both
extremes of elevation or of depression;  but much  depends on the
nature of the disease.
  The best general temperature of a sick-room  is 60° (Fahr.); and it
is preferable  to  regulate this rather by the thermometer than by the
sensations of the patient or the attendants.   Under some circumstan-
ces, however,  the  feelings of  the patient, and  his susceptibility of
impressions upon  the skin, should not be overlooked.  Thus if the
temperature be a little above that of  summer, and the patient, never-
theless, feel chilly, it should be raised five or six degrees.   This chil-
liness is very apt to be felt in a dyspeptic state of the habit, and more
especially when it is accompanied with  hypochondriasis.  It differs
from that more severe but transient coldness which accompanies inter-
mittent fevers, and some other periodical affections ;  and it requires
an elevated temperature  of  the air for  its removal, whilst the cold
stage of intermittent diseases is best relieved  by the warm  bath,
either general or local.
  So important is  the regulation of temperature, especially in  fevers,
that  it often does more good  than  any other remedial measure.  I
have seen  patients laboring under high delirium in  a close, ill-venti-
lated room, become rapidly  quite collected  by merely lowering the
heat of the apartment twelve or fifteen degrees.
  In convalescence, as the air of the sick-chamber should be  fre-
quently renewed, the temperatue in spring and  autumn ought  to be
maintained as near as possible at 55° to 60° Fahr.;  and it should be
very gradually lowered as the invalid  acquires  strength, so as to ena-
ble him to bear with impunity the varying temperature of these sea-
sons in the open  air.   Even  then, if the previous disease has been
pulmonary, the air admitted to the lungs  should be tempered by the
use of the Respirator, or a muslin handkerchief tied around the mouth.
When the  invalid first ventures out  of doors,  nothing, indeed, is so
essential, in a prophylactic point of view, as avoiding extremes  and
sudden transitions of temperature.
  Cleanliness. — Although cleanliness in  the sick-room is essential,
yet it may be carried so far as to become  an annoyance to the inva-
lid, and consequently to prove  injurious.  It is not requisite to sweep
the room-daily, nor to dust and arrange the furniture every morning,
provided order be preserved in  the room, and nothing but what is im-
mediately necessary for the comfort  and convenience of the invalid
be permitted to remain in it.  It is truly distressing to observe the
confusion which prevails in  some sick-rooms;  everything  being out
of place, and to be searched for when  it is wanted. 
556        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
     The period chosen for cleaning and arranging* the sick-room should
   be the morning;  as, after a night's rest, the patient is more able to
   bear the little noise and bustle which it always more or less occasions.
•  The carpet  should be sprinkled with moist tea-leaves, and lightly
   swept; and  during this operation the  curtains of the bed, if there be
   any, should be drawn.
     It is scarcely requisite to insist on the  necessity of the utmost
   attention to the  cleanliness  of everything in  the  sick-room.   The
   moment after any vessel or implement is used by the invalid, it should
   be removed from the apartment, and returned as soon as it is cleaned.
   Nothing in the  form of a slop-basin or a slop-pail is admissible: they
   only administer to the laziness of nurses.
     The necessity of cleanliness in the vessels used for the  food of in-
   valids  is  strikingly illustrated in the bad effects arising from the neg-
   lect of it  when an infant is brought up by hand.  In such a case, if
   either  the feeding-bottle, or  the boat, which is  employed, be not in-
   stantly cleansed after the  meal  has been given, the small portion of
   the pap or food which remains in the vessel becomes sour, and taints
   the whole of the fresh  food  mixed with  it, causing colic and convul-
   sions in the infant.  The same risk of injury occurs in the sick-room,
   if the  vessels used for administering  food to the invalid  be not  in-
   stantly and well cleansed after every time they are used.
     It is too common  also to use one  glass  or cup for  administering
   medicines, and  to leave it unrinsed  from  time to time, — a custom
   which  may prove as deleterious as a defect of cleanliness in vessels em-
   ployed for food.  Some medicines, when they are  exposed  to  the air,
   rapidly undergo changes which alter their properties ; and this altera-
   tion having been undergone by  the small portion which is always left
   in the glass  or cup, communicates the disposition to be decomposed
   to that which may be next poured into the cup.   An active medicine
   may be thus rendered inert; or one which  is mild  in its  operation
   may be so changed as to operate with  hazardous energy.  The same
   precaution, as to cleanliness, is also requisite as to the minim measure,
   when  the medicines are directed to be administered in a form which
   requires its employment.

     Darkening the Sick-room. — It is a common error to imagine that
   a sick-room should always be either partially or wholly darkened.   In
  .some diseases,  as, for example, fevers, when the eyes are acutely sen-
   sible to light, so that they remain  half closed, and the  eyebrows are
   contracted, the  greatest relief is  experienced from darkening the room.
   When delirium is  present, a certain  degree of darkening is in some
   instances  serviceable; whilst in others, especially when  the delirium
   is accompanied with visual illusions, nothing so readily dispels these,
   and consequently abates the delirium, as the admission of the  full
   daylight into the  sick-room.   There is much difficulty, however, in
   determining  which state of the apartment is likely to be most ser-
   viceable  in any particular case.  Observation of  the effects of light
   and darkness, in the individual case, must be our guide.
     These illusions of the sight are generally the result of former im- 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.       _557
pressions, renewed at a moment when the brain is in such a disturbed
condition as to set aside the exercise of judgment.  In this condition
of the brain, the  renewed conceptions are not readily corrected, as in
health, by impressions  received  from  the external world;  hence, they
become more vivid in the mind of the invalid when the  sick-room is
darkened, and  all visible  objects are shut out.  They are usually dis-
pelled by new impressions on  the organ  of sense chiefly implicated;
on which account, those which are connected with sight seldom occur
during the day, when real objects are presented to the eye, unless  toe
brain be so over-excited as to bring the conceptive faculty into intense
exercise, sufficient to awaken those false perceptions which create a
belief of the presence  of individuals not only not present, but who
have  been long dead.   This state of the  mental organ is similar to
that on which depends the spectral illusions of the insane, but differ-
ing from it in its transient  nature.  I have frequently witnessed  the
conversation with one of these spectral beings  instantly terminated,
and the whole  illusion  dispelled, on opening the  window,  shutters, of
the room ;  whilst the invalid has thus expressed  himself:  " Bless me !
I thought I was talking with Mr.----, just now ; I must have been
dreaming; for  now  I recollect  he has been dead  many years."   A
twilight  obscurity in the  sick-room is often more productive of these
illusions than darkness.
                                          »
  The Nurse. — When all the arrangements are completed in the sick-
room, little benefit can be anticipated if a proper nurse be not obtained
to render them available to the invalid.  Every female, who wishes to
act as a sick-nurse, should be obliged to  serve a certain  time as an
assistant nurse in one of the public hospitals, and to receive a certifi-
cate of her efficiency before  she leaves the establishment.  The  ad-
vantages which the  public would derive  from a body of nurses edu-
cated in this  manner, must be obvious*  to  every  one who has had
opportunities  of observing  the miserable  working  of  the  present
system.
  In hiring a sick-nurse, the qualifications which  should  regulate  our
choice, refer to age, strength,  health,  temper, disposition, habits, and
education.

  Age.— She should not be under twenty-five, nor above fifty-five
years of age.   This period is  fixed upon,  on  account both  of  the
physical  powers  and the moral conduct of the individual.   Under
twenty-five, the strength  of  a woman  has not reached its maturity,
and is scarcely adequate  for lifting patients in  and  out of bed, and
for  many  other duties which  require  strength,  connected with  the
office  of a nurse; but the strength and the muscular power in females
begin to  fail after fifty-five, when the natural transition from maturity
to decay takes  place.

  Strength. — The foregoing remarks respecting  age render it  al-
most  unnecessary to  say  that a woman  of  a  naturally delicate
frame of body is unfit  for a sick-nurse : at the  same time, a coarse,
heavy, and masculine  woman is, for many reasons, objectionable. 
558         DOMESTIC MANAGEMENT OF THE SICK-ROOM.
.---•____________________________________________________________.
Whilst strength  is requisite, the frame should be such as to indicate
activity.

  Health. — None of the qualifications of a  sick-nurse are of impor-
tance more  than  health.   An individual who herself requires attention
is ill-calculated to  attend upon others.  A woman who is asthmatic,
or-has any difficulty of breathing, or an habitual cough ; who is rheu-
matic or gouty, or has any spasmodic affection ; who is afflicted with
palpitation ; or suffers from periodical headache, vertigo, or a tendency
to paralysis; or who is consumptive, or scrofulous; or has defective
sight  or hearing; or anything which causes decrepitude, is disquali-
fied for a sick-nurse.  It is important, also, to ascertain that there  is
no  hypochondriacal  nor  hysterical  tendency, nor predisposition  to
mental depression.

  Temper and Disposition. — It is scarcely  requisite to say that an
attendant upon the sick  should possess a happy, cheerful, equal flow
of spirits; a temper not easily ruffled; and  kind  and sympathetic
feelings ;  but, at  the same time, not such as to interfere with firmness
of character.  The  expression of the countenance should be open and
winning, so as to attract the good-will and confidence of the invalid;
a pleasing and gentle manner being  more likely to gain  esteem, and
insure obedience to the  orders of the physician, than the most per-
suasive arguments  which can be addressed  to the understanding of
the patient.
  , A collected, cheerful expression of the countenance, in the  attend-
ant on the sick, is likely to inspire hope, and  to aid the efforts of the
physician for the recovery of his patient
  The general disposition of a sick-nurse should  be obliging.  Every
little office which the invalid may require to  be done,  should be per-
formed at once,  and without the smallest apparent reluctance, even
when the necessity for  its immediate  performance is not absolute.
There is  also an earnestness of manner, which should, if possible, be
obtained  or acquiesced in by the  sick-nurse, as it impresses the idea
that she feels deeply interested in the case;  a circumstance which  is
always highly appreciated by the patient
  Finally, it is unnecessary to  say that a nurse should be honest, as
no description of servant  has so much in her power.  But the honesty
of the nurse is not to be measured  by her respect  for  property; she
must be above imposing on the physician, with respect  either to medi-
cines or to diet   Her religion, also, should be sincere, but not pharisai-
cal; and although she may occasionally persuade her charge " to put
his trust in  God, the fountain of health," * yet  she must recollect that
preaching is not her province ; and, when mistimed, even the best ad-
vice may prove not only profitless, but injurious: and this is especially
likely to be  the result, when the doctrines which she professes are of a
controversial kind.
  With respect to gossiping, it is a detestable habit under any circum-
* Fuller. 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.         559
 stances ; but, in a nurse, it  may be productive of the greatest danger,
 produce family feuds, and a thousand other evils.

   In her Habits, a  sick-nurse should be  sober, active, orderly, and
 clean, and neat in her person.
   The first  of these habits — namely,  sobriety, — is so essential  a
 qualification in every attendant in the  sick-room,  that it requires no
 comment.   Happily, the  desire for ardent spirits is now less frequent
 than formerly, when women  were seldom employed as nurses until
 they were nearly  superannuated,  and until their habits, good or bad,
 were too firmly rooted to be removed.

   The Activity essential for a good nurse does not imply a bustling or
 fidgety manner, but a quiet, steady method of proceeding in the per-
 formance of her duties, equally devoid of fluster, turbulence, or noise.
 This activity is generally associated with orderly habits ; a most valua-
 ble qualification, and without which the  sick-room becomes a scene of
 confusion and disgust.  Every medical man must have witnessed this
 state of disorder with regret, when, on visiting his patient, he finds no
 chair  to sit  upon, until some article of bedding, or of clothing, be re-
 moved from  it, and the  seat dusted with the apron  of the nurse ; and
 when a former prescription, or anything else, is wanted, he must wait
 until the nurse rummages out half a dozen of drawers in search of it
   Another quality, usually conjoined with activity  and orderly habits
 in a nurse, is cleanliness in her own person, and in  that of her charge,
 as well  as that of the  sick-room. The dress of a nurse should, be
 simple and neat, without trimmings.   Nothing is  more out of pTafte
 than a fine lady attempting to perform the duties of a nurse.

   Education. — It may appear a refinement to talk  of the education of
 a nurse; but there is not  a greater difference  between  noon-day and
 midnight than between  an educated and an ignorant nurse.   The for-
 mer is often  an aid to the physician,  not only in carrying his  orders
 into effect, but by observing and informing him of symptoms of great
 importance which  have  occurred during his absence :  whereas the lat-
 ter is a source of constant anxiety, and too often assumes the privi-
 lege of acting in  direct contradiction to his orders, and according to
 her own  opinion.


                    Unhired Attendants.

   The selection of  a good nurse, however  eminently qualified she
 may be for her duties, does not supersede the attendance of a rela-
 tive or a friend in the sick-room ;  on the contrary, I can conceive no
 condition so deplorable as that of an invalid left altogether to the care
 and management of  a hireling.  It is, nevertheless,  too true that  few
 ladies, even those who are wives and mothers, have any acquaintance
 with the  arrangements of  the sick-room,  and the management  of the
invalid ;  they are, consequently, too often forced to  be guided by,  and
 to rely for  instruction on, the nurse, instead of being able to superin- 
560        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
tend her conduct, to ascertain that she performs her duty, and to cor-
rect her failings.
  The degree of intelligence  which is demanded in  a nurse is very
different to that which is requisite for a wife or a relative in the sick-
room.   The intelligence of the nurse is directed  to supply theVants
of the invalid, to administer to his comforts, and to obey the instruc-
tions  of the  physician ; that of the  friend or relative  involves the
power of discriminating disposition  and temper; of watching the
progress of the disease, and judging of the propriety of not pursuing
certain measures, which, although indicated by the symptoms at the
time of prescribing, yet may require  to  be altered, and consequently
detailed to the physician, whose presence may be  requisite  before his
next intended visit.  It  is  of the utmost importance, also, that rela-
tives attending in the sick-room should, be able to control  their feel-
ings in the presence of the invalid.
  Nothing is more  essential, in the domestic management of diseases,
than a knowledge of the natural disposition and  temper of the inva-
lid.  An irritable or a passionate man requires a very different man-
agement from  that which  is proper for a man of naturally mild and
easy disposition. Disease  awakens in an augmented degree, the irri-
tability of the former; he becomes impatient of contradiction; and
every time his opinions are injudiciously opposed, the turbulent agi-
tation  of the nervous  system which follows, either increases the dis-
ease or weakens the influence of the remedial  agents.   On  the other
hand, a mild and gentle disposition  often leads to extreme sensitive-
lies^ when disease  attacks the body: a word, a look, is-sufficient to
touch some sympathetic cord; to unstring the whole nervous system;
and to augment the morbid susceptibility already present in the habit
to a degree which is not always devoid of danger.  Much discretion
and  judgment, therefore, are  requisite in  both instances :  in the one
case, to prevent  ebullitions of temper;  in the other, to refrain from
anything that might be construed by the invalid  into harshness ; and
yet, at the same time, in  each case, to maintain  that influence over
the patient which the treatment of every disease  demands in an at-
tendant on the sick.
                                                  •
  Prejudice and Antipathies. — In those who  are imperfectly or erro-
neously educated, the judgment is apt to be biassed by prejudice and
antipathies ; and, under the influence of these, it is misdirected in a
manner of which the individual is often wholly unconscious; thence
the necessity of freedom from prejudice in the attendants in the sick-
room,  and the farther importance of the friends or relatives of the
sick being able to  superintend the conduct and the  management of
hired nurses.  On the other hand, the judgment, even in the well-edu-
cated, is apt to be misled by the affections, the influence of which is
as much opposed to the healthy exercise of discrimination as the pre-
judices of the ignorant.   Self-control, therefore,  is also an essential
qualification of the sick-room.
   It is only from knowing that the  attendants of the sick  are pos-
sessed of intelligence  and self-control, that a physician can rely upon 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        561
having his orders correctly and duly executed :  when those  qualities
are absent, he has to dread, on the one hand, the presumption of igno-
rant prejudice; and, on the other, the improper yielding of  sensitive
indulgence.   To  the invalid, also, it is important to know  that  the
directions of his  physician are fulfilled by an intelligent person;  for,
even in the most severe diseases, as long as the mental faculties re-
main  unaffected, a sick man is capable of detecting ignorance, or the
effects of prejudice, in  his attendants;  and, when he is convinced of
the existence of either, all  the  influence of the individual, whether
nurse, or friend, or  relative, is at an end.
   Were the business of the sick-room (independent  of the wants and
comforts of the invalid) confined to the mere observation and  collec-
tion of facts — namely, the noting of the symptoms  of disease — and
reporting them to  the physician, it would be superfluous to urge the
necessity of superior intelligence in its  superintendent; but  many of
its duties require  not only  a  well-regulated understanding, but an
equally sound condition of the moral feelings and the benevolent af-
fections,  with  a recognition of  the  authority of conscience in  the
Whole operations of life.  In the period of sickness, under the direc-
tion of the judicious and discreet, an invalid may be led to the inves-
tigation of his moral and religious condition, and to review his  past
conduct, with the determination of turning the result to his  future
welfare, should he happily recover and re-enter society.   Surely such
important duties as these cannot be  intrusted to the unqualified, or
the ignorant, or the hireling; nor can more be required to demonstrate
the importance of adding to the other branches of  female education
a knowledge of the various important duties of the sick-room, which
females, whether as mothers or  daughters, or wives or  friends^ are
likely to be called upon to fulfil.


                         Prognostics.

   In every disease the medical attendant is naturally called upon to
deliver his opinion of the  degree of danger which hangs  over  the
patient:  hence, it unnecessary to enter into-any minute details on the
subject of prognostics.   But, as  in many diseases changes  occur, in
the absence of the practitioner, which ought instantly to be examined
into, in order that the danger  likely to accrue from them may be
averted, it is important that the friends and ordinary attendants of
the sick should be  aware of their presence,  so as to  obtain the imme-
diate  assistance  of the medical attendant.  Were  this information,
also, more generally diffused, many unnecessary visits would be saved
to the physician, and much unfounded suspicion of danger  prevented
from distressing and torturing the minds of  the friends of the sick.

   In  Fevers, delirium alone should excite no alarm,  unless it be very
high,  or of the low, muttering, incoherent kind.  In jaundice, and in
diseases  of the  chest,  it is alarming;  and in the latter  stages of
pulmonary consumption, its  presence always indicates the  approach
of death.                     „H 
562        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
  Great confusion of thought, loss of recollection  of the most recent
occurrence, a restless, wandering eye, and a correspondent vacancy or
confusion of countenance, are always to be dreaded in fevers and in
diseases  of  the brain.   An expression of great anxiety is  equally
alarming^n all acute diseases; and a presentiment of death is still
more to be dreaded.

  Hoarseness, with constant spitting, occurring at an  early period in
small-pox, is very unfavorable.

  Squinting in affections of  the head ought to be particularly noticed,
and mentioned to the attending practitioner;  and the same  remark
applies to a greatly contracted, or a dilated, or an immovable condition
of the  pupil of the eye; or the turning up  of the pupils under the
upper eyelids.
  Deafness is not an unfavorable occurrence in continued fever; but
a sudden  attack of headache  in pulmonary diseases ought instantly
to be mentioned to the physician.

  The  Sudden Disappearance of Pain  in inflammatory affections of
the bowels is always to be dreaded ;  but it does not in every instance
portend the existence of mortification.

  Cough  depending  on inflammation of the bronchial membrane,
suddenly  supervening on  a suppressed  eruption, is  always  to  be
dreaded.
  In Croup, when the breathing is  audible, or when there is a crow-
ing sound in inspiration, or a cooing or croaking respiration, danger is
present.
  In Hooping-Cough, when  the  paroxysms suddenly increase in vio-
lence, and the face becomes livid, and the thumbs are drawn across
into  the palms of the hands, the  appearance of convulsions may be
anticipated:  hence immediate notice of these symptoms should be
communicated to the medical attendant.

  Rigors  invariably excite  alarm;  but they are only dangerous in
chronic internal diseases, in which they often indicate the formation
of pus, or the existence of suppuration.

  Pallidness of the countenance, with a slight degree of lividity, are
symptoms of hazard in the inflammation of the lungs.

  The  Position of the Patient as  he lies in bed, especially in fevers,
is of much  importance.  Constantly  lying on  his back, with a ten-
dency  to  sink  to  the  bottom of the bed; a propensity to keep the
arms and the feet out of bed, and  to uncover the trunk; or to pick
the bed-clothes ;  tremors ;  twitching of the tendons ;  grinding of the
teeth, and 'sleeping with the eyelids half  open, and the white of the
eyes only seen ; are all justly regarded as symptoms of great danger.

  Fainting (Syncope) is to be considered alarming in  diseases of the
heart,  or  during profuse bleeding from the nose, or from any  other 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        563
part: deep sighing, also, under such circumstances, is most unfavora-
ble, and often indicates rapid dissolution.

   Hiccup, in the advanced stages of either acute or chronic diseases*
is invariably alarming.

   Difficulty of Swallowing, also, in the advanced stages of fever, palsy,
and affections of the head, always indicates extreme danger; vomiting,
on the  contrary, is not unfavorable, unless it be very  severe and pro-
tracted ; but, if the ejected matters be  putrid, or feculent,  then  the
vomiting is always to be dreaded.

   Coma, or an irresistible propensity  to sleep, following the sudden
suppression  of gout, or the cessation of periodical bleeding in piles,
or the healing of old sores, is always  alarming, and requires prompt
medical assistance.
   Convulsions without fever  or any  affection of the head, seldom
prove dangerous : but they^ire never free from danger when they are
accompanied with stupor or coma.  They are also dangerous when
inflammatory fever is present.   The^r are less dangerous in women
than in men, in the young than in advanced age.   In infancy, convul-
sions are more  to be dreaded in the robust thaTi in the delicate and
irritable child.
   Diarrhoea is, under every circumstance, an unfavorable event, when
it occurs either  in fevers, or in the termination  of chronic diseases;
and the passing of involuntary  stools, when  scarcely any diarrhoea
exists, is equally to be dreaded.

   Retention of the Urine, as well as its involuntary discharge, is aL
ways an unfavorable symptom.

   Purple Spots appearing on the skin,  livid  lips and cheeks, oozing of
blood, sudden flushings followed by pallor, are unfavorable symptoms;
and the appearance of  oedematous swellings of the legs and skin in
the last stage of chronic organic  diseases, always indicate approach-
ing death.   When purple  spots,  also, appiar in  small-pox, with  flat-
tening of the pustules on  the  trunk of the body, and a white pasty
aspect of the eruption in the face; and  if,  at  the  same time,  the
extremities become cold, any hope of  recovery can scarcely be enter-
tained.
   Great and continued, or progressing emaciation in chronic  diseases,
and what is termed the fades Hippocratica,  are to be dreaded.

   Excoriations on the parts on which  the body rests, — for example,
the haunches, or the  lower part of the back, — especially if these be-
come livid and sloughy, always indicate extreme  danger.

   Great Difficulty of Breathing, even to a  feeling of suffocation, is
not necessarily hazardous in asthma;  for although few diseases  are
so little under  control  by the  interference  of the  physician,  yet,
asthma  seldom proves fatal, unless it tends to the production of other
diseases. 
564        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
  In Consumption, partial  sweating, as of the  head, the chest, or the
limbs, are always unfavorable symptoms.
  When pregnancy occurs  in a woman laboring under consumption,
the disease  is arrested, until after  delivery, as if Providence threw a
shield over the mother for the safety of the offspring.

  The Sudden Disappearance  of Swelling of the Legs, in chronic or-
ganic diseases, is indicative of approaching death.
  When a child, instead of rallying after any acute disease, becomes
emaciated, and the belly is large and tympanitic, there is always much
danger.

  Ovarian Disease, or, as  it  is  usually termed, ovarian  dropsy, has
hitherto proved  incurable; but it is relieved by tapping; and, if the
powers of life be  sustained by proper food, and carriage exercise in
the open air; and if all medicines be let alone, except such as are
required to regulate the bowels, life may be sustained for many years.
  All diseases not involving  organic changes, are, with a few excep-
tions, more or  less under  the control  of medicines, and are conse-
quently curable.   But some diseases, in which no organic changes
have been  discovered, are  nevertheless incurable.   This is the case
with spasmodic asthma, which has  rarely  been  cured.
  It is true that functional  disturbances are .not unfrequently associ-
ated with organic diseases;  but, under such circumstances, it is the
province  of  the attending physician to point out to the friends of the
patient the greater or the less degree of danger  in these complications.


       Diet, etc.,  in Disease and Convalescence.

  In numerous  instances,  much hazard often  exists after disease has
disappeared, and when the patient is declared convalescent: and as
this period in the removal of diseases is left to the management either
of the patient himself or of his friends, some general remarks respect-
ing it, and also in reference^o particular diseases, are requisite.
  In every recovery from sickness, whether external or internal, before
the salutary advantages obtained  from the  treatment be confirmed,
the organ or part which has suffered must be  either left at rest or be
used, according  to the nature of the  case.  Thus, if any part  have
suffered from inflammation, it must not  be  used for some time after
the inflammation  is subdued.  If the  eyes have suffered, the person
must neither read nor write, nor expose the eyes to the heat of the
fire, nor  to  a strong  light, until  some  days  after  every trace of the
disease has disappeared.   If the arm has been affected, it must be
kept at rest; and if  the leg, not  only should walking be  refrained
from, but the limb should be placed rather higher than the trunk of
the body.  If the previous  disease  has affected the brain, every men-
tal exertion  must  be avoided ; and  so on, whatever may be the organ
which has  especially suffered.  Even when the exercise of the organ
is resumed, it should not be carried to fatigue, nor, on any account,
should it be such as to produce excitement.   At  the  same time, it 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        565
 must not be forgotten that, in the treatment of external injuries, when
 it has been necessary to keep the limb long in a sling, in one position,
 — as, for instance, in fractures, — the .muscles which bend the  arm
 acquire from  the habit  a  contraction which  cannot be overcome by
 the  antagonist muscles, owing  to the length of time they have been
 on the  stretch weakening their contractile  power.  The arm, there-
 fore, should be frequently taken from the sling, and, being rested upon
 the elbow, a moderate weight should be held in the hand, and friction
 with oil employed upon the contracted muscles.   It is true that sur-
 geons usually give  directions for this operation, before they quit the
 management  of the case; but surgeons, as well as physicians, are
 sometimes  dismissed before the convalescence is complete; on  which
 account, arms and limbs have remained contracted for life, from a want
 of the knowledge necessary to counteract the evil at an early stage.
   I say nothing  respecting the  continuance of remedies  during con-
 valescence  from many diseases, except urging the  necessity of regu-
 lating the bowels.
   The  most important part of the management of convalescence cer-
 tainly refers to air, exercise, and  diet.   The  errors daily committed,
 in all of these matters, exert the most powerful influence in retarding
 complete restoration to  health; and often, indeea, induce  evils of a
 more formidable kind than the  diseases  from which the patients have
 just emerged.
   1.  Air.   In  every convalescence,  whatever  may  have  been  the
 nature of the  disease, if it has  been  so  severe as to wear  down the
 strength of the  invalid, country air is  essential.   The  benevolent
 Author of our existence has made medicinal the hills, the vales, the
 groves,  and all the harmonies of nature; and in  the repose of these
 man  finds a balm, not only for a wounded spirit, but for his stricken
 body.
   In selecting a country residence for a convalescent, care must be
 taken to ascertain whether any  source of malaria exists in the neigh-
 borhood ; as, in that case, even if all other circumstances be favorable,
 the place is exceptionable.
   2. Exercise.  In convalescence, much caution is requisite in appor-
 tioning  the exercise to the degree of returning strength.  When the
 convalescent is still too feeble to take sufficient exercise on foot, the
 best substitute for it is riding horseback ; but, as soon as walking can
 be borne, it should be preferred to either horse or carriage exercise.
   3. Diet.   In health, diet may be left, in  a great  degree, to the in-
 clination or the taste, as far as regards the quality  of the food; and,
 although diseases occasionally  originate from repletion,  yet, in gen-
 eral, the appetite may be considered as the best regulator  of quantity,
 when the food is simple, and the appetite  is not pampered by high
 seasoning and rich sauces.   In  disease, however, a very opposite rule
 is to be  observed: the regulation of both the quantity and the quality
 of the food is  of the utmost importance.  The taste is often so per-
 verted as to desire that which woul<4 prove injurious ; and were appe-
tite to be the guide of quantity, diseases would frequently not only be
increased in severity, but life itself would be brought into jeopardy. 
566         DOMESTIC MANAGEMENT OF THE SICK-ROOM.
  As soon  as solid  animal food  can be  taken with  impunity, that
which is most digestible should be  selected.   An opinion has gener-
ally prevailed that gelatinous matters, and meats which readily yield
jelly, — such, for  example, as veal and  lamb, — are the most easily
digested, and at the  same time, are also the most nutritive.   This is
a mistake;  for, with  the exception of poultry, the flesh of young ani-
mals is  stringy and of a lax fibre, and is even less easily digested than
that of  too old animals,  which presents a great density of texture.
The middle-aged animals afford the most digestible food.
  Nothing tends  to  lessen the density of the fibre of every kind  of
animal  food so much as  keeping  it for a certain time before it is
cooked.  In this case, the tenderness is the result of incipient decom-
position or putrefaction ;  but the  utmost caution is requisite to pre-
vent this from  advancing  so far  as to  present the slightest trace  of
taint, in the food of the convalescent.  In  the low state of vitality in
convalescence, the change which  commencing decomposition  (putre-
faction) causes, renders animal food, in that condition, a source likely
to occasion either a  relapse into the disease from which the patient
has recovered, or to form a new disease.
  In examining the relative value of other articles of diet adapted for the
sick and the convalescent, the first which presents itself to our notice is

  Milk. — As milk is the food of almost  all young animals, its diges-
tibility appears  at once evident;  and there can be little doubt that it
is very digestible, when it is drunk immediately after it is drawn from
the udder of the cow, or that of the ass, or the goat, before its com-
ponents have time to separate.   When this  separation  is effected,
either spontaneously  by time, or by means  of rennet or  other agents,
its properties are altered, and its digestibility is lessened.
  Cream, when  intimately united with the other components of milk,
— namely, the curd,  or the  caseous part, and the whey, — is not the
same substance as after its separation.  In the milk, it is more easily
digested, and is the most nutritive part of  the milk.  But in its sepa-
rate state, it is ill adapted  either for the sick  or convalescent, except
in the form of butter, which is not unwholesome, unless it  be  eaten
in excess or be melted*  In the same manner the separate curd is in-
digestible ; and whey itself, although highly nutritive, yet is flatulent;
nevertheless, it is  an  excellent demulcent  in  many cases  of disease.
But  none of the components  of milk are equal  to milk itself.  It  is
often necessary, in convalescence, to dilute it in water.
  Eggs. — It is  not uncommon to  hear  that the yolk of a raw egg,
beaten up with water and sugar, with the addition of a small quan-
tity of white wine, is a light and  nutritive aliment  in convalescence,
and even in some  states of disease : but eggs are much less digestible
in this form than when they are lightly boiled.   In jaundice,  however,
arising from viscid mucus obstructing the orifice  of the common duct,
the yolk of  a raw egg beaten up with colcL water is serviceable.

  * [Although cream is not as digestible as milk, yet it is much less liable to turn acid
in the stomach; it is often beneficial to dyspeptics, either alone or diluted with water.] 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        567
  Fish, at least  the white  kind,  stimulates much  less than the  flesh
of land animals;  hence it is a proper food  for those laboring under
some acute diseases;  and also for convalescents, when a sudden re-
turn to more stimulating food  would  prove hurtful.  But it is not
adapted for convalescents, when the object is to bring up rapidly the
strength of debilitated habits.
  Raw oysters  have  been erroneously supposed to be both  easy of
digestion  and nutritive.   The latter opinion is, in some degree, true;
but  the former is erroneous.  Raw oysters  are less digestible  than
plainly cooked oysters.  Both are improper for the sick and for early
convalescents.   Lobsters,  crabs, prawns, cray-fish,  scallops, and other
shell fish, are still more objectionable.
  If fish of any kind be admissible, it should be simply boiled:  fried
fish  is even worse for invalids than the outside or the brown of roasted
meat.
  Vegetables. — In reference to  vegetable diet, it  is only the  mildest
description of esculent roots  that are fitted for the use of the sick.   In
preparing all of them for the sick-room, they should be well boiled in
two distinct waters, until they  are soft and very soluble, and in a state
not  to leave undissolved anything which could act  as  a mechanical
irritant on the  intestinal  canal.   When properly cooked, they are
moderately  nutritive,  and free from any stimulant  properties; and
they are well adapted  for  the stomach of the sick, unless  in cases in
which the torpor of the organ  is  such  as to permit them to run into
acetous fermentation and to  prove flatulent.

  Fruits. — With respect  to fruits, they produce the most deversified
effects: and, consequently, are more or less proper  for  invalids, ac-
cording to circumstances, either  connected with  themselves  or  with
the condition of the patient  at the time.  The stone fruits, with the
exception of the ripe peach,  or the nectarine, are to be rejected.   The
apple tribe, except very soluble  pears, are  still less admissible.   The
apple, however,  when roasted,  and when the seeds and  the hard cen-
tral  parts, as well  as the skin, are removed, is less objectionable ;  and,
as it possesses laxative properties, the roasted apple is well adapted for
the sick, when food is at all allowable, and when  the bowels  are tor-
pid.   The orange, if fully  ripe, is grateful and wholesome to all inva-
lids, and is only equalled in these qualities by the grape; but in using
the orange, the pulp should  be rejected.  Care, also, should be taken •
not to swallow either the skin or the seeds of the grape.   Strawberries
are a little stimulant, of easy digestion, and more  cooling than the
other small fruits; mulberries are, also, unexceptionable; but currants
and  gooseberries,  and even raspberries, are not free from objection for
invalids laboring under acute diseases.
  With the exception of  oat and wheaten bread, all the varieties of
farinaceous aliments may  be regarded as modifications of starch, con-
taining little nutritive matter, and therefore well adapted for the  sick-
room.  It has been supposed that arrow-root, sago, tapioca, and simi-
lar substances, are very nutritive, because they form mucilages with
boiling water: but this is  not  the  fact; and were  they very nutritive,
« 
568        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
   they would be ill adapted for invalids.  Rice in every case where the
   stomach is in an acescent state, is preferable to the other farinaceae,
   because it is less fermentable.
     The farinaceous food, which is ordered in the convalescence of chil-
   dren from acute diseases, is  often made of bread so as to constitute
   pap.   No description of food has a greater tendency than this to be-
   come  sour;  a  quantity only sufficient  for  a single meal, therefore,
   should be made at a time;  for what remains is always  sour before
   the  next  meal; and even if the quantity be small, and it be mixed
   with fresh pap, it communicates  its faculty of becoming sour to the
   whole mass.


                          Fluid Aliments.

     Water. — The best and the most universal beverage for the sick is
   water:, but  the  qualities of  water differ,  according to the  sources
   whence it is procured.  The fewer foreign ingredients  it holds  in
   solution the greater are its diluent properties.  Distilled water, or rain
   or river water  filtered,  and that of soft water springs which filtrate
   through silicious strata, are  the only kinds  proper for the use of the
   sick-room.  Hard water, under whatever name it is found, whether as
   spring water, or pump water, or well water, should be excluded.   The
   impurities of river and rain water are merely held in suspension;  con-
   sequently, they are readily removed by filtration.
     Water  itself is aliment; many  individuals under certain  circum-
   stances have lived for a considerable time upon it alone.   Those  who
   live  chiefly on  animal  food require more drink  than those who eat
   much vegetable matter.
     The influence of water on the animal economy may be regarded in
   two  points of view:

                         As an article of diet.
                         As a medicinal agent

     As an article of diet,  in health, water is the beverage provided by
   nature for all animals,  man not excepted.   The sensation of  thirst is
   the natural call for fluids, either to assist digestion, or to allay a dry,
   hot condition of  the mouth and the gullet.   The consequence of not
•  satisfying this  call is fever of a nervous kind; and, if  it be long re-
   sisted, inflammation of the  air passages.   On  the  other hand, too
   much fluid is injurious ; for although the vital powers of the stomach
   counteract the  tendency which it affords, by over-diluting  the gastric
   fluid, to the  fermentation of the aliment in the stomach, yet,  when it
   is in excess, those vital  powers languish; hence spontaneous chemical
   changes in the  contents of the stomach take, place, and induce  dys-
   pepsia. For all the purposes of dilution, in health, water is adequate,
   and it is the only truly wholesome beverage.
     As a medicinal agent, water is demanded in every disease in which
   a dry skin, and an elevation of the natural heat of the surface, consti-
   tuting fever, are present.  In this case, the desire is for cold water, or
# 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        569
cooling fluids;  and it should always  be indulged.   The degree  of
temperature, however, must be regulated by the condition of the in-
valid : but the best medium temperature is between 50° and 60° Fahr.;
although even 60° is too low, when the  debility of the frame is consid-
erable.
  The qualities of the various kinds of beverages proper, and gener-
ally employed in the sick-room, should  be known.

  Toast-water, when properly  prepared, which it seldom  is, forms a
useful beverage in the sick-room.  It is slightly nutritive, owing to its
containing a small  portion of gluten, in conjunction with fecula and
sugar.   It is one of the oldest and one of the best diluent demulcents;
diluting at the same time that it softens the acrimony of the secreted
juices  of the stomach, in febrile diseases.

  Gruel, whether made of groats or of oatmeal,  is  less mild and de-
mulcent than barley water ; and it is more likely to undergo the ace-
tous fermentation in the heat of the stomach; a circumstance which
is greatly favored by the sugar and butter which is sometimes added
to it.   Unless gruel be very thin, it can scarcely be regarded as dilu-
ent ; and when thick, it is too heating an aliment for patients laboring
under febrile symptoms.

  Tea, in the form in which it is usually taken, is too stimulant and
astringent to be a £ood diluent;  and, when it is strong, the narcotic
property which it possesses renders it improper  for most invalids,
whatever may be the nature of their diseases.  As it is, nevertheless,
agreeable to  most palates, and very refreshing, it may be taken in
moderate quantity, provided it be not strong, without any  hazard.

  Sage, balm, and mint teas, are often substituted for common tea.
Each of them undoubtedly allays the irritability of the stomach in
some cases ; but, as general beverages in disease, they are  less useful
than toast water.   Raspberry vinegar, lemonade, tamarind lea, apple
tea, and similar compound diluents,  should never be  administered
without the consent of the physician.   If a patient be taking an anti-
monial, they wall excite vomiting; if a mercurial,  griping; and they
are equally incompatible with many other medicines, and  with  many
conditions  of the  stomach in disease.   They  are a description  of
beverage greatly recommended and  largely distributed  by the  Lady  m
Bountifuls in the country, and  have  frequently been productive  of
serious mischief.

  Coffee is more heating, and,  consequently, less admissible than tea ;
it may, however, be taken, if it be largely combined with milk.   Cocoa
and chocolate are still more objectionable than either tea or coffee in
the sick-room.

  With Respect to the Number of Meals, and the periods best adapted
for  taking them, it is  scarcely requisite to remark, that, although in
health, three  moderate meals, at proper intervals, are customary, and
well adapted for the support of the frame, yet, under the changed 
570        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
condition of the system in disease, it would be improper to take any
regular number of meals, or to observe any stated periods for taking
them :  hence no general rules can apply.
  As a general rule, in the decline of diseases, and on the approach
of convalescence, when the desire of taking food returns, the best time
for the principal meal, dinner, is about two  hours after noon.  If the
breakfast be taken at nine o'clock, and the evening meal at seven, the
hour of two is the middle period of the day ; so  that, when dinner is
taken  at that time, the intervals  between breakfast and dinner, and
between  dinner and supper,  are not  only  equal, but  neither is  too
short to limit the complete  digestion of the previous  meal; nor too
long to injure the  powers of the  weakened stomach  by protracted
fasting.
  All  acute diseases require more or less abstinence, especially when
the object  of the  treatment  is to lower the  system; and in some
chronic affections, abstinence is almost essential.  If this be true, the
necessity of the strictest observance of the directions of the physician
on this subject  must be  obvious.  It is one, however, which is  not
only neglected, but  is often  combated both  by  nurses and  friends;
and  indulgences, which  are   supposed to be of  too trivial  a nature
to cause any injury to the  sick, have often been followed by fatal
effects.
  But, although abstinence  be  requisite during  the existence of an
acute  disease, yet it is injurious when  it  is too Rigidly maintained
after convalescence  is actually established; it often induces a new
train of symptoms, not very  unlike those for which it was properly
prescribed, and  the  removal  of which it has aided: namely, accel-
eration of  the pulse, increased  impetus of the heart, headache, and
even delirium.

                      General  Diseases.

  Happily, in febrile affections, the  appetite of the invalid is not in
a condition to desire food;  and  no  stronger demonstration can be
required of the impropriety of forcing it upon him under such circum-
stances.  Simple fluids, such as diluents, are  all that  he  desires, all
that the stomach can bear; and such alone should be administered in
fever, before  that low condition of the system,  which demands  the
use of wine  or other stimulants, supervenes.  In these  cases, when
the patient desires more nourishment than is usual, animal food ought
not to be  given, unless  by the direct recommendation of the physi-
cian.   Indeed, in  general, the inclination of the invalid  happily re-
volts from  animal  food, as much as experience condemns its adminis-
tration.
  While febrile symptoms are present, farinaceous matters, little  nu-
tritious, such as barley-water,  gruel, arrow-root mucilage, or sago,
acidulated with lemon-juice, and sweetened to the taste of the patient,
are most suitable ; but even these should be given in small quantity,
and at considerable intervals.   The beverage generally most agreeable,
and  also most salutary, to those suffering under fever, is cold water. 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        571
  In the decline of fevers even, as I have already remarked, although
the severity respecting diet should be relaxed, yet much danger  may
result from mistaken kindness and over-zeal, in urging animal and
stimulant food at too early a period of the convalescence.  Indeed,
the necessity of caution at this time is  greater than  during the  con-
tinuance of the fever; and the  more acute the disease has been, the
greater  must be the caution in the convalescence,  especially if the
treatment has been of an evacuant and lowering description.
   The  first change of diet, in  the  decline of fevers,  should be to an-
other article of the same kind of food which was allowed in  the dis-
ease ; for example, from  simple arrow-root mucilage to arrow-root and
milk, or to some  other of the farinaceous  compounds ; whilst, at the
same time, asses' milk may be given, in small quantity in the morn-
ing.  Rice, one of the farinacese, is generally supposed to be astrin-
gent, but this  is a mistake.  It forms an excellent diet in all  cases of
early but decided convalescence.   It should be well boiled, and mixed
either with broth and beef-tea, or gravy which  has been  cooled, and
the  fat taken  from it.   In  the  transition to animal  food,  beef-tea,
chicken-broth, and mutton-broth, and other liquid animal decoctions,
should  be first resorted to;  then white-fish,  simply  cooked ; for,  al-
•thoucrh fish is  more  digestible than animal food, yet it affords much
less stimulant nourishment;  it is therefore better fitted for the  early
stage of convalescence.   When  convalescence  is  completed, a  more
generous diet is admissible.
   With respect to beverage, water, toast-water, or lemon-peel-water, is
sufficient, until the  medical  attendant declares  that a little wine is
requisite.
   In convalescence from fever, it is an error to permit the patient to
get up  too soon.  He should not leave his bed until his  strength be
considerably advanced.    No danger can  result from  too strict  an
observance of  this rule ; whereas much risk may be incurred by its
neglect.
   If the head  has been  much affected, every mental exertion should
be refrained from during the convalescence ; and,  according to  the
degree  of suffering in any local organ, precautions  must be taken to
guard that part of the frame against a fresh attack of disease.

   Eruptive Fevers require more precaution in convalescence than gen-
eral fevers, both as regards diet and exposure to sudden  alternations
of heat and cold.  This is more especially essential after measles and
scarlet  fever.
   Measles are  often followed by a distressing cough, and other symp-
toms of pulmonary inflammation ;  or by a harassing diarrhoea, which
wears  down the strength; or by inflamed eyes, catarrh, or obstinate
toothache.   In infants, canker of  the mouth occasionally makes its
attack  and proves fatal.  All these affections,  after measles, might
generally be prevented  by taking care not to allow  too soon a return
to the use of animal food, or too early an exposure to cold or to night
air.  Even in summer, flannel should be worn next  the skin for some
weeks  after the disease has disappeared. 
572        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
  Scarlatina  is frequently followed by dropsical symptoms;  which,
however, might generally be avoided by the same attention to diet
and regimen as after measles.

  Small-Pox, when severe, and especially when confluent, is very apt
to awaken into activity the dormant seeds of scrofula, if any heredi-
tary taint  exists in the constitution:  hence  abscesses, ulcers, and
swelled glands, make  their appearance.  These demand  the  aid of
the physician or the  surgeon.   But  if the convalescent be properly
dieted, and recourse be had to a change of air as soon as his strength
will permit, these evils may be avoided.

  Erysipelas  not  unfrequently attacks convalescents from  small-pox
and other eruptive fevers.  When it occurs, independent of any prior
disease, the same attention to diet and regimen is requisite as in other
eruptive fevers.          •

  Convulsions, it  is well known, are not unfrequently the result of
errors in diet, in individuals with an  irritable condition of the stom-
ach and  bowels.   Advice should always be demanded respecting the
diet of those  who are  liable to, and who suffer from, convulsions; but
it must not be supposed that, when they occur in children  and have*
been subdued,  a system of starvation is necessary to prevent their
recurrence.   As far as  regards convalescence in such cases, it will be
proper to bear in recollection the following rules :
  1. When the patient is of a full habit, has a short neck, and a ten-
dency to diseases of the head, the diet should be spare.  The use of
animal food, indeed, in such a habit, should be wholly prohibited in
childhood, and  very sparingly employed by adults ; whilst vegetables,
farinaceous matters, milk, and weak broths, may be allowed.
  2. When the habit  of body is spare, and when languor and chilli-
ness are  present, the  diet, although free from stimulus, yet should be
nourishing, and consist of  the lighter kinds of animal food; namely,
poultry and fish, with a moderate share of  vegetable matters.
  3. Under all circumstances, and at every period of life, fermented
liquors and  wine  should  be  either wholly avoided, or very sparingly
used, in almost all convulsive diseases connected with  affections of
the head.
  In convalescence from some  varieties of convulsive  diseases, the
nature of the diet must depend on  circumstances which cannot be
judged of by the attendants of the sick-room : hence  it should be
referred solely to the medical attendant.   In St. Vitus's Dance (chorea),
for example,  although a tonic plan of treatment may have been  suc-
cessfully pursued, yet  the diet may be required to be mild, and wholly
free from stimulus.
   Attention to diet in Hysteria is most important  When the disease
is  connected with indigestion, the meals  should be moderate; and
rest in the horizontal posture should be indulged for an hour after-
wards, and then moderate exercise taken.  Fluid food, such as broths
and gruel, are  improper; yet animal food should be eaten only once
a day.  Tea and coffee should be very sparingly taken ; and the sim- 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        57l
plest beverages, even water and toast-water, should be taken in great
moderation after a meal, and should not be drunk during dinner.
  In convalescence from hysteria, change of scene and air are abso-
lutely requisite.   The mind should be directed to  solid studies, and
everything which can cherish morbid sensibility of the nervous system
avoided.
  Dropsy. — An opinion was long  maintained that fluids are to be
withheld  from dropsical patients.   No opinion was ever founded on
more erroneous principles.  Dropsical patients, indeed,  should be al-
lowed  the free use of fluids.  With respect to diet, it should, gener-
ally speaking, be  light and unstimulating: but much depends on the
causes  of dropsy.  There is, however, less necessity  for a rigid ad-
herence to low diet in this than in other inflammatory affections.

  In Palsy,  abstinence from  all stimulating food, solid  or fluid, must
be rigidly observed; and the  restriction should not be  discontinued in
convalescence.  At the same time, change of  air and of scene is al-
ways of decided advantage.   In every instance, an easy state  of mind,
and freedom from every source of irritation, as well as from the anxi-
eties of business,  are indispensable.

  Gout  and  Rheumatism. — In no diseases affecting the general habit
are abstinence and repose more essential during the attacks than in
the two which head this paragraph,  when they assume an acute form.
When  they  occur in weakened or  in broken down habits, it is too
often supposed that the opposite plan of diet  is to be  pursued, and
that stimulating food and a liberal supply of wine should be indulged;
but nothing is more likely to  prove injurious.
  When the paroxysm subsides, it  is too customary to permit the in-
valid to glide into his usual habits with respect to diet and regimen ;
consequently the  plethora which originated the disease gradually re-
turns ;  and the same plan being continued,  paroxysm follows  after
paroxysm, at shortening  intervals, until  scarcely any interval occurs ;
and life is sacrificed on the altar of  self-indulgence.
  For  some weeks after the paroxysm  of gout has subsided,  in a
young or a middle-aged man, animal food should be sparingly taken,
and fermented liquors altogether avoided.
  Chlorosis, or Green Sickness, is a state of the  habit which seems to
depend  on an impaired  condition of the blood itself.   Its treatment
is well  understood, and • recourse to medical  advice should never be
neglected; otherwise it may terminate either in mental derangement
or in sudden death.  In convalescence from it, the diet should be mild
and light,  but nutritious; the exercise should be much within the  lim-
its of fatigue, and consist of both walking and horse exercise, daily,
in the  open  air:  the  body,  more  especially  the  lower extremities,
should  be  warmly clothed : the mind ought to  be amused ; all seden-
tary occupations thrown aside ; and confidence placed  in  the honor
of the  physician, who  should be made  the repository of any mental
anxiety, especially connected with  the tender  passion, which may be
preying upon the  vital energy of the body. 
574        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
                  Affections  of the Head.

  Whatever may be the cause of Apoplexy, no disease requires more
prompt and energetic treatment  : the alarming nature of the  symp-
toms  is always  sufficient to prevent any time from being lost by at-
tempts to relieve the sufferer without medical assistance.  Should the
attack not prove fatal at the time, and should it  not be followed by
palsy, still the utmost caution is requisite to prevent a recurrence of
the disease.   It  is scarcely  necessary to insist on the strictest  adher-
ence to temperance, both as to meat and to drink; and the impor-
tance of daily exercise, when the  attack  is over; and indeed for the
remainder of life.  Prolonged study and  intense thinking  roust be
given up ; the violent and exciting passions should be subdued;  and
even the pleasurable moderated.
  Inflammation of the brain is one of those diseases which reqmre, as
observed respecting Apoplexy, the most  energetic treatment.   When
convalescence has fortunately been  established, the  attention  of the
physician is  still requisite, during several weeks, until  complete re-
covery be fully confirmed ;  for the brain, after  suffering  from inflam-
mation, is very apt to relapse into the same state, from the excitement
of too full a meal, or over-exercise, or even slight mental exertions or
emotions.  On this account, the  convalescent must be kept perfectly
quiet, and completely free from the  smallest excitement; and the
strictest regimen observed.   His diet should  not only  be mild  and
unstimulating, but small in quantity.
  Inflammation of the eyes  requires the same caution when convales-
cence is  secured  as  other inflammatory  affections; namely, quiet,
great moderation in diet, and avoiding exposure  either to much light,
heat, or cold, or  whatever can  stimulate the still  highly  excitable
organ.

                  Affections  of the  Chest.

  Inflammation of the Lungs (Pneunfonia).— In convalescence from
this disease, the temperature of the room in  which the patient sits
should not exceed 60° F.;  and it should be free from currents  of air;
but, at the same time, it should  not be close.  The necessity for con-
tinuing  the  same elevated position of the shoulders when in  bed,
which is demanded during the existence of the disease, remains even
when the convalescence is advanced.  The patient should be  pre-
vented from talking,  and from exerting any muscular motion that can
accelerate the circulation.   The diet  should  be of that description
which will  support  the strength without exciting or producing reple-
tion.  As the convalescence  advances,  and  exercise is  permitted by
the medical  attendant, it  should be regular, but not hurried nor vio-
lent ; and evening air should  be sedulously avoided.

   Pleurisy. — Inflammation of the  lining membrane of the chest re-
quires the same attention  to  diet and regimen during convalescence 
DOMESTIC MANAGEMENT OF THE SICKROOM.         575
as the last-mentioned disease, except that  a greater strictness with
regard* to abstemiousness  in  food is requisite ;  the least  deviation
being likely to bring on a renewal of the inflammation.  When the
disease assumes a chronic character, and when the object is to remove
fluid effused into the cavity of the chest, and pressing upon the lungs
so as to circumscribe their action, the same degree of strictness with
respect to diet is not necessary; but,  as in this condition of the habit
the physician must continue his attendance, the regulation of the diet
devolves upon him.

   Angina. — In  that condition of  the habit, which  is connected with
a predisposition to gout, but in which, instead of  a  regular paroxysm,
the heart and the pulmonary organs become affected, and the disease
assumes that  form which has been denominated diaphragmatic gout
(Angina pectoris), the regulation of diet is of vital importance;  and
it  should be of  as  low a standard as the constitutional powers  will
admit.  It should not be of a description either to nourish much, or
to augment or to cause fulness of habit:  mild animal food, in mod-
erate quantity, may be allowed ; but the staple should be of a farina-
ceous kind; every stimuJant, whether solid or fluid, should be avoided;
and wine and malt liquors regarded as poisons.   The invalid himself
should be made  aware, that whatever tends to excite or to hurry the
circulation is calculated to bring on a paroxysm ; nor is it sufficient
that he avoids all stimulating viands and beverages; he should  also
be instructed that the same  deleterious  effects  are  likely  to follow a
full meal, even of the most proper and mildest food.
   The same attention  to diet,  both as regards quantity and quality is
essential in palpitations depending on organic disease of the heart

  Asthma. — In  no affection of the chest is attention to diet so impor-
tant as in asthma.  Sir John  Floyer, who Tiimself  suffered from the
disease, recommends almost a degree of abstinence ; which is correct
in reference to quantity ; but the diet, although of a light, yet should
be of a solid,  kind.   This is  especially necessary,  when dyspepsia is
present to aggravate and excite the disease of the lungs.

  In Hooping-cough, the diet, whether the patient  be un adult or a
child, should be  of the mildest description ; and, perhaps,  no nutri-
ment is so well adapted to support the  tone of the body, without
exciting it, as milk.   In infancy, nothing but the  breast should be
given ; the system of the nurse, at the same time,  being kept as  cool
as possible by mild diet, and her mind in a tranquil  state.   If convul-
sions  occur, these sometimes  depend on  the nature of the milk; in
which case the  nurse  should  be changed.  It is  still customary with
non-professional persons to consider change of air essential in hooping-
cough ; but it is  only after the malady has run  its course, and conva-
lescence  is progressing,  when the cough remains as a habit,  that
change of air  is  really beneficial.  It is unnecessary to  combat the
absurd opinion, that a  change  even to a worse air is salutary. 
576        DOMESTIC MANAGEMENT OF THE SICK-ROOM.
         Affections  of the  Stomach and  Bowels.

   Although acute inflammation of the stomach rarely occurs, yet there
is a chronic form of that disease, in which, during its actual existence,
and also in convalescence from it, much of the  safety of the  invalid
depends upon  domestic management.   Every source of excitement
should be avoided; the sick-room should be airy, and its temperature
that of summer.   The food  should be of  the  blandest kind, given
cold, or iced, and in small quantity;  even when  the  convalescence is
established, the diet should consist of farinaceous matters, mixed with
small quantities  of beef-tea,  or  weak broths ;  and this severe diet
should be persisted in for a considerable time after recovery.

   Enteritis. — When inflammatory action  extends to, or exclusively
exists in, the mucous lining  of the bowels, constituting this disease,
the diet, during the early stage of it, should be confined to cold water,
or iced almond-emulsion ; after which, milk and barley-water, or weak
chicken or veal-tea, may be given in small quantities ; namely,  two or
three  tablespoonfuls, at intervals of three or four hours.   Nothing
stronger should be  ventured  upon, unless expressly  ordered  by  the
medical attendant.

   Atonic Dyspepsia, or simple  indigestion. — During the attack, absti-
nence to a certain degree, is necessary;  but, if this is not essential, the
diet should be  somewhat stimulant, but simple ; namely, a small cup
of  moderately  strong coffee,  with little  sugar or milk; or beef-tea,
with a small quantity  of dry toast; and, as the stomach begins to
retain its tone, a little animal food of easy digestion, such as mutton
or poultry.
   During the intervals  of the paroxysms of indigestion, attention to
diet is of the first importance.  As a general rule, the patient  should
be  confined to a spare animal diet,  with a moderate share of well-
boiled vegetables, and a considerable restriction with respect  to the
use of fluids.

  Dysentery,  which implies  inflammation,  acute or  chronic,  of the
same membrane as in enteritis, but confined to the larger and lower
bowels, requires the diet to consist o#the mildest farinaceous matters,
strictly avoiding all solid animal food.   It  should be given in small
quantity at a time, and the whole allowance  for the day should be
moderate.  The farinaceous  food should not  be either solid, nor yet
altogether fluid; the former may prove injurious  as a mechanical irri-
tant ;  the latter is apt to excite griping, from the extrication of much
flatus.
  Diarrhoea. — Much of the domestic, as well as  the medical manage-
ment of diarrhoea depends on  the nature of the attack, and its causes;
but too much  attention cannot be paid to the regulation of the diet.
It should be both small  in quantity, and mild in quality.   In the early
stage, and the acute form of the disease,  barley-water, arrow-root,
made with water, rice or grit  gruel, and light broths, are proper.  In 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        577
chronic diarrhoea, rice, properly boiled, and mixed with a small quan-
tity of beef-tea, forms an excellent diet, as it nourishes moderately,
and leaves scarcely any feculent matter behind it
  In Cholera, convalescence is often tedious;  and nothing is so likely
to cause relapse as even slight irregularities of diet.   For weeks after
the feverish symptoms have disappeared, the  diet  should consist of a
very moderate  quantity of vegetable matter  only.  The feet should
be kept especially warm, and the whole body clothed  in flannel, to
prevent that  irregular distribution of blood which so strongly charac-
terizes the disease.
  After inflammation of  the lining membrane of the cavity of the
belly (peritonitis)  has been  subdued, the invalid should still observe
the strictest  diet and regimen.   He  should  return very gradually to
the use of animal food and wine.   The bowels should  be moderately
and daily opened, the feet kept warm, and the skin  maintained in a
healthy condition by wearing flannel next to it, for a very considerable
time after every trace of the disease has disappeared.
  Diseases of the Liver. — In all cases of recovery from  these diseases,
whether inflammatory or otherwise, every precaution  should be taken
to guard against the deleterious influence of alternations of tempera-
ture and also of damp, by clothing in  flannel  next  the skin.   Errors in
diet should be avoided; and fermented liquors and stimulating bever-
age of  every kind, refrained from.  When pains of the  side  continue,
after all the  other symptoms of the  disease  have disappeared, the
introduction  of a seton, if prescribed, should not  be objected to; as
the greatest benefit has often followed that mode of counter irritation.
                                73 
COOKERY  FOR  THE  SICK-ROOM.
  It was said by the distinguished Dr. Rush, in his lectures before his
class, that a physician ought to spend six months in a kitchen before
beginning practice.   A knowledge of dietetic preparations fitted for
the sick, and for those recovering from disease, however apparently
unimportant, adds much to a physician's power over his  patient, and
to his popularity and usefulness.
  In giving nourishment to the sick, who are suffering from low dis-
eases, it is an important rule which should never be forgotten, to give
but littla at a time, and to repeat that often.  In cases of great prostra-
tion from  disease, life may at times be endangered by a delay in giv-
ing nourishment of even a few minutes beyond the proper time.

                       Barley-Water.

  Pearl barley, two  ounces ; boiling water, two quarts.  Boil to one
half, and strain. A  little  lemon juice  and sugar may be added, if
desirable.   To be taken freely in inflammatory diseases.

                         Rice-Water.

  Rice, two ounces; water, two  quarts.   Boil an  hour and a half,
and add sugar and nutmeg.
  Rice, when boiled  for a  considerable  time, becomes a kind of jelly,
and, mixed with milk, is a  very excellent diet for children.  It has in
some measure  a constipating property, which may  be increased by
boiling the milk.

                    Decoction of  Bran.

  New wheat  bran,  one pint; water, three quarts.  Boil down  one
third, strain off  the liquor,  and add sugar, honey, or molasses, accord-
ing to the  taste  of the patient. A bran tea  may be made by using
boiling water, and suffering the mixture to stand in a covered vessel
for three or four hours.

                          Sage Tea.

  Dried leaves  of sage, half an ounce ;  boiling water, one quart  In-
fuse for half  an hour, and strain.  Add sugar and lemon juice as 
COOKERY FOR THE SICK-ROOM.
579
 required by the patient  Balm and other teas are made in the same
 manner.
   The above infusions form agreeable and useful drinks in fevers, and
 their diaphoretic powers may be  increased by adding a little sweet
 spirits of nitre.

                        parley  Coffee.

   Roast one pint of common barley in the same way in which coffee
 is roasted.  Add two large  spoonfuls  of this to  a quart of boiling
 water; boil five minutes.   Add a little sugar.

                        Lemon-Water.

   Put two slices of lemon, thinly pared, into a teapot, a little bit of the
 peel and a bit of sugar.   Pour in a pint of boiling  water, and cover it
 close two hours.

              A Refreshing Drink in  Fevers.

   Put a little  sage, two sprigs of balm,  and a little sorrel into a stone
 jug, having first washed and dried them.   Peel thin a small lemon,
 slice it, and put a small piece of the peel in ; then  pour in three pints
 of boiling water.  Sweeten, and cover it close.

                           Anpther.

  Boil an ounce and a  half of tamarinds, three ounces  of cran-
 berries, and two ounces of stoned raisins, in three  pints of water, till
 the water is reduced  to two pints.  Strain, and add a bit of lemon
 peel, which must be removed in an  hour, as it gives a bitter taste if
 left too long.

                 A Very Pleasant  Drink.,

  Put a teacupful of cranberries into a cup of water, and mash them.
 In the mean time, boil two  quarts of water with one large  spoonful
 of corn or oat meal and a bit of lemon peel; then add the cranberries.
 As  much  fine  sugar as  shall leave a smart flavor  of the fruit, and a
 wineglassful of sherry.   Boil the whole  gently for fifteen minutes,
 and strain.

                        Crust Coffee.

  Toast slowly one or two  slices of brown or white bread, pour boil-
ing water over it, and drink hot or cold, according to preference.

                     Infusion  of Malt.

  To one pint  of ground malt add three pints of scalding water, that
is, water not quite brought to the  boiling point;  infuse two hours, 
580               COOKERY FOR THE SICK-ROOM.
and strain.  Add sugar or lemon juice as desired.   An excellent pre.
paration in inflammatory fevers.

                         Lemonade.

  Fresh lemon juice, four ounces ; thin peel of lemon, half an ounce;
white sugar, four ounces ; boiling water, three pints.  Let them stand
until cold, and strain.   When used in fevers, a little nitrate of potash
or sweet spirits of nitre may be added.  It may be further diluted to
the taste of the patient.

                       Water Gruel.

  Oat or corn meal, two tablespoonfuls ; water,  one quart.   Boil foi
ten or fifteen minutes, and strain, adding salt, and sugar if desired by
the patient.

                      Milk for Infants.

  Cows' milk, one part; water, two parts ; sweeten slightly with loaf
sugar.
  It is necessary when  children are to be raised by hand to dilute the
milk.   The  above proportions may be altered as the child advances
in age.

                         Rice Gruel.          m

  Ground  rice, one  heaping tablespoonful; ground cinnamon, one
teaspoonful; water, one quart.  Boil  gently for twenty minutes, add-
ing the cinnamon near the conclusion.  Strain and sweeten.  Wine
may be added in some cases.

                           Panada.

  White  bread, tone  ounce; ground  cinnamon, one teaspoonful;
water, one  pint.  Boil  them until well mixed, and add a little sugar
and nutmeg.   Wine or butter may also be added, if desirable.


                Compound Salep Powders.

  Salep, tragacanth, and  sago, each four ounces; cochineal, half a
dram ; prepared oyster shells, one ounce. Mix,  and divide into pow-
ders  of one dram each.  Stir one of these powders into a pint of
milk, and  boil for ten or fifteen minutes.  To be drunk freely in diar-
rhoea and dysentery.

                           Another.

  Gum arabic, tragacanth, maranta,  sago, tapioca, each  two drams.
Mix  them well together, and boil in a pint of milk, flavored with nut-
meg or cinnamon. To be used as a diet in dysentery, diarrhoea, etc. 
COOKERY FOR THE SICK-ROOM.              58]
                         Sago  Gruel.

   Sago, two tablespoonfuls; water, one pint  Boil gently until it
 thickens,  frequently stirring.   Wine, sugar, and  nutmeg, may be
 added,  according to circumstances.


                     Arrow-Root Gruel.

   Arrow-root, one tablespoonful; sweet milk, half a  pint; boiling
 water^half a pint  To be sweetened with loaf sugar.   Excellent ali-
 ment for children when the bowels are irritable.


                        Tapioca Jelly.

   Tapioca, two tablespoonfuls; water, one pint  Boil  gently for an
 hour, or until it assumes a jelly-like appearance.   Add sugar,  wine,
 and nutmeg,  with lemon juice to suit the taste of the patient, and the
 nature of the case.

                    Jelly  of Irish Moss.

   Irish moss, half an ounce; fresh milk, a pint  and  a  half.   Boil
 down to a pint.   Remove any sediment by straining,  and add the
 proper quantity"of sugar and lemon juice, or peach water, to give it
 an agreeable flavor.

                      Isinglass  Jelly.

   Isinglass, one roll.   Boil in one pint of water until it is dissolved.
 Strain, and add  one pint of sweet milk.   Put it again  over the fire,
 and let it just boil up.  Sweeten with loaf sugar, and grate nutmeg
 upon it  When properly made, it resembles custard.
   This  forms an excellent diet for persons recovering from sickness,
 and is well adapted to the bowel complaints of children.


                        Apple  Water.
                                r
   Cut two large apples in slices, and pour a quart of boiling water
 on them.  Or, pour the same amount of water on roasted apples.  In
 two or three hours, strain and sweeten slightly.


                       Milk Porridge.

   Wheat flour, corn meal, or oatmeal, two tablespoonfuls; milk, one
pint; water, one pint.  Mix the flour or meal with cold  water, to
form a thin paste;  put the  milk and water over the fire,  and when
they come to the boiling point, add the paste,  carefully stirring. 
58°               COOKERY FOR THE SICK-ROOM.
                  French  Milk Porridge.

  Stir  some oatmeal and water together; let the mixture stand to
clear, and pour off the water.   Then put more water to the meal, stir
it well, and let it stand till the next day.  Strain through a fine sieve,
and boil the water, adding milk while  so  doing.  The proportion of
water must be small.   With toast,  this is a good  preparation  for
weak persons.

                     Ground-Rice Milk.               /

  Boil  one spoonful of good rice, rubbed down smooth, with a pint
and  a  half of milk,  a little cinnamon, lemon peel, and  nutmeg.
Sweeten when nearly done.

                        Boiled Flour.

  Tie up as tight as possible, in a linen cloth, one pound of flour;
and,  after frequently dipping it in cold  water, dredge the outside with
flour till a crust is formed round it, which will prevent the water from
soaking into it while  boiling.  Place it in water and  boil until it be-
comes a hard, dry mass.
  Two  or three spoonfuls of this may be grated, and  prepared in the
same manner as arrow-root gruel, for which it is an excellent substi-
tute.

                      Vegetable  Soup.

  Take one turnip, one potatoe, and  one onion, let  them be sliced
and  boiled in one quart of water for an hour.   Add as much salt as
is agreeable, and pour the whole upon  a piece of dry toast.
  This  forms an  agreeable substitute for animal food, and may be
given when the latter is inadmissible.


                          Beef Tea.

  Lean beef, cut into shreds, one pound; water, one quart.  Boil for
twenty minutes, taking off the scum as it rises.   When it grows cold,
strain.

                     Essence of  Beef.

  Lean beef sliced.   Put a sufficient  quantity into a porter bottle to
fill up its body, cork it loosely, and place it in a pot of cold  water,
attaching  the neck, by means of a string, to the handle of the  vessel.
Boil  this for an hour and a half or  two hours ; then pour off the
liquor and skim it
  To this preparation may be added spices, salt, wine,  brandy, etc.,
according to the taste  of the patient, and nature of the disease. 
COOKERY FOR THE SICK-ROOM.              583
                     Calf s-feet Jelly.

   Take two calf's feet, and add to them one gallon of water.  Boil
down to one quart.  Strain, and  when cold, skim off the fat.  Add
to this the white of six or eight eggs well beaten, a pint of wine, half
a pound of loaf sugar, and  the juice of four lemons, and let them be
well mixed.  Boil the whole for a few minutes, stirring constantly,
and then pass it through a flannel strainer.
   This forms a  very  nutritious article of diet for the sick, and for
those recovering from disease.  The wine  may be omitted or added,
according to choice.

                     Chicken  Water.

   Take half a chicken, divested of all fat, and break  the bones ; add
to this half a gallon of water, and boil for half an  hour.   Season
With salt.

                        Suet Ptisan.

   Sheep's  suet, two ounces; milk, one pint; starch, half an ounce.
Boil slowly for half  an hour.   This may be used as a common drink
in dysentery.

                       Rennet  Whey.

   New milk, one quart;  rennet, a large spoonful.  Heat the milk, and
then add the rennet.  Boil until the curd  separates, which  is to  be
taken off.   To many persons, this forms an  agreeable nutriment

                       Vinegar Whey.

   Milk, one pint; vinegar, one tablespoonful.  Boil for a few  min-
utes, and separate the  curd.

                       Tartar Whey.

   Milk, one quart;  cream of tartar, one dessert spoonful. Boil, and
separate the curd.

                       Mustard  Whey.

   Bruised  mustard-seed, one tablespoonful;  milk, one  pint.   Boil
together for a few minutes, and separate the curd.
   This has been  found  a useful drink in dropsy.  A teacupful may
be taken at a time.

                        Alum  Whey.

   Alum, one teaspoonful; milk, one pint.  Boil together, and strain,
to separate the curd. 
584               COOKERY FOR THE SICK-ROOM.
                       Orange Whey.

  Milk, one  pint; the juice of an orange with a portion of the peel.
Boil the milk; then put the orange to it, and let it stand till coagula-
tion takes place.   Strain.

                        Sweet  Whey.

  Skimmed milk, two quarts ;  a piece of prepared calf's rennet.  Mix,
and put in a warm place till coagulation takes place ;  then strain.


                  Whey  with  Tamarinds.

  Milk,  boiling,  one  pint; tamarinds, two ounces.  Boil them  to-
gether till coagulation takes place.


                        Wine  Whey.

  Milk, two  thirds of a pint;  water, one third of a pint; Madeira,
or other wine, one gill; sugar, one  dessert  spoonful.   Place the milk
and water together in a deep  pan on the fire, and  at the moment
when it begins to boil, pour in the wine and the sugar, stirring assidu-
ously whilst  it boils,  for twelve or fifteen minutes.   Lastly, strain
through a sieve.   This is  excellent in all forms of fever,  given in
small quantities.  It may be drunk either cold or tepid, a wineglassful
at a time.

                  Milk  and Soda Water.

  Heat nearly to boiling, a teacupful of milk; dissolve in it, a tea-
spoonful of refined sugar;  put  this into a large tumbler, and fill with
soda  water.   This is  an  excellent mode of taking  milk when  the
stomach is charged with acid, and is oppressed by milk alone.


                           Sippets.

  On an  extremely hot plate, put two or three  slices of bread^and
pour  over them some  of the juices of boiled beef, mutton, or veal, if
there be no butter in the dish.   Sprinkle over them a  little salt.


                        Restorative.

  Take  two calf's feet, one  quart of water, and one quart of new
milk; place  all  in a  close-covered jar, and bake three hours and a
half.  When cold, remove the fat.  Any desired  flavor may be given,
by  adding lemon-peel, cinnamon, or mace, while  baking.  Add sugar
afterwards.                                                * 
COOKERY FOR" THE SICK-ROOM.              585
                         Coffee Milk.

  Boil a dessertspoonful of ground coffee in nearly a pint of milk, for
a quarter of an hour, then put into it a shaving of isinglass, and clear
it  Let it boil a few  minutes, and  set it  beside the fire to clarify.
Sweeten with loaf sugar.

                      Nutritive  Fluid.

  Take two teaspoonfuls of lump magnesia, one teaspoonful of sal-
eratus, one teaspoonful of salt, two teaspoonfuls of flour, half a pint
of milk, and one pint of water.  Put the milk and water united over
the fire, and rub  up the  flour with a little cold water to make a thin
paste.  Just when the milk and water begin to boil, stir  in the paste.
This will make a  thin porridge, which should boil about five minutes.
At the end of  this time, remove from the fire, and pour into a pitcher.
Now add  the magnesia, pulverized, and  mixed with the saleratus and
salt.   Sweeten to suit the taste.
  This may be drank freely, several times a day, so as to produce two
evacuations of the bowels in twenty-four hours, in those cases of dys-
pepsia attended by acidity of the stomach, and in many debilitated
conditions of the system in which there is a tendency to loss of flesh.
  This is one of the leading fluids used  by those who pursue what is
called the  " Nutritive System " of treating disease, and is really a val-
uable preparation, having the  effect  often to increase the flesh, even
while it acts as a cathartic 
MEDICINES  AND  THEIR  PREPARATIONS.
                      Materia Medica.

   That department of medicine which treats of remedies, their doses,
modes of using, and influences upon the constitution, is called materia
medica.  The agents employed in the treatment of disease are taken
from three kingdoms of nature, — the vegetable, the animal, and the
mineral.
   The largest portion of medicinal  substances are taken from the
vegetable  world.   They consist of leaves, flowers, seeds, barks, and
roots.  These lose much or all of their medicinal powers unless gath-
ered at the  right seasons  of the year, and are properly cured.  The
different parts of a plant are to be gathered when their peculiar juices
are most abundant in them.

  The  Roots of Annual Plants are best supplied with their juices be-
fore they are in flower; they should be gathered at this time.

  The  Roots of Biennial Plants should be gathered in the autumn,
after their first year's growth.

  The  Roots of Perennial Plants should  be  gathered in the spring,
before  vegetation  has begun.
  Before they are dried, the  solid parts of these roots are to be cut in
slices,  after  being washed, and  the small fibres, unless they are the
parts used, are to be thrown away.

  Bulbous Roots  are to be  gathered at the time  their leaves decay.
Their  outer covering being rejected, they must be  sliced, strung upon
threads, and  hung in a warm, airy room to dry.   After  being dried,
roots should be packed in barrels or boxes, and kept as free as possi-
ble from moisture.

  Barks, whether of the roots, trunk, or branches, must  be gathered
in autumn, or early in the spring, when they peel off most easily, and
the dead outside and  all rotten parts being  separated, they must be
dried  in  the same manner as roots.  The most active barks are gen-
erally from young trees.

  Leaves are to be gathered  when they are full grown, and just before
the fading of the  flower. 
MEDICINES AND THEIR PREPARATIONS.           587
  Those of biennial plants are not to be collected  until the second
year.   For drying, they should be thinly spread on the floor of a
room  through which a current of air passes.   For preservation, they
should be packed in vessels, and kept free from moisture, and insects.
  Flowers must generally be collected about the time of their open-
ing,— either a little before, or just after.
  They should be dried as rapidly as possible, but not in the sun, and
may be packed away in the same manner as leaves.
  Fruits, Berries, etc., may be spread thinly upon the floor, or hung
up in bunches to dry.

       Articles  to  Accompany §a  Medicine Chest.

  As the author intends to prepare a Medicine  Chest to accompany
this volume, it is well to mention the  following articles  as  necessary
to be  had with it:
  1. A  Spatula for mixing ointments and pills, arid  for  spreading
plasters.
  2. A piece of smooth marble on which the  above articles may be
mixed, divided, and spread.
  3. A glass funnel.
  4. A domestic syringe for injections.
  5. Adhesive or sticking plaster.
  6. Lint.
  7. Scales and weights.
  8. A glass or wedgewood mortar and pestle.
  9. A  graduated wineglass  for  measuring teaspoonfuls and table-
spoonfuls of liquids.
  10. A minim graduated measure.
  11. A two-ounce graduated measure.
3 Dram.
Fig. 186.
Fig. 187.
§ Ounce.
5 Dram.
minim: measure
TWO-OUNCE MEASURE.
  The minim measure  is represented by Fig. 186, and contains one
fluid dram, or sixty minims, which is divided by twelve lines, — each
line representing five minims.  A minim is considered about equal to
one and a half drops. 
588            MEDICINES AND THEIR PREPARATIONS.

  The two ounce measure is  represented by Fig. 187, and is divided
off from half a dram upward.


                      Doses, Weights, etc.

  Apothecary's weights, by which all medicinal  preparations  ought
to be weighed, are divided into pounds, ounces, scruples, drams, and
grains.
  The characters  marked on  weights  and graduated measures, are
explained as follows:
gj one ounce.
f|j one fluid ounce.
|ss half an ounce.
5j one dram.
£5j  one fluid dram.
3ss half a dram.
gj  one scruple.
9ss half a scruple.
The grain weights are stamped with punch marks.
    20 grains make one scruple.
     3 scruples make one dram.
     8 drams make one ounce.

  By apothecary's weight:

lb   The pound is equal to 12 ounces.
§    "   ounce     "      8 drams.

  By apothecary's measure:
60 drops make one fluid-dram.
 8 drams make one fluid-ounce.
16 ounces make one pint.
3  The dram is equal to 3 scruples.
9    "   scruple    "   20 grains.
           0   The pint is equal to sixteen ounces.
           3    "  dram     "     ninety drops, or sixty minims.

   The marks and words used by physicians and apothecaries may be
a little more fully explained by  the following table :

  R stands for recipe, and means take.
  ad stand for ana, and mean of each.
  lb stands for libra vel librae, and means a pound or pounds.
  | stands for uncia vel unciae, and  means an ounce or ounces.
  3 stands for drachma vel drachmae, and means a dram or drams.
  £) stands for scrupulus vel scrupuli, and means a scruple or scruples.
  0 stands for octarius vel octarii, and means a pint or pints.
  f§ stands for fluiduncia vel fluiduncioe, and means a fluid ounce  or fluid
ounces.
  f 3 stands for fluidrachma vel fluidrachma, and means a fluid drachm or fluid
drachms.
  m stands for minimum vel minima, and means a minim or minims.
  Chart, stands for chartula vel chartulce, and means a small paper or papers.
  Coch. stands for cochlear vel cochlearia, and means a spoonful or spoonfuls.
  CoUyr. stands for collyrium, and means an eye-water.
  Cong, stands for conguis vel conguii, and means a gallon or gallons.
  Decoct, stands for decoctum, and means a decoction.
  Ft. stands for fiat, and means make. 
MEDICINES AND THEIR PREPARATIONS.            589
   Gary, stands for gargarysma, and means a gargle.
   Gr. stands for granum vel grana, and means a grain or grains.
   Gtt. stands for gutta vel guttce, and means a drop or drops.
   Haust. stands for haustus, and means a draught.
   Infus. stands for infusum, and means an infusion.
   M. stands for misce, and means mix.
   Mass. stands for massa, and means a mass.
   Mist, stands for mistura, and means a mixture.
   Pil. stands for pilula vel pilulce, and means a pill or pills.
   Pulv. stands for pulves velpulveres, and means a powder or powders.
   Q. S. stands for quantum siifltcit, and means a sufficient quantity.
   S. stands for signa, and means write.
   Ss. stands for semis, and means a half.

   Domestic, or Approximate Measnres. — A tablespoon contains about
 four  drams; a teaspoon, one dram; a dessertspoon, three drams ;  a
 wineglass, two ounces.    Spoons vary  so much in size,  that they
 should not be used as measures in giving powerful medicines.


 The Approximate Value of French  Decimal  Weights.

         One centigramme is equal to                  ^ grain.
         Two centigrammes   "                      | grain.
         One demi-decigramme "                      1 grain.
         One decigramme     "                      2 grains.
         One gramme        "                     18 grains.
     *   One gramme and three decigrammes is equal to  1 scruple.
         Two grammes                        "      \ drachm.
         Four grammes                        "      1 drachm.
         One decagramme is equal to    2 drachms and 36 grains.
         Three decagrammes and two grammes is equal to 1 ounce.
         Demi-kilogramme                      "     1 pound.
         Kilogramme                          "   .  2 pounds.

   At Paris, the  scruple is equal to 24  grains; the drachm,  to 72
 grains.
   Everywhere else, the scruple is equal to 20  grains; and  the drachm,
 to 60 grains.
   The following  table shows  the relative doses for young people of
 different ages:

      The dose for a person of middle age being       1 or 1 drachm.
      That of a person from 14 to 21 years will be    § or 2 scruples.
                       "    7 to 14  "    "       i or £ drachm.
                       "    4 to 7    "    "       I or 1 scruple.
                      of    4        "    "       £ or 15 grains.
                      tl    3        "    «       i or 10 grains.
                       "    2        "    "       I or 8 grains.
                       "    1        "    "      ^ or 5 grains.

  In  administering medicines, it is  always  well  to begin with the
smallest  dose  mentioned  and gradually increase until the desired in-
fluence is produced. 
590           MEDICINES AND THEIR PREPARATIONS.
                              Tinctures.

      The preparations called tinctures are made by grinding or bruising
    the roots, leaves, or barks used, to a coarse powder, placing it in the
 j   proper amount of either  alcohol or diluted alcohol, letting it stand'
    from seven to fourteen days, — shaking each day,—and, finally, filter-
 j   ing through paper.  A large proportion of tinctures are made by tak-
 i   ing one ounce of the medicinal substance to one pint of the spirit; and
    whenever tinctures are spoken of  in  this  Materia Medica, and the
    quantities are not named, the  above proportions are to be presumed.
    When a larger proportion of the medicine is to be used, I shall simply
    indicate the proportions in the fewest words, as under " Black Cohosh,
 i   —this tincture, four ounces to the pint of alcohol," meaning thereby,
(j   that the tincture is made  by using four ounces of the root to the pint
    of alcohol.   Tilden & Co.'s fluid  extracts, which are the most reliable
    of any with which I am  acquainted, have  the same strength, ounce
    for ounce, with the roots, barks, leaves, etc., of which they are made.
    Tinctures may therefore be made with  very little  trouble, by substi-
    tuting, in each case, the same number of ounces of their fluid extracts
    to the pint of alcohol, which I name of the  gross  substance, or, when
 |   no quantity is named, one ounce to the pint.


                              Infusions.

      Infusions are solutions of vegetable medicines, generally obtained
    by pouring boiling water upon the substance, and letting it  stand till
    it cools.  When a more prolonged  application of heat is desired, the
    vessel may  stand for a while by the  fire, but must not be permitted to
 I   boil.   The vessel should usually be covered.
 j     As in the case of tinctures,  I  have uniformly, while  writing this
    Materia  Medica, briefly named the quantity to be  used to the pint,
 !   whenever it varies from one ounce.

      Acetic Acid.— This is a clear liquid, without color, and has a strong,
    sour taste, and an agreeable smell.  When  held to  the nose, its fine,
 |   pungent odor often relieves headache.   A  piece of cambric wetted
 j   with it and applied to the skin,  excites  heat and redness, and, very
 i   soon, a blister, — for which this acid may be substituted in inflamma-
 ;   tory sore throat, and other cases requiring speedy  action.   Applied to
    corns and warts, with a  camel's-hair brush, it destroys  them.   One
    part to seven of water, makes a good vinegar.

      Citric  Acid. — This acid is extracted from lemon, or lime juice; it is
 '   also present in the cranberry, currant, strawberry, raspberry, tamarind,
 I   and is very abundant in the red  elderberry.   It is refrigerant, and anti-
 i   septic, and is  chiefly employed  as a substitute for  lemonade.  Nine
 I   and a half drams of the crystals,  two drops of oil of lemon, and one
    pint of water, answers a good purpose, in place of lemon-juice.

      Diluted Nitric Acid. — This, in the undiluted state, passes under the 
MEDICINES AND THEIR PREPARATIONS.           591
name of aqua-fortis.  It is tonic and antiseptic.  Largely diluted with
water, it forms a good drink  in fevers, especially typhus.   Taken in
large doses, it is a powerful poison.   One dram of this preparation,
thirteen ounces of soft water, and one ounce of simple syrup, make a
good drink in fevers, of which half a wineglass to a wineglassful is a
dose.  Excellent in cases of hooping-cough.

   Nitro-Muriatic  Acid.— This acid, when properly diluted, has a tonic
and stimulant influence.  It is much used as a foot-bath in affections
of the liver, and in deficient secretions of the bile.

   Diluted Hydrochloric Acid.—This is known by the name of diluted
muriatic acid.   It is  tonic, antiseptic, and diuretic, and is used in
typhus, eruptions of the skin, and with  other articles, as a gargle in
inflammatory and  putrid sore throats.   Dose, from  five to twenty
drops, in a wineglassful of water.   It is given in scarlet and typhoid
fevers, about twenty drops being  put into a bowl of barley-water or
gruel.
   Diluted Hydrocyanic Acid.—This is commonly known by the name
of prussic acid.  It is sedative and  antispasmodic, and is useful in
spasmodic coughs, asthma, hooping cough,  nervous  affections,  hic-
cough,  palpitation of the heart,  irritable  stomach, and dyspepsia.
Dose, from two to five drops, in a glass of water or tea of Peruvian
bark.
   Diluted Sulphuric Acid.— This  acid, known by the name of diluted
oil of vitriol, is tonic, antiseptic,  refrigerant, and  astringent.    It is
useful in dyspepsia, diabetes, menorrhagia,  haemoptysis, eruptions of
the skin, hectic, and diarrhoea.  It is often given with some bitter in-
fusions, as cascarilla,  columbo, peruvian bark, or quassia.  The   aro-
matic  sulphuric acid  is  often used in  place of it,  being sometimes
considered more  grateful to the taste.  Dose of each, from five to
fifteen drops.

   Tannic Acid. — This is an astringent preparation, and passes under
the name of  tannin.  It  is prepared from  galls.  It is used in diar-
rhoea,  dysentery, passive hemorrhages, and diabetes.   Dose of  the
powder, from one to five grains.

   Tartaric Acid. — This  is refrigerant and  antiseptic, and is used in
inflammatory affections, fevers, and scurvy.  It is much used in  pre-
paring what is called lemon syrup, and forms an agreeable and health-
ful drink.
   Alcohol. — Alcohol is the result of the  fermentation of the juices of
many vegetables.  It is the intoxicating  constituent in whiskey, rum,
brandy, gin, wines, porter, ale, beer, and cider.  Its principal use in
medicine is  in the preparation of tinctures, essences, and  extracts.
One part of pure alcohol, to one part of water, forms the diluted alco-
hol of the shops.

  Almonds.— The Amygdalus Communis, or almond tree, grows in the
south of Europe  and  Asia, and  yields the sweet and  bitter almond. 
592
MEDICINES AND THEIR PREPARATIONS.
The oil of the  sweet almond is used as a demulcent, in  coughs, etc.
A dose is a teaspoonful.  The oil of the bitter almond is poisonous,
and  is occasionally used as a valuable sedative.  Its taste is like that
of a peach kernel.  Dose, from a quarter of a drop  to  a drop.  It
owes its poisonous properties to hydrocyanic  acid.   Cakes, etc., are
sometimes flavored with an essence prepared from it
  Aloes. — This is the hardened juice of the leaves of  several  species
of the aloe tree, in North and South Africa, in the south of Europe,
and in the island of Socotra.   Aloes is purgative, acting chiefly upon
the rectum, or lower bowel, in which it frequently produces  irritation,
and  is  apt to  aggravate and induce piles.   It is much used to excite
the flow of the menses, and should  never be given  to  women during
pregnancy.   It produces griping of the  bowels, which may be dimin-
ished by combining it with soap, or carbonate of potash.
  Alum (Alumen).— The chemical name of this  is sulphate  of alu-
mina and  potassa.  In  ordinary doses,  alum is astringent  and anti-
spasmodic.  In large  doses it is  purgative and emetic, and is used
both  externally "and internally.  It is often used in solution as a gar-
gle in sore throat, and falling  down of the uvula, and as an injection
in leucorrhoea.   In doses of thirty or forty grains, it acts  as a purga-
tive, and used in this way, is useful in painter's colic.   When exposed
to heat  in a vessel till it ceases  to boil, it becomes dry, and is then
called burnt alum, which, when pulverized, is applied with advantage
to canker spots in the  mouth, and to proud flesh.
  American Hellebore (Veratrum Viride). — This plant grows in many
parts of the United States, usually in swamps,, wet meadows, and on
the banks of mountain streamlets.  The root is the part  used.  It is
slightly  acrid, alterative in  a marked degree, very decidedly and ac-
tively expectorant and  diaphoretic, and it is an  excellent nervine,
though not narcotic.  But  its most marked and  valuable  quality —
that in which it has no rival—is  its sedative action upon the circula-
tion.   In suitable doses, it can be  relied  upon to bring  the pulse down
from a hundred and fifty beats in a minute to forty, or even to thirty.
In fevers,  therefore, in some  diseases of the  heart, in acute rheuma-
tism, and  in many other conditions which involve an excited state of
the circulation, it is an article of exceedingly great value, because it is
always reliable.  It has  recently come into use ; and I doubt whether
so valuable a contribution has been made  to our list of medicines in
a hundred years.
   Preparations. — Veratrum  is used  chiefly in  the form of tincture,
six ounces to  the  pint  of diluted alcohol, or of fluid extract.  The
dose of each of these preparations, for a grown person, is three or
four drops, every hour or two, in a little  sweetened water, and gradu-
ally increased,  if necessary,  till  the  pulse comes down to sixty or
seventy.   If taken in so large a  dose as to produce vomiting, or too
much depression, a full dose of morphine or laudanum, in  a little
brandy or ginger, is a complete antidote.
   Veratrin, the active principle of veratrum, is also used, in doses of
one-half to one-third of a grain. 
MEDICINES AND THEIR PREPARATIONS.           593
  American Ipecacuanha (Euphorbia Ipecac). — This  plant  is peren-
nial, and grows in sandy soils in the  Middle and Southern  States.
When cut or broken  it gives out a milky juice.   The  root is the
medicinal part.  It is  emetic, cathartic, and diaphoretic.   Dose, as a
cathartic, ten or twelve grains ; as a diaphoretic, three or four grains,
every three or four hours.

  American Ivy (Ampelopsis Quinquefolia). — This vine grows in all
parts of the United States.   It is known by the names of false grape,
and  wild woodbine.   It is alterative, tonic,  astringent, and expecto-
rant   Used in  scrofula and syphilis.

  Water of Ammonia (Liquor Ammonia?). — This preparation, called
hartshorn, or spirits of hartshorn, is formed by the union  of water
with  ammonia gas.   It has a powerful  ammoniacal odor, and an
alkaline, caustic taste.   Taken internally it is stimulant, sudorific, and
antacid, and applied  externally, it is rubefacient.  It stimulates par-
ticularly the heart  and arteries, without very much exciting the brain.
It is an excellent remedy in heartburn, and for sick headache, depend-
ent on sourness of the stomach.   A dose is from  ten to thirty drops,
largely diluted with water.   United with oils, or with alcohol in about
equal proportions,  and applied externally,  it reddens the  skin, and, if
the.cloth wet with it be covered with oiled silk, or with flannel to pre-
vent evaporation, it will sometimes quickly raise a blister.  In  cases
of fainting, it is frequently applied to the  nostrils,  to excite  the brain,
and rouse the system.

  Carbonate  of Ammonia. — This is a white, moderately hard, crys-
talline salt, — having  a pungent, ammoniacal smell, and a sharp, pen-
etrating taste.  When exposed to the air, it loses  some of its  ammo-
nia,  becomes a bicarbonate, and falls  to powder.  It is  stimulant,
diaphoretic, antispasmodic, powerfully antacid, and,  in  large  doses,
emetic.  Internally, it is more often used than water of ammonia,
and  for similar purposes.   Coarsely bruised, and  scented with oil of
lavender, it constitutes the common smelling salts, so much used  in
fainting and hysterics.  For internal  use, the  dose  is from  five  to
twenty grains,  taken  in the form  of pills, every two, three, or four
hours.
  Muriate of Ammonia (Sal Ammoniac).— This,  also called hydro-
chlorate of ammonia, is a  white, translucent, tough, fibrous  salt,  in
large cakes, about two inches thick, convex on one side, and concave
on the other.
  It has a saline, pungent taste, but no  smell, dissolves in one part
of boiling  water,  and three parts of  cold.   Taken  internally,  it is
stimulant and  alterative.   It is  a valuable  remedy in chronic  bron-
chitis, pleurisy, and inflammation of the serous and mucous mem-
branes generally.  But it must only be used after the first violence  of
these inflammations has abated.   Pulverized, and placed over a spirit
lamp in a tin cup, the fumes which  arise when it sublimes, may  be
inhaled five or ten minutes once or twice a day, with great advantage
in chronic bronchitis, and in chronic inflammations generally of the 
air passages.  A solution composed of one ounce of the salt dissolved
in nine fluid ounces of water, and  one of alcohol, may be used as a
wash, for bruises, indolent tumors, and ulcers.
  Solution of Acetate of Ammonia (Liquor Ammonia Acetatis). — This
is known by the common name of spirit of mindererus.   The taste
is saline, and  is like that of a mixture of nitre and sugar.  It is a
valuable diaphoretic, and is  much employed, 'alone or  mixed with
sweet  spirit of nitre, two parts to  one, in fevers and inflammations.
It is a valuable external application  in  mumps, applied hot upon a
piece of flannel.   One ounce mixed with seven ounces of rose-water,
and  two drams of laudanum, forms a valuable wash  for the  eyes in
chronic ophthalmia.  The dose is  from two drams to  half a fluid
ounce, mixed with sweetened water, every two or three hours.
  Aromatic  Spirit of  Ammonia (Spiritus  Ammonia Aromaticus).—
Taken  internally,  this answers the same purpose of other prepara-
tions of ammonia,  and is  much used  on account  of its agreeable
taste and smell.   It  is  valuable  as  an antacid  in sick  headache.
Dose,  from  thirty drops to  a dram, sufficiently  diluted with water.
  Anise (Pimpinella Anisum). — This is a perennial plant, and grows
in Egypt  Its fruit is  called anise-seed.  It is aromatic and carmina-
tive.   It is much  used to allay nausea, flatulency, and colic, particu-
larly in children.  It is frequently added to other medicines to  make
them more agreeable, and to lessen the griping effects of  physic.
  The oil extracted from the seeds, dissolved in alcohol, an ounce of
the former to a pint of the latter, forms what is called the essence of
anise.   Dose of the  essence, from thirty drops to  a dram in sweetened
water.   Anise forms a very valuable addition to  cough preparations.

  Arnica (Arnica  Montana). — This is a perennial plant, growing in
moist, shady places  in  Siberia, etc.  It is often called leopard's bane.
It is much  used  externally  as a stimulating application to bruises,-
local inflammation,  etc.
  Preparations. — It*is chiefly used in the form of  tincture, or fluid
extract. Dose, ten  to  sixty  drops.  Half an ounce of tincture, five
and a half ounces of boiling vinegar,  and two drams of carbonate of
ammonia, used warm, make in some cases a valuable  fomentation.
It is one of the leading homoeopathic  remedies.
  Arrow-root. — This  is  prepared  from  the  Maranta Arundinacea, a
plant of the West Indies.   It is chiefly used in  forming  dietetic pre-
parations, and belongs to the first or saccharine group of food-articles
(see page 66).
   Assafoetida. — This is the  hardened  juice from the root of a Persian
plant.   It is stimulant, antispasmodic, and expectorant, and is much
used in nervous  complaints.   A dose of the powder, is  from five  to
ten  grains, and of the tincture, made  by macerating  two ounces in a
pint of diluted alcohol, from thirty  to sixty drops.
   Balm (Melissa  Officinalis). — This  is a perennial plant, growing in
 Europe and this country. It.is moderately stimulant and diaphoretic. 
MEDICINES AND TIIKIR PREPARATIONS.           595
The warm infusion causes perspiration, and is used to relieve painful
menstruation.
  B.ilm of Cilead  (Populus Candicans). — This is a tree  growing  in
the northern parts  of our country.  A tincture made from  the buds, in
doses of from one to four fluid drams, is useful in affections of the
kidneys, in scurvy, and rheumatism.  Steeped in lard they form a use-
ful ointment for some purposes.

  B:ilmony (Chelone Glabra).— This is  a perennial plant, common to
the United States.  It is tonic, cathartic, and vermifuge.   It  is used
in indigestion, debility, and derangements of the liver.   A dose of the
powdered leaves, is one dram ; of the tincture, two fluid drams ;  of
the decoction, one or two fluid ounces ;  of the active  principle called
chelonin, one to two grains.   A decoction of  balmony combined with
tincture of assafoetida, forms  a valuable injection for worms.   An
ointment  made from the fresh leaves, is valuable for piles, inflamed
breasts, tumors, and painful ulcers.

  Balsam Copaiva. — This  is obtained  from a South American tree
called the Copaifera Officinalis.   It  is a clear yellowish  fluid, about
the consistence of honey.   It is a stimulating  diuretic, and is much
used  in chronic gonorrhoea, gleet, irritable conditions of  the bladder,
and chronic bronchitis.   In some  persons it causes an eruption on the
skin,  with itching, etc.
   In  large doses, it acts  as a cathartic.
   Balsam Tolu. — This  is the juice of the  tree  Myrospernum Tolui-
ferum, growing in South America.  It is soft,  tenacious, and  of a
pale  brown color; and, like balsam copaiva, is soluble in  alcohol,
ether, and volatile oils.   It has been used in asthma, cough, bronchitis,
etc.  Dose from ten to thirty grains, in mucilage  or syrup.

   Barberry (Berberis Vulgaris). — This shrub grows along the Atlan-
tic coast,  from Canada to Virginia.  The parts used are the bark and
berries.   It is tonic and  laxative,  and, in doses of a teaspoonful, pow-
dered, is useful in jaundice, chronic diarrhoea, and chronic  dysentery.
A decoction  of the berries forms an agreeable acid  drink  in fevers,
cholera infantum, etc., and as a  gargle, it is useful for ulcers of the
mouth, etc., as a wash, for chronic inflammation of the eyes, and as an
injection for leucorrhoea.
   Bear-berry  (Uvaursi). — This  plant,  also called upland  cranberry.
has a wide range, being found in the northern parts of Asia,  Europe,
and  America.  It flowers from  June  to September, and  ripens  its
berries in the winter.  The leaves are the only  medicinal  parts.  It is
astringent and tonic, and acts particularly  upon the urinary organs,
for complaints of  which it is particularly used.    It is specially valued
as  an antilithic in gravel, and as a remedy for chronic inflammation
of  the kidneys, and ulceration of the bladder,etc.
   Preparations. — Fluid extract, dose, one third of  a dram to  a dram;
solid extract, dose, five to fifteen grains;  tincture, dose, one to two
ounces. 
596           MEDICINES AN
  Bayberry (Myrica Cerifera). — This is found in  damp places, in
many parts of the United States, and is very abundant in New Jersey.
The bark of the root is the part used.  It is astringent and stimulant.
Pulverized, and combined with powdered blood-root, it forms an ex-
cellent application to indolent ulcers.  In the  form of poultice, com-
bined with powdered slippery elm, it is a useful application to scrofu-
lous tumors or ulcers.   The decoction is  a good wash for sore mouth,
and spongy, bleeding gums.  It is chiefly  used  in the form of tincture,
dose, half an ounce ;  fluid extract, dose, one to two drams ;  and the
active principle myricin, dose, two to ten  grains.

                                              Fia. 189.
BEAR-BERRY.                         BAYBERRY.
  Beef's Galls (Fel Bovinum). — This being  dried  by evaporation, is
sometimes used as a tonic, and laxative, in torpor of the liver, jaun-
dice, indigestion, and costiveness, in doses of from  one  to ten grains.
Three  drams of ox  gall, one dram of extract of conium, two drams
of soda soap, and one  ounce of sweet oil, make a valuable prepara-
tion, which, when  applied externally, has a surprisingly rapid effect in
reducing enlargement and hardening of the breasts, glandular tumors,
particularly enlargement of the tonsils, and is useful in  hypertrophies
generally.   For application  to the tonsils, the gall may be rubbed up
with water, to the consistence of  an  ointment, and may be applied
with a camel's-hair brush.

  Benzoin. — This is the hardened juice  of  a tree of  Sumatra and
Borneo.   It is very brittle, of a reddish brown color, and is soluble in
alcohol and ether.  It  is chiefly used for inhalation in chronic laryn-
gitis and bronchitis.  When used for this purpose, it may be added to
boiling water, and the  vapor be inhaled; or it  may be burned upon
coals, or a hot shovel, the fumes being inhaled.

  Benzoic  Acid. — This is prepared by heating  benzoin, and causing
it to sublime.   It consists of silky, feathery crystals, which are white
and soft   It has been found useful in the phosphatic variety of gravel.
A convenient way of giving it is to unite one  part of it with four parts
of phosphate of soda, the dose of which is from ten to thirty grains. 
MEDICINES AND THEIR PREPARATIONS.           597
  •Bethroot (Trillium Pendulum). — A perennial plant, growing in rich
 soils, in  the Middle and Western States.  The root is  used, and is
 astringent,  tonic,  and antiseptic.  It is useful in  bleeding from  the
 lungs and  kidueys ;  also  in  excessive  menstruation, cough, asthma,
 and difficult  breathing.  Boiled  in  milk, it is used, in  the western
 country, in diarrhoea and dysentery.
   Preparations. — Fluid extract, dose, one  to three drams;  trilliin,
 dose four  to eight grains; infusion, dose, two to four ounces ; decoc-
 tion, used  as a local application to ulcers and sore  mouth, and as an
 injection in leucorrhoea and gleet.  A poultice made from the root, is
 useful for  carbuncles,  indolent  tumors, buboes, foul ulcers, and for
 stings of insects.
   Bitter-root (Apocynum Androsamiifolium). — An indigenous  plant,
                    growing in rich soils in the United States and
                    Canada.   The  root  is the part used, and is laxa-
                    tive, tonic, diaphoretic, and alterative.  It is em-
                    ployed in chronic affections of  the liver, syphilis,
                    scrofula, intermittents, and the low  stage  of ty-
                    phoid fevers.   Forty to sixty  grains* will cause
                    vomiting without much nausea.
                       Preparations. — Fluid extract, dose, as a tonic,
                    ten to twenty drops; as a diaphoretic, fifteen to
                    twenty-five drops; as an emetic,  half a dram
                    to  a dram.   Solid  extract, dose, two to  eight
                    grains; apocynin, the active principle of the root
                    dose, half a,grain  to two grains; tincture, dose,
                    two to three  drams; infusion, dose,  a wineglass-
 ful,  three times a day.
   Bismuth.— The principal  preparation  of this metal used in medi-
 cine, is the trisnitrate of bismuth, also  called nitrate, subnitrate,  and
 while oxide of bismuth.   It is a white powder, without smell or taste.
 It is used for various irritable and painful affections of the stomach,
 when  there is no acute inflammation.  It  is particularly  useful in
 chronic diarrhoea,  more especially the diarrhoea of the latter  stages of
 consumption, — over which it has more  control than  any other known
 remedy.  To  show its  best effects in this form of diarrhoea, it should
 be given in large doses, not less than twenty to thirty grains, immedi-
 ately after  each  meal.   The small doses  usually given are  compara-
 tively useless.  Given in these full doses, it is also almost  a specific
 in heartburn and water-brash.   The unpleasant symptoms spoken of
 in books, as arising from large doses, are fabulous.

  Bittersweet (Solanum Dulcamara). — This  is common  in Europe
 and North  America.  It is a woody vine, the roots and stalks of which
 are used in medicine.   It is slightly narcotic, and has alterative  and
diaphoretic properties.   It is used in scaly and syphilitic affections of
the skin.  It is said to have antephrodisiac properties, and is servicea-
ble in mania, connected with strong venereal propensities.

  Preparations. — Fluid extract, dose, half a  dram to a dram;  solid
 
598            MEDICINES AND THEIR PREPARATIONS.
extract, dose, three to eight grains; infusion, dose, one to three ounces,
three or four times a day.

   Black Alder (Prinos Verticillalus). — This shrub is common in the
United States;  its bark and berries are used.   It has been found use-
ful in jaundice, diarrhoea, intermittent fever, and other  diseases con-
nected with debility.   Applied  locally in the  form of a wash  or
poultice, and given internally, it is popular in chronic eruptions of the
skin,  and in flabby, ill-conditioned ulcers, and mortification.
   Preparations. — Fluid extract, dose, two drams; tincture, dose, two
to four drams.
   Two drains of the fluid extract of black alder,  one dram of the
fluid  extract of golden seal, and one pint of water, mixed,  and taken
in doses of four  fluid ounces, three or four times a day, are valuable
in dyspepsia.

   Blackberry (Rubus  Villosus). — There  are  many species of this
growing in the United States.   The bark of the  root is the  part used.
It is  tonic, and strongly astringent, and is a valuable remedy in diar-
rhoea, dysentery, cholera-infantum, relaxed condition of the  bowels of
children, and the passive discharge of blood from the stomach, bowejs,
and womb.
   Preparations. — Fluid  extract, dose, half a dram  to a dram; solid
extract, four to  six  grains ; tincture,  dose, two to  four  drams; infu-
sion, dose, one ounce.   This last preparation is  also useful as an injec-
tion in gleet, leucorrhoea,  and  prolapsus of the rectum and  womb,
The syrup of the blackberry root is  also a valuable preparation; so
also is blackberry brandy, so  called, which is  the juice of the fruit
mixed with brandy.   This  is excellent in summer complaints.

              Fig. 191.                            Fig. 192.
            BLACK COHOSH.                        BLOODROOT.

  Bhick Cohosh (Cimicifuga Racemosa). — This  grows in rich soils
throughout the United States.   The root is the part used.   It is
slightly narcotic, sedative,  antispasmodic,  antiperiodic,  and exerts a
marked influence over the nervous system;  being  useful in St. Vitus's
 
MEDICINES AND THEIR PREPARATIONS.           5£9
dance, epilepsy, nervous excitability, asthma,  delirium tremens, and
many spasmodic affections.  It has an especial affinity for the uterus.
  It reduces the  arterial  action very materially, and  hence is  useful
in palpitation of the  heart  It has been used successfully in  acute
rheumatism, but more particularly in chronic rheumatism.
  Preparations. — Fluid extract, dose, half a dram  to  two drams;
solid extract, dose, four to eight grains ; tincture, four ounces  to the
pint of alcohol; dose, one to three drams; cimicifugin, the  active
principle, dose, one to six  grains.

  Black Willow (Salix Nigra). — This tree is  found in the Northern
States, along the banks of rivers, especially in New York and  Penn-
sylvania, and is known  by the common name of pussy willow.   It is
a bitter tonic, and is sometimes used in fever and  ague.  A decoction
made from the buds, is said to be a powerful antaphrodisiac, and is
accordingly useful in the treatment spermatorrhea.

  Bloodroot (Sanguinaria Canadensis).— A perennial plant, growing
in light, rich soils, in  most parts of the United States.  The root is
the part used.   It is  emetic, narcotic, expectorant, alterative,  escha-
rotic, and errhine.   It is used in typhoid pneumonia, bronchitis, rheu-
matism, dyspepsia, etc.   Three to five grains*stimulates the digestive
organs, and accelerates the pulse.
  Preparations. — Fluid extract, dose, five to fifteen drops ; solid ex-
tract, half a grain to a grain and a  half; tincture, twenty drops to a
dram; sanguinaria, the alkaloid principle, from one twentieth  to one
tenth of a grain ; sanguinarin, the resinous principle, one quarter  to
one grain.
  Four-grain pills, made  of sanguinarin, twelve grains,  caulophyllin,
twelve grains, solid extract of cimicifuga, twelve grains, are said to be
efficacious in amenorrhoea, dysmenorrhosa, and other female disorders.

               Fig. 193.                             Fig. 194.
             BLUE COHOSH.                         BLUE FLAG.

  Blue  Cohosh  (Caulophyllum  Thalictroides). — A  perennial  plant,
growing in  low, moist grounds in most parts  of the United  States.
 
600           MEDICINES AND THEIR PREPARATIONS.
The root is the part used.  It is antispasmodic, diuretic, diaphoretic,
alterative,  emmenagogue, anthelmintic,  parturient,  and tonic.   It is
used in rheumatism, dropsy, epilepsy, hysterics, cramps, amenorrhoea,
dysmenorrhoea, chorea, leucorrhoea, hiccough, to hasten delivery, and
to relieve after-pains.
   Preparations. — Fluid  extract, dose,  fifteen to forty drops;  solid
extract, dose, one  to  five grains; tincture,  dose, half a dram  to a
dram; infusion, dose, two to four ounces; caulophyllin, the active
principle of the root, dose, one quarter of a grain to two grains.
   In cases of protracted  labor, occasioned by fatigue or debility, the
infusion  is said to  be  fully equal to  ergot in hastening delivery.  A
wash made by combining one  ounce of  fluid extract with  one ounce
of the  fluid extract of golden seal, and eight ounces of water, is very
excellent for apthous sore mouth.

   Blue Flag' (Iris Versicolor). — A perennial plant, growing  in damp
places, in most parts of the United States.  The root is the part  used
for medicinal purposes.   It is  cathartic,  alterative, sialagogue, and
diuretic.   It acts particularly on  the glandular system;  in large doses,
it evacuates and exhausts the system, acting on the liver, and fulfill-
ing the purposes of mercury.
   Preparations. — Fluid  extract, dose, twenty to sixty drops; solid
extract, one to four grains ; tincture, one to two drams.  Iridin, the
active  and resinous principle, dose, half a grain to four grains.  Equal
parts of blue flag, mandrake, and  prickly-ash bark, mixed, and given
in five to ten-grain  doses, every two or three  hours, will act as a pow-
erful alterative, and cause free salivation, without making the breath
offensive or injuring the gums.   Three grains of iridin, five grains of
leptandrin, and twenty grains of bitartrate of potassa, form  an excel-
lent cathartic in dropsy, producing free watery stools.

   Blue Pill (Hydrargyri  Pilulm). — This mercurial  preparation, gen-
erally known by the common name of blue mass, or blue pill, is made
by rubbing mercury, confection of roses, and pulverized liquorice-root
together until all the mercurial globules disappear.  The mass is di-
vided into pills when wanterj.  It is the mildest of all the mercurial
preparations, and the  least liable to produce salivation or  irritation
of the system.   But  even this  should  be used sparingly, and  with
caution.
   The blue mass is alterative and cathartic, and is considerably given
to stimulate the action of the liver, and to produce an alterative effect
upon the digestive organs.  The leptandra and the podophyllum have
become its rivals, and  will, I sincerely hope, finally take its place.

   Boneset (Eupatorium Perfoliatum). — An indigenous plant growing
in most parts of the United  States.   The tops and leaves  are medic-
inal.   It  is tonic,  diaphoretic, expectorant, and, in large doses,  or
when taken as a warm infusion, emetic, and aperient.
   Preparations. — Fluid extract, dose, one to two drams; solid extract,
dose, five to  twenty grains; tincture, dose, one  to two ounces;  infuj
sion, dose, one to three ounces.  Eupatorin, dose, one to three grains. 
MEDICINES AND THEIR PREPARATIONS.           601
  Two scruples of eupatorin, one scruple of xanthoxylin, and one grain
of strychnia, mixed, and  made into  twenty powders, is excellent for
torpor of the liver, or kidneys, and for rheumatism;  one powder being
taken three or four times a day.
Fig. 195.                           Fig. 196.
BONESET.                            BUCHU.
  Buchu (Barosma  Crenata). — It grows at the Cape of Good  Hope.
The leaves are the medicinal portion ; they are stimulant, diuretic,
antispasmodic, and  tonic.  Buchu is chiefly given in complaints of
the urinary organs,  attended with increased uric-acid gravel, chronic
inflammation or morbid irritation of the bladder, urethra, and prostate,
and retention, or incontinence of  urine.
  Preparations. — Fluid extract,  dose, half a  dram  to two drams ;
tincture, dose, twTo to six drams ; infusion, one to six ounces.  A com-
bination  of fluid  extract of  buchu, half an ounce ; acetate of potash,
two  drams ;  and  water, eight  ounces, taken in doses of four ounces,
three or four times a day, is a valuable diuretic.
  This combination, however, may be improved by the addition of a
little sweet spirits of nitre.

  Buckhorn Brake  (Osmunda Regalis). — This is a fern growing in
moist grounds in  most parts of the  United States.   The root, which
is the medicinal part, should be gathered in the latter part of May, and
in August, and very carefully dried, to prevent moulding.  It is  mucil-
aginous and tonic, and is used in  coughs, diarrhoea, and dysentery, and
as a tonic while getting up from exhausting disease.   One root.infused
in a pint of hot water for half an  hour will convert it into a thick jelly.
This mucilage may be sweetened with sugar, and freely taken.

  Buckthorn  (Rhamnus Catharticus). — This plant grows in Europe,
where it is much esteemed by practitioners.  The berries  and juice
are actively medicinal.   It is a  powerful cathartic,  producing large
watery discharges.  It is seldom used alone on account of the severity
of its action.
  Preparations. — Fluid extract, dose,  one dram ; syrup of buckthorn,
made by uniting  four ounces of fluid extract with twelve  ounces of
simple syrup, dose,  two drams. 
602           MEDICINES AND  THEIR PREPARATIONS.
   Bug'leweed (Lycopus Virginicus). — This  grows in shady and wet
 places throughout a greater  part of the United States.   The whole
 herb is used.   It is a mild narcotic, sedative, sub-astringent, and styp-
 tic.   It is a valuable remedy in bleeding from the lungs,  incipient
 consumption, and pneumonia.   It quiets irritation, and allays cough,
 and nervous excitement.
   Preparations. — Fluid  extract, dose,  one to two  drams;  infusion,
 dose, two to four ounces.
   Burdock  (Lappa Minor). — A native of Europe, and growing in the
 United States.   The  root is used, which is useful in scurvy, syphilis,
 scrofula, gout, leprosy, and  disease  of  the  kidneys.   It needs to be
 used for a long time.  It is said to be useful for persons afflicted with
 boils, stye, etc.  An ointment prepared  from it is serviceable in some
 diseases of  the skin, and  obstinate ulcers.
   Preparations. — Fluid  extract, dose, one dram; solid extract, dose,
 five to twenty grains; tincture, dose, half an ounce to an ounce.
   Burgundy Pitch. — This is the concrete juice of the Norway pine,
 abies  excelsa, growing in  Europe and Northern Asia, and of the silver
 fir tree of Europe, abies picea.  It gently excites the skin, and is used
 chiefly in the form of  plasters, either alone or mixed with other gums
 and resins.
   Butternut (luglans  Cinerea). — This  is a forest tree,  growing in
 various parts of the  continent, known  also  by the  names of oilnut,
 and white walnut.   The  inner bark of the root is used, and is a mild
 cathartic, — being useful in cases of constipation.  It is much employed
 by families,  as a domestic remedy, in intermittent and remittent fevers.
 It evacuates the bowels without debilitating them.
   Preparations. — Fluid  extract,  dose, one to two drams; solid ex-
 tract, dose, five to twenty grains; juglandin, the active principle, dose,
 one to five  grains.  A very good pill is made  by mixing one and a
 quarter drams of the  solid extract of butternut, three  quarters of a
 dram of the solid extract of jalap, and ten grains of soap, and divid-
ing the whole into sixteen pills.  From two to  five may be taken for
a dose.
  Calcined Deer's Horn (Cornu Cervinm TJstum).— The horns of the
deer are said to be in velvet between August and December, and dur-
ing this  period, those which fall are collected, coarsely rasped,  and
placed in an iron vessel, which  is tightly covered, and placed in an
oven,  or  elsewhere, and subjected to a heat of 200° F.,  which is con-
tinued until the  rasped  horn  becomes of the color of roasted coffee.
 When cooled, it is reduced to powder by. trituration,  and preserved in
closely stopped vials.  It is a powerful  styptic, taken  in teaspoonful
doses,  every half hour; or, a teaspoonful added to a  gill of hot water,
and a tablespoonful of this taken every five  or  ten minutes.  It  has
much efficacy in floodings from the womb, and  in excessive menstru-
ation.
  Calomel (Hydrargyri   Chhridum Mite). — This is prepared from
 mercury, sulphuric acid, and common salt   It is alterative, antisyphi- 
MEDICINES AND THEIR PREPARATIONS.           60o
litic, and  anthelmintic, and, in large doses,  purgative.  It is much
used in venereal diseases, and chronic affections of the liver, combined
with opium; in dropsies, combined  with squill, foxglove, and elate-
rium;  and in rheumatism and  leprosy, combined with antimonials,
guaiacum, and other sudorifics.   In the beginning of fevers and other
complaints, it is often  combined with purgatives, as gamboge, scam-
mony,  jalap, and rhubarb.  Given in  small doses, not large enough to
purge,  it gradually excites salivation.   Dose, from one to ten grains.
   The  tendency  of this article  to produce salivation, to injure the
gums,  loosen the teeth, etc., has  given rise to  much  prejudice against
it in the public mind; and, indeed, it must be  confessed that it has
been used by many, from  time  immemorial,  with great indiscretion.
In the  hands of sensible and prudent men,  it is very serviceable in
some cases; but the podophyllum and leptandra have so fine an action
upon the liver, .hat they are fast taking the place of calomel and other
mercurials, and possibly  may in time wholly supersede them.   I have
prescribed calomel but two or three times in this book, and am willing
to see  it banished  from the materia medica, as
soon as the  careful  investigations  of science
shall find  cause to decree its  expulsion.
   Camphor. — This is obtained  from an ever-
green  tree, growing in the East Indies, — the
laurus  camphor a.   It  is a white, shiny, crystal-
line substance, extracted from  the  wood and
roots of the above named tree, by boiling them,
and is subsequently  purified by sublimation.
It has  a  penetrating,  peculiar  diffusible odor,
and a pungent, cooling taste.  It is moderately
stimulant, diaphoretic, and antaphrodisiac. Dose,
from one to ten grains.
   Canada  Balsam.— This is  the  fluid obtained
from the fir balsam, abies balsamea, of Canada,
Maine, etc.   It is a stimulating diuretic, and,  in large doses, cathartic.
A dose is  from ten to twenty drops, two or three times a clay, in pills,
or in emulsion.  It forms a part of several ointments and plasters.  It
is used to  mount objects  in microscopic investigations.
   Canada  Fleabane (Erigeron Canadense). —  An annual plant, grow-
ing in  the Northern  and  Middle States.  It is  diuretic, tonic, and
astringent, and has been found  useful in dropsical  complaints, and
diarrhoea.   The dose of  the  powder  is from  thirty grains to a dram  ;
of the  infusion, from  two to four fluid ounces ; of the solid extract,
from five  to  ten grains ;  to  be  repeated, in each case, every  two or
three hours.
  Canella  (Canella Alba). — This is  the  bark of a South  American
tree, and is an aromatic stimulant, and a gentle tonic, and useful in
debility of the stomach.
  Caraway (Carum. Carui). — This biennial plant grows in Europe.
The seeds are the part used, and  are aromatic and carminative ;  they
 
C04           MEDICINES AND  THEIR PREPARATIONS.
   are used in wind colic, and to improve the flavor of other medicine.
,   The dose is from ten to sixty grains.   The dose of the oil of caraway,
   extracted from the seeds, is from one to ten drops.

     Cardamom  (Alpinia Cardamomum). — This plant grows  on the
   mountains of Malabar.  The seeds, which are the medicinal parts, are
   aromatic, and carminative, and are used to expel wind, and to flavor
   medicines.  Dose, from ten grains to two  drams.  The volatile oil
   obtained from them has similar properties.

     Cascarilla.— This medicine is the bark of the West  India shrub,
   croton eleuteria.   It  has an aromatic odor, and a warm, spicy taste.
   It is a pleasant aromatic and  tonic,  and  is used in dyspepsia,  chronic
   diarrhoea and dysentery, wind colic, and other debilities of the stom-
  • ach and bowels.  It counteracts the  tendency of cinchona to produce
   nausea.
      Preparations. — Fluid extract dose, twenty to thirty drops; tincture,
   dose, one dram; infusion, dose, one to three drams.   An alkaline infu-
   sion, composed of fluid  extract, three  ounces ; carbonate of potassa,
   two drams; and wateiyten ounces, is excellent in weak stomach, with
   acidity.  Dose, one  dram.
      Castor (Castoreum). — A peculiar substance obtained from the bea-
   ver.  It is antispasmodic  and emmenagogue. _ It is used  in  typhus,
   hysterics, epilepsy, retention of the menses, and in  many other ner-
   vous diseases.   Dose, from ten to twenty grains.  A medicine of no
   great value.
     jDastor Oil (Oleum Ricini).— This is obtained by expression from
   the seeds of the castor oil bush, ricinus communis.  When exposed to
   the air, it turns rancid, and spoils.
      As a mild cathartic, this oil is extensively used, particularly among
   children.   It is an  exceedingly nauseous medicine, but maybe ren-
   dered less  offensive  by being mixed with  a few drops of oil of winter-
   green, peppermint,  or cinnamon; and its bad  taste may be nearly
   destroyed  by rubbing it up to a thick batter with carbonate of mag-
 !  nesia.  Or, if boiled a few minutes with a little sweet milk, sweetened
 I  with loaf  sugar,  and flavored  with  essence  of cinnamon  or  pepper-
   mint, it may be easily taken.  Dose, for an adult, one to  three table-
   spoonfuls ; for d  child, one, two, or three teaspoonfuls, according to
   its age.
      Catechu. — This  is a  solid  extract, made  from  the wood  of the
   acacia  catechu, a tree growing in Asia.   It  is in dark, brown, and
    brittle  pieces,  and is soluble in alcohol.  It is a powerful astringent,
   and is used in chronic diarrhoea, and chronic dysentery.   It makes a
    useful gargle in some forms of sore mouth, in elongated uvula, spongy
   gums, and sore nipples.   The  dose of the powder is  from ten to thirty
    grains, and of the tincture, from one to two teaspoonfuls.

       Catnip (Nepeta Cataria). — A native of Europe, and widely natural-
    ized in this country.  The tops and  leaves are the medicinal part, and
    are carminative and diaphoretic when drank as  a warm infusion.   It 
MEDICINES AND THEIR PREPARATIONS.           605
  is useful in fevers, in wind colic, nervous headache, hysterics, and ner-
  vous irritability.                  ,
    Preparations. — Fluid  extract,  dose, two to four drams;  infusion,
  dose, two to four ounces.   Fluid  extract of catnip, two  ounces ; and
  the fluid  extract of saffron,  one  ounce  and«a half, united, make a
  popular remedy for colds, and the  rashes of children.   In nervous
  complaints, a combination of fluid extract of catnip, six  drams ; fluid
  extract  of valerian, four drams;  and  fluid extract  of scullcap, four
  drams, is a valuable remedy.   Dose, one to three drams.

    Cayenne'Pepper (Capsicum Annuum). — This plant  grows  in  hot
  climates,  and  is known  by the  common name of red pepper.   The
  berry, which is the part used, has an intensely hot and pungent taste.
  It is a powerful, diffusible  stimulant, and is about the only  stimulus
  which the stomach will bear in certain forms of dyspepsia.   It is use-
  ful  in all cases of diminished vital action, and is frequently  united
  with other medicines, cither  to promote their action, or to lessen the
  severity of their operation.  It is  much used in colds, hoarseness, etc.,
  as it  promotes a  free discharge  of  mucus  and phlegm.   Taken in
  small doses, it has a fine effect upon  the mucous membrane  of  the
» stomach and  bowels, lessening very much the  severity  of piles, and
  sometimes curing them.   It may be sprinkled daily upon the food, or
  taken in the  form of cayenne lozenges ; it is frequently useful as a
  gargle in sore throats, scarlet fever, etc.  Dose of the  powder from
  one to ten grains.
    Preparations. — Fluid  extract, dose, five to fifteen drops; tincture,
  dose, half a dram to a dram, used in low forms of fever, and gastric
  insensibility;  infusion, dose, one  to  three drams.  A valuable gargle
  in scarlet fever may be made by combining fluid extract of cayenne,
  one ounce; common  salt, one dram ;  boiling vinegar, one pint; boil-
  ing water, one pint.

    Celandine  (Chelidonium Majus).  — This  plant is indigenous  to
  Europe, and  is extensively naturalized in the  United States.  It is a
  drastic purge,  producing  watery stools, and is  equal to gamboge ; it is
  useful in affections of the liver, and particularly in those  of the spleen.
  In the form of a poultice it is effective in  scrofula, indolent ulcers,
  skin diseases,  and piles.
    Preparations. — Fluid extract, dose, ten to  twenty drops ;  solid ex-
  tract, dose, five to ten grains; tincture, dose, half a dram to a dram ;
  infusion, dose, two and  a half to five drams.   A very good hydra-
  gogue cathartic is made by compounding two and a half drams of
  fluid extract  of celandine, with  half a dram  of fluid extract of hen-
  bane, one ounce of sulphate of potassa, one grain of tartar emetic,
  six ounces of  elder w ater, and ounce of  syrup of squill.

    Chalk. — On account of its gritty particles, it is unfit  for medicinal
  use until  it has been levigated, after which it is called prepared chalk.
  This is  the only form in  which it is used in medicine.  It is an excel-
  lent antacid, and is admirably adapted to diarrhoea, accompanied with
  acidity.   The most convenient form of administering ch^k is that of 
006-           MEDICINES AND THEIR PREPARATIONS.
the chalk mixture, which consists  of prepared chalk, half an ounce*
sugar and  powdered gum arabic, two  drams  each ; cinnamon-water
and  water, four fluid ounces each,  and rubbed together in a mortar
till they are thoroughly mixed.   Dose, a tablespoonful frequently re-
peated.                •
                                                    #
             Fig. 198.                              Fig. 199.
         CAYENNE FEFFER.                          CHAMOMILE.

  Chamomile (Anthemis Nobilis). — This perennial plant grows in
Europe, and its flowers are considerably used in medicine, the whitest
of which are best.  They are gently tonic, and are generally used in
cold infusion, in cases of weak  stomach, dyspepsia,  etc.  In large
doses, the warm infusion will act as an emetic.
  Preparations. — Fluid extract, dose, half a dram to  a dram; solid
extract, dose, four to  twenty grains ;  infusion, dose, half an ounce to
an ounce.  For  dyspepsia, wind in the stomach, etc., thirty pills may
be made, by combining one dram  of  solid extract of chamomile with
five grains of the solid extract of rhubarb, and  ten grains of assa-
foetida, and taken, one  pill at a time, two or three times a day, with
advantage.

  Charcoal (Carbo Ligni). — Prepared charcoal is antiseptic and  ab-
sorbent, and  is employed with  great  advantage, in certain forms of
dyspepsia, attended with bad breath, and putrid eructations;  it has a
good effect in correcting the fetor of the stools  in dysentery: it is con-
siderably used, and with  much  advantage  as  an  ingredient in poul-
tices.   Dose, when taken internally, from one to four teaspoonfuls.

  Chloroform (Chloroformum). — This is an anaesthetic, used to pro-
duce insensibility during surgical operations.   A teaspoonful or more
is  poured upon  a handkerchief, which is  held to  the  patient's nose,
but not so closely as to prevent the admission  of air.   The numerous
sudden deaths which have  occurred from  its use,  prove it to be  an
unsafe agent, and it  is now seldom employed by careful surgeons.
Taken internally it is sedative and narcotic ;  applied externally, com-
bined with ether articles, it is useful in painful affections, as  nervous
 
MEDICINES AND THEIR PREPARATIONS.           607
headache, rheumatism,  neuralgia, etc.  The dose when taken  inter-
nally, is from ten to sixty drops, in flax-seed tea.

   Cinnamon.— This is the bark of trees growing in  Ceylon, Malabar,
and Sumatra.  It is a very grateful aromatic, being warm and cordial
to the stomach; it is also carminative and astringent
   It is not often  prescribed alone, but is chiefly used as an aid to less
pleasant medicines, and enters into a great number of  preparations.
It is peculiarly adapted to diarrhoea; and in treating this complaint
it is often joined with chalk and stringents.  Dose of the bark, from
ten to twenty  grains.   The oil  has  properties  similar to those of the
bark.
   Cassia Buds. — This spice is a product of China.  It consists  of the
calyx surrounding the  young germ of  one  or more species of cinna-
mon.  Cassia buds have some  resemblance to cloves, and are  com-
pared to small nails with round heads.  They may be used for the
same purposes  as the cinnamon  bark.

   Cleavers (Galium Aparine). — An annual plant, common to this
country and Europe, having an acid,  astringent taste.   The whole
herb is used in  infusion, as a cooling diuretic, in scalding of the  urine,
inflammation of the kidneys and bladder, in gravel, suppression of the
urine, etc.
   It is  also used in fevers, and  all  acute diseases.  The infusion is
made by adding two ounces of the herb to a pint and a half of warm
water.   It should stand three or four hours,  and be drank freely when
cold.  Equal parts of elder-blows, cleavers, and  maiden-hair, infused
in warm water, make a refreshing  drink in scarlet fever, and other
eruptive diseases.
   Cloves (Caryophyllus Aromaticus). — The flowers of  this tree, a
native of tropical climates, collected before  they are fully developed,
form cloves.  They are  highly stimulant and aromatic, and are  used
to give tone to  the  digestive organs,  particularly when flatulency
exists, and to relieve nausea and vomiting.   They are more generally
employed to improve the taste  and modify the action of other  medi-
cines.  The dose in powder is from five  to ten  grains.   The oil of
cloves has similar properties; dose, two to five  drops.  A little cotton
moistened with the  oil,  and pressed into a decayed tooth, will fre-
quently relieve  the toothache.
  Cochineal (Coccus Cacti). — An insect found in Mexico, inhabiting
different species of cactus.  They are gathered for  use  by detaching
them from the  plant with  a blunt knife, and dipping  them, enclosed
in a bag, into  boiling water.   Cochineal is anodyne, and has  been
used with advantage in hooping-cough and neuralgia.   It is  much
used for coloring tinctures, and  ointments,  and the color called car-
mine is prepared from it.  A tincture is prepared  by macerating two
ounces of cochineal,  in one pint  of alcohol, for  seven days, and  filter-
ing through paper.  Dose, from twenty  to thirty drops, twice a day.

  Cod Liver Oil (Oleum Morrhua?). — This  oil is obtained from the 
608           MEDICINES AND THEIR PREPARATIONS.
livers of codfish, and is nutritive and alterative.  It is a popular rem-
edy in consumption and scrofula, and in  those complaints generally
in  which  there  is  impaired  digestion, assimilation, and  nutrition.
Dose, a tablespoonful three times a day.
   Inability to  digest this oil, to eat fat meats, or to take fats in any
form, is an unfavorable indication in consumption.  •

   Collodion.— This  is gun-cotton dissolved in ether.  It is  applied
with a camel's-hair  brush, to cuts,  burns,  wounds,  leech-bites,  etc.,
over which it forms a thin pellicle or skin, protecting the injured  part
from the  atmosphere.   It should be kept in well stopped bottles, to
prevent its evaporating and becoming unfit for use.

   Colocynth (Cucumis  Colocynthis). — A  native of northern  Africa.
The part  used in  medicine is the fruit, deprived of its rind.  It is a
powerful  drastic, hydragogue cathartic; causing by its harsh action,
griping, vomiting, and sometimes bloody discharges; from  the severity
of its operations, it is rarely used alone.  Useful in dropsy, derange-
ments  of the brain, and for overcoming torpid conditions of the diges-
tive and biliary organs.
   Preparations. — Solid extract, dose, two  to thirty grains; compound
extract, dose, two to thirty grains.

   Colombo (Cocculus Palmatus). — A perennial climbing plant, grow-
ing in east Africa, and  cultivated in  the Isle of France.   It is a pure,
bitter tonic, and is  used in dyspepsia, bilious vomitings which attend
pregnancy, and during recovery from exhausting diseases.
   Preparations. — Fluid  extract, dose, twenty to sixty drops; solid
extract, dose, four to ten grains ;  tincture, dose,  one  to four drams;
infusion, dose, three drams to an ounce.   A  compound infusion made
by uniting on*? drqm of fluid extract, four drams of orange peel,  and
one ounce of watei, is useful in  a  weakened state of the bowels,
showing itself  in a  diarrhoea.  Dose, two drams every hour.   Fluid
extract of  Colombo, one  ounce ;  fluid extract of ginger,  two  drams,
and water, one pint, also  make a useful compound for the same pur-
pose.   Fluid extract of Colombo, one dram ; fluid extract  of rhubarb,
one dram; fluid  extract  of ginger, half a dram; wTater, one pint,—
this is useful for a like purpose.   The following is also a very good
preparation for a similar use: fluid extract of Colombo, half an  ounce;
fluid extract of cascarilla, two drams;  tincture of orange peel, two
drams ; syrup of cinnamon, one ounce ; water, six ounces.   Dose,  one
dram every hour.

  Coltsfoot (Tussilago Farfara). — A native of Europe, and natural-
ized in this country, especially in the Northern States. It grows in
wet places, and  low meadows.    The  leaves are principally used.
They are  emollient, demulcent, and  slightly tonic; used in coughs,
asthma, and hooping-cough; and externally in the form  of poultice
for scrofulous tumors.

   Comfrey  (Symphytum  Officinale). — A  perennial European plant,
cultivated  in this country.   The root is the part used.  It is demul- 
MEDICINES AND THEIR PREPARATIONS.           609
  cent, and  slightly  astringent,  and is  serviceable in  diseases of  the
  mucous tissues, and in scrofulous habits ; also in diarrhoea, dysenterv,
  coughs, bleeding from  the lungs, whites, etc.  It may be taken as an
  infusion, or as a syrup, one ounce to a pint of water; the dose being
  one to  four fluid ounces, three to four times a day.   The fresh root
  bruised forms a valuable application to ulcers, bruises, fresh wounds,
  sore breasts, and white swellings.

    Common Silk-Weed (Asclepias Syriaca).— This is a  perennial plant,
  common throughout the  United  States.  It gives out a milky juice
  upon being wounded, and hence is often called milk-weed.   The root
  is diuretic, alterative, emmenagogue, and anodyne ; and is sometimes
  used in dropsy, retention  of urine, suppressed menstruation, scrofula,
  and rheumatism.   Dose of the  powder, from eight to twenty-five
  grains;  of the decoction, from  one to three fluid ounces.

    Copper (Cuprum). — The following are the principal salts of copper
  used in  medicine.

    Subacetate of  Copper (Cupri Subacetas).— This is  known by the
  name of verdigris, and  is used as a detergent and  escharotic; it  is
  applied  to warts and fungous growths, and to foul  ulcers and ring-
  worm.  When reduced to a fine powder, by trituration in a porcelain
  mortar, the finer  parts of this are separated, and called prepared sub-
  acetate of copper; this is the preparation used for the purposes above
  named.

   Sulphate of Copper (Cupri  Sulphas). — In  small doses, the sulphate
 of copper is astringent and tonic ;  in large ones, a prompt emetic.   It
 is given  in small  doses in hysterics, epilepsy, and intermittent fevers ;
 and in large doses, to produce speedy vomiting in  croup, and to eject
 poisons  from the stomach.  A  weak solution is sometimes used for
 syphilitic ulcers,  and as an injection in gleet.  Dose,  as a tonic, one
 quarter of a grain to two grains, in pill; as a rapid vomit, from two
 to ten grains, in two ounces of water.   The  medicines which are in-
 compatible  with  copper, are  alkalies,  earths, and their  carbonates,
 borax, salts of lead, acetate of iron, and astringent  vegetable  infu-
 sions, decoctions, and tinctures.

   Corrosive Sublimate. — This,  in  chemical  language, is the bichlo-
 ride of mercury.   It is one  of the milder  mercurial preparations,
 although when taken in large doses, it is a violent poison, and oper-
 ates very quickly.   It is less apt to salivate than any other mercurial,
 except blue pill.   It is  much used as  a remedy in syphilis, particu-
 larly in the secondary  stage, in which, in many cases, it  does  much
 good.  It is  also popular  in many skin diseases, as leprosy.  When
 employed for this purpone, it is generally associated  with "alterative
 and diaphoretic medicines, such as the compound decoction  or  syrup
 of sarsaparilla, preparations of  yellow  dock, etc.   In  order  to  avoid
its irritating effects, it is often united with opium, or extract of conium.
Dissolved in water, it is valuable as a wash in some skin diseases.  It
is an ingredient in many of the quack nostrums which are extensively
                                77                               J 
610           MEDICINES AND THEIR PREPARATIONS
advertised, and was the active principle in Swaim's Panacea, which
had so vast a sale a few years since, and gave such a princely fortune
to its proprietor.  One ounce of corrosive sublimate, dissolved in one
quart of alcohol, is a complete bed-bug exterminator.

  Cotton (Gossypium Herbaceum).— Cotton  is  chiefly employed  in
cases of recent burns, and scalds, — an application of it, which sur-
geons  have learned from popular use.  It diminishes  the inflamma-
tion, prevents blistering, and  hastens the cure.  It is applied in thin
and  successive layers.  The inner bark of the  root is  said to be em-
menagogue, parturient, and  abortive.   A  decoction of it, made by
boiling four ounces of the inner bark of the root in a quart of water,
down to a pint, is said to be given in wineglassful doses by the female
slaves  of the South, for the purpose of producing abortion.   It  is ex-
cellent in chlorosis.
  Preparation. — Fluid extract, dose, four drams.

  Cranesbill (Geranium, Maculatum). — An indigenous plant, growing
in all parts of the United States, in the open woods.  The root  is the
medicinal part.   It is  a powerful astringent,
similar to kino, and catechu, and a valuable
substitute for those articles,  because less ex-
pensive.  It forms an excellent gargle  in sore
throats and ulcerations of the mouth, and  is
valuable for treating those discharges  arising
from  debility, after  the exciting causes  are
removed.   It has no unpleasant taste, and is
therefore well adapted  to infants, and persons
of delicate stomachs.  As an  injection, it  is
used in gleet, and whites.
  Preparations. — Fluid extract, dose, half a
dram to a dram ; solid extract, dose, three to
fifteen grains ;  geraniin, the  active  principle,
dose, one to five grains; tincture, dose, two
and a half to four drams;  infusion, dose, one
to two ounces.  A valuable astringent wash
for sore mouth, etc., and as  an injection in leucorrhoea, etc., is  made
by uniting fluid extract of cranesbill, half  an ounce ; fluid extract of
black  cohosh, half an  ounce; fluid extract of  golden seal,  half an
ounce ; fluid extract of witch-hazel, half an  ounce ; and  water, one
quart.   Geraniin, dioscorein, and caulophyllin, united in equal  parts,
and  given  to an adult in six-grain doses, every fifteen or twenty min-
utes, have an excellent effect in  diarrhoea  and cholera-rnorbus,  when
there is much pain and rumbling of the bowels.

  Crawley (Corallorhiza Odontorhiza).— A perennial  plant, growing
on barren  hills and  hard clay soils in New York.   The  root is the
part  used.   It is sedative  and  diaphoretic, and is used in inflamma-
tory  diseases, and in typhoid fever; also in flatulency,  cramps,  hectic
fever, and night sweats.  When the liver  requires to be acted  upon,
it should be combined with mandrake or Culver's root.   The powdered
 
MEDICINES AND THEIR PREPARATIONS.           611'
   root should be kept in well-stopped vials ; its dose is from twenty to
!   thirty grains, in warm water, every hour or two.

     Creosote (Creosotum). — This is obtained by the distillation of tar.   i
I   It is irritant, narcotic, styptic, antiseptic, and moderately escharotic.
!   It has been given in diabetes, epilepsy, hysterics, neuralgia, bleeding
   from the lungs, and chronic bronchitis.  It is an excellent remedy for
   arresting nausea and vomiting, when not dependent on inflammation.
   The dose, when given internally, is one or two drops.  It is most easily
   taken in the form of pill.   In some forms of bronchitis, the vapor of
   creosote is inhaled with advantage. .  It may  sometimes be applied
   with excellent effect, to indolent or ill-conditioned ulcers, in which case,
   two, four, or six drops may be dissolved in an ounce of distilled water.
   In  some cases the solution is  mixed with  poultices.    One or  two
   drops of pure creosote, introduced into a hollow tooth on a little cot-
   ton, is generally a speedy remedy for toothache, but great care  must
   be taken that it does not come in contact with the tongue or cheek.
     Croton Oil (Oleum Tiglii).— This is obtained from the seeds of the
    Croton Tiglium, a plant growing in the East  Indies.  It is a powerful
   cathartic, producing watery stools,  and is  used in torpidity of the
;   bowels, dropsy,  apoplexy, mania, inflammation, of the brain, hydro-
j   cephalus, coma,  and wherever a powerful revulsive  action is  needed
j   to call the blood away from the brain.  A drop placed on the tongue
   of a person in the comatose state, will generally operate.  Two to six
   drops, rubbed upon the skin, produce an eruption or pimples in twelve
   hours.  In this way, it is used in diseases of  the throat and chest, and
I   some other affections.  If the skin is very sensitive, let it be combined
|   with an equal quantity of sweet oil.
      Cubebs (Cubebce).— A climbing  perennial plant, growing in the
i   East Indies.  The berries are  the medicinal part.  They are stimu-
   lant,  purgative, and diuretic, acting  particularly upon  the urinary
   organs, and arresting discharges from the water pipe, and much used
   in the treatment of gonorrhoea and gleet.   It should not be used dur-
   ing active inflammation.  Dose  of  powdered  cubebs, from thirty to
   sixty grains.
      Preparations. — Fluid extract, dose, half a dram to  a dram and a
   half; ethereal fluid extract, dose, one to  two drams; solid extract,
   dose, two to  twenty grains;  tincture, dose, one to two drams.   A
   compound, made of fluid extract of cubebs, five drams ; fluid extract
   of  ergot, one  and a half drams; cinnamon  water, half a dram ; and
   powdered  loaf sugar, one dram, may be  taken with  advantage in
   gonorrhoea, gleet, and leucorrhoea;  dose, one dram.
     Culver's Root (Leptandra Virginica). — A perennial plant growing
   throughout the United States in  limestone districts, and flowering in
   July and  August.  The root is  the  medicinal  part.  It is frequently
   called black root.  When dried, it is tonic, cholagogue, and laxative,
   and is a very valuable  remedy  in  affections  of the liver,  as it acts
   upon this organ with energy, without purgation.  It is also useful in
   typhoid fevers, and in dyspepsia, diarrhoea, and dysentery.   A powder 
612           MEDICINES AND THEIR PREPARATIONS.
is made from it, containing its active principle, and called leptandrki,
which has a fine eff'ect in diarrhoea, cholera infantum, typhoid fever,
some forms of  dyspepsia, and in all diseases connected with derange-
ments of the liver.
  Preparations. — Fluid extract, dose, one third of a dram to a dram;
leptandrin, the  active  principle, dose, in acute cases, one fourth of a
grain to one grain ; in chronic cases, one to two grains ; tincture, two
ounces to a pint of alcohol, dose, one dram to one ounce.

  Dandelion (Taraxacum, Dens-Leonis). — This perennial  herb is diu-
retic, aperient, and  tonic.   It is generally thought to act especially
upon the  liver.   Used in dyspepsia, diseases of the liver and spleen,
and in debilitated and irritable conditions of the stomach and bowels.
  Preparations. — Fluid extract, dose, one to two drams ; compound
fluid extract, dose, one to two drams ; fluid extract of dandelion and
senna, dose, one to two drams ; solid  extract, dose, ten to twenty
grains ; infusion, two ounces to one pint of water, dose, four to six
ounces.  In dropsical affections, the following compound infusion will
be found useful:  fluid extract of dandelion, six drams; fluid extract
of rhubarb, one and a half drams ; fluid extract of henbane, twenty-
four drops; bicarbonate  of soda,  half a dram;  tartrate  of potassa,
three drams; water, three  and a half ounces;  take one  third, three
times a day.   For jaundice, and diseases  of the liver  and kidneys,
the following pills  have much  efficacy.  Solid extract of dandelion,
one dram; solid extract of bloodroot, one dram :  leptandrin, one  scru-
ple ; podophylfin, five  grains; oil of peppermint, five minims;  to  be
divided into fifty pills, and one or two taken three times a day.

            Fig. 201.                         ' Fig. 202.
         DEADLY NIGHTSHADE.                     DOGWOOD.

  Deadly Nightshade (Atropa Belladonna). — A perennial plant, grow-
ing in Europe and this country, and having a faint odor, and a sweet,
nauseous taste.   It is narcotic, diaphoretic, and diuretic; is a valuable
remedy in convulsions,  neuralgia, hooping-cough, rheumatism, gout,
paralysis, and many diseases having their seat in the nervous system.
It has been  much  praised as a preventive of scarlet fever, though its
powers for this purpose are doubtful.
  Preparations. — Fluid extract, dose, five to ten drops ; solid extract,
dose, one quarter to one  grain ;  tincture,  two ounces to a pint of
 
MEDICINES AND THEIR PREPARATIONS.
613
 diluted alcohol, dose, from fifteen to thirty drops.  The solid extract is
 used, mixed with lard or with other substances, as a ldfcal application
 for relieving pain, dilating the pupil of the eye, for removing stricture
 of the urethra, the anus, rigidity of the mouth of the womb, etc.

  Dogwood (Cornus  Florida). — This is a small tree growing most
 abundantly in  the Middle States.   The bark is  used as a medicine.
 It is tonic, astringent, antiperiodic, and stimulant.  It increases the
 frequency of the pulse, and elevates the temperature of the  body..  It
 has been substituted  for peruvian bark  in intermittent fevers.   Dose
 of the powdered bark, from ten to sixty grains.
  Preparations. — Fluid  extract, dose,  half a dram to two drams;
 solid extract, dose, five to ten grains ; tincture, four ounces to a pint
 of alcohol, dose, one  to four drams ; infusion, two ounces to a pint of
 water; dose, half an  ounce to two ounces; cornin, the active principle,
 dose, one to ten grains.

  Dwarf Elder (Aralia Hispida).— A perennial under-shrub, growing
 from New  England to Virginia.  The bark of the root is diuretic and
 alterative.  An infusion made  from it is used in gravel, suppression
 of urine, and dropsy; to be taken in wineglassful doses, three or four
 times a day.                         •

  Elder  (Sambucus  Canadensis).— The flowers, berries,  and inner
 bark  of the elder, are  used  in medicine.  A warm infusion of the
 flowers is diaphoretic, and gently stimulant.   A cold infusion is diu-
 retic, alterative, and cooling; used in erysipelas, liver  affections of chil-
 dren, rheumatism, scrofula, and some syphilitic diseases.   The bark,
 pounded with lard, forms a useful ointment for burns and scalds, and
 some diseases of the  skin.

  Elecampane (Inula Helenium).— This perennial plant is a native of
 Europe and Japan,  and is. cultivated in this  country.  The  root  is
 stimulant,  tonic, diuretic, and  expectorant, and  is  used in chronic
 affections of the lungs  and air passages.  It is said a decoction  from
 the root forms a good application for the itch, and other skin diseases.
 Dose of the powdered root, from a scruple to a dram; of the infusion,
 one or two fluid ounces.

  Electro-Magnetism.  — Within a few  years,  electro-magnetism has
 been  employed extensively as a remedial agent, particularly in the '
 various forms of nervous disorders.   That it is  a valuable agent in the
 treatment of disease, few  thinking physicians doubt;  yet, like most
 other new  things  in  medicine,  it  has had its enthusiastic  admirers,
 who have claimed for  it remedial  powers beyond what it really has,
 and who have applied it to purposes  beyond its sphere of usefulness.
 Various instruments  have been constructed for applying this remedy,
but no one  has appeared to me so well adapted to its purpose, as that
manufactured by Messrs. Hinds & Williams, of this  city.

  Feverfew (Pyrethium Parthenium). — In warm infusion, this herb is
valuable  in recent colds, flatulency,  worms, irregular  menstruation, 
614           MEDICINES AND THEIR PREPARATIONS.
hysterics, and suppression of the urine.  The cold infusion is a tonic.
A poultice made of the leaves, soothes and alleviates pain.

  Figwort (Scrophularia Nodosa). — The leaves and.root are diuretic,
alterative, and anodyne, and in some places are  used in  liver  com-
plaints, scrofula, dropsy, and diseases of the skin.  Applied externally
in the form of ointment, or fomentation, it is said to be useful in  piles,
painful tumors, bruises, ringworm, and inflammation of the breasts.
Dose of the infusion, from two to four fluid ounces, three times a day.

  Flaxseed (Linum Usitatissimum). — This is demulcent  and nutri-
tive, and is much used in coughs, bronchial diseases, inflammation of
the urinary organs, bowels, and lungs; chiefly taken in the form of
flaxseed tea.   The infusion is sometimes used as  an  injection in dys-
entery  and piles.   Linseed oil is prepared from flaxseed..
Fig. 203.                            Fig. 204.
FOXGLOVE.                           GINSENG.
  Foxglove (Digitalis Purpurea). — A biennial plant, growing in the
temperate parts of Europe.   The leaves, in proper doses, are sedative
and diuretic, reducing the pulse, and increasing the flow of urine.  In
large doses, they are a narcotic poison.  The medicine has been much
used in inflammatory diseases, palpitation of the heart, and in dropsy
connected  with  diseased  heart or kidneys.   When  taken  for some
time, it is liable  to accumulate in the system, and suddenly to mani-
fest poisonous and alarming symptoms, as if a large dose  had been
taken.   The American hellebore is fast supplanting it as a remedy.
Dose of the powdered leaves of foxglove, from one  to three  grains;
of the  tincture, from eight to twelve drops.

  Frostweed (Helianthemum Canadense). — This  herb, also known by
the name of rockrose, is tonic, astringent, and alterative, and has been
considerably used in scrofula; combined with turkey corn, and queen s
root, it is said to have effected cures in secondary syphilis.  A decoc-
tion forms a useful gargle in ulcerations of the  mouth and throat in 
MEDICINES AND THEIR PREPARATIONS.           615
 scarlet fever, and other diseases, and as a wash in scrofulous  inflam-
 mation of the eyes.  Dose of the fluid extract, one to two drams,
 three or four times a day.

   Galls.— These are the  unhealthy excrescences found growing on
 the young boughs of the dyer's  oak,  quercus infectoria, growing in
 Asia.   They are powerfully astringent  In  the  form of infusion, or
 decoction, made  in the proportion of half an ounce to a pint of water,
 they are useful as an astringent gargle, wash, or injection ;  and finely
 powdered galls,  one  part to eight parts of lard, make a valuable oint-
 ment for  bleeding'piles.   Dose of powdered galls, from ten to twenty
 grains.

   Gamboge. — The  hardened  juice  of trees growing  in  Siam  and
 Cochin China.    This gum-resin  is a hydragogue  cathartic, acting
 severely and harshly upon the bowels, and hence is not often  used
 alone.  On account of the severity of its action, it is improper to use
 it during inflammation  of the  stomach or bowels, piles, pregnancy,
 diseased womb, or excessive menstruation.  Combined with cream of
 tartar and jalap,  it is a valuable remedy in dropsy.  The dose is one
 or two grains.
   Garlic (Allium  Sativum). — The bulb is the part used.  It is stimu-
 lant, diuretic, expectorant, and  rubefacient; useful in coughs,  hoarse-
 ness, hooping-cough, and in the nervous spasmodic coughs of children.
 Dose,  from  twenty grains to three drams ; dose  of  the juice, mixed
 with sugar, half  a teaspoonful  to a teaspoonful.
   The bruised bulbs are  sometimes usefully applied  as a poultice
 to  the chests of  young  children having inflammation  of the lungs,
 and as drafts to the feet in inflammation of the brain, fevers, etc.
   Gentian (Gentiana Lutea). — It grows among the Alps, Apennines,
 and Pyrenees.  The root is the part used, and is brought to this coun-
 try from Germany.  This  medicine has long maintained its reputa-
 tion, having,  it is said, derived its name from  Gentius, king of  Illyria.
 It is a pure and simple bitter, exciting  the appetite, and invigorating
 the digestive powers.  It may  be used  in all cases dependent on pure
 debility.  It is much employed in  dyspepsia, and  during recovery
 from exhausting diseases.
   Preparations. — Fluid  extract, dose, half a dram to a dram ; com-
 pound fluid extract, dose, half  a dram to a dram; solid extract, dose,
 three to fifteen grains ; tincture, four ounces to  one pint of diluted
 alcohol, dose, two to five drams.  A valuable preparation is made, by
 uniting fluid  extract of rhubarb, two ounces ;  fluid extract of gentian,
 half an ounce ; diluted alcohol, two pints; dose, half an  ounce  to two
 ounces.
  Ginger (Zingiber Officinale). — This is a native of Hindostan, and
is cultivated in all parts of India.   The root is the part used.   It is a
grateful stimulant and carminative, and is much  used for dyspepsia,
wind in the  stomach, colic, gout, etc.  It is an excellent addition to
bitter infusions, and is much used to disguise the taste of nauseous
medicines.  Dose, from ten to thirty grains. 
MEDICINES AND THEIR PREPARATIONS.
       Preparations.— Fluid extract, dose, half a dram to a dram ; tincture,
    four ounces to one pint of diluted alcohol, dose, two to four drams;
    infusion, dose, one to two ounces ; syrup, dose, one to two drams.

       Ginseng (Panax Quinquifolium). — A  perennial  plant, growing in
  I  the  Middle and  Southern States.  It is a mild tonic  and stimulant,
    and has some reputation for improving impaired appetite, and for
    nervous debility, weak stomach, etc.   Some persons are in the habit
    of chewing it, and it is  considerably used in this way.   Dose of the
    powdered  root, from ten to sixty grains ; of the infusion, from two to
  I  four fluid ounces.

       Glycerin. — This is the sweet or sugary portion of oils, and is ob-
    tained from them during the manufacture of lead plaster.  It is demul-
  J  cent and antiseptic, and  has been recently recommended and used, to
    some extent,  in place of cod liver oil, in consumption.   It has been
    still more  used, however, as a soothing and emolient external applica-
    tion in skin  diseases, and also in place of lard in  the preparation of
    ointments.
       Gold. — The chief sort of  gold used in medicine, is the chloride or
    muriate of gold and soda.  It is  diuretic and  alterative.  It is used
    in scrofula, skin  diseases, goitre, scirrhous tumors, opthalmia, dropsy,
    and syphilis.  The dose is from one thirtieth to one twelfth of a grain,
    and is  given  dissolved in water, or made into pill with starch or gum
    arabic.
       Golden Seal (Hydrastis Canadensis). — A perennial plant, growing
    throughout the United States, particularly in the  West.  The root is
    the  medicinal part.   It is  a tonic, having
  |  especial action upon diseased mucous tis-
    sues, and  is particularly beneficial during
  i  recovery  from exhausting diseases.   It is
  {  used in dyspepsia, chronic affections of the
    nervous coats of  the stomach,  erysipelas,
    and  remittent,  intermittent, and  typhoid
    fevers.   United with geranium, it has  a fine
  |  effect in chronic diarrhoea and dysentery.
  I     Preparations. — Fluid extract, dose,  half a
    dram to two  drams; solid extract, dose, two
    to five grains; hydrastin (resinoid), dose, one
    half to five grains; hydrastin (neutral), dose,
    two  to six   grains ;  hydrastina  (alkaloid),
    dose, one to five grains; tincture, dose, three
    ounces to  one pint of diluted alcohol, dose,
    half an ounce to an ounce and a half.   For
    various forms of sore mouth and ulcerated
    sore throat, the following is a useful gargle :
    fluid extract  of golden seal, half an ounce;
    fluid extract of blue  cohosh,  half an ounce;
'  i  fluid extract of witch-hazel, half an ounce; pulverized alum, one dram;
    honey, three  drams; water, one pint.   As a stimulant  for a sluggish
!   616
 
MEDICINES AND THEIR PREPARATIONS.           617
   liver, and as a tonic in enfeebled mucous  membrane in epidemic dys-
   entery,  and other complaints, the  following  powders are  valuable:
   hydrastin, twenty grains; leptandrin, twelve grains; podophylfin, two
   grains; pulverized cayenne, two grains; sugar of milk, or pulverized
   loaf sugar, one dram ; rubbed together thoroughly in a  mortar, and
   divide into twenty powders;  give one every two hours.

      Ground Ivy (Nepeta  Glechoma).— A  perennial  herb,  common  to
   the  United States and Europe; in some places known  as gill-over-
   the-ground.   The leaves are the part used, which -are stimulant, tonic,
   and pectoral; considered useful in jaundice, asthma, and diseases  of
   the kidneys and lungs.

      Guaiacum. — This medicine is the shavings or chips of the wood  of
   a tree growing in the West Indies,  also resin obtained from the same
   tree.   It is stimulant and alterative, and  is used in chronic rheuma-
   tism, diseases of the skin, scrofula, and venereal  complaints.   The
   tincture of the resin is valuable as an emmenagogue.   Dose of the
   tincture, from one-half to two teaspoonfuls, to be taken with milk.
    The wood is much used as an ingredient in alterative preparations  of
   sarsaparilla, etc.

      Gum Arabic. — This is the hardened  juice of  trees  growing  in
    Egypt, Arabia,  and other tropical countries, being several varieties
   of the acacia.   It is demulcent, and  a  combustive nutritive, and is
   much  used in  forming mixtures for hoarseness, cough,  sore  throat,
   gonorrhoea, inflammation  of the bladder, strangury,  bronchitis, and
   irritations of mucous membranes generally.  Mucilage of gum arabic
   is a preparation made by dissolving four ounces of powdered gum in
   a pint of boiling water.

      Gum Hemlock.— This is the hardened juice of the  hemlock, Abies
    Canadensis, a tree growing in Canada and Maine.   This  gum is a
   mild rubefacient, and like burgundy pitch, chiefly used to make plas-
   ters, etc., for which purpose it is very valuable.  A tincture of the gum
   is diuretic and stimulant.  The oil of hemlock is valuable, in combi-
   nation with other oils, in preparing  liniments.  The bark is astringent,
   and is much used in tanning leather.

      Hamiastasis. — This  word  is used  to  imply the retention of the
   venous blood in the  limbs by  ligatures.  A cord or  common  handker-
   chief, is tied  round the upper part  of the arms, or thighs, and a piece
   of wood being slipped under the cord, is twisted round until the cord
   is so tightened  as to prevent the return of the venous blood, but not
»I  to prevent the outward passage of the  arterial blood.   In this way,
 j  the blood passing out  continually  in  the  arteries,  and not returning
 I  by the  veins, the vessels  of the limbs become filled to their utmost
 i  capacity,'and a great quantity, for the  time being, is withdrawn from
 i  the trunk, — greater  than any surgeon  would dare to remove with the
 |  lancet.   This  process is useful in bleedings from the lungs, stomach,
 ;  and womb, and inflammation of the  brain, lungs, bowels,  etc., and
   Ui whatever  case  it may  be thought desirable, for  the  time being, 
618           MEDICINES AND THEIR PREPARATIONS.
 to lessen the  blood in the head or trunk,  without debilitating the
 patient.

   Hair-cap Moss (Polytrichum Juniperum).— An evergreen plant grow-
 ing on poor sandy soils in the  Northern States.   A strong infusion of
 it is powerfully diuretic.   In dropsical cases, two fluid ounces of the
 infusion should be taken every half hour.   It is useful in fevers, in-
 flammations, gravel, etc.

   Hardback (Spiraea Tomentosa).— This is a  beautiful shrub, com-
 mon in the United States.   Its leaves are of a dark green color above,
 and white  underneath.  It  is tonic and astringent, and is
 much used in chronic diarrhoea, cholera infantum, etc.  It
 agrees well with the stomach, and  is deservedly a popular
 remedy in summer complaints of children.
   A fluid extract of it is prepared  by Tilden & Co.; dose,
 four to twenty drops.  It is much used in the form of infu-
 sion.   The green  herb boiled in milk forms a valuable pre-
 paration  in chronic diarrhoea, when  attended with much
 debility.

   Hardleaf Golden-Rod  (Solidago  Rigida). — A perennial
 plant, growing throughout the United States, especially on
 the western prairies.  It  is tonic, astringent, and styptic, and
 useful to arrest bleeding from the nose, lungs, stomach, and
 bowels.  The  powder and infusion are used, both externally
 and internally.                                            hardhack.

   Helonias (Helonias Dioica). — This  herb is common in  the United
 States, and is  known by  the name of False  Unicorn plant.  The root,
 which is the  part used, is  tonic, diuretic, and vermifuge.  In large
 doses, it  is emetic, and when  used  fresh, sialagogue.   In  five or ten
 grain doses, three times a day, it relieves dyspepsia, restores the appe-
 tite, expels worms, and relieves colic.  It is a valuable womb tonic,
 gradually  removing  debility of that organ, and  curing'whites, pain-
 ful  menstruation, and a tendency to habitual abortion.  Dose of the
 decoction, from two to four fluid ounces.  The decoction is said to
 kill insects, bugs, etc.
   Preparations. — Fluid  extract, dose, one  to three drams; helonin,
 the active principle, dose half a grain to a grain.

   Henbane (Hyoscyamus Niger). — This plant grows abundantly in
 Great Britain,- and on the  continent  of Europe, and is rare in this
 country.   All  the parts are active.   It is narcotic, gently accelerating
 the circulation, increasing the  general  warmth, occasioning a sense of
 heat in the throat, and after a time inducing sleep.   It is  often used
'in the place of opium, because it does not bind the bowels.  Used in
 rheumatism, gout, bronchitis,  asthma, consumption, hooping-cough,
 hysterics, and  spasmodic affections generally.
   Preparations. — Fluid  extract, dose, ten to twenty drops ; solid ex-
 tract, dose, half a grain to a grain; tincture, two ounces to one pint
 of diluted alcohol, dose,  half a dram to a dram and a half; hyoscya-
 
MEDICINES AND THEIR PREPARATIONS.           619
min, the active principle, dose, one eighth to half a grain.   In neural-
gia,  rheumatism, St Vitus's  dance, painful  menstruation,  etc., the
following  may  be found  useful:  solid extract of  hyoscyamus,  two
drams ; solid extract of  valerian, two drams ; solid extract of aconite,
one dram  ; sulphate  of  quinia, one dram.   Mix, and divide into  two
grain pills; one pill every  two or three hours.
  High Cranberry (Viburnum Opulus). — This  shrub  grows in  rich
soils in Canada, and in  the northern United States.   The bark, which
is the medicinal part, is  antispasmodic, being used in cramps, spasms,
asthma, hysterics, and is useful for those who are subject  to convul-
sions during pregnancy, and at the time of childbirth.   It is popularly
known by the name  of  Cramp Bark.   A decoction  or infusion of the
bark, may be used in tablespoonful doses,  two or three times a  day.
Dose of the  extract, from one to five grains; in womb troubles, it
may be united with caulophyllin,  cimicifugin, aletriain, senecin, and
asclepidin; and in flatulent colic, spasmodic pains of the  stomach
and bowels, it may be combined with dioscorein.
Fig. 207.                              Fig. 208.
HENBANE.                           HORKHOUND.
  Horehound (Marubium Vulgare).— This well known perennial herb
is a native of Europe, and  has become naturalized in this country.
It is tonic, aperient, pectoral, and sudorific.  It is deservedly popular
in domestic practice, for colds, asthma, throat-ails, bronchitis, and other
pectoral affections, attended with cough.  It is much used in candy.
  Preparations. — Fluid extract, dose, half a dram  to one dram ; solid
extract, dose, five to ten grains ; tincture, two  ounces to one pint of
alcohol, dose, half an ounce to an  ounce; syrup,  three ounces fluid
extract to one pint of simple syrup, dose, three to six drams.
  Hops (Humulus Lupulus).,— The cones of this well-known "plant
are  tonic, hypnotic, antilithic,  and anthelmintic.   They are  chiefly
used for promoting sleep, and relieving  pain and irritability  of the
nervous system.   Hops are valuable in the form  of fomentation, either
alone, or in combination with boneset, and other bitter  herbs.  An 
6*20           MEDICINES AND THEIR PREPARATIONS.
ointment of hops and stramonium leaves is sometimes used in salt-
rheum, and upon painful tumors and  ulcers.   A pillow stuffed with
hops, dipped in hot water, and placed under the head of the patient,
relieves pain and procures sleep.
  Lupulin is  the yellow  powder obtained by threshing the hops, and
is preferable to the  hop itself.  It is a powerful antaphrodisiac, com-
posing the genital  organs, and quieting painful erections, in gonor-
rhoea, etc.
  Preparations. — Fluid  extract, dose, half a dram  to  a  dram ; solid
extract, dose, five to twenty grains ; tincture, two and half ounces to
one pint of alcohol, dose,  three to six drams;  infusion,  four drams to
one pint of water, dose, two  to four ounces ; lupulin, dose, six to ten
grains; tincture of lupulin, two ounces to one pint of alcohol, dose, one
to two drams, in sweetened water ; fifteen to twenty grains of lupulin,
well rubbed up* with white sugar in a  mortar, is very efficacious in
priapism, chordee, and spermatorrhoea.

  Horsemint (Monarda Punctata).— This well-known plant, which is
common to the United  States, is stimulant, carminative, and diuretic.
A warm infusion may be used  in flatulence, nausea,  and vomiting.
If the body be kept cool while taking it, it will act as a  diuretic.  The
oil of horsemint, is  used  for similar purposes with the plant.  Dose,
from  two to six drops on sugar.  Dose of the essence,  from ten to
forty drops in sweetened  water.  The oil is frequently  used  as an in-
gredient in liniments.

  Horseradish (Cochlearia Armoracia). — The  fresh root  of this  well
known perennial is  stimulant, diuretic,  antiscorbutic, and rubefacient.
It is useful in  rheumatic, paralytic, scorbutic, dropsical,  and dyspeptic
affections.   It is said that a warm infusion of  the fresh root in cider,
drank freely every  night,  will cause perspiration, and  a free  flow of
urine, and  will consequently cure dropsy.   The fresh root grated in
vinegar, and eaten with meat at dinner, strengthens  the stomach, and
promotes digestion.
  Houseleek (Sempervivum, Tectorum). — The bruised  leaves of this
perennial, form a cooling  application to burns, stings of  insects, ery-
sipelas, and other inflammations ; valuable also for ringworm, shingles,
and other skin, diseases.
  Hydrangea (Hydrangea Arborescens).— This grows  abundantly in
the  Southern,  Middle, and Western States.   Its root is  medicinal. It
is diuretic,  and has been  much praised for its power of relieving the
excruciating pain, caused  by the passage of stone through the urethra,
as well as for  infallibly removing such  stones  from the bladder, pro-
vided they are not  already too large for passage through the water
pipe.   As many as  one hundred and twenty calculi have  been known
to pass off from one  person, under the  use of this  remedy.   A  con-
centrated  decoction, or the  fluid extract prepared by Tilden &  Co.,
may be taken in teaspoonful doses several times a day, — care being
taken not to push the medicine to the extent  of dizziness, or oppres-
sion of the chest. 
MEDICINES AND THEIR PREPARATIONS.           621
  Hyssop  (Hyssopus Officinalis). — This  is a native of the continent
of Europe, and is cultivated in this country.  The tops and leaves are
the*parts used.  They are stimulant, aromatic, carminative, and tonic.
The  infusion  has been  much employed in chronic bronchitis of old
people, and those of debilitated habits.  It makes the raising of mucus
more easy.  The infusion may be combined with sage and alum, and
sweetened with honey.   The fresh leaves bruised, and applied exter-
nally, relieve the pain, and disperse the  spots and marks caused by
contusions.

  Iceland Moss  (Cetraria  Islandica).—  This  plant is  found in  the
northern latitudes, both of the old  and  new world, and is abundant
on the mountains, and  in the sandy plains of New England.   It re-
ceived its name from  its prevalence in  Iceland, in  which country, as
well as in Lapland, it serves, in consequence of the'gum and starch
it contains, as food for  the inhabitants.   It is demulcent, tonic, and
nutritious, and is well fitted to relieve affections  of  the mucous mem-
brane of the lungs and bowels, connected with debility of the digestive
organs; it is given therefore in chronic bronchitis, and other affections
of the chest,  attended with  copious expectoration, especially when
the matter  discharged is purulent; also in dyspepsia,  chronic  dys-
entery, and  diarrhoea.  It is usually employed in the form of decoc-
tion ; and is much used in the  common article of diet, called blanc
mange.

  Ice Plant (Monotropa  Uniflora). — This perennial plant, found in
various  parts  of the country, is  snow white, resembling frozen  jelly,
and is juicy and tender,  dissolving in the hands like ice.  The flowers
are in shape like a pipe;  it is hence called  the pipe plant.   The  root
is the medicinal part, and is tonic, nervine, and antispasmodic.  It
has also been considered  sedative and diaphoretic ; and the  powder
has been  sometimes used in the place  of opium.   It is  said to be
valuable in  epilepsy,  chorea, and other  spasmodic affections.   Dose
of the  powdered root, from thirty to sixty grains, two to three times
a day.

  Indian Hemp  (Apocynum Cannabinum).— This perennial plant re-
sembles bitter-root, and grows  in similar situations..  The  root is
powerfully emetic, and  in decoction,  diuretic,  and diaphoretic.   It
diminishes the frequency of the  pulse, and produces drowsiness.  It
has great efficacy in dropsy.
  Preparations. — Fluid  extract, dose, as a tonic, five to fifteen drops,
as an emetic, twenty to sixty drops; solid extract, dose, one to five
grains;  tincture, dose, one to two drams, as a tonic, half an ounce to
an ounce, as an  emetic; infusion, half an  ounce to a pint of water,
dose, half an ounce to two ounces.

  Indian  Turnip (Arum  Triphyllum). — This  is a perennial plant,
growing in damp places in North and South America, and known by
the name of dragon root.  The root when chewed, is excessively acrid,
producing a biting sensation  which may be  somewhat relieved by 
622           MEDICINES AND THEIR PREPARATIONS.
milk.  The fresh root is acrid, expectorant, and diaphoretic, and haa
been used in asthma, hooping-cough, chronic bronchitis, chronic rheu-
matism,  and colic, and externally, in  scrofulous tumors, scald  head,
and other skin disorders.  Dose of the grated root, in syrup or mucil-
age, ten grains, three or four times a day.

  Iodine (Iodinum). — This  is prepared from the ashes of kelp, or sea-
weed,  and is in  small bluish-black, shining scales.  It is alterative,
tonic, And  somewhat diuretic.  It has been chiefly employed in dis-
eases of the absorbent and glandular system, particularly  scrofula,
goitre, and glandular tumors generally.   Dose, in substance, half a
grain, two  or three  times a day, in  form of pill; in form of  tincture,
five to ten drops.
  Iodide of Potassium (Potassii Iodidum). — This is one  of  the pre-
parations of iodine, and is sometimes improperly called hydriodate of
potassa.  It is formed by decomposing the iodide of iron, by carbon-
ate of potassa.  It is used for  the same purposes as iodine, but chiefly
as an alterative in tertiary syphilis, for which it is a specific; also in
some forms of chronic rheumatism, and in leprosy.   Dose of the salt,
from two to  twenty grains.   It  is  much combined with  bitter  tinc-
tures, and  particularly with the compound preparations  of  sarsapa-
rilla, yellow dock, and queen's root.  The acids and metallic  salts are
incompatible with it.
  Ipecacuanha.— This is a small perennial plant, growing in moist
woods, in several countries  of South America.  The root is the part
used.  It is a very valuable  emetic, in  large doses ; in  smaller doses,
it is sudorific and expectorant   Used  to  produce vomiting in the
commencement of fevers, inflammatory diseases, swelled testicles, and
before  the  paroxysms of  ague; and to  excite nausea in dysentery,
asthma, hooping-cough, various hemorrhages, and  inflammation  of
the lungs;  and, combined  with opium, to produce diaphoresis in  rheu-
matism, gout, and febrile complaints.  Dose, as an emetic, from fifteen
to thirty grains; to excite nausea, from  one to three grains; and to
produce diaphoresis, two to  six grains, with one grain of opium.
  Preparations. — Fluid  extract, dose, as an expectorant, five to ten
drops; as an emetic,  half  a  dram  to a dram ;  tincture,  half an ounce
to an ounce  and a half;  wine of  ipecac,  three ounces  to one pint of
sherry wine, dose, a quarter  to half a  dram, as an expectorant; two
and a half  to five drams as an emetic.   The following is a useful ex-
pectorant for young children :  fluid extract  of ipecac, two  drams;
syrup of tolu, five drams ;  mucilage of gum arabic, one  ounce ; sherry
wine, three drams,— mix.   Dose, one dram.

  Iron (Ferrum).— As this  is the  most  abundant, so it is the  most
useful of all  the  metals.   It is widely diffused through the  mineral,
the vegetable, and the animal kingdoms.  It is an  essential constitu-
ent in the blood of man, and  as a medicine it has  great value, being
a powerful tonic.  In most cases where the blood is thin and  reduced,
iron is our  best remedy;  it raises  the pulse, promotes the secretions,
and gives color, body, and nutritive qualities to the blood.  It is much 
MEDICINES AND THEIR PREPARATIONS.           623
used, in some one of its prepared forms, in chronic anaemia, chlorosis,
hysterics, whites, rickets, chorea, dyspepsia, neuralgia, and particularly
consumption.   The following are most of the chemical preparations
of iron used in medicine.
  Ammonio-Citrate of Iron (Ferri Ammonio-Citras).— This is in the
form of thin scales, of a beautiful, garnet-red color, and has a slightly
acid taste.  It  is very soluble  in water.   Its great solubility gives it
some advantages over the citrate.  The dose is five grains, three times
a day, in solution.
  Black Oxide  of Iron (Ferri  Oxidum Nigrum). — This is  a dark,
grayish-black powder, unchangeable in the air, and  having magnetic
properties.  It  is a valuable chalybeate, and may be given in five to
fifteen-grain doses.
  Citrate  of Iron (Ferri  Citras).— This is a valuable  preparation of
iron.  It is soluble in water.   Usually given in the form  of pill, in
two to five grain  doses, three times a day.
  Citrate  of Iron and Quinia (Ferri et Quina Citras). — In the form
of shining scales, garnet-colored, and  soluble in water.  An excellent
antiperiodic and tonic. Given  in intermittents, when the blood is low,
etc.  Dose, five to ten grains, two or three times a day.
  Citrate  of Iron and Strychnia. — Dr. James R. Nichols & Co., of
this city,  were the first  to introduce  this combination  of strychnia
with iron, to American physicians.  It is a valuable preparation, and
is constantly winning the favor of the profession.  It combines the
properties of iron and strychnia, and has proved an efficacious remedy
in atonic  dyspepsia, absence of the  menses, St. Vitus's dance, green-
sickness, hysterics, etc.  It  is a beautiful salt, looking like citrate of
iron, except that it is a little darker.  Three grains of the iron are com-
bined with one sixteenth of a grain of strychnia.
  Hydrated Oxide  of Iron (Ferri Oxidum Hydralum). — This is in
a reddish-brown,  moist mass, not much used  in medicine, except as
an antidote to the poison of arsenic, for which it is very  valuable.  It
should be  given in tablespoonful doses, often repeated.
  Iodide of Iron  (Ferri Iodidum). — The iodide of irpn is a crystalline
substance, of a greenish-black  color, and styptic taste.   It has tonic,
alterative, diuretic, and  emmenagogue properties.   It  is  employed
chiefly in  scrofulous  complaints, swelling of the glands of the neck,
chlorosis, absence of the menses, and leucorrhoea.   In  obstinate syph-
ilitic ulcers, and in secondary syphilis, occurring  in  scrofulous  and
debilitated subjects, it has been used with success.  Dose, three grains,
gradually  increased to eight.  It  should never  be  given in the form
of pill. •
  Lactate  of Iron (Ferri Lactas).— This  has the  general medicinal
properties of the ferruginous preparations.  It increases the appetite
in a marked degree, and  has been used with decided  benefit in chlo-
rosis.   Dose, one to three  grains, three times a day.   The dose  may
be gradually increased.  Given in the  form of solution, pill, or lozenge. 
624           MEDICINES AND THEIR PREPARATIONS.
  Phosphate of Iron (Ferri Phosphas).— This is a slate-colored pow«
der, insoluble in water.   It is a valuable remedy  in  consumption,
cancer,  and  nervous  diseases, accompanied  by a  low  state of the
blood.   Dose, one or two grains, three times a day.
  Per Salt of Iron (MonseVs Styptic). — This is a most valuable styp-
tic, and is used with success in restraining violent bleedings.   It pro-
duces no irritant effects upon the tissues, and  may be used with safety
both in  slight and  extensive surgical operations.  Physicians should
have it  by them, and will find it very serviceable in  sudden emergen-
cies of bleeding.  It is prepared in solution  and in the form of dry
salt, by  Dr. James R. Nichols & Co., of this city.' The solution is the
most convenient and eligible form, and may be applied as prepared.

  Powder of Iron (Ferri Pulvis). — This is what is  often called iron
by hydrogen, or Que'venne's iron.  It is an impalpaple powder, and of
an iron-gray color.   If black, it is worthless.   It is used in anaemia,
and in  all those conditions characterized  by deficiency of  coloring
matter in the blood.  The best metallic iron for medicinal use.  Dose,
from two to six grains, several times a day; to be given in the form
of pill.
  Precipitated Carbonate of Iron  (Ferri Subcarbonas). •— This is a
reddish  powder, insoluble in  water.  It  is tonic, alterative, and em-
menagogue, and is used in neuralgia, chorea, chlorosis, anemia, epi-
lepsy, scrofula, etc.  Dose, five to thirty grains, three times a day, to
be taken in a little water.
  Protoxide  of  Iron  (Ferri Protoxidum). —  This  is of a dark blue
color, and  has a tendency to absorb  oxygen from the air, which con-
verts it into the sesquioxide.   It  is a valuable preparation of iron.
Dose, from two to six grains, three times a day.
  Solution of Protoxide  of Iron. — The protoxide of iron being more
readily  absorbed and assimilated, and agreeing better with the stom-
ach, than any other preparation of this metal, has  led to a general desire
for this  salt in some eligible form, protected from the chemical changes
to which it is so liable.   This desire has been  met by  Dr. James R.
Nichols & Co. of this city, who, by a new  method  of  chemical ma-
nipulation, have prepared an unchangeable solution  of it, in the form
of an elegant syrup, which is permanent in form, pleasant to the taste,
and free from the  inky flavor peculiar to iron  preparations.   Dr. Nich-
ols, one of the most reliable practical  chemists in  the country, has
conferred a benefit upon  the profession by  preparing this syrup.  I
have had the pleasure of using it, with peculiar satisfaction.  Dose,
from one to two teaspoonfuls, three times a day.
   Solution Protoxide Iron, with Rhubarb and Columbo. — This is a
composition of protoxide of iron with  vegetable tonics; a combina-
tion long  desired, but just now, for the first  time effected, by  Dr.
James  R.  Nichols & Co. of this city.  As  a remedy in many forms
of dyspepsia, it must prove of great value.
   Solution Protoxide Iron, with Quinine. — This has become a remedy 
MEDICINES AND THEIR PREPARATIONS.           625
of established reputation.  Quinine combined with iron, particularly
with the protoxide, must have great advantages as a chalybeate tonic
This is one of the reliable preparations of Dr. Nichols.  Each table-
spoonful contains half a grain of quinine.

  Solution Protoxide  Iron, with Iodide of Potassa. — In this prepara-
tion, the valuable alterative properties of iodide of potassium,  are
connected wifh iron.   It is therefore alterative and tonic, and may be
used in scrofulous and other weakened conditions of the system.   It
is a remedy of decided merit.   Three grains of the  iodide of potas-
sium are contained in each tablespoonful.   This is also  prepared by
Dr. James R. Nichols &  Co.

  Sulphate of Iron (Ferri Sulphas). — This is in the  form of transpa-
rent  crystals, of a pale, bluish-green color, and  efflorescent in the  air.
It has a styptic  taste, and is soluble in about twice its  weight of
cold water, but insoluble in alcohol.   It is  astringent and tonic.  In
large doses, it produces nausea and griping of the  bowels.   Useful in
scrofula, and as  an  astringent, in  passive  hemorrhages, sweats, dia-
betes, chronic mucous catarrh, leucorrhoea, and  gleet.   As a tonic, it
is useful in dyspepsia."

  Syrup of Iodide of Iron (Syrupus Iodidi Ferri). — This is an ele-
gant preparation of iodine and  iron, and is given in  all  debilitated
conditions of the system, when there is a  taint of scrofula.  Dose,
from twenty to fifty drops, well diluted, at the moment  of taking, with
water.
  Syrup of Iodide Iron  and  Manganese. — This is of a light straw
color, prepared from  protosulphate of iron,  protosulphate  of manga-
nese, and  iodide  of potassium.   It is a remedy of unsurpassed effi-
cacy in anaemic, scrofulous,  syphilitic, and  cancerous affections.   It
is considered superior to the syrup  of  iodide of iron.   This is another
of Dr. J. R. Nichols  & Co.'s valuable preparations.   Dose, from  ten
to sixty drops.
  Tartrate of Iron and Potassa  (Ferri et Potasses  Tartras).—This is in
the form of beautiful shining scales, of a dark ruby color, of a slightly
chalybeate taste, and  very soluble  in water.  It is one  of the  mild-
est of the salts of iron, and is considerably used in scrofula, weak-
ness of the bowels, general debility, etc.   It is much used of late, as
a remedy for syphilis, both  externally and internally.   The dose is
ten to thirty grains in solution.
  Tincture of Muriate of Iron (Tinctura Ferri  Chloridi). — This  has
a reddish-brown,  yellowish color, a  sour and very styptic taste, and an
odor like muriatic ether.  It is  one  of  the most active and certain pre-
parations  of iron, generally agreeing with the stomach,  and much
employed  for purposes for which iron  is used.  It is useful jn scrofula,
gleet, and leucorrhoea ; also in hemorrhages from the womb, kidneys,
and bladder, of a passive character.  Dose, from ten to thirty drops,
gradually  increased  to one or two drams,  two or three times a day-
It should be given diluted with water.
                                79 
626            MEDICINES AND THEIR PREPARATIONS.
   Valerianate of Iron. — This salt is in the form of a dark-red pow-
 der, having a faint odor, and a taste of valerianic acid.   It is soluble
 in alcohol, and insoluble  in water.   Given in hysterical affections,
 complicated with chlorosis.  Dose, one grain, several times a day.

   Isinglass (Ichthyocolla). — A gelatinous  substance, prepared  from
 the bladder of fishes.   It is soluble in alkaline  solutions, and diluted
 acids.  In boiling, it dissolves, and forms a jelly upon coBling, in which
 form it is chiefly used as a nutritive diet for the sick.

   Jalap (Ipomaa Jalapa).— This is a Mexican  plant  Its root is an
 active cathartic, producing liquid stools, more or less griping.   United
 with cream of tartar, it becomes a hydragogue, and is useful in dropsy.
 The dose is from fifteen to thirty grains.
   Preparations. — Fluid extract, dose, a  quarter to one  dram;  solid
 extract, dose, three to eight grains; tincture, two ounces to the pint
 diluted alcohol, dose, one to two and  a half drams; jalapin, the active
 principle, dose, one to two  grains.

   Juniper (luniperis  Communis).— This evergreen shrub  is a native
 of Europe, and  is naturalized in some parts'of this country.  The
 berries, which are the part used, are wrinkled, of a dark-purple color,
 about the size of a pea.  They are gently stimulant and diuretic, and
 have been used in scurvy, and inflammation of  the bladder, chiefly in
 connection with more  active diuretics.  The oil of juniper obtained
 from the berries is used for similar purposes.  Five minims of the oil,
 mixed with one fluid dram of sweet  spirits of nitre, and given three
 times a day, is valuable in  dropsy.  Dose of the berries, from one to
 two drams;  of the oil, from five to fifteen drops.

   Kino. — This is the hardened juice of an  East Indian  tree, Ptero-
 carpus Marsupium.  There are several varieties of it.   It  is a power-
 ful and valuable astringent, and is much used in diarrhoea, not atten-
 ded with inflammation.  Opium  is often united with it, and it is a
 favorite addition to chalk mixture.  It is also used in  chronic dysen-
 tery, leucorrhoea and diabetes.  It may be used in the form of powder,
 infusion, or tincture.   Dose of the powder, ten to thirty grains; of the
 tincture, one or two fluid drams; the infusion is useful as an injection,
 in leucorrhoea and gonorrhoea.   The  powder is sometimes sprinkled
 with advantage on indolent and flabby ulcers.

   Ladies' Slipper (Cypripedium  Pubescens). — The  fibrous roots' are
 the parts used of this plant.  It is tonic, nervine, and  antispasmodic,
 and is employed in nervous headache, and other nervous affections, as
 excitability, hysterics, neuralgia, etc.
   Preparations. — Fluid  extract, dose, half  a dram to a dram; solid
 extract, dose, five to fifteen grains ; tincture, two ounces to a pint of
 diluted  alcohol, dose, half an  ounce  to  an  ounce; cypripedin, the
 active principle, dose, two to four grains.   The following is a useful
 preparation for producing  sleep, in wakeful and excited conditions'.
 fluid  extract  ladies' slipper,  one ounce ;  fluid extract pleurisy root,
one ounce;  fluid extract skunk cabbage, one  ounce;  fluid extract 
MEDICINES AND THEIR PREPARATIONS.           627
scullcap, one ounce ; mix ;  dose, half a dram to a dram, three*times a
day.
  For sick and nervous headache, dependent on an acid stomach, the
following is useful: fluid extract ladies' slipper, half an ounce;  fluid
extract  catnip, hatf an ounce;  fluid extract scullcap, half an ounce;
water, one pint; mix ; dose, one and a half to  three drams.

  Lead  (Plumbum). — Lead acts upon  the system as a sedative and
astringent  Internally, it is used for the purpose of reducing the  force
of the circulation,  and  for restraining improper bleeding,  and other
excessive discharges.  Externally, it is employed to subdue inflamma-
tion.  It should not be excessively used;  for, if taken  internally  for a
long  time, it  injures the nervous  system, and brings on apoplexy,
palsy, and particularly lead colic.   Nature generally gives notice when
it is doing mischief, by drawing a blue line around the edge of the gum.
The preparation of lead  chiefly used in medicine is the following:

  Acetate of Lead (Plumbi Acetas). — This is known by  the name
of sugar of lead, and is a white salt, crystallized in brilliant needles.
It has first a sweetish, and then  an astringent taste.   In  medicinal
doses, it is a powerful sedative  and astringent j in  large  ones, an irri-
tant poison.   It is principally  used, internally, for bleeding  from the
lungs, bowels, and womb.  The dose is generally two grains, united
to half  a grain to a grain of opium, in  the form of pill.  Externally,
it is employed in  form of  solution, and applied to inflamed surfaces
with-cloths.   Four grains of sugar of lead, and four of pulverized
opium to the pint of water, makes a good lotion for various purposes.

  Lemon (Citrus Limonum). — This is a well-known tropical fruit,
the juice of which  has a grateful  acid taste, which  is much used in
fevers and inflammatory complaints,  to  form the agreeable drink
called lemonade.   The  oil of lemon, obtained from the  fresh  rind
of the fruit, is chiefly used in  perfumery, and  to render  the taste of
medicines more agreeable.

  Lettuce (Lactuca Sativa). — The medicinal  properties of this  gar-
den plant are contained in the milk.   It is given when  opium  disa-
grees with the patient, to allay  cough and irritability.
  Preparations. — Fluid extract, dose,  half a  dram to two drams;
solid extract, dose, two to five grains.   The following is a useful com-
pound syrup : fluid extract lettuce, two ounces; fluid extract poppy,
four ounces ; simple syrup, ten ounces;  mix ;  dose, half a dram to a
dram.

  Life Root (Senecio  Aureus). — This is  a perennial  plant, growing
on the banks of marshy creeks, in the Northern and Western States,
and sometimes called Ragwort.  Both the root and  herb are diuretic,
pectoral, diaphoretic, and tonic, considerably valued as  a remedy in
gravel, and other urinary affections, particularly strangury.   It is use-
ful for promoting menstrual discharges.
  Preparations. — Fluid  extract, dose, half a dram to a  dram;  infu-
sion, dose, one to  four  ounces;  sen'ecin,  the  active principle, dose, 
628           MEDICINES AND THEIR PREPARATIONS.
three to* five grains.   For chlorosis, accompanied by absence of the
menses, the following is a useful preparation:  senecin, aletrin, and
sulphate of iron, four grains  each.   Mix, and divide into two grain
powders.   Six grains each of senecin and geraniin, mixed, and taken
in doses of two  to  four grains, has a good effect 1n restraining an
immoderate flow of  the  menses.   In painful menstruation the follow-
ing  is a good pill:  senecin, two grains; quinine, six grains; solid
extract  belladonna, three grains; make into ten pills, and  take one
every three hours, till the pain is subdued.

  Lime (Calx). — This is one of the alkaline earths, and is  an abun-
dant natural production.  It is used in several forms  in  medicine, of
which the following  are the chief.

  Chloride of Lime   (Calx Chlorinata). — This  is a moist, grayish-
white substance,  having  the odor of chlorine, and possessing powerful
bleaching  properties.  Externally used,  it is disinfectant,  and, dis-
solved in water,  is applied with advantage to  ill-conditioned ulcers,
burns, chilblains,  and eruptions of the skin, also as a gargle  in putrid
sore throat, and  as  a wash  for  ulcerated gums, and to purify  the
breath.   It has been used with advantage in dysentery, both  by mouth
and injection,  to correct  the fetor of the stools.

  Lime Water (Aqua Calcis). — This is made  by  dissolving four
ounces  of  lime in a gallon of water, and letting the solution stand
in a covered vessel, and  pouring off the clear liquor when it is wanted
for use.  It is antacid, antilithic, tonic, and astringent, valuable in all
complaints attended  with acidity of the stomach.  United with milk,
and used as the sole diet, it is sometimes the only remedy for chronic
diarrhoea of long standing.   Dose  of  lime water, half  an  ounce to
two ounces.
  Liquorice (Glycyrrhiza Glabra). — This grows in the  south of
Europe and Asia.  The  root is the part  used.   It is demulcent and
expectorant, and  is useful in cough, chronic bronchitis, and irritations
of the mucous surfaces  generally.   The pulverized root, united with
an  equal amount of sulphur, and a little  molasses, is a valuable pre-
paration for coughs.  The black extract may be used for  the same
purposes as the root.
  Liverwort (Hepatica Americana).— An  indigenous plant, growing
in woods, upon  the  sides of  hills and mountains.  The leaves with-
stand the  cold of winter, and the flowers appear early in the spring.
The whole plant is medicinal.  It is a  mild demulcent tonic and as-
tringent, and  has been used in fevers, liver complaints, bleeding from
the lungs, and coughs.
   Preparations. — Fluid extract, dose,  two to three drams;  infusion,
four ounces to the pint of water, to be taken freely.
   Lobelia (Lobelia Inflata).— This weed grows throughout the United
States ; both its  seeds and leaves are used in medicine.  The plant is
emetic, expectorant, sedative, and antispasmodic.  As an emetic, it is
generally used in combination with other articles for that purpose. 
MEDICINES AND THEIR PREPARATIONS.
629
It is of great advantage in spasmodic asthma, as well as in bronchitis,
croup, hooping-cough, and other throat and chest affections.   When-
ever  relaxation is required to subdue spasm, or for  other purposes,
lobelia will be found useful.
  Preparations. — Fluid extract, dose, as an expectorant, ten  to sixty
drops; as an  emetic, one fourth of a dram to a dram ; tincture, two
ounces to a pint of diluted alcohol, dose, as an expectorant, one to
three drams,  as an emetic, half an ounce; infusion,  dose, an ounce
every half hour till  vomiting ensues; lobelin, the active principle, dose,
half  a  grain to a grain  and a half.  The following mixture  will be
found  excellent, as an expectorant and sudorific, in spasmodic croup,
hooping-cough, and asthma, and for  subduing mucous inflammation
about the throat and air passages : tincture of lobelia, half an ounce;
tincture of bloodroot, two ounces ;  oil of spearmint, half a dram ;
empyreumatic syrup, five ounces ; dose, half a dram every two hours.
A poultice made of lobelia, elm bark, and weak lye,  relieves  sprains,
bruises, rheumatic  pains, erysipelatous inflammations,  and  poison
from ivy or dogwood.

              Fig. 209.
Fig.	210.
a&i	rTH
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LADIES' SLIPPER.
  Logwood (Hamiatoxylon Campechianum). — This tree is a native of
tropical America.  The wood is used in medicine.   It  is tonic and
astringent, and  is used with advantage in diarrhoea, dysentery, and in
the relaxed state of the bowels after  cholera infantum.   Used freely
with other treatment, it also benefits constitutions broken down by
disease or dissipation.
  Preparations. — Fluid extract, dose, half a dram to a dram;  solid
extract, dose, five to  thirty grains; infusion, half an ounce to a pint
of water, dose,  four drams every three or four hours, in diarrhoea.
  Magnesia (Magnesia Usta).— Calcined magnesia is obtained  from
carbonate of magnesia, by exposure to a strong heat.  It is a white,
inodorous, light powder, of a feeble alkaline  taste. It is antacid and
laxative, and is much used. in dyspepsia, sick headache, gout, and in
other complaints attended with sour stomach  and costiveness;  like-
wise a favorite  remedy in complaints of children.   Dose, as a laxative, 
630           MEDICINES AND  THEIR PREPARATIONS.
 from thirty to sixty grains;  as  an antacid, or antilithic, ten to thirty
 grains, once or twice a day.
   Carbonate of Magnesia (Magnesia  Carbonas). — This is  prepared
 from sulphate of magnesia, by carbonate of soda.   It is antacid, and
 When it meets with acid in the stomach and bowels, it is laxative.
   Sulphate of Mag*nesia (Magnesia  Salphas). — Obtained from  sea-
 water.  This  is  the well-known Epsom salts and  is purgative  and
 diuretic.   Used in all cases  which require purgatives.  It generally
 operates without griping, and, when united with an acidulated infu-
 sion of roses,  will remain on  the stomach when all other things are
 rejected.   The'less it is diluted, the better and more easily it operates,
 provided a draught of warm  water be  taken  an hour  afterwards.   It
 may be made to act as a diuretic, by keeping the skin cool, and walk-
 ing about  after it has been taken.
   Male Fern, (Aspidium Filix Mas). — This perennial plant is found in
 both Europe  and America, also in Asia and northern Africa.  The
 root, which is the medicinal part, should  be gathered during summer,
 as the  active principle  is more abundant at  that  season than  any
 other.  It  is also said to deteriorate by age, and become nearly worth-
less  in  two years.   It  is slightly tonic and  astringent, but its chief
 value consists in its p§wer to destroy and expel the tapeworm.
   Preparations. — Solid extract,  dose, nine to fifteen grains.   The fol-
 lowing compound  pills  are adapted to the destruction  of  the tape-
 worm : solid  extract male  fern,  two scruples;  gamboge,  fourteen
 grains; calomel, fourteen grains;  scammony, eighteen grains.  Mix,
 and  divide into twenty pills.  Dose, two  to four pills.
   Mandrake (Podophyllum Peltatum). — This is exclusively an Ameri-
 can  plant   The root is the medicinal part  It is cathartic, alterative,
 anthelmintic, hydragogue, sialagogue, and, in large doses, emetic.  It
 stimulates and quickens the action of the liver and kidneys, promotes
 expectoration, and determines the blood to the  surface.   Combined
 with cream of tartar, it produces watery stools, and is useful in dropsy.
 It is used  in jaundice, dysentery, diarrhoea, bilious, remittent, and in-
 termittent  fevers,  puerperal  fever, typhoid fever, and all glandular
 enlargements.  But it  has a more particular action upon the liver,
 and  is especially useful in derangements  of that organ.
   The severity of its action seems to be the only objection to its very
 extensive use.   Its harshness, however, may be much  lessened by its
 combination with castile soap, alkalies, ginger, or caulophyllin.
   Preparations. — Fluid extract, dose,  half a dram to a dram ; com-
 pound fluid extract, dose, one to  two drams;  solid extract, dose, three
 to twelve  grains; tincture, three and  a  half  ounces to one  pint of
 alcohol, dose, one to four  drams;  podophylfin, the active  principle,
 dose, as an alterative, one eighth to a quarter of a grain ; as a cathar-
 tic, one to  two grains.
   Manna. — This is the  concrete juice  of  the  tree called  Ornus
 Europaja, growing in Sicily, Calabria, and Apulia, as well as of several
 other species  of tree.   Manna is a gentle laxative, operating mildly, 
MEDICINES AND THEIR PREPARATIONS.          631
though sometimes  producing wind and pain.   It is consirorably used
as a gentle physic  for children, and women in the family way.   The
usual way of prescribing it is in connection with senna, rhubarb, mag-
nesia, or the neutral salts.   Being sweet, it conceals the taste of these
remedies,  in some measure, while it  adds to their purgative  effect.
Dose of manna, for a grown person, from one to two ounces; for a
child, from one to four drams, according to age.
  Marsh Rosemary (Statice  Caroliniana). — This plant grows on the
coast from Maine to Georgia.  The  root of it is the medicinal part.
A decoction of it is much used in diarrhoea, dysentery, etc., also as a
gargle  in  ulcerated sore  mouth, and  the  throat affection  of scarlet
fever, and as an injection in gleet, whites, and falling of the womb,
and bowel.  Dose of the decoction, one or two tablespoonfuls, every
hour or two.

               Fig. 211.                         Fig. 212.
             MANDRAKE.                       MARSHMALLOW.

  Marshmallow (Althma Officinalis). — A perennial plant, growing in
salt marshes, and  other  moist places, in Europe.   The  root is the
medicinal part, and its properties are those of a demulcent  A decoc-
tion of it is used in irritations and inflammations of mucous mem-
branes, as in inflammation of the lungs, stomach, bowels, and bladder,
and some affections of the kidneys.   The powdered root, and also the
leaves and flowers, are sometimes employed in the form  of poultice.
  Mastich.— This is the hardened gum or  resin which  flows from
incisions in the  small tree or shrub pistacia lentiscus, growing upon
the borders of the Mediterranean.   It is not much used in medicine,
but is chiefly employed in manufacturing a brilliant varnish.  I intro-
duce it here principally for the purpose of recommending  the follow-
ing use of it in carious teeth, — particularly h. those  new parts of the
country where dentistry  is not much known.   Dissolve, in a well-
stopped bottle, four parts of mastich  in one part of sulphuric ether.
Saturate with this solution a small piece of cotton of the size of the
cavity in the  tooth, and then, having cleansed and dried the cavity,
gently press the cotton into it.   The ether will  soon evaporate, and
leave the gum  to  attach itself to the sides of the tooth, and protect
its inner surfaces from the action of the air and food.
 
632
MEDICINES AND THEIR PREPARATIONS.
  Matico (ttper Angustifolium).— The leafves of this plant are styptic,
and somewhat stimulant and tonic.  The leaves  brought in contact
with a bleeding  wound, have considerable power to arrest the flow of
blood.
  Preparations. — Fluid extract, dose, half a dram to  a dram; tinc-
ture, four ounces to a pint of diluted alcohol, dose, two drams to an
ounce;  infusion, half an ounce to a pint of water, dose, one to two
ounces.

  Meadow Saffron (Colchicum Autumnale). — This is a native of the
temperate parts of Europe, where  it grows wild  in moist meadows.
The roots and seeds are used.  Colchicum is justly regarded as a
valuable remedy in gout and rheumatism, in which it is much and
chiefly used.  It is thought, also,  to act upon the nervous system,
allaying pain, and producing other sedative effects.   When not car-
ried  off  by  the bowels, it  produces sweating,  and is occasionally
diuretic and expectorant  Dose of the dried root, from two to eight
grains.
  Preparations. — Fluid extract of  root, dose, three to twelve drops;
fluid extract of seeds, dose, five to fifteen drops ; tincture, four ounces
to twelve ounces diluted  alcohol, dose,  ten drops to  half  a dram;
syrup, two ounces to fourteen ounces simple syrup, dose, one third of
a dram to a dram; wine, three ounces of root  to a pint of sherry
wine, dose, thirty to forty drops.

  Monk's Hood  (Aconite). — This is anodyne, sedative, and diapho-
retic.   The  leaves and root are generally used separately.  It is  use-
ful in inflammatory diseases, neuralgia, epilepsy,  paralysis, gout, and
particularly  in fevers.
  Preparations. — Fluid extract, dose, two to six drops ; solid extract,
dose, one quarter of a grain  to a grain ; tincture, eight ounces of the
root to a pint of alcohol, dose, three to eight drops.
  A preparation composed of one dram of the  tincture  of aconite
root, and two ounces  of the tincture of  black  cohosh, and  taken in
doses of one teaspoonful every four hours, has  great power  in reliev-
ing the various  forms  of neuralgia, and also chronic rheumatic pains,
particularly  among old people.
  For nervous headache, irritability, restlessness, and wakefulness, the
following combination of aconite is useful:
  Solid extract of aconite, half a dram ; solid extract of stramonium,
four grains ;  valerianate of quinia, one scruple.   Mix, and divide into
sixty pills, of which one is to be taken every two,  three, or four hours,
according to symptoms.

  Motherwort (Leonurus  Cardiaca). — This perennial plant is  sup-
posed to be a native  of Tartary,  and introduced into this country.
It is considerably used in domestic practice, for nervous complaints,
and  many  chronic  disorders  attended  with  restlessness, disturbed
sleep, pains  of the nerves, and  affections of the liver.   A warm infu-
sion of  the  tops and leaves  is useful in restoring menstrual suppres-
sion from colds. 
MEDICINES AND THEIR PREPARATIONS.           633
  Preparation. — Solid extract, dose, three to  six grains.   Combined
with blue cohosh and skunk cabbage, the solid extract is a nervine,
antispasmodic, and emmenagogue.

             Fig. 213.                           Fig. 214.
           MEADOW SAFFRON.                   MOUNTAIN* LAUREL.

   Mountain Laurel (Kalmia Latifolia). — The laurel is found in most
 parts of the United  States, on hills and mountains, flowering in June
 and Ji%, and is very ornamental.   It  is sometimes called big ivy, or
 calico bush.  The  narrow-leaf laurel, or  sheep laurel, kalmia angusti-
 folia, is also common, and similarly medicinal.  The leaves of these
 plants are used in medicine, and produce, when taken in large doses,
 vertigo, dimness of sight, etc.  In medicinal doses, they are sedative and
 astringent.  The saturated tincture is the best form of administration,
 which may be taken in ten to twenty-drop doses, every two or three
 hours, in syphilis, active hemorrhages, hypertrophy of the heart, and
 jaundice.

   Mullein (Verbascum Thapsus). — The leaves and flowers of this bien-
 nial plant are antispasmodic, diuretic,  and demulcent.  The infusion
 is frequently used m domestic  practice, and is useful in colds, coughs,
 bronchitis, etc.; arret may be drank  freely.  The leaves are sometimes
 boiled in  milk,  sweetened, and taken for  bowel complaints.   The
 leaves, dipped in hot vinegar  and water, are very useful, applied as a
 fomentation in mumps, acute inflammation of the tonsils, and malig-
 nant sore throat; a handful of them may also be placed in  an old tea-
 pot, with hot water, and the steam be inhaled through the spout, in
 tne same complaints.'
  Mustard. — The  seeds of the white  mustard, sinapis alba, were, a
 few years ago, much  recommended as a cure for constipation of  the
 bowels; and, swallowed whole, in teaspoonful, or even, in some obsti-
 nate cases, in  tablespoonful doses, they afford a wholesome stimulus
to the bowels,  and accomplish some good.  The ground-mustard is a
valuable condiment to eat  in small quantities, at dinner, in dyspeptic
cases.  It finds its  most important uses, however, as a prompt and
almost instantaneous emetic in cases of  poiSoning, and also as a val-
uable counter-irritant, when applied externally.  The volatile oil of
mustard, one part, and ten  parts of sweet oil, may be  applied to  the
skin, instead of the mustard poultice, and with similar results.
 
634           MEDICINES AND THEIR PREPARATIONS.
  Myrrh. — The tree balsamodendron myrrha, growing in Arabia, etc.,
yields a juice which hardens into a gum-resin, called myrrh.  This
pleasant, aromatic gum, is stimulant, tonic, antiseptic, emmenagogue,
and expectorant.   It is employed  in chronic bronchitis, consumption,
chlorosis, absence of the menses, etc.   It is generally combined with
iron  and other tonics,  and in amenorrhoea, is frequently combined
with aloes.   Locally, it is considerably used as a wash to improve
spongy gums, ulcers  of the mouth, etc.  The dose is from ten to thirty
grains, to be given  in  pill, or in  powder suspended in water.  The
tincture of myrrh is  a useful external application.

  Naptha. — This  belongs to the class of native inflammable sub-
stances, called  bitumens.  It is a transparent, yellowish white, very
light and inflammable liquid, and is found abundantly in Persia. Said
to have been used with advantage in Asiatic cholera.   It is composed
exclusively of carbon and hydrogen.   Dose, from ten to twenty drops,
given in half a glass of wine, or mint water.  During  the  formation
of coal gas, an artificial napthia is obtained, which, when purified,
has the property of dissolving India rubber.
  Medicinally,  it is  chiefly used  for purposes of inhalation, in affec-
tions of the chest.

  Naphthaline. — This is obtained from a distillation of coal tar.   It
is soluble in ether, alcohol, naphtha, and oils, but not in water. It is
an excellent expectorant, particularly in cases of impending suffoca-
tion of old persons, from chronic bronchitis ;  also in asthma and other
pectoral affections.   Being stimulating, it is improper in  acute bron-
chitis, and  pulmonary inflammation.   The  dose is from ten to thirty
grains, given in emulsion, or  syrup, every fifteen minutes, until abun-
dant expectoration takes place.  A scruple of napthaline, mixed with
five drams of lard, makes a good ointment for psoriasis, dry tetter,
and leprosy.                                    ^

  Nitrate of Silver (Argenti Nitras).— Nitrate of silver is a solution
of silver in  nitric acid, and commonly passes under the name of lunar  |
caustic.  It is both in the form of small cylindrical rods, and of crys-
tals, the latter being  more pure than the former.
  As an internal remedy, nitrate of silver is tonic and antispasmodic,
and is given chiefly  in nervous diseases, as epilepsy, StVitus's dance,
and neuralgia of the heart; also in some forms of dyspepsia, attended
with pain in the stomach, and vomiting. The dose is from one fourth
to half a grain, in  the form of pill.  It should  never be  taken regu-
larly as an internal remedy, more than three months, as it is apt, after
long use, to change the skin to an indelible slate blue.
  But nitrate of silver is most used as an external remedy, in pharyn-
gitis, laryngitis, tracheitis, and other chronic and acute inflammations
of mucous membranes.  For reducing  these inflammations, it is very
nearly a specific; certainly, it is altogether the best remedy we have.
It fails in some few cases; but when skilfully used it never does harm.
The solutions  to be  applied to the throat, require to have a strength
of from fifteen to a hundred and twenty grains to the ounce of soft 
MEDICINES AND THEIR PREPARATIONS.           635
  water.  A solution containing one to four or more grains to the ounce
  of water is often used in inflammations of  the eye, gonorrhoea, etc.
    Nitre (Potassa Nitras). — Nitre, which also passes  under the name
,  of nitrate of potassa, and saltpetre, is both a  natural and artificial  j
  production.   As a medicine,  it is refrigerant, diuretic, and diaphoretic,
  and is much used in inflammatory diseases.  It increases the secre-
  tion of urine and sweat, and  lessens the heat of the body, and  the fre-
  quency of the pulse.  United with tartar emetic and calomel, it forms
  the well-known nitrous powders, which  promote  most of the secre-
  tions, particularly those of the liver and skin.   One of these powders,
  constituting a dose, to be given every two or three  hours, is composed
  of eight grains of nitre, one fourth of a grain of calomel, and  one
  eighth of a grain of tartar emetic.
    Sweet Spirit  of Nitre (Spiritus JEtheris Nitrici). — Sweet spirit of
  nitre  is diuretic, diaphoretic,  and* antispasmodic.   It is deservedly
  much esteemed as a medicine, and is extensively'employed in  febrile
  diseases, either  alone, or in union with tartar emetic,  or with spirit of
  mindererus.   It is often a grateful stimulus to the stomach, relieving
  nausea and vomiting, and promoting  sleep.  It acts especially upon   \
  the kidneys, augmenting the  secretion of urine, and  is often given in
  conjunction with  squills, digitalis, and acetate of potassa.   The dose   j
  is a teaspoonful, given in water every two or three  hours.
    Nutmeg' (Myristica Moschata). — The nutmeg is from a tree grow-   j
  ing in the  Molucca Islands.   It is stimulant and carminative, and
  somewhat used to remove flatulency, as well as to render  other medi-
  cines  palatable  ; it is most employed, however, to flavor drinks, and
  articles of diet   In large doses, it is poisonous, producing stupor and
  delirium.
    Nux Vomica  (Strychnos  Nux Vomica). — The tree  which produces
  nux vomica, grows in Bengal, Malabar, and the coast of Coromandel,
  and in other regions.   The seeds are  the me-
  dicinal part.
    Nux vomica is  an emphatic excitant of the
  brain  and spinal  cord,  and, in large  doses, is
  an active poison ; frequently  repeated in small
  doses, it is tonic, diuretic, and slightly laxative.
    Given in full  doses, it is apt to produce mus-
  cular contraction, as in lock-jaw, together with
  frequent starts and twitches, as if from electric
  shocks.  It is much employed in treatment of
  jjaralysis, and is more beneficial in general than
  in partial palsy.
    Preparations. — Fluid extract, dose, two  to
  ten drops; solid extract, dose, half a grain to two grains ; tincture,
  four ounces to the pint of  alcohol, dose, five to fifteen drops ; strych-
  nia, commonly called strychnine, the  active principle, dose, one six-
  teenth to one eighth of a grain.
    0J1 of Cajeput (Oleum Cajuputi). — This  oil is  obtained from the
 
636           MEDICINES AND THEIR PREPARATIONS.
   leaves of the East  Indian tree  cajuputi.  It is diaphoretic and anti-
j   spasmodic, and a powerful diffusive stimulant.   Given in cramps of
   the stomach and  bowels, colic, flatulency, hysterics, and chronic rheu-
   matism.   It is considerably used as an ingredient  in liniments, to be
   applied externally in  rheumatism, and neuralgia.  Dose, from one to
i   five drops, on sugar.
j     Oil of Turpentine (Oleum Terebinthina). — This is generally called
I   spirits  of  turpentine, and  is obtained  by distilling turpentine.  As a
I   medicine,  it is  stimulant, cathartic, diuretic, anthelmintic, and astrin-
i   gent  In large doses, it causes strangury, and other unpleasant symp-
I   toms.  The dose is from five to thirty drops, repeated every two or
!   three hours.  Fifteen drops, taken every fifteen minutes or half hour,
I   powerfully restrains bleeding from the lungs, and is, perhaps, the best
'   remedy we have for this frightful accident.
     It is akso very efficacious in  checking other  hemorrhages.  Exter-
   nally, it is used considerably as  an ingredient in liniments and rube-
   facients, in rheumatism, paralysis, etc.  Combined with linseed oil, it
   is much used for  burns  and scalds.
i     Olive Oil (Oleum Oliva). — This oil,  often called  sweet oil, is ex-
   pressed from the  fruit of the olive tree, Olea Europea.  It is nutrient
   and emollient, and in doses of  one to two  fluid ounces, laxative.  It
   is much employed as  a  constituent of  cerates, liniments, and  plasters.

     Onion (Allium  Cepa). — The  medicinal properties of the onion are
   much  like those  of garlic.  The juice, mixed with sugar, is used to
   some extent as a  remedy for the  coughs and colds of infants.   Roasted
}   onions, applied as a poultice, hasten the suppuration  of boils, tumors,
   etc.   They are also useful, in some cases, applied as drafts to the feet.

     Opium. — This is the hardened juice of the unripe seed of the poppy,
   Papaver Somniferum.   It is a stimulant narcotic.  A moderate  dose
   increases the fulness and frequency of the pulse, augments the warmth
   of the skin, invigorates  the muscular system, quickens the senses, ani-
'   mates the spirits, and gives energy to the mental faculties.  Its opera-
   tion is directed with  special  force to the brain, which it sometimes
   excites to intoxication  and delirium, which excitement subsides in a
   short time, and is followed by a delightful calmness, and  placidity of
   mind,  all  care and  anxiety being banished, and  the thoughts  yielded
   to the control of pleasing fancies.  At the end of an hour or more,
!   this reverie is  succeeded by sleep, which, at the end of  eight or ten
   hours, passes off, and is  followed by headache, nausea,  tremors, and
   other  nervous  disturbances.   Large  doses are followed by shorter
   periods of exhilaration  and excitement, and by more protracted sleep.
      Opium is used in medicine to produce gentle perspiration, relieve
   pain, and lessen  nervous excitability  in all  febrile and inflammatory
   diseases; also  as an antispasmodic'  in  hysterics, colic,  convulsions,
   coughs, etc.  It  should not be  used in cases of constipation of  the
   bowels.   A solution, composed of two  grains of opium to one ounce
   of  water, is  sometimes a valuable injection in  gonorrhoea and  spas-
   modic stricture.  Dose, as a stimulant one quarter to one half a grain; 
MEDICINES AND THEIR PREPARATIONS.           637
    as a narcotic, one to twTo grains; in some spasmodic  affections, it is
    given in very large doses.

      Morphia, generally called morphine, is one of the alkaloid principles
    of opium.  It is used under the various forms of sulphate, muriate,
    acetate, and valerianate of morphia,—all having the general propertied .
    of opium, and are given for similar purposes, in doses of one eighth
    to one quarter of a grain.   One sixth of a grain is equal to one grain
    of opium.
       Strong coffee is an excellent antidote to the poisonous effects, both
    of opium and  morphia.  A solution  of  morphia may be made by
    adding ten grains of the salt to one fluid ounce and a half of distilled
    water, and half an ounce  of diluted  alcohol,  and then adding two
    drops of sulphuric acid, if it be the sulphate of morphia, or two drops
    of acetic acid, if it be the acetate of morphia,  or two  drops of muri-
    atic acid,  if it be  the muriate of morphia.  The effects of morphia
    may be obtained by sprinkling some of it on a blistered surface.

      Orange  Peel (Aurantii Cortex). — The  orange is the fruit of a tree
    belonging to the tropical climates.   Orange juice is a  pleasant refrig-
    erant, useful in fevers, and particularly in  scurvy.  Sick persons suck-
    ing the juice of the  orange, should  be careful not to swallow any of
    the skinny portion, or the peel.   The peel of the orange is chiefly
    employed to give a pleasant flavor to other medicines, and to prevent
    their nauseating properties.  It is a miid tonic, carminative, and stom-
    achic, and improves  the bitter infusions  and  decoctions of gentian,
    quassia, columbo, and peruvian  bark.   Orange peel should never be
    given in substance.
      Preparations. — Fluid extract, dose, half a  dram  to two drams;
    tincture, one  ounce  and three quarters to a pint of diluted alcohol,
    chiefly used as an addition to infusions, etc.; syrup, two ounces  fluid
    extract or tincture to a pint of simple syrup, used with water as an
    agreeable drink.

      Origanum (Origanum Vulgare). — A  perennial  herb growing in
    Europe and this country.  The warm infusion of it causes perspira-
    tion, and promotes the menstrual discharge, when interrupted by a
    cold.  The oil of  origanum is  a very useful  ingredient, in  several
    stimulant and rubefacient liniments.

      Parsley  (Petroselinum Sativum). — The root  of this biennial plant
    is aperient and diuretic, and is  used in dropsy, scarlet fever, and dis-
    eases -of the kidneys ; also in retention of the urine, gonorrhoea, and
    strangury.  The dose of the infusion is from two to four fluid ounces,
    two or three times a day.
      The bruised leaves  are  applied with advantage  to contusions,
    swelled breasts, and enlarged glands.

      Partridge Berry (Mitchella Repens). — This perennial, evergreen,
    creeping herb, grows in dry woods and  swampy places throughout
    the United States,  and has white, fragrant flowers in  June  and July.
    It  is parturient,  diuretic, and astringent, and is used  in dropsy, sup-

1_________                                      ----1 
638           MEDICINES AND THEIR PREPARATIONS.
pression of urine, and  diarrhoea.   It acts as a tonic upon the repro-
ductive organs, giving tone and vigor to the womb, and making labor
less tedious.   Dose of the  decoction, from two to four fluid ounces,
two or three times a day.
  Peach (Amygdalus Persica).—The leaves of the peach are sedative
and slightly laxative, and are used in  inflammations of the stomach
and bowels;  likewise in irritable bladder, hooping-cough, sickness  at
the stomach, and dysentery.  They are used in the form of cold infu-
sion, a tablespoonful being a dose, to be taken every hour or two.   A
good tonic is  made by adding four ounces of the bruised kernels to a
quart of honey.
  Pennyroyal  (Hedeoma Pulegioides).— Pennyroyal is a gently stim-
ulant aromatic ;  it relieves wind colic and sick stomach, and qualifies
the action of  other medicines.   Like most aromatic herbs, it has the
property, when given as a warm infusion, of promoting perspiration,
and of exciting  the menses, when the  system is  already disposed  to
the effort.  In cases of recent  suppression, it may be given at bed-
time as a warm tea, after bathing the  feet in warm water.   The oil
of pennyroyal has the properties of the herb.

          Fig. 216.                              Fig. 217.
        PENNYROYAL.                          PERUVIAN BARK.

  Peppermint (Mentha  Piperita). — The  peppermint is a native of
England, where  it is largely cultivated, as it is to some extent in this
country, for the sake of its essential oil.   It is a valuable herb, having
a strong aromatic smell, and a pungent, warming taste.  It may be
used in the form of tea, which, when  largely drank, imparts warmth
to the system.  It is valuable in colds, flatulent colic, hysterics, spasms,
cramps in the stomach, nausea, and vomiting, and to disguise unpleas-
ant medicines.
  The peppermint furnishes an essential oil, which, dissolved in alco-
hol, forms the essence of peppermint.   The dose of this is fifteen to
thirty drops, on a lump of sugar, or in sweetened water, warm or cold.
 
MEDICINES AND THEIR PREPARATIONS.           639
     Persimmon (Diospyros  Virginiana). — This is a  tree growing in
   the Southern and Middle States.   The bark and  unripe fruit are
   used in medicine, — being astringent and tonic.  Persimmon has been
   found useful in  chronic diarrhoea, chronic dysentery, hemorrhage from
   the womb, and  fever  and ague.  It is  used  in  the  form of infusion
   and syrup, in doses of a tablespoonful, every two or three hours.  The
   infusion is also used  as a wash and gargle in sore mduth and throat,
   and as an injection in whites.
     Peruvian Bark (Cinchona). — This valuable bark is derived from
   several species  of the cinchona tree, on the  western coast of  South   j
  . America.   The remedy is said to have been first introduced into
   Europe  in  1640, by  the  Countess  of Cinchon, wife of the Viceroy
   of Peru, on her return to Spain.
     There  are three varieties of this bark :  the pale,  the  red, and the
   yellow.   The pale bark is least liable  to  offend the stomach,  and is
   perhaps the best as  a general  tonic; but  for the treatment of fever
   and ague, the red and the yellow are both preferable to the pale, and
   the red is considered  better than the yellow.
     Cinchona is  tonic  and  antiperiodic,  and is much  used,  and with
   great success, in all  periodical  diseases, as fever and ague, remittent
   fever, neuralgia, and  epidemic diseases ; also  in chronic diseases  at-
   tended with debility,  as scrofula, dropsy, and affections of the skin.
   Dose of the powdered bark, as a tonic, from ten to sixty grains ; as
   an antiperiodic, from twenty to a hundred grains.
     Preparations. — Fluid extract, dose, half a  dram to  a dram; com-
   pound fluid extract, dose, half a dram to a dram ; tincture, four ounces
   to one pint diluted alcohol, dose, one to four drams; infusion, dose,
|   one to two ounces.   A good compound infusion of cinchona is made
!   by combining one ounce  fluid extract  .with  half an ounce of fluid
I   extract of snake-root, two drams of fluid extract of  orange peel, one
j   dram of fluid extract of cloves,  one dram of carbonate of potassa, and
   one pint of water.  Dose,  one to one and a half ounces.  The foliow-
;   ing is a good nervine  and tonic for persons  of nervous temperaments:
   fluid extract of cinchona, one  ounce ;  fluid  extract of valerian, one
j   ounce; essence  of cardamom, two drams; dose, one dram every three
1   hours.                   ,
     Cinchonia is a white crystalline substance obtained from  the  peru-
   vian  bark.   It is sometimes used  as a  substitute for quinia, in doses
   of from one to four grains, three times a day.

     Sulphate of Quinia  is snow white, and in satin-like  crystals, having
   an exceedingly bitter taste.  It is completely soluble in water, or alco-
   hol, by adding a few  drops of sulphuric  acid.  It is the chief  active
   principle  of cinchona, and has similar  properties,, namely,  febrifuge,
   tonic, and antiperiodic;  it is, however, less apt to nauseate and op-
   press the stomach.   In  the treatment of intermittent fevers,  it has
   almost entirely superseded the use of the bark.

     Valerianate of Quinia. — This is a combination of quinia and vale-
  rianic acid.  It  is tonic febrifuge  and sedative.  It is used for head- 
640           MEDICINES AND THEIR PREPARATIONS.
ache of a periodic character, and for nervous irritability, wakefulness,
restlessness, etc.  Dose, from half a grain to two grains.

  Petrolium. — This is a blackish  liquid bitumen, flowing spontane-
ously from the earth in Italy, France, West India Islands^ etc.  As a
medicine, it is stimulating, antispasmodic, and sudorific.   It is occa-
sionally administered  in  affections of the  chest, when not attended
with inflammation.  Externally, it is employed in chilblains, chronic
rheumatism, paralysis, diseases of the  joints, and affections  of  the
skin.   It  is an ingredient in the well-known  remedy called British
oil.  The petrolium found in the State  of New York,  and called
Seneca oil,  is extensively used in domestic practice.  The dose  of .
petrolium is from thirty drops to a  dram.

  Phosphorus. — This  is a semi-transparent solid, and is flexible, and
has a waxy lustre.  It is extracted  from  bones by sulphuric acid.  As
a medicine in small doses, it acts as a powerful general stimulant;  in
large  doses, as  a violent, irritant  poison.   When taken in  substance
it causes  irritation of  the stomach, and should, therefore, always be
administered in solution ; and even in this form it is objectionable; it
is better to resort to the  phosphates, and the hypophosphites.  Phos-
phorus, being an element in the composition of the brain, has been
given, and with  advantage, in  the  various  forms of nervous debility,
as consumption, typhus  fever, amaurosis, paralysis, and  the general
breakdown of the vital powers.  Phosphorus burns when exposed to
the air, and should therefore be kept covered with water.

              Fig. 218.                           Fig. 219.
             PINK BOOT.                        PIPSISBEWA.

  Pink Root (Spigelia Marilandica). — This  perennial herb grows in
rich soils in the Middle and Southern States.  The root is the medici-
nal part  It is a powerful anthelmintic,  and is but little  used, except
for expelling worms.
  Preparations. — Fluid extract, dose, half a dram to  a  dram and a
half;  compound fluid extract, dose, half a dram to two drams;  fluid
 
MEDICINES AND THEIR PREPARATIONS.            641
   extract of pink root and senna, dose, half a dram to a dram ; infusion,
   half an ounce to a pint of water, dose, two to six ounces.
     Pipsissewa  (Chimaphila  Umbellata). — This is  a small evergreen
   plant, growing' in the  United States,  and in Northern  Europe and
   Asia.  It is known by the name of princes'' pine.   The whole plant is    i
j   tonic, diuretic, and astringent, and has  proved itself useful in dropsy,
1 j   general debility, rheumatism, chronic disorders of the kidneys, bladder,
11   urethra, etc.
     Preparations. — Fluid extract, dose,  one  dram ;  solid extract, dose,
ji   ten to twenty grains ;  infusion, dose, two ounces.                 %
     Plantain  (Plantago  Major). — This  perennial herb  grows both  in
   Europe and America.   A strong decoction of the  tops and the roots
   is highly spoken of for syphilis and scrofufa;  the dose being from two
   to four fluid ounces, two or three times a day.  But the bruised leaves
   are most useful, when applied to  wounds, ulcers, bites of poisonous
   insects, erysipelas, etc.
     Pleurisy Root (Asclepias Tuberosa). — This perennial plant is abun-
   dant  in the  Southern  States.  The root, which is the part used, is
   carminative, tonic, and diuretic; used in pleurisy, bronchitis, inflamma-
   tion of the lungs,  acute rheumatism, and dysentery.  The warm infu-
   sion  promotes diaphoresis, without raising  the  temperature  of  the
   body.  United with the warm infusion of wild yam root, it is excel-
   lent for flatulency and wind colic.
     Preparations. — Fluid  extract, dose, half  a dram  to  two  drams;
   tincture, four ounces to a pint of  diluted alcohol, dose,  three  to five
   drams; infusion, dose, one to four ounces; asclepidin, dose, one to five
   grains. Asclepidin and dioscorein, united in equal parts, make a valua-
   ble preparation for flatulent and bilious colic; dose, two to four  grains.
Fig. 220.                             Fig. 221.
PLEUBISY BOOT.                      POISON HEMLOCK.
  Poison Hemlock  (Conium Maculatum).— This biennial  plant is a
native of Europe and  Asia, and is naturalized  in this country.  The
leaves and the seeds are used in medicine.  Conium  is narcotic, ano-
dyne, antispasmodic, and deobstruent ;  used in neuralgia,  asthma,
syphilis, chronic rheumatism, and various other affections. 
642
MEDICINES AND THEIR PREPARATIONS.
Fig. 222.
  Preparations. — Fluid  extract, dose, five  to  twenty  drops;  solid
extract, dose, half a grain  to  two grains; tincture, three ounces to a
pint of diluted alcohol, dose, thirty drops to a dram; infusion, half
an  ounce to a pint of water, mainly used as a wash for malignant
ulcers, etc.

  Poison Oak (Rhus Toxicodendron). — The leaves are the medicinal
part of this creeping shrub, which is common in  this country.   The
form of using this medicine is that of a saturated tincture, made from
the fresh  leaves, and to  be kept in well-corked vials.  It  has been
fo»nd  useful in paralysis  of  the  bladder and rectum, in diseases of
the eyes and skin, and in chronic  rheumatism.   Dose of the  tincture,
from five to ten drops, three times a day.  Large doses should be
avoided.

  Poke (Phytolacca  Decandra). — A perennial plant, growing in nearly
all  parts of the country, and called garget,  pigeon-berry, and scoke.
The root is the part used.  It is emetic, cathar-
tic, alterative, and slightly narcotic.  It excites
the whole glandular  system, and  is  used in
syphilis, scrofula, rheumatism, and affections of
the skin.   The root, buried in hot  ashes until
soft, and then  mashed, and applied as a poul-
tice, is said, in King's Dispensatory, to be un-
rivalled in  felons and various  tumors.  Dose
of  the powdered root, as an  emetic, twelve
grains to half a dram ; as an alterative, from
two to six grains.
   Preparations. — Fluid  extract, dose, ten to
thirty  drops;  solid  extract,  dose, one to four
grains; tincture, four ounces to  a pint of di-
luted  alcohol,  dose, half  a  dram to a  dram;          POKa
syrup, two ounces to fourteen  ounces of sim-
ple syrup, dose, one to two drams; phytolaccin, the  active  principle,
dose, one quarter to one  grain.   For mercurial and  syphilitic pains
in the bones, the following pill  is  useful: solid extract of poke, two
drams ; solid extract of stillingia, one  dram ; solid extract of stramo-
nium, eight grains.   Mix, and divide into sixty pills, of which one pill
is to be taken  every one, two, or three hours.

   Potassa. — This is used in medicine under the name of caustic
potassa.  It is made by boiling a solution of potassa in a clean iron
vessel until ebullition ceases, and the potassa-melts, and then pouring
it into cylindrical moulds; when cold it is to be kept in well-stopped
bottles.   It is  a very powerful escharotic, quickly  destroying the flesh
which it touches, and extending its action deep  under the surface.  It
differs in this respect from nitrate of silver, which only acts  upon the
surface, and is not,  properly speaking, a caustic.
   Caustic potassa is used for forming issues.  The method of using
it for this purpose is  to  cut in apiece of adhesive plaster, a hole as
large as the desired issue, and tinm, having stuck  this upon the skin,
 
MEDICINES AND THEIR PREPARATIONS.           643
to apply the end of the caustic, previously moistened, to the opening.
This application is to be continued till the life of the part is destroyed,
when the caustic must be neutralized by vinegar, or carefully washed
off with a wet sponge.
  The following preparations of potassa are used in medicine :

  Acetate  of Potassa (Potassa  Acetas). — This is made by the union
of acetic acid and  carbonate of potassa, and in consequence of its
extreme deliquescence when exposed to the air, it is kept in closely-
stopped bottles.  It is diuretic, deobstruent, and mildly cathartic.   It
is used in febrile  diseases, several  skin diseases, such  as psoriasis,
eczema, and  lepra, and particularly  in dropsical  affections.  Dose, as
a diuretic, from twenty to thirty grains ; as an  aperient  from two to
three drams.

  Bicarbonate of Potassa (Potassa  Bicarbonas). — This is a solution
of carbonate of potassa, saturated with  carbonic acid.   This  acid  is
diuretic,  antacid, and deobstruent;  used in dropsy,  acidity of the
stomach,  and glandular  obstructions.  Dose,  ten  to  thirty grains.
Twenty grains dissolved in eight fluid ounces  of water, and  mixed
with  four  fluid drams  of  lemon juice, forms  a good effervescing
draught.

  Bitartrate  of Potassa (Potassa Bitartras). — This salt  is  better
known as cream of tartar, and  super tartrate of potassa.  It is formed
from  the  matter deposited  on  the bottom and  sides of casks, during
the fermentation of sour wines.   As a medicine it is  diuretic, cathar-
tic, and refrigerant.   In  small doses, it acts as a cooling aperient,
gently opening the bowels ; in large ones, as a hydragogue cathartic,
causing free, watery stools.  This property, as well as its power of
acting upon the kidneys, causes it to be  much used  in dropsical com-
plaints.  Dissolved in boiling  water, allowed to  cool,  and then sweet-
ened  with loaf sugar, it forms a  cooling, pleasant, acid  drink.  This
kind of solution, with a little fresh lemon peel added  to  it, forms the
drink called  imperial.  Combined with  sulphur, it is often  used  in
skin diseases.  Dose, as an  aperient, a dram or two ;  as a hydragogue
cathartic,  half an ounce to an ounce ; as a diuretic in  dropsical com-
plaints, a dram and a half to two drams, several times a day.   Cream
of tartar, powdered  rhatany, and  myrrh, mixed in equal proportions,
form  a good preparation for cleansing the teeth.

  Carbonate of Potassa (Potassa  Carbonas). — Carbonate  of potassa
is purifiedpearlash, and is frequently called salt of tartar.  The com-
mon  saleratus  is a composition between the carbonate  and  bicarbo-
nate.   Carbonate of potassa has the same medicinal  properties with
the bicarbonate, and is used for similar purposes.

  Chlorate of Potassa. — This is prepared by  passing an excess of
chlorine through carbonate of  potassa.   It is refrigerant and diuretic,
and is given  in scurvy, scarlet fever, etc., and as a wash in canker  in
the mouth, and various unhealthy ulcers, and as an  injection in leu-
corrhoea and gleet. 
644            MEDICINES AND THEIR PREPARATIONS.
      Citrate of Potassa (Potassa Citras). — A grateful, cooling diapho-
    retic, long and much used in fevers, chiefly in the forms of the neutral
    mixture, and effervescing draught.

      Solution of Citrate of Potassa (Liquor Potassa Citralis). — This is
    prepared by taking half a pint of lemon juice, and adding bicarbonate
    of potassa  gradually to  it, until it is saturated, then  filtering.   This
    passes under the name of neutral mixture, saline mixture, and efferves-
    cing draught.   It is  a valuable refrigerant diaphoretic, well adapted'
    to the hot  stage of remittent and intermittent fevers, and indeed to
    almost all cases of fever, with a dry, hot skin.  The  dose is a table-
    spoonful, or half a fluid ounce, which should be diluted when taken,
    and be repeated every one, two, or  three hours, according to the neces-
,j   sities of the case.
      Solution of Potassa (Liquor Potassa).— This is a transparent, caus-
    tic fluid, which requires to be kept in green  bottles, tightly corked.
    It  is antacid, antilithic, and  diuretic.   It is used in some affections
    of the skin, and  scrofula,  but more particularly for scalding of the
    urethra,  in gonorrhoea;  in  this case, it is well to  unite a few drops
    of laudanum with it   The dose is from fifteen to forty drops, two or
    three times a day, in half a tumblerful of water.  In dyspeptic cases,
    attended with acidity of the stomach, it may be associated with some
    simple bitters.
      Sulphate of Potassa (Potassa Sulphas). — This is a mild purgative,
    operating without irritation  or pain.   As  an aperient, it should be
    given  in doses of from  a scruple to a dram.   Ten grains  of rhubarb
    and one dram of carbonate  of potassa, united, and divided  into six
    powders, is an excellent alterative  cathartic for children  having defec-
    tive digestion and nutrition, and a tumid state of the abdomen.   One
    powder  may be given at a time, as often as may  be necessary to open
    the bowels gently.
      Tartrate of Potassa (Potassa Tartras). — This often passes under
    the name of soluble tartar.   It is a mild, cooling purgative, operating,
    as most of the neutral  salts do, without much  pain, and producing
    watery stools.   It is useful in fevers.   Combining it with senna, de-
    stroys its  tendency to  produce griping of the  bowels.   The  dose  j
    varies from a dram to an ounce, according to the eff'ect desired.        '

      Potassium. — This is a soft, bluish-white metal.   Its union  with
    oxygen,  in the proportion of  one equivalent of each, forms potassa or
    potash.  The following preparations of it are used in medicine:

      Bromide  of Potassium (Potassii Bromidum).—This is a permanent,
    colorless salt, having a pungent, saline taste, a little more acrid  than
    common salt, yet  similar to it  As a medicine, it is  alterative and
    resolvent, and is  used  occasionally for secondary  syphilis, scrofula,
    and enlarged spleen.   Dose, from three to ten grains, three times a
    day, in  pill or solution.   One dram of the bromide  of  potassium,
    rubbed up with an ounce of lard, makes an ointment which  has been
    used with some good, effect in goitre, and scrofulous affections. 
MEDICINES AND THEIR PREPARATIONS.           645
   Cyanuret of Potassium (Potassii Cyanuretum). — This is eminently
 poisonous, acting both  as  a medicine and as a poison, like  hydro-
 cyanic acid.  It has therefore been  recommended as a substitute for
 that acid.   The dose is one eighth of a grain, dissolved in half a fluid
 ounce of water.

   Sulphuret  of Potassium  (Potassii Sulphuretum). — This is called
 liver of sulphur, and hepar, being composed of sulphur and potassium.
 It has been  used in chronic bronchitis,  asthma, hooping-cough, and
 rheumatism.  Half  an ounce to an  ounce of  it, dissolved in several
 gallons of warm water, makes a valuable  sulphur bath for several skin
 diseases, as itch, prurigo, etc.

   Prickly Ash  (Xanthoxylum Fraxineum).— This  shrub grows in
 various parts of the United  States.   The  leaves and capsules have
               a pleasant, aromatic  smell.  Its  medicinal properties
               are in the bark  and berries.  The bark is  stimulant,
               tonic, alterative, and sialagogue.   It is used to rouse
               and  excite  the system, when in a languid  state, and
               for derangements of the liver, rheumatism, and chronic
               syphilis.  It stimulates and  strengthens mucous' mem-
               branes, and  is a valuable  tonic in low typhoid fever.
               Applied  externally, it improves  indolent and malig-
               nant ulcers.   Dose of the  powdered bark, from ten to
               thirty grains, three times a day.
                 Preparations. — Fluid extract, dose, fifteen to forty-
               five drops ; tincture, four  ounces  to  a pint of diluted
               alcohol, dose, half a dram to a dram and a half; infu-
               sion, half an  ounce to a pint of  water, dose, half an
               ounce to two ounces ; xanthoxylin, the active princi-
               ple, dose, two to six grains.
                 For  chronic rheumatism,  the following is a good
 preparation : xanthoxylin, one dram ; cimicifugin, one  dram ; apocy-
 nin, one dram ; diluted alcohol, one pint; dose, four drams, three
 times a day.

   Prickly Ash Berries are carminative, antispasmodic, and stimulant,
 and have a special direction to mucous membranes.   The tincture is
 excellent in nervous  diseases, spasms of the bowels, flatulency, and
 diarrhoea; and, combined with  the tincture of poke berries, is very
 serviceable in chronic rheumatism and syphilis.  It is said  to have
 been used with great success, in the West, in Asiatic  cholera.  Dose
 of the  tincture, from ten drops  to a fluid dram,  in sweetened water.
 Dose of the oil of prickly ash berries,  from two to ten drops, on sugar.

  Prickly Elder (Aralia Spinosa). — This is a tree which grows in
the Southern and Western States, and is called southern prickly ash,
and toothache tree.  The bark is stimulant, alterative, and diaphoretic.
The fresh bark, emetic and cathartic.  The tincture is serviceable in
skin diseases, syphilis, and chronic rheumatism.   Dr.  John King re-
ports, that in the cholera of 1849, it was found very serviceable, where
cathartics were required, in  the  following  combination :  compound
 
646           MEDICINES AND THEIR PREPARATIONS.
powder of jalap, one  dram ;  powdered prickly elder bark, one dram •
compound powder of rhubarb, two drams.  These were mixed, and
given in half-teaspoonful doses,  every half hour, or hour, until they
operated.   The bark  is  sialagogue, and, in small doses, powdered, is
said to  relieve the  dry and  parched condition of the throat, in many
diseases.
  Pumpkin Seeds.—The infusion of pumpkin seeds, made by placing
them in water without bruising them,  are mucilaginous  and diuretic,
and are used in inflammation of  the stomach and bowels, scalding of
the urine, strangury, etc.  But this infusion is more particularly valu-
able for its power of expelling  the tape-worm.   It  may be drank
freely.   The oil of  pumpkin  seeds, obtained by expression, has simi-
lar  properties, and may  be  taken in doses of six to twelve drops,
several times a day.
  Quassia (Picrana Excelsa) — This is the wood of a tall tree grow-
ing in  Surinam and  some of the West India Islands.  It is an  in-
tensely  bitter tonic, febrifuge, and anthelmintic,  possessing  in the
highest  degree, the properties of the  simple bitters.  It invigorates
the digestive organs,  without producing much excitement of the cir-
culation.  It is well  adapted to  dyspepsia and  the debility  of the
stomach which succeeds acute  disease,  and  indeed  all complaints
where simple bitter is required. Its generic title perpetuates the name
of the  negro Quassi, of Surinam, who first discovered  its medicinal
virtues,  about the middle of the last century, and  who became famous
for  treating  malignant fevers  with it, as a secret remedy.
  Preparations. — Fluid extract,  dose,  half a dram to a dram; solid
extract,  dose, three  to five grains ; tincture, dose,  four to  eight drams;
infusion, two drams to a pint of water, dose, two to four ounces.

  Queen of the Meadow (Eupatorium  Purpureum) — This  perennial
herb grows in low,  swampy places, in  many parts of this country.   It
is called trumpet  weed, and, from  its  fine  medicinal effects in com-
plaints of the urinary organs, gravel root.   It is an excellent diuretic,
tonic, and stimulant   Used  in gout, rheumatism, hematuria, chronic
diseases of the urinary organs, strangury, gravel, and dropsical affec-
tions.   The decoction is  the form in which it is most used; the dose
being two to four ©unces, two or three times a day.
  A preparation called eupurpurin is also extracted from it, which, in
three-grain doses, is a powerful diuretic, occasioning, in some cases, it
is said,  an enormous flow of  urine.

  Queen's Root (Stillingia Sylvatica).— This  perennial herb  grows
in sandy soils in  the  Southern States.  The root is medicinal, being
in large doses, emetic and cathartic; in small doses, an  alterative of
considerable value in  skin diseases, rheumatism, syphilis, and scrofula,
and in such other complaints as require alteratives.
  Preparations. — Fluid extract, dose, five to fifteen drops ; compound
fluid extract, dose, half a dram to a dram ; tincture, two ounces to a
pint of  diluted alcohol, dose, one  to three drams ;  infusion, dose, one
to two  ounces.   In chronic  bronchitis, and  similar complaints,  the 
MEDICINES AND THEIR PREPARATIONS.           647
    following syrup is well recommended: fluid extract of stillingia, two
    ounces;  fluid extract of bloodroot, two ounces; fluid extract of cherry
    bark, two ounces;  balsam of tolu, one ounce  and a half; syrup, two
    and a half pints.  Dose, one to two drams.

      Red Chickweed (Anagallis Arvensis). — An  annual plant, common
    in Europe and this country.   It has small scarlet flowers in June and
    July.  It has been used in nervous diseases, as mania, delirium, epi-
    lepsy, and particularly hydrophobia.  Old  and  ill-conditioned ulcers
    are improved by its use, in the form of poultice.

      Red Root (Ceanothus Americanus). — This  shrubby plant has the
    names of New Jersey Tea and wild snow-ball, and is found in all parts
    of the United States.   The bark  is antispasmodic, sedative,  astrin-
    gent, and expectorant, and tastes and  smells like the peach  leaf,   A
    decoction is useful  in dysentery, diarrhoea, hooping-cough, and chronic
    bronchitis, in  doses of a tablespoonful, three  times a day.  It makes,
    likewise, a very good injection in leucorrhoea  and gleet, and  gargle
    for ulcerations of the mouth and throat.
      Red Clover (Trifolium Pratense). — The blossoms of this very com-
    mon biennial  plant are medicinal, and  are highly  recommended  in
    deep, ragged, and  cancerous  ulcers, as well as in  badly-conditioned
    burns.   They are  soothing and detergent,  and  promote  healthful
    granulation.
      Preparation. — Solid extract, to be used as an external application,
    chiefly in the  form of ointment, made by uniting four  ounces of it
    with half a pound  of lard.
      Red Rose (Rosa Gallica).— The petals of the rose are slightly tonic
    and astringent, and are  considerably employed  in chronic inflamma-
    tions of the eye.   Rose water, distilled  from the petals, is  used for
 j   similar purposes.
      Red Saunders (Pterocarpus Santalinus). — This is a large tree grow-
    ing  in Ceylon, the wood  of which  imparts  a  red  color to alcohol,
 j   ether, and alkaline solutions, but not to water.  It is almost solely
    used for imparting color to tinctures, etc., having little or no medici-
    nal properties.
      Rosin. —  This is  the solid resinous matter which  remains after the
    distillation of turpentine.  It  is much  used as an ingredient in oint-
    ments and plasters, but  is never taken internally.  The  vapor which
    arises from  heating it upon some hot surface is sometimes inhaled
    with  great  advantage in chronic  bronchitis, and other chronic affec-
    tions of  the air tubes.
      Rhatany (Krameria Triandra). — This  is a native of Peru,  growing
    in dry, sandy places.   It is a powerful  astringent, and a gentle tonic.
il   It is  given  with advantage  in excessive menstruation,  vomiting of
|!   blood, chronic diarrhoea, leucorrhoea, and  inability to retain the urine;
I    likewise, as  a local  application in falling of the bowel.   It is valuable
I    also for  nose-bleed, and  bleeding  gums.  Dose of the powder, for in-
!    ternal use, from ten to thirty grains. 
648           MEDICINES AND THEIR PREPARATIONS.
  Preparations. — Fluid extract, dose, half a dram  to a  dram; solid
extract, dose, five to twenty grains;  tincture, three  ounces to a pint
of diluted  alcohol, dose, three to six drams ; infusion, two ounces to
a pint of water, dose, half an ounce to an ounce.
  Rhubarb (Rheum  Palmatum). — This  root is derived  from several
species of rheum, and  passes under the various names of European,
Russian, Chinese, East India, and Turkey rhubarb.   The variety called
Russian, or Turkey rhubarb  (for they are the same), is considered  the
best.  Rhubarb  is cathartic, astringent, and tonic.  It is much used
in mild cases of diarrhoea and cholera infantum;  likewise, as a stom-
achic and  gentle tonic in dyspepsia, accompanied with a debilitated
state  of the digestive  organs.   It is  a valuable remedy  in the com-
plaints of children, and is deservedly  much used in treating them.   It
acts upon  the muscular coat of the bowels, producing  thick rather
than watery stools.   It is therefore not- adapted to the  treatment of
dropsical complaints.   Its astringency may be  increased by roasting
it, or  diminished, by combination with soap, or an alkali.
  Preparations. — Fluid extract dose, half  a dram to a dram; aro-
matic fluid extract, dose, half a  dram to  a dram ;  fluid extract of rhu-
barb and senna, dose, half a  dram to  a dram; solid extract, dose, two
to ten grains ; tincture, an ounce and a half of fluid extract, and half
an  ounce of essence of cardamom, to a pint of diluted alcohol, dose,
half an ounce to an ounce and a half; infusion, one ounce  fluid  ex-
tract and two ounces spirit of cinnamon to a pint of water, dose, one
to three ounces ; syrup, three ounces of fluid extract to fourteen of
syrup, dose, two to five drams.
  Rosemary (Rosmarinus Officinalis). — This evergreen  shrub grows
on the borders of the Mediterranean, and is cultivated in Europe and
this country.  It is stimulant, antispasmodic, and emmenagogue.   It
is  not used, in this  country, however, except to  perfume ointments,
tinctures, and syrups.
  Round-Leaved Pyrola (Pyrola Rotundifolia). — This perennial shrub
grows in  various parts of our  country, and bears white flowers in
June.  It is called canker lettuce, pear-leaf wintergreen, etc.  Its me-
dicinal  properties are those of a tonic, astringent, antispasmodic, and
diuretic.  Used in decoction for epilepsy and other nervous disorders;
also for gravel, and other diseases of  the bladder  and kidneys.   The
decoction may be used, too, as  a wash for ulcerations of the mouth,
indolent ulcers, and chronic  opthalmia.   The decoction may likewise
be used in making  poultices for painful  swellings, boils, and carbun-
cles.  It may be taken in doses of from  one to six ounces.
  Rue  (Ruta  Graveolens). — Rue has  the  medicinal virtues of  the
antispasmodics, anthelmintics, and emmenagogues.   In large doses, it
is poisonous.   It is useful in  wind  colic, worms, hysterics, epilepsy,
etc.  Dose of the leaves, from  ten to twenty grains ; of  the infusion,
from  one to four ounces.
  Saffron (Crocus Sativus). — This is a native of  Greece and Asia
Minor ; it is also cultivated in France, England, and America, as well 
MEDICINES AND THEIR PREPARATIONS.           649
 as in other countries.  It has been thought to be stimulant and anti-
 spasmodic, in small doses, relieving pain, and producing sleep; in lar<*e
 doses, giving rise to headache, and producing stupor.   In  the general
 judgment of the profession, it is now considered, however, as having
 very  little activity.   It is  accordingly not  much used, except in do-
 mestic practice, where it has some reputation among nurses for its
 power to bring out  measles, and other eruptions.  It is also thought
 to be beneficial in amenorrhoea, dysmenorrhoea, chlorosis, and hysteria.
 It is chiefly used at present to impart flavor and color to tinctures.
   Preparations. — Fluid extract, dose, twenty to sixty drops ; tincture,
 dose, half a dram to a dram ; infusion, one dram to a pint of water,
 dose, two to three ounces.

   Sage (Salvia Officinalis). — The tops and leaves of this  well-known
 garden plant are aromatic, astringent, diaphoretic, and slightly tonic.
 The  infusion is useful in debilitated conditions of the stomach, at-
 tended with  flatulence ;  it frequently relieves nausea ; the cold  infu-
 sion  checks  and  sometimes entirely removes  the  night-sweats  of
 hectic.   The infusion is useful  as  a gargle in  inflammation of the
 throat, particularly, if united with a little noney and alum. Dose of
 the infusion, from one to three fluid ounces.
   Sarsaparilla (Smilax Officinalis).— Grows in  swamps  and  hedges
 in the Middle and Southern States.   The root has long been held°in
 esteem as an alterative, diuretic, and demulcent, being used in scrofula,
 chronic rheumatism,  and affections  of the skin; but its most exten-
 sive and useful application has been found to be in the treatment of
 secondary and  tertiary syphilis ;  and especially in  the broken condi-
 tion of the  system which follows  the use  of mercury in  these affec-
 tions.
  Preparations. — Fluid extract, dose, one dram ; fluid extract of sar-
 saparilla and dandelion, dose, one dram ; solid  extract, dose,  five to
 twenty grains; infusion, dose, two to four ounces.

  Sassafras (Laurus Sassafras).— This tree is common in the United
 States.   The bark of the root, which is the medicinal  part, is altera-
 tive,  diuretic, diaphoretic, and a warm  aromatic stimulant    It is
 mainly used  to improve the flavor of other medicines, and also, as a
 constituent of those compounds,  which are recommended  in chronic
 rheumatism,  syphiloid affections,  eruptions of  the skin,  and scurvy.
  Preparations. — Fluid extract, dose,  one to two drams; tincture,
 six ounces to a pint of alcohol, dose, half an ounce to  an  ounce; in-
 fusion, two ounces to a pint of water, to be drank as desired.

  Savin (Juniperus Sabina). — An evergreen shrub'growing in Europe
 and North America.   The  tops  and leaves are  diuretic, diaphoretic,
 emmenagogue, and anthelmintic.   The warm infusion promotes men-
 struation, and destroys worms.   Care should  be taken never to ad-
 minister  this, medicine during pregnancy, its effects being  violent and
 dangerous.
  Preparations. — Fluid  extract,  dose, ten to thirty drops; solid ex-
tract, dose, one to five grains;  tincture, four ounces to a pint of diluted 
650           MEDICINES AND THEIR PREPARATIONS.
alcohol, dose,  half a dram to a  dram and a half; infusion, half an
ounce to a pint of wTater, dose, half an ounce to an ounce.   The fol-
lowing mixture is useful in amenorrhoea •  fluid extract of savin, half
a dram ;  fluid extract of ginger, one dram ;  sulphate of potassa, two
drams.   Mix.  . Dose, half a dram, twice a  day.   The oil of savin has
properties  similar to those of the leaves.   Dose, from  two to five
drops, on sugar.

  Scammony  (Convolvulus Scammonia). — This plant is  a  native of
Syria,  and the neighboring  countries.  The  medicinal  part  is the
hardened juice of the fresh root.  It is an energetic cathartic, produc-
ing griping, and  sometimes  operating  with decided  harshness,  on
which account it is generally combined with other medicines which
lessen the  severity of its  action.  The dose is from  five to twenty
grains.
  Scullcap (Scutellaria Lateriflora). — An indigenous plant, flowering
in July and August.  The whole herb is used.  It is a valuable ner-
vine, tonic, and antispasmodic;  while  it gives
support to the nerves, therefore, it imparts both
quietness and  strength to the whole system, and
does not, like other nervines, leave the  patient
excited  and irritable.   It  finds  its  use in the
treatment of neuralgia, chorea, convulsions, lock-
jaw, and most other  diseases of the  nervous
system.
  Preparations. — Fluid extract, dose,  half a
dram to  a dram ;  compound  fluid extract,  dose,
half a  dram to a dram;  tincture, four'ounces
to a pint of diluted alcohol, dose, one  to  two
drams; infusion, dose, a wineglassful, three times
a day; scutellarin, the active principle, dose, two
to six grains.

  Seneka (Polygala Senega). — An indigenous
plant, commonly called snake-root, the root of
which is used in medicine.  It is a stimulating  diuretic and expecto-
rant, and in large doses, an  emetic and cathartic.  It excites all the
secretions.  It is useful in chronic  bronchitis,  and in other chronic
affections of the breathing tubes.
  Preparations.— Fluid extract, dose, twenty to forty drops; infusion,
dose, one ounce to an  ounce and a half;  syrup, four ounces of fluid
extract  to  twelve ounces simple syrup, dose, half a dram to a dram.
The following is a. very good expectorant cough  preparation : fluid
extract  of seneka, three drams;  fluid extract of squill, half a dram;
syrup of tolu,  two drams;  paregoric, two drams; carbonate of ammo-
nia, twenty grains ; water, four and a half ounces.  Mix.  Dose, one
dram.
  Senna (Cassia Acutifolia). — Grows abundantly in  Upper  Egypt
The leaves are the medicinal part.  It is a mild, active, and  certain
cathartic, and is much used in combination with other medicines,
 
MEDICINES AND THEIR PREPARATIONS.           651
particularly  epsom salts.  The addition of cloves, ginger, cinnamon,
and other aromatics, removes all its tendency to griping, and makes it
a safe and  gentle, yet  active purgative, in most  cases, calling for an
evacuation of the bowels.
  Preparations.— Fluid extract, dose, one to two drams; fluid  ex-
tract of senna and jalap, dose, half a dram to a dram ; solid  extract,
dose, three  to  eight grains ; tincture, three ounces to thirteen ounces
of diluted alcohol, dose, half an ounce  to an ounce; infusion, two
ounces to a pint of water, dose, half an ounce to  an ounce.

  Shrubby Trefoil (Ptelea Trifoliata). — Th\s shrub, which'grows in
the West, is called wafer-ash, and wingseed.  Its bark and root have
tonic properties, and are used in intermittent and remittent fevers, and
wherever nature  needs a lift in getting up from exhausting complaints.
The medicine, like other tonics, improves  the appetite and digestion.
Dose of the solid extract, from three to five grains, three or four times
a day; of the cold infusion, a tablespoonful, every two or three hours.
  The oleo-resinous  principle of the crude bark is called  ptelein, and
is a powerful tonic.  Dose, one or  two grains, three  or  four  times a
day.
Fl»- 225-                             Fig. 226.
BKUNK CABBAGB.                       SLIPPERT BLM.
  Skunk Cabbage (Symplocarpus Fatidus).— A perennial plant, grow-
ing in moist places throughout the United States ;  sometimes called
meadow cabbage.  The root is stimulant, expectorant, antispasmodic,
and slightly narcotic.  It is given for pulmonary and bronchial affec-
tions, epilepsy, hysterics, asthma, hooping-cough, and irritable  nerves.
  Preparations. — Fluid extract, dose, twenty  to  eighty drops ; tinc-
ture, three  ounces to a pint of alcohol, dose, half a dram to a dram;
infusion, dose, one to tWo ounces ; syrup, two ounces of fluid  extract
to eight ounces  of  simple syrup,  dose,  two to  three drams.  For
asthma and cough, and to promote expectoration, and remove tight-
ness across the chest, the following is a very good compound prepara- 
652           MEDICINES AND THEIR PREPARATIONS.
tion :  one ounce each of the fluid  extract of skunk cabbage, lobelia,
bloodroot, pleurisy root, and ginger, one pint of water, and three pints
of alcohol.  Dose, two to four drams.
  Slippery Elm (TJlmus Fulva). — The inner bark of this well-known
tree is nutritive, demulcent,  emollient, and  slightly expectorant and -
diuretic.   It is valuable as a demulcent drink in inflammations of the
lungs, stomach, bowels, bladder, and kidneys; also, for coughs, stran-
gury, dysentery, and the summer complaint of infants.   It makes a
valuable  poultice for various purposes.
  Small  Spikenard (Aralia Nudicaulis), — This plant grows through-
out the United States, from Canada to the Carolinas, in rocky woods.
It is called false sarsaparilla and  wild sarsaparilla.  The  root is a
gentle stimulant, diaphoretic, and alterative.   It is used in domestic
practice,  and  by some physicians, in rheumatism, syphilis, and  cuta-
neous diseases.   The American spikenard,  aralia racemosa, resem-
bles the small spikenard in medical properties.   Either of these  roots
is valuable in chronic affections of the lungs  and air tubes.

  Soap (Sapo).— Soap is laxative, antacid, and antilithic, and is much
used in  combination with cathartics,  to  lessen the severity of their
action.   In mesenteric fever, advantage is derived from rubbing the
tumid belly of children with a strong lather of soap, morning and
evening;  and few things are more effectual in removing  hardened
feces from the rectum in cases of obstinate costiveness than an injec-
tion of soap-suds.
  Sodium. — This is a soft white metal.   United with oxygen in the
proportion of one equivalent each,  it forms the alkali, soda.   The fol-
lowing are the principal preparations of soda used in medicine;

  Bicarbonate of Soda (Soda Bicarbonas).—-This is a white, inodor-
ous powder, generally called super  carbonate of soda.   It is antacid,
antilithic, and slightly diuretic.   It is chiefly used in preparing what
are called soda powders, and  in various preparations of medicine,
when  an antacid is required.   It is also taken simply dissolved in
water, for acidity of the stomach.  The yeast powders, now so much
used, are said to be composed of about two and a half parts of cream
of tartar, and one part  each of corn starch and bicarbonate of soda.
Housewives may as  well make the  combination for themselves.

  Borate  of Soda (Soda Boras).— This is everywhere known by the
name of borax.   It exists naturally formed in several  parts of the
world, and is likewise  manufactured.   It is a mild refrigerant and
diuretic;  also an emmenagogue, promoting menstruation, facilitating
parturition, and favoring the expulsion of the  after-birth, by its spe-
cific influence upon the womb.  It  has considerable reputation in the
treatment  of urinary diseases, particularly those  connected  with an
excess of uric acid.   The dose is from twenty to forty grains in solu-
tion.  Combined with rose-water,  honey, and  various other things,
according  to circumstances, borax  makes a valuable wash for inflam-
matory affections of the mouth and throat, skin diseases, etc. 
MEDICINES AND THEIR PREPARATIONS.           653
   Cliloride of Sodium (Sodii Chloridum). — This is the chemical name
 of muriate of soda, or common salt.   In small doses, it is tonic, altera-
 tive, and  anthelmintic.   It checks  bleeding  from the  lungs, when
 taken in teaspoonful doses.   The dose as an  alterative is from ten
 to sixty grains.   As moderately used in food by most  civilized people,
 it promotes digestion and improves the general health.

   Sulphate of Soda  (Soda  Sulphas).— This has a very pretty name,
 but it  will not sound half as well  to  thousands of young persons,
 when they are told that it is the well-known glauber's salts.  From
 half an ounce to an  ounce of it, dissolved in half  a tumblerful of
 water,  acts as a cathartic; a smaller  dose, as a laxative and diuretic.
 Its  nauseous and bitter taste  may be somewhat concealed, by a little
 cream of tartar, or lemon juice, or a few drops  of sulphuric acid.

   Sulphite of Soda (Soda Sulphis).— This preparation is in-the form
 of transparent crystals,  and is very soluble in water.   In doses of
 sixty grains, this  is said to have  been used with  success  in frothy
 vomitings; it is  also well  spoken of as a remedy  in acute  rheuma-
 tism, and as a wash in thrush, and some diseases of the skin.

   Tartrate of Potassa and  Soda (Soda et  Potassa Tartras). — This
 is one of the mildest, and most cooling purgatives among the salts.  It
 is known as rochelle  salt, and  generally agrees well with irritable and
 delicate stomachs. Dose, from two drams to an ounce, in a tumbler-
 ful of water.  The gentle physic called seidlitz powders is composed
 of two drams of rochelle salt and two scruples of bicarbonate of soda
 in a blue paper, and thirty-five grains of tartaric acid in a white paper.
 The contents of each paper is  dissolved in half a tumbler of water by
 itself; one solution is then poured into the other,  and the whole is
 drank during the effervescence.

   Solomon's  Seal (Convalaria Multifiora). — This is one of our own
 perennial plants, and is  found in various parts of the country.  The
 root is  tonic, mucilaginous, and  astringent.  It acts  especially upon
 mucous tissues, and  has therefore found its use in chronic dysentery,
 and piles, and in  chronic inflammation of the  stomach  and bowels.
 Dose of the decoction, or infusion, from one to four fluid ounces, three
 or four  times a day.   Large doses purge and vomit.   The decoction,
 applied locally, relieves the inflammation caused by  the poison vine.

  "Solution of Arsenite of Potassa (Liquor Potassa Arsenitis). — This
 is known under the names of arsenical solution and Fowler's solution.
 It is a transparent liquid, having the  color, taste, and  smell of spirits
 of lavender.   It has the general action upon the human body of the
 arsenical  preparations.  It  is  the  preparation  generally resorted  to
 when arsenic is given internally, and is used with  considerable suc-
 cess in intermittent fever, leprosy, and several other skin diseases, St.
 Vitus's  dance, periodical headache, and some other complaints.  The
"dose is  from three to ten drops, three times a day, given in  water;
 generally, it is better not to  go beyond five drops.  Sometimes it dis-
 turbs the stomach, and binds the bowels, producing headache, dizzi- 
654           MEDICINES AND THEIR ^REPARATIONS.
   ness, and  confusion of mind.   When  such effects follow its use,  it
   must be laid aside, and a purgative given.  After an interval of two
   weeks, it may be resumed  in smaller doses.  It often  requires to be
   used for several months.

     Spanish  Flies  (Cantharis  Vesicatoria). — These insects  are  of  a
   beautiful,  shining, golden-green  color.    They  attach  themselves to,
   such trees, in PVance,  Spain,  and Italy, as the  white poplar, elder,
   privet, and lilach, upon the leaves of which they feed.  They make
   their appearance in swarms upon these trees, in May and June, and
   are shaken off in the morning,  while torpid with the cold.  Internally
   administered, they are a powerful stimulant, exercising a peculiar in-
   fluence over  the urinary and  genital  organs.   In large doses, they
   excite violent inflammation of the alimentary  canal and urinary or-
   gans,' strangury, irritation of the sexual organs, headache, delirium,
   and convulsions ; also painful  priapism? vomiting, bloody stools, sali-
   vation, fetid  breath, hurried breathing,  and difficulty  of swallowing.
   They are given internally for chronic gonorrhoea, leucorrhoea, seminal
   weakness, and paralysis of the bladder.  Dose of the powder, from
   half a  grain to two grains;  of  the tincture,  from twenty to  sixty
   drops.   Solution of potassa, given every hour, in thirty-drop doses,
   is a remedy  for strangury produced by cantharides.    Spanish  flies
   are  used externally, in the form of blistering plaster; also in the form
I   of tincture,  mixed  with various solutions, to produce irritation and
!   redness of the skin.
I
     Spearmint  (Mentha  Viridis). — This  has carminative, diuretic,'and
!   antispasmodic virtues.   The warm infusion of it is much  employed
   in domestic  practice, to  produce perspiration, after taking cold, and
   while suffering  from feverish  symptoms, from various  causes.   The
   oil  of spearmint has similar properties with the  herb, and may be
   taken in five to ten  drop doses, on  sugar.  One ounce of the oil of
   spearmint, dissolved in a pint of alcohol,  constitutes  the essence of
   spearmint

     Spermaceti (Cetaceum). — This is a white crystalline substance, ob-
   tained from the  head of the spermaceti whale.  In household practice,
   it is considerably used for the coughs and  colds of  children,  being
   generally  simmered with molasses or loaf sugar.   It  forms a part of
   several cerates and ointments.

|     Spider's Web  (Tela  Aranea). — The web of  the black  or brown
   spider, gathered in barns, cellars, etc., is sometimes given  in five  or   i
   six-grain doses,  in pill form, and it is said with good eff'ect, in periodi-
   cal  headache, hysterics, St. Vitus's dance, asthma, and fever and ague.
   It is likewise applied externally to check bleeding.

!     Spirit  of Nitric  Ether  (Spiritus  Mlheris  Nitrici). — The general
   reader will  know this  article  better under the name of sweet spirits
1   of nitre.   It is diuretic, diaphoretic, antispasmodic, and stimulant, and
   in large doses, a narcotic  poison.  It is much  used in diseases of the
|   urinary organs, either  alone or combined with  sedatives,  and other 
MEDICINES AND THEIR PREPARATIONS.           655
diuretics.   Dose, from twenty drops to two  fluid drams, to be taken
in water, three or four times a day.

   Sponge (Spongia). — When burned, this is used as an alterative in
scrofula, scrofulous tumors, goitre, and obstinate diseases of the skin.
It is much  employed by homoeopathic physicians, though it has much
less  remedial  power than iodine.  Dose, one to  three drams, mixed
with honey or syrup.

   Spurred  Rye (Secale Cornutum).— This is a diseased  product of
rye, known by the name of ergot.  This article has a peculiar effect
upon the womb, causing it to contract with great, energy, when given
in full doses.   It should never be given, however, continuously, for a
great length of time, as it has been known, when so used, to produce
dry  gangrene, typhus fever, and nervous disorders connected  with
convulsions.   Such were its effects in certain provinces of  France, in
consequence of the use of rye bread contaminated with it.   It is use-
ful in excessive uterine  hemorrhage, which  it arrests by causing the
womb to contract, and thus to  condense its tissue, and  close up  its
bleeding vessels.  It  has also been successful  in bleeding from the
lungs.
   Preparations. — Fluid extract, dose, half a dram  to a dram; tinc-
ture, four ounces to a  pint of  diluted alcohol, dose, two and a half to
five  drams ; infusion, dose, one  to  two  ounces ; wine, five ounces of
fluid extract to a pint of sherry wine, dose, two to four drams, in cases
of labor; for other purposes, one to two drams.

   Squill (Scilla Maritima).— A perennial plant growing in countries
on the Mediterranean.  In large doses, it is emetic and purgative ; in
small doses, expectorant and diuretic.  It is used  in pulmonary affec-
tions to increase expectoration, and in  dropsical complaints to aug-
ment the  secretions of the kidneys.   Dose of the dried root, one to
five grains, generally to be united with nitre  or ipecac.
   Preparations. — Fluid extract, dose, as an  expectorant and diuretic,
two  to  six drops ; as  an emetic, twelve to twenty-four drops ;  com-
pound  fluid extract, dose, ten to twenty drops ; tincture, two ounces
to a  pint of diluted alcohol, dose, twenty to  forty drops; syrup, dose,
a quarter to half a dram.

   Star Grass  (Aletris  Farinosa). — This plant  is found  in dry soils
throughout most parts of the United  States, and  called  unicorn root,
ague root, and crow corn.   The  root is  an intensely bitlcr tonic, and
is  used to improve the tone of the stomach, and  for flatulent colic and
hysterics.   It is said also to give tone to  the female generative organs,
affording a protection against  miscarriage.   The   Eclectics call  it
one of their best agents in chlorosis, suppressed menstruation, engorge-
ment and falling of the womb, and painful menstruation.   Dose of the
powdered root, from five to ten grains, three times a day.
  Preparations. — Fluid extract, dose, ten to thirty drops;  tincture,
two ounces to a pint of-diluted alcohol,  dose  half a dram to a dram;
infusion, two  drams  to a pint  of  water, dose, one to  two ounces; 
656
MEDICINES AND THEIR PREPARATIONS.
syrup, dose, one to two drams; aletridin, the  active principle, dose,
one to three grains.

  St.  Ignatius's  Bean (Faba Sancti Jgnatii). — The seeds are the part
used, and are the product of the Ignatia Amara, — a tree of middle size,
growing in the  Philippine  Islands, and is a  species of the strichnos.
These seeds possess a large amount of strychnine, and  consequently,
in medicinal doses, are a powerful nervine tonic, and are used for im-
proving the digestive functions, and  for  rousing  and  strengthening
the whole system when prostrated by nervous complaints.
  Preparations.  — Fluid extract, dose, five to  ten drops ; solid extract,
dose, half a grain to a grain and a half.

  Storax (Styrax  Officinale).— This  is  the hardened juice of the
storax,  a native of the countries along the  Mediterranean.   It is a
stimulant and expectorant, and is used for chronic  bronchitis, laryn-
gitis, and cough.   The liquid  storax is sometimes  employed instead
of copaiva in gonorrhoea  and  gleet   The dose is from ten to twenty
grains.   Storax  is a constituent in the compound tincture of benzoin.
Fig. 227.
Fig. 228.
STAR GRASS.
STRAMONIUM.
  Stramonium  (Datura  Stramonium). — This annual  plant  is most
known in this country by the name of Jamestown weed; in England,
by that of thornapple.  The leaves and seeds are medicinal.   Stramo-
nium is a powerful  narcotic; it is also antispasmodic, anodyne, and
sedative.  It is used in various nervous affections, as chorea, epilepsy,
palsy, tetanus, and mania.  It is much used for relieving acute pains,
etc.  Taken  in large doses, it is a powerful poison.
  Preparations. — Fluid  extract, dose, five  to  twenty drops;  solid
extract, dose, half a grain  to a grain ; tincture, two ounces to a  pint
of alcohol, dose, half a dram to a dram and  a half, and to be gradu-
ally  increased.

  Sulphur.— This is considerably used  in medicine, being  laxative,
diaphoretic, and resolvent.   It  is chiefly used for piles, chronic rheu-
matism, gout, asthma,  and those affections  of the breathing organs 
MEDICINES AND THEIR PREPARATIONS.           657
 not attended with acute inflammation.  Externally and  internally, it
 is much employed in skin diseases, particularly the itch, for which it
 is a specific.   In these affections, it is frequently applied in the  form
 of sulphur baths.  The dose of sulphur is from one to three drams,
 mixed with syrup, molasses, or milk.   When sublimed, this article  is
 called flowers of sulphur, which is the form in which it is chiefly used
 in medicine.

   Sumach  (Rhus Glabrum).— Found in almost all parts of the United
 States, in  old neglected fields, and  by the  side of fences.   The bark
 and berries are astringent,  tonic, antiseptic,  and diuretic, and are used
 in diarrhoea,  dysentery, gonorrhoea, whites,  hectic fever, and scrofula.
 The berries make a valuable gargle in quinsy, and ulcerations of the
 mouth and throat, and also a useful  wash for ringworm,  tetter, and
 ulcers.  The excrescences  which grow upon  the leaves, have nearly
 as much astringency as galls, and, when pulverized and mixed with
 lard, have a similarly soothing effect upon piles.
   Preparations. — Fluid extract, dose, one to two drams; tincture,
 four ounces to thirteen ounces of diluted alcohol, dose, half an ounce
 to an ounce.

   Sunflower (Helianthus Annuus).— The seeds and  the leaves of this
 plant are expectorant and diuretic, and  are useful in several pulmon-
 ary affections.   The seeds yield a fixed  oil, in which their  medicinal
 virtues are chiefly  found.   In  doses  of  ten or twenty drops, this oil
 acts  favorably  upon  inflamed mucous surfaces, and  in doses three
 times as large, it greatly augments the flow of urine.
   Swamp Dogwood (Cornus Serkea)—This is found in damp places,
 and along  the banks of rivers, in various parts of our country, and  is
 known as red ozier, red willovj, and rose willow.  The bark is tonic,
 stimulant, and astringent, and has been used for similar purposes with
 dogwood bark ;  well spoken of, also,  for dyspepsia, diarrhoea, malig-
 nant fevers, and as  an external application to foul and ill-conditioned
 ulcers.  Dose of  the powdered bark, from twenty to sixty grains ;  of
 the infusion, from two to four fluid ounces.
   Swamp Milkweed (Asclepias Incarnata). — This is a native of the
 United States, and bears red flowers from June to August.  It has
 the name of  white  Indian  hemp.  The root is emetic, cathartic, and
 diuretic, and is useful in asthma, bronchitis, rheumatism, syphilis, and
 worms.
   Preparations. — Fluid extract, dose, twenty to forty drops;  solid
 extract, dose, three  to five  grains ; tincture, two  ounces to a pint  of
 diluted alcohol, dose, one and a half  to  three drams; infusion, dose,
 three  to six drams  ; syrup, four ounces fluid extract to twelve  ounces
 simple syrup, dose,  half a dram to a dram and a half.
  Sweet Fern (Comptonia  Asplenifolia). — This  shrub,  growing  in
 stony pastures  in New England and Virginia,  is  tonic, astringent,
 alterative, and aromatic, and is used  in diarrhoea, dysentery, cholera
infantum, rheumatism, and debility after fevers.  Dose of the  decoc-
tion, from one to four fluid ounces, three  or  four times a day.
                             83 
658           MEDICINES AND THEIR PREPARATIONS.
  Sweet Flag  (Acorus Calamus). — Found  in damp  places, in.most
parts of the world.   The root is stimulant, tonic, and aromatic; use*
ful in wind colic, weakened conditions of the stomach, and dyspepsia.
Dose of the root, from twenty to  sixty grains;  of the infusion, from
two to four fluid ounces. '

  Sweet Gum  (Liquidamber  Styraciflua). — This tree grows in  the
Middle and  Southern  States.  Being wounded, it yields a yellowish-
white,  honey-like balsam, which hardens into a gum.  This, melted
with equal parts of lard or tallow, forms an ointment which is used
in some  parts of the country for  piles, ringworm of the  scalp, fever
sores, and other complaints.   Used internally, it has very nearly the
same effects with storax.

  Tag  Alder (Alnus Rubra). — This shrub grows in swamps and other
damp  places,  in northern  United  States.   The bark is alterative,
emetic, and astringent.  It  is used  in  scrofula, secondary  syphilis,
herpes, impetigo, and other skin diseases.
  Preparations. — Fluid extract, dose,  one to two drams; infusion, two
o'unces to a pint of water, dose, one to two ounces ; alnuin, the active
principle, dose, one to three grains.

  Tansy  (Tanacetum  Vulgare).— Tansy is  a perennial herb, having
tonic, emmenagogue, and  diaphoretic properties;  the cold  infusion
being tonic, and useful in  dyspepsia, wind in the stomach, jaundice,
and worms; the warm infusion, diaphoretic and emmenagogue. Dose
of the  infusion,  from one to  four fluid  ounces, two or three times a
day.
  Tar (Pix Liquida). — The medicinal qualities of tar are like those of
turpentine, and it is sometimes used  in old chronic coughs and bron-
chitis.  The vapor of boiling tar was  once thought to be very service-
able in bronchial diseases, when inhaled.   Doubtless it is useful in
some cases, but  its virtues have been  extolled above their  merits.   In
the form  of ointment, it has real efficacy in  scald head and tetter.

  Thimbleweed  (Rudbeckia Laciniata). — The whole of this herb  is
balsamic,  diuretic,  and tonic,  and, in  the  form of  decoction, used
freely,  is  said to have been found useful in  some urinary complaints,
as Bright's disease,  strangury, etc.

  Tobacco (Nicotiana Tabacum). — The leaves  of tobacco are acrid,
narcotic, and poisonous, and  are chiefly used in the form of ointment,
in skin diseases, etc.  Its poisonous qualities, however, render it dan-
gerous when much used, even externally.

  Trailing Arbutus  (Epigaa  Repens). — This grows in sandy woods,
and  rocky soils,  its flowers  appearing in early spring, and exhaling a
spicy fragrance.   The leaves are diuretic and astringent, and are very
useful in  gravel, and most diseases of the urinary organs, being re-
garded in some  cases superior to Uva ursi and buchu.
  Preparations.  — Fluid extract, dose, one  to two drams;  infusion,
dose, two to four ounces. 
MEDICINES AND THEIR PREPARATIONS.           659
  Tapioca (Janipha Manihot). — This plant grows in'the West Indies
and Brazil.   It  i» cultivated chiefly on account of the root, Which is
largely used as an article of food, particularly for the sick, or rather,
for  those recovering from  sickness.   The starch which it contains is
separated by washing, scraping, grating, and  grinding, and is in the
form of hard, white, rough grains.   It is prepared for use by boiling;
and, in  debility  and low forms of disease, may have the addition of
wine, nutmeg, or other aromatics.

  Tulip Tree (Liriodendron Tulipifera). — This  is a large and elegant
tree growing in many parts of the country, and called poplar and white
poplar.  The bark of the root is aromatic, stimulant, and tonic, and
in warm infusion, diaphoretic.   It is used in  fever and ague, chronic
rheumatism, and chronic diseases of the  stomach and bowels.  Dose
of the powdered bark, from a scruple to two drams; of the infusion,
from one to two fluid ounces.

  Turkey  Corn (Corydalis Formosa).— This perennial plant is called
wild-turkey pea,  and stagger-weed,  and  grows  in rich  soils  in the
Southern  and Western States.   The tuber, which is the  medicinal
part, should only be collected while the'plant is in flower.  It is tonic,
diuretic, and  alterative.  It is much valued  as  a remedy in  syphilis
and scrofula.
  Preparations. — Fluid extract, dose, ten to forty  drops; tincture,
three ounces to a pint of diluted alcohol, dose, half a dram to two
drams;  corydalin, the  active principle, dose, half a grain  to a grain.
A valuable alterative for  syphilis is made by uniting eight grains of
corydalin with ten grains of hydrastin, and dividing into  twelve pow-
ders. Dose, one powder, three or four times a day.

  Turmeric (Curcuma Longa). — This is a native of  the  East Indies
and Cochin China.  The root is a stimulant aromatic  and tonic, some-
what like ginger, employed in debilitated states  of the stomach, etc.
  Preparations. — Fluid extract, dose, two to three drams; tincture,
two ounces to twelve ounces of diluted alcohol, dose, one and a half
to two ounces ; infusion, dose, two to four ounces.

  Valerian (Valeriana  Officinalis). — This is a European plant, flow-
ering in June or July.  The root is tonic, nervine, and antispasmodic,
and is much used  in  cases of irregular  nervous action, particularly
morbid nervous vigilance, or hypochondria, epilepsy, lowness of spirits,
and nervous headache.
  Preparations. — Fluid extract, dose, half a  dram to a  dram and a
half; solid extract, dose three to ten grains;  tincture, four ounces to
a pint of diluted alcohol, dose, two  to four drams ; infusion, half an
ounce to a pint of water, dose, two to four ounces ; syrup, four ounces
of fluid extract to a pint of simple syrup, dose, two to four drams.

  Vervain (Verbena Hastata). — A  perennial plant,  common  in the
United  States.   The root is tonic, emetic, expectorant, and sudorific.
It is used in  intermittent fevers, colds, and obstructed  menstruation,
in the form of warm infusion.  The cold infusion is a good tonic in 
660
MEDICINES AND THEIR PREPARATIONS.
loss, of appetite, debility, etc.   Dose of the powdered root, one or two
scruples ;  of the infusion, from two to four ounces, 4hree or four times
a day.
  Vinegar (Acetum). — This  is  refrigerant, diuretic,  astringent, and
tonic; used in fevers and  inflammatory complaints, likewise in scurvy
and typhus, as an antiseptic.   It has been found useful in dysentery
and scarlet fever, saturated with common  salt.   Externally, it is ap-
plied to bruises, inflammations, sprains, and swellings.  It sometimes
has a good effect as a gargle in putrid sore throat, etc., and as a cool-
ing wash  in headache during fevers.
Fig. 229.
Fig. 230.	
HH9	SiHI
	
	JNZ^QHIH
HlHr .Jfi	lkUfRȤ?^H
Hm]	|bfej
	^U^JESfl
I ^mi	
Fig. 231.
              TAPIOCA.                       VIRGINIA J3NAKK-ROOT.

  Virginia Snake-root (Aristolochia'Serpentaria).— This is a peren-
nial herb of the Middle and Southern States.   The root is stimulant,
tonic, and diaphoretic.  It is used  in typhoid fevers, when the sys-
tem needs support, but cannot bear active stimulation.
Combined with peruvian bark, it is also used in inter-
mittent fevers.  The cold infusion is employed in some
forms of dyspepsia ;  likewise as a gargle  in malignant
sore throat.
  Preparations. — Fluid  extract, dose,  one quarter  to
half a dram ;  tincture, three ounces  to a pint of diluted
alcohol, dose, one to two drams;  infusion,  half an  ounce
to a pint of water, dose, one to two ounces, in low forms
of fever.   The following is a good compound  tincture:
half an ounce each of fluid  extract of snake-root, fluid
extract of ipecac, fluid extract  of saffron, fluid extract
of ladies' slipper, together with  half an ounce of cam-
phor, and one and a half pints of diluted alcohol; dose,
a dram to a dram and a half.

   Water  Horehound. — This  article has been  described
under Bugle  Weed, but the cut was  forgotten.   See  Bugle Weed
(Lycopus Virginicus).
 
MEDICINES AND THEIR PREPARATIONS.           661
  Water Pepper (Polygonum Punctatum). — This annual plant is called
smart-weed,  and grows  throughout our country, in low grounds, and
along ditches and  brooks.   It  has a pungent, biting  taste,  and is
stimulant, diuretic, emmenagogue, antiseptic, and vesicant.  It is used
in coughs, colds, gravel, and womb complaints.
  Preparations. — Fluid extract,  dose, ten to sixty drops; solid extract,
dose, two  to three grains; tincture, four ounces to a  pint of diluted
alcohol, dose, half a dram to two drams ; infusion, half an ounce to a
pint of water, dose, half an ounce to an ounce.

  Wahoo  (Euonymus Atropurpureus). — A small shrub growing  in
woods in  many parts of the United States.   The bark of the root is
a bitter tonic,  laxative, alterative, diuretic, and expectorant,  and is
advantageously used in pulmonary  affections, dropsy, constipation,
torpidity of  the liver, dyspepsia, and.intermittent fevers.
  Preparations. — Fluid extract, dose,  one to two  drams ; tincture,
four ounces to twelve ounces of diluted alcohol, dose, half an ounce
to an ounce.

  Wax. — The yellow and white wax are chiefly used  as ingredients
of plasters and ointments.

  White Hellebore (Veratrum Album). — This is an European peren-
nial.plant, the root of which is a violent emetic and purgative, and in
large doses  is  poisonous; not  often used,  except externally,  in  the
form of ointment or decoction,  for the cure of itch, and some other
skin diseases.

  White Oak (Quercus  Alba).— The inner bark of the white  oak is
astringent,, tonic, and antiseptic, and has  been used  in  intermittent
fever, chronic diarrhoea, chronic  mucous discharges, and passive hem-
orrhages.  As a wash, applied externally, it sometimes arrests night-
sweats, and  as an astringent gargle and injection, its  use is common
for relaxed palate, spongy gums, leucorrhoea, falling of the bowel, etc.
  Preparations. — Fluid extract, dose, half a dram to  a dram; solid
extract, dose, ten  to  twenty grains ; tincture, two ounces to a pint of
diluted alcohol, dose, half an ounce to an ounce.

  White Pond  Lily (Nymphaa Odorata). — This grows in ponds and
marshes in many parts of our country.  The root  is demulcent, ano-
dyne, astringent and alterative; used in dysentery, diarrhoea,  gonor-
rhoea, whites, and scrofula.   An infusion  is  sometimes  used as a
gargle in  ulcers of the  mouth and throat, and as  an injection  in leu-
corrhoea.   Dose of the infusion,  from two to four fluid ounces.

  Wild Cherry (Prunus Viginiana). — This tree grows  extensively in
the  American forests, flourishing where  the soil is fertile, and the cli-
mate temperate.  The inner bark is tonic and stimulant to the diges-
tive organs, and sedative to the nerves and the circulation.  It is much
used in consumption, scrofula, and dyspepsia.
  Preparations. — Fluid extract, dose, two to four  drams ; compound
fluid extract, dose, half a dram to two drams; infusion, half an ounce 
662           MEDICINES AND THEIR PREPARATIONS.
to a pint of water, dose,  two ounces; syrup,  three ounces of fluid
extract  to  thirteen  ounces of simple  syrup, dose, two drams  to  an
ounce.

  Wild  Cucumber (Momordica Elaterium). — This, sometimes  called
squirting cucumber, is a  native of the south of Europe, and is culti-
vated in Great Britain.   It is a powerful hydragogue cathartic, and
in large doses, causes  nausea  and vomiting.   On account of the
watery  stools it prodnces, it  is much  used in  dropsical complaints,
though  the severity of its  action forbids its being used alone.  Dose,
a quarter to half a grain, repeated every hour till it operates; of elate-
rin, from a sixteenth to a twentieth of a grain, given in solution.
  Wild  Ginger (Asarum  Canadense). — This is  known by the names
of coWs-foot and Canada snake-root, and is  common in all  parts  of
the country.   The root is tonic, stimulant, aromatic, expectorant, and
diaphoretic.  It is  used  in pains of the stomach, colic, etc.   Dose of
the powder, half a dram ;  of the tincture, half  a dram to two drams.
Fig. 232.                         Fig. 233.
WILD INDIGO.                       WITCH HAZEL.
  Wild Indigo (Baptisia Tinctoria). — This perennial shrub is found
in most parts of the country.   The  bark of the root is  purgative,
emetic, stimulant, astringent, and antiseptic.  It is chiefly used for its
antiseptic properties.  For  external use, it is valuable as  a wash or
gargle for various ulcers, mercurial sore mouth,  and scrofulous and
syphilitic ophthalmia.
  Preparations. — Fluid extract, dose, a quarter to half a dram ;  tinc-
ture, two ounces to a pint of diluted alcohol, dose, two to four drams;
infusion, dose, half an ounce ; baptisin, the active principle, a quarter
to half a grain ; gargle, four ounces of fluid extract to twelve ounces
of water, to be used as occasion requires.
  Wild Yam (Dioscorea Villosa). — A perennial  vine, found mostly
at the South.   The root is antispasmodic, and is successfully used in
bilious colic.  It is  said to bring relief  in the most violent cases of
this complaint  It allays nausea and spasms during pregnancy.  It is
given in the form of decoction, two  or three fluid  ounces every thirty 
MEDICINES AND THEIR PREPARATIONS.           663
or forty minutes.  Dose of the tincture, from a quarter of a dram to
a dram; of dioscorein, the active principle, one to fcuir grains.

  Willow  (Silex  Alba). — The  willow  is common  in  Europe and
America.  Its bark is tonic and astringent; and is used, occasionally,
as a substitute for peruvian bark, in  intermittent fever.  It is also
employed  in the treatment of chronic diarrhoea and dysentery.   Dose
of the powdered  bark, one dram ; of the decoction, one to two fluid
ounces.   Salicin,  the active principle, is given, sometimes, in place of
quinine ;  dose, from two to ten grains.

  Wintergreen  (Gaultheria Procumbens). — This evergreen grows in
mountainous, barren regions, throughout our country.   The leaves are
an agreeable stimulant, aromatic, anfl astringent.  Used for chronic
diarrhoea,  and as  an emmenagogue.   The oil and essence are useful
in flatulent colic ; dose of the oil, from five  to  ten drops, on sugar;
of the essence, thirty to forty drops.  Much used to flavor other medi-
cines.

  Witch Hazel (Hamamelis Virginica). — This derives its name from
its having fruit and flowers together on the same tree.   It is found in
most parts of our country.  The bark and leaves are tonic, astringent,
and sedative.  It  is used in bleeding from the lungs and stomach, and
in diarrhoea, dysentery, and excessive mucous discharges.  *lt is also
used in incipient consumption, and for sore mouth, etc.
  Preparations. — Fluid extract,  dose, one to two drams ; infusion,
dose, four  drams; syrup, four ounces of fluid extract to twelve ounces
of simple  syrup, dose, one to two drams.

               Fig 234.                           Fig. 235.
              WOLFSBANE.                        WORMWOOD.

  Wolfsbane (Aconitum Napellus). — This has already been described.
under its  other  common  name, which  is Monkshood;  but as the cut
we Jiad prepared to accompany it was omitted, we give it a place
here, referring the reader to monkshood for its description.
 
664           MEDICINES AND THEIR PREPARATIONS.
  Wormseed (Chenopodium Anthelminticum). — This perennial is called
Jerusalem oak, and is found in waste places all over the United States.
An oil is extracted from the seeds, which, in doses of from four to
eight drops,  morning and evening,  for a  child,  destroys worms.  A
strong infusion of the tops  has a similar effect.   The remedy should
be used four or five days, and be followed by  a purge.
  Wormwood (Artemisia Absinthium).— The  tops and leaves of this
perennial are tonic and anthelmintic; used in  intermittent fever, jaun-
dice, and worms.  It restores the appetite in a weakened state of the
digestive organs, and is also useful in amenorrhoea.   It is excellent
applied as a tincture, or in the form of fomentation, to bruises, sprains,
and local inflammations.
  Preparations. — Fluid  extract, dose, one third to two thirds of a
dram ; solid  extract, dose, three to five grains ;  tincture, two  ounces
to fourteen ounces of diluted alcohol, dose, two to four drams; syrup,
two ounces  fluid extract to six ounces of simple syrup, dose, one to
two drams.
  Yarrow (Achillea Millefolium).— A  perennial  herb, common to the
Old World and  New, and growing in old fields, and along fences.  It
is tonic,  astringent, and alterative, and has been  used in intermittent
fever, bleeding from the lungs, excessive menstruation, wind colic, and
chronic dysentery.  Dose of the infusion, a wineglassful, three or four
times a day.
  Yeast  (Cerevisia Fermentum).—Yeast is slightly tonic and stimula-
ting, and has been used with advantage in typhoid fever; also in scar-
let  fever, and in all diseases where  there is a disposition to putridity.
The dose is  from one to two  fluid ounces, every two or three hours.
It  makes an excellent  antiseptic  poultice, for  unhealthy and  fetid
ulcers, especially if combined with  powdered slippery elm bark, and
charcoal.
  Yellow Dock  (Rumex  Crispus), — The root of this
perennial plant  is alterative,  tonic, diuretic, and deter-
gent, and is regarded as very valuable in the  treatment
of  scrofula* syphilis, leprosy, scurvy, and other skin dis-
eases.
   Preparations.  —. Fluid extract, dose,  one to two
drams;  solid extract, dose, four to eight grains;  syrup,
four ounces of fluid extract to twelve ounces of  simple
syrup, dose, half  an ounce to an  ounce; rumin,  the
active principle, dose, two to four grains.
   Yellow Jessamine (Gelseminum Sempervirens).—This
abounds in  the Southern States, where it is  cultivated
as  an ornamental vine.  The root is a powerful febri-
fuge, narcotic, and relaxant, controlling  and subduing  yjxlow dock.
fever, quieting  nervous irritability  and  excitement,
equalizing  the  circulation,  promoting perspiration, and rectifying  the
secretions.   It is much used  by the ^Eclectics of the Western States,
but the general judgment of the profession  is, that it is too powerful
 
MEDICINES AND THEIR PREPARATIONS.           665
a remedy to be safe.  My own opinion is, that the American hellebore
is equally effective with the yellow jessamine, and thai its general use
involves far less danger.                            ~
  Preparations. — Fluid extract, dose, two to twenty drops ; tincture
four ounces to a pint of alcohol, dose, fifteen to sixty drops, and  in-
crease ;  gelseminin, the active principle, dose, half a grain to a grain
and a half.
  Yellow Ladies' Slipper  (Cypripedium Pubescens). — This perennial
plant is called American  valerian, nerve root, etc.  The fibrous roots
are tonic, nervine,  antispasmodic, and diaphoretic, and are  used in
nervous headache,  nervous excitability, hysterics,  neuralgia,  and  St
Vitus's dance.   Dose of the powder, from ten to thirty grains.
  Preparations. — Fluid extract, dose, half a dram to a dram  ; solid
extract, dose, five to fifteen grains ; tincture, two ounces to a pint of
diluted alcohol, dose, half an  ounce to an ounce ;  syrup, four ounces
of fluid extract to fourteen ounces of simple syrup, dose, two to four
drams ;  cypripedin, the active principle, dose, two to four grains.

  Yellow  Parilla (Menispermum Canadense). — This is a perennial
plant, growing in  woods, and near  streams, throughout the country.
The root  has  the  properties of a tonic, laxative, alterative, and diu-
retic.   It is valued in the  treatment of scrofula, syphilis, skin diseases,
gout,  rheumatism, dyspepsia, general debility, and  chronic inflamma-
tion of the stomach and bovfels.  Dose of the decoction, from two to
four fluid ounces, three times a day;  of the solid extract, from two to
four grains.
  Zinc. — Several  preparations of this metal are used in medicine, as
follows:                                                  »

  Acetate  of Zinc. — This is used as  an external remedy only,  gener-
ally as an  astringent wash for  inflammations of the  eye, and  as  an
injection in gonorrhoea, but only after the acute stage of these diseases
has past.  The strength of these solutions generally should be  one or
two grains to a fluid ounce of soft water.
  Chloride of  Zinc (Unci Chloridum). — This is a powerful escharotic,
and is employed as an external  application to cancers and obstinate
ulcers.  A weak solution  of it is occasionally employed  in old chronic
gleet,  also  in  whites, and purulent discharge from the neck  of the
womb.
  Iodide of Zinc (Zinci lodidum).— This is in the  form of  white
needles, and is tonic and astringent.  It is  not much used,  except
externally,  being applied in a  solution of twenty grains to a fluid
ounce of water, to enlarged tonsils, by means of a camel's-hair  pencil,
or a piece of sponge tied to the  end of  a stick.

  Oxide of Zinc (Zinci Oxidum). — This is an inodorous, white pow-
der, insoluble  in water and alcohol.  It is tonic and antispasmodic,
and is given in chorea, epilepsy, hooping-cough, and other similar dis-
eases  ; but it  is more especially employed to arrest the night-sweats
of consumption, for which  purpose, we  have  at present no other 
666
MEDICINES AND THEIR PREPARATIONS.
article of equal efficacy.   It is sprinkled  externally upon excoriated
surfaces, and is^ised in ointments.  Dose from two to eight grains, in
the form of pilfr

  Precipitated  Carbonate of Zinc (Zinci  Carbonas  Pracipitatas).—
This is employed for the same  purpose as prepared calamine, being
adapted only to external use.

  Prepared Calamine (Calamina Praparata). — This is in the form
of a pinkish or flesh-colored powder, of an earthy appearance.  It is
employed only as an  external application, being dusted on excoria-
tions and superficial ulcerations, as a mild astringent.  It should be a
very fine powder.

  Sulphate of Zinc (Zinci  Sulphas). — This is a colorless, transparent
salt, crystallizing usually in small, four-sided prisms.   It is tonic and
astringent, and in large  doses, a prompt emetic.  Used as a tonic in
cases of debility attended with irritation.  In obstinate intermitfents, it
is sometimes conjoined with sulphate of quinia; it is chiefly employed,
however, in such spasmodic diseases as epilepsy, chorea, and hooping-
cough.   As an astringent, it is used externally, being applied in solu-
tion to bleeding surfaces, as a wash in ophthalmia, and as an injection
in whites and chronic gonorrhoea.

  Valerianate of  Zinc  (Zinci Valerianas)m—This is  in  white,  pearly
scales, with a faint odor of valerianic acid.   It is  tonic  and antispas-
modic, and is used in the various nervous affections which accompany
chlorosis.  Dose, one or two grains,  several times a day, in the form
of pill.

                 Preparations.  Pharmacy.

   The preparation of medicines for  use, constitutes the art of phar-
macy.   It is the peculiar  business of the  apothecary.   It will not be
necessary in these  pages to describe his  art, in  all  particulars,  but
merely as many of the preparations which it is his duty to prepare as
are really needed in  the treatment of  disease.  In  doing this, I shall
classify the preparations alphabetically, and begin with
                   •
                            Cerates.

   These substances have a degree of hardness midway between oint«
ments and plasters.   They may be spread upon leather or linen, with
out the use of heat, and they do not melt and run when applied to the
skin.   They are  made of wax, or spermaceti, combined with  lard or
oil.  The articles are melted together by a very gentle heat, and dur-
ing the process of cooling, the whole should be well stirred.

   Calamine Cerate. — Prepared calamine and yellow wax, each three
ounces; lard, one pound.  Melt the  lard  and wax together.  When
the mixture begins  to  thicken, on cooling, gradually stir in the cala
miiie. 
MEDICINES AND THEIR PREPARATIONS.            667
  This is called Turner's cerate, and is useful for burns, excoriations,
superficial ulcers, and sores.                         «

  Goulard's Cerate. — Take of solution  of subacetate of lead,  two
fluid ounces and a half; white wax, four ounces; olive oil, nine fluid
ounces; camphor, half a dram.  Mix the wax, previously melted, with
eight fluid ounces of the oil; remove from the fire, and when the mix-
ture begins to thicken, gradually pour in the solution of subacetate of
lead, stirring constantly, with a wooden spatula, till  it becomes cool.
Then add the  camphor, dissolved in the remainder of the oil.
  This is the cerate of subacetate of lead, and is used for excoriations,
inflamed burns, scalds,  and chilblains, and for eruptions of the skin.
Excellent for blistered surfaces, indisposed to heal.
  Half an  ounce of  this preparation  united with half an ounce of
simple cerate, and one  dram each of  calomel  and powdered  opium,
makes a very valuable remedy for various eruptions  of the skin, of a
local nature.

  Resin Cerate. — Take  of resin,  five  ounces;  lard, eight  ounces;
yellow wax, two ounces.   Melt together with a gentle heat, and stir
till  cool.
  This  is known as basilicon ointment, and is used as a gentle stimu-
lant to blistered surfaces, indolent ulcers, burns, scalds, and chilblains.

  Compound-Resin Cerate. — Take of resin, suet, and yellow  wax,
each a  pound;  turpentine, half a  pound; flax-seed  oil, half a pint,
Melt together, strain through linen, and stir till cool.
  This, under the name of  Deshlefs salve, is popularly used for simi-
lar  purposes with the resin cerate.

  Savine Cerate. — Take powdered savine, two ounces ; resin cerate,
a pound.   Mix the savine with the cerate, previously softened.
  Used as  a dressing for perpetual blisters.

  Simple Cerate. — Lard, eight ounces; white wax, four ounces.  Melt
together, and stir till cool.
  Used for dressing blisters, wounds, etc., where it is desirable simply
to preserve the moisture of  the part, and to exclude the air.

  Spanish  Flies Cerate, known  as blistering  plaster.  Take finely
powdered Spanish  flies, a pound ;  yellow wax and resin, ea(jh seven
ounces;  lard,  ten ounces.    To the wax,' resin,  and  lard, previously
melted together and strained, add the Spanish  flies, and, by means of
the  most gentle heat, keep the mixture  in  a  fluid state  for  half an
hour, stirring occasionally, then remove the heat, and stir till cool.
  This can be easily spread without the aid of heat, and  is used for
the  purpose of drawing blisters.  It is now, however, superseded in a
great  degree  by various preparations, composed for  the most part of
cantharidin, either dissolved in oil, and applied to the skin by means
of a piece of paper saturated with  it, or incorporated  with wax, and
spread in a very thin layer  upon fine waxed cloth, silk, or paper, con-
stituting the blistering cloth, blistering paper, etc. 
CCS           MEDICINES AND THEIR PREPARATIONS.
       Confections, Conserves, and  Electuaries.

  These are soft solids, in which medicinal articles  are incorporated
with sugar, syrup, honey, or some other sacharine matter, for the pur-
pose both of preserving the mass, and of rendering the medicine more
palatable and convenient for use.

  Aromatic  Confection.— Take of aromatic  powder, five  and a half
ounces; powdered saffron,  half an ounce ; syrup of orange peel, six
ounces; clarified honey, two ounces.  Rub the aromatic powder with
the saffron ; then add" the  syrup and honey, and  beat the whole to-
gether, in  a  mortar, till they are thoroughly mixed.
  Given in  debilitated states of  the stomach, as a vehicle  for other
medicines.  Dose, from ten grains to a dram.

  Compound Confection of Catechu.— Take of compound powder of
catechu, five ounces :  simple syrup, five fluid ounces.  Add the syrup
gradually  to the powder, and mix them well.
  To be given in diarrhoea  and chronic dysentery, in the dose of half
a dram to a dram.

  Confection of Senna,  otherwise called lenitive electuary.   Take of
senna, eight ounces ;  coriander seeds, four ounces; bruised liquorice
root, three ounces ; figs, a pound ; pulp of prunes, pulp of tamarinds,
pulp of purging cassia, each, half a pound ; refined sugar, two pounds
and a half;  water, four pints.  Rub the senna and coriander together,
and separate ten ounces of the powder with a sieve.  Boil the residue
with the  liquorice root and figs, in the water, to one half;  then press
out the liquor, and strain.   Evaporate the strained liquor, by the most
gentle heat, to  a pint and  a half; then  add the sugar and form a
syrup.  Lastly,  rub the pulps with the  syrup, added gradually, and,
having thrown in the sifted powder, beat all together till well mixed.
   This is a pleasant  and admirable laxative, being well  adapted to
the habitual costiveness of pregnant women, and  those affected with
piles ;  for this latter purpose, it is still better combined with cream of
tartar  and sulphur, as described in No. 6 of the prescriptions, at the
end of the book.

                          Decoctions.

   These  are  solutions of vegetable medicines, obtained by  boiling
them  in  water.  They differ from infusions, in  being subjected to
a greater degree of heat,  the water during their preparation being
kept  up to the boiling point.  The process should be conducted in a
covered vessel, and the boiling must not be continued for a very long
time.  Medicines, whose active principle is volatile, are not proper for
decoctions,  the active principle being driven off by heat, and lost
   The usual proportion of vegetable  substances  used  in making de-
coctions is  <jne ounce  to a pint  of water, and the dose of the decoc-
tion, from o«e to four ounces. 
MEDICINES AND THEIR PREPARATIONS.            669
                               Essences.

      These are generally prepared by dissolving one ounce of the essen-
    tial oils of plants in one pint of alcohol.   The oils of lemon, pepper-
    mint, sassafras, etc., are made in this way, and  their properties,  of
  j  course, are  similar to the oils  from which they are prepared.   They
  j  are generally taken in a little sweetened water, in doses of ten drops
  |  to a teaspoonful.

                               Extracts.

      These are soft solids, obtained by evaporating the tinctures,  or
    solutions, of vegetable  substances.   The  active  principles of dried
    vegetables can  only be extracted  by some liquid ; this, for preparing
  ;  extracts, is  either water, or  alcohol, or a mixture of the two.  Those
  I  obtained by the use of water are called aqueous, or watery extracts;
    those by means of alcohol, alcoholic extracts;  and those by both alco-
  j  hoi and water, hydro-alcoholic extracts.
      Extracts  are  generally prepared  on a  large scale, by persons who
  J  make a business  of it.   Like other articles, many of these' prepara-
  j  tions get into  the  market  which  are inferior in quality, and even
    worthless.   Without disparaging the preparations of-other manufac-
    turers, I would  mention those  prepared  by the large  manufacturing
  i  house of Tilden & Co., at  New Lebanon, New York, as worthy of
  i  public confidence.  Most of  their solid extracts, with the proper doses,
    are  mentioned in previous pages, under the several articles from which
  j  they are made.

                           Fluid  Extracts.

      These are concentrations, into a small bulk, in liquid form, of the
 |  active principles of medicinal substances.  They are a valuable class
    of remedies, being in some cases preferable to tinctures,  having less
 |   alcohol; and better than extracts or decoctions, because not so often
 j   injured by heat in their  preparation, and not requiring to  be taken in
 j   large doses.   Great  skill  is required in  their preparation, and they
 j   should always  be obtained  from those  who have the  reputation of
 jj   making  reliable articles. ** None  that I  am  acquainted with,  better
    deserve confidence than  those of Tilden & Co.

                            Fomentations.

      Fomentation is a sort of partial or  local  hot  bath, and consists
 j   either in the application of  cloths dipped in hot water, or some hot
 j   medicated decoction, and applied to the affected part,  or,  of bitter or
h   anodyne herbs  steeped in vinegar or water, and  then, while hot, en-
ji   closed in a muslin bag, and laid upon the diseased  place.  In either
 I   case, whether the  cloths wet in a decoction of the herbs, or the herbs
 J   themselves, slightly steeped, be applied in a bag, the application should 
670           MEDICINES AND THEIR PREPARATIONS.
be as hot as#can be  borne, and not so moist as to  wet the  bed or
clothes of the patient.
  Fomentations act  by their  warmth  and moisture  chiefly;  and
slightly, in some cases, by their medicinal  virtues.   Their  object is
to lessen pain and inflammation, by relaxing the parts, and relieving
tension and spasm.   They may be prepared from equal parts of hops,
tansy, and wormwood, or from equal parts of hops, lobelia,  and stra-
monium, etc., etc.

                          Infusions.

  For a description of simple infusions, see page 588.  Those made
of one article only are sufficiently referred to in previous pages.  It
will  only be necessary here to insert such compound  infusions as  are
deemed important.
  Compound Infusion of Catechu. — Take of powdered catechu, half
an ounce;  bruised cinnamon, a  dram; boiling  water, a pint;  macer-
ate for an  hour in a covered vessel, and  strain.  An elegant mode of
administering catechu.  Dose, from one to three fluid  ounces, three or
four times a day.
  Compound Infusion of Gentian. — Take of bruised gentian, half an
ounce ; dried orange  peel and coriander seeds, bruised, each a dram;
diluted alcohol, four  fluid ounces; cold water, twelve  fluid ounces.
First, pour on the diluted alcohol, then, three hours afterward,  the
water.  Let the whole stand twelve hours, and strain.  An  excellent
form for using gentian.  Dose, one fluid ounce, three or four times a
day.
  Compound Infusion of Geranium. — Take of geranium root, sweet
bugle leaves, golden seal root, witch-hazel bark, each, in coarse powder,
one  ounce; boiling water, four pints.  Mix, and allow all to stand in
a covered vessel, two hours, applying a gentle heat; then strain. Two
drams of alum may or may not  be added.
  Used in  chronic diarrhoea and dysentery, in one or two tablespoon-
ful  doses, every two  or three hours; also  as  an injection  in gleet,
whites, falling of the bowel, etc.; and as a gargle in ulcerations of
the mouth and throat.
  Compound Infusion of Parsley. — Take of parsley roots and seeds,
and  subcarbonate of iron, each, two ounces; horseradish  root,  one
ounce;  squill, juniper berries,  white mustard  seed,  mandrake root,
and  queen of the meadow root, each, half an ounce; coarsely bruise
these articles, and  place  them in boiling cider, and expose  them, for
twenty-four hours, to a very gentle heat, in a covered earthen vessel.
The cider should be sparkling and tart.  Let the articles stand in the
cider.
   Useful in dropsy.   Dose,  one or two fluid ounces,  three  or four
times a day.
  Compound Infusion of Senna. — Take  of senna and  manna, each,
one  ounce; jalap, cream of tartar, and caraway seeds, bruised, each, 
MEDICINES AND THEIR PREPARATIONS.           6? I
 two drams; boiling water, one  pint  Add all the ingredients to the
 water, in a covered vessel, and  let them stand twelve hours.   Then
 add four ounces of elixir salutis.
   This is a valuable, and not disagreeable, gentle physic for various
 purposes.  Dose, from one to four ounces.

   Compound  Infusion of Trailing  Arbutus. — Take of queen  of the
 meadow root, dwarf elder bark, marshmallow root, and trailing arbu-
 tus, each, coarsely  bruised,  half an ounce; add to them, one pint
 of boiling water, and one pint of Holland gin, and steep by the fire
 four hours, in  a closely covered vessel.   Strain, and sweeten  with
 honey.
   Excellent for gravel,  suppression of urine, scalding of urine, and
 various other disorders  of the urinary organs.  Dose, from an ounce
 to a wineglassful, with  more or less frequency, according to the ur-
 gency of the  case.

                    Injections.— Clysters.

   These are  preparations to be introduced into the lower bowel by
 means of a syringe.  A sufficient  number of them are given among
 the recipes at the end  of the book.   It is not necessary to  repeat
 them here.

                         Liniments.

   These are  liquid preparations, generally a little thicker than water,
 and thinner than oils, intended only to be applied to inflamed, pain-
 ful, or  swelled parts.  They are designed to soothe, or quiet, or stim-
 ulate, or make red the part to which they are applied; and are rubbed
 on with the  hand, or a  piece of flannel or cotton, and frequently in
 connection with heat, by sitting or standing before a fire.
   A large number of liniments are given under the head of recipes
 at the end of  the book.    To  those,  I add a few valuable ones here.

   Camphor Liniment. — Take six drams of camphor, and dissolve it
 in one fluid ounce of chloroform, and  add to this one fluid ounce of
 olive oil.
   For sprains, neuralgia, rheumatism, etc.

   Compound  Camphor Liniment. — Take two  ounces  and a half of
 camphor, a fluid dram  of oil of lavender, seventeen fluid  ounces of
 alcohol, and three fluid  ounces of strong solution of ammonia.   Dis-
 solve the camphor and the oil in the alcohol; then add the ammonia,
 and shake till they are mixed.
   To be used as a rubefacient and  anodyne for local  pains, particu-
larly rheumatism.                                              •

  Compound  Liniment   of Ammonia. — Take  five  fluid ounces of
strong water  of ammonia, two  fluid ounces of tincture of camphor,
and one fluid  ounce of spirit of  rosemary.   Mix them well together. 
072
MEDICINES AND THEIR PREPARATIONS.
  This is similar to Dr. Granville's counter-irritant lotion; and is used
as a prompt and powerful rubefacient, or even vesicatory, in neural-
gia, rheumatism, gout, spasms, and inflammations.

  Croton Oil Liniment. — Take  one  fluid ounce  of croton  oil, and
seven fluid ounces of oil of turpentine.  Mix, and  shake them well
together.
  A good  rubefacient and pustulating preparation  to  apply to the
chest and other parts.
  Liniment of Opium. — Take six ounces of castile soap, an ounce
and a half of opium, three ounces of camphor, six fluid  drams of oil
of rosemary, and two pints of alcohol.   Macerate the soap and opium
in the spirit for  three  days ; then  filter, and add the oil and camphor,
and shake briskly.
  This  is a useful anodyne and rubefacient  liniment  for bruises,
sprains, and pains of a rheumatic and gouty nature.

  Liniment of Spanish Flies. — Take an ounce of powdered Spanish
flies, and half a pmt of oil of turpentine.  Mix,  and apply gentle heat
to them, in a covered vessel, for three hours.   Then strain.
  Employed with advantage^ externally, in  the sinking stage of ty-
phoid fevers.  If so powerful as to be in danger of causing blistering,
it may be weakened by adding flax-seed or olive oil.

  Liniment of Turpentine.— Take half a pint of oil of turpentine, and
a pound of resin cerate.  Melt the cerate, and  add the oil to it, — mix-
ing them well.
  This  is a valuable remedy for scalds and burns, and should  be
applied soon after the accident, and be  discontinued when the inflam-
mation  excited by the fire is removed.   The burned or scalded surface
should be covered with lint wet with the liniment.

  Opodeldoc. — Take three ounces of white bar soap, sliced, an ounce
of camphor, a  fluid dram each of oil  of rosemary  and  oil of origa-
num, and a pint of alcohol.  Digest the soap in the  alcohol by means
of a gentle heat, until it is dissolved ; then add the camphor and oils,
and when they are  dissolved, pour the whole into broad-mouthed
vials.
   This  is the  camphorated soap liniment, and is used as an anodyne
application to sprains, bruises, and painful tumors, etc.

                      Medicated  Waters.

   Those preparations consisting of water  impregnated with  soms
medicinal substance are called medicated waters.  They are prepared
from volatile  oils by triturating in  a mortar a dram of the oil, more
or less,  with a small quantity of carbonate of magnesia, and then very
gradually pouring on one quart of water, while the  trituration is con-
tinued.   At last, the preparation is filtered through paper.  The quan-
tity of  oil, magnesia, and water, used for each preparation, is as fol-
lows : 
                 MEDICINES AND THEIR PREPARATIONS.           673
    ■   -   ■   ------------------------------------------------------------------------------v-------------------------------.--------------------------------------------
      Oil  of bitter almonds, sixteen  minims; carbonate  of magnesia, a
    dram;  water, one quart
      Oil of cinnamon, half a fluid dram ; carbonate of magnesia, a dram*
 [|   water, one quart.
      Twenty minims of oil of roses, a dram of carbonate of magnesia,
    and one quart of water.
      Oil  of fennel, half a  fluid dram; carbonate of magnesia, a dram*
    water, a quart
      Peppermint Water, Spearmint  Water, and Pennyroyal  Water, are
    all prepared from the same quantities of their several oils, as Cinna-
 !   mon Water.
      The dose of these waters is half a fluid ounce to two fluid ounces,
    except the bitter almond water, which is one or two fluid drams.

 i     Camphor Water. — Take  two drams of camphor, forty  minims of
 j   alcohol, four drams of carbonate of magnesia, and one quart of water.
    Rub the camphor first with the alcohol, afterwards with the carbonate
    of magnesia, and lastly, with the water, gradually added.   Then filter
    through paper.

                        Medicated Wines.

      Wines  are used in making certain  preparations, because the alco-
    hol they contain will extract from  plants,  etc., some medicinal proper-
    ties which water will  not, and at the same  time is less stimulating
    than the tinctures, etc., made from alcoholic spirits.

     Compound  Wine of Comfrey (Restorative  Wine  Bitters). — Take
    one ounce, each, bruised, of comfrey, Solomon's  seal, and  spikenard;
    and half an ounce, each, bruised, of chamomile flowers, Colombo, and
    gentian.   Cover these with boiling water, and let them stand twenty-
    four hours, in a covered  vessel.  Then add two quarts  of sherry wine.
    Macerate fourteen days, express and strain.
     Valuable in leucorrhoea and other female complaints.  Dose, from
 i   half a fluid ounce to two fluid ounces, three or four times a day.

     Compound Wine of Golden Seal. — Take one dram,  each, bruised,
   of golden  seal root, tulip tree bark, and  bitter  root, half a dram of
   pulverized cayenne, and two  quarts of sherry  wine.   Macerate  for
   fourteen days,  with occasional shaking; then express and strain.
j     This is a pleasant bitter tonic in dyspepsia, etc.  Dose, from half a
|   fluid ounce to two fluid ounces, three times a day.

     Wine of Ipecacuanha.  — Take two ounces  of bruised ipecac,  and
!   one quart  of sherry wine.   Macerate fourteen days, with  occasional
   shaking.   Then express and filter through paper.
     This is  a  valuable  emetic preparation, — especially for children.
   Dose, as an emetic, for an adult, one fluid ounce ; as an expectorant,
   from ten to thirty minims; for a child  two years old, as an emetic,
   one fluid dram, repeated  every fifteen minutes till it operates.
                               85 
674           MEDICINES AND THEIR PREPARATIONS.
.--------------r_--------------------------------_

                           Mixtures.

  These are preparations in which medicinal substances which can-
not be dissolved in water are suspended in it by means of some viscid
matter, like sugar, or gum arabic.  Their object is to conceal the taste,
prevent the sickening effect,  and make it more easy to take disagreea-
ble  medicines.  To make a perfect mixture requires skill.  Generally,
the medicine to be suspended should  be triturated in a mortar with
the sugar, gum arabic, etc., before the water is added.

  Almond Mixture. — Take  half an  ounce  of sweet almonds, half a
dram of powdered  gum  arabic, two drams of sugar, and  eight fluid
ounces of water.  Soak the almonds in  the water, and having removed
their  external  coat, beat  them with  the gum arabic and  sugar in a
mortar, till they are thoroughly mixed ; then rub the mixture, gradu-
ally adding the water, and lastly, strain.
  This is an agreeable, nutritive  demulcent, in bronchial, dysenteric,
and urinary affections.   It must be used freely, the dose being from
two to eight fluid ounces.

  Chalk Mixture. — Take half an ounce of  prepared chalk, two drams
each of refined sugar and powdered gum arabic, and four fluid ounces
each of cinnamon-water and water.  Rub them together till they are
thoroughly mixed.
  This is much used in looseness of  the bowels, accompanied with
acidity, particularly among children.  If an increase of its astringency
be required, add laudanum, or kino, or  catechu.

  Compound Mixture of Iron. — Take  a dram of  myrrh, twenty-five
grains of carbonate of potassa, one  scruple of powdered sulphate of
iron, half a fluid ounce of spirit of lavender, one dram of  refined sugar,
and seven and a half fluid ounces of rose water.   Rub  the  myrrh in
a mortar, gradually adding  the rose water, then  mix with these the
spirit of lavender,  sugar, and carbonate of  potassa,  and lastly, the
sulphate of iron.   Pour the  whole  into a glass bottle, and keep it
well stopped'.
  This is about the same  thing as Griffith's myrrh mixture, and is
considerably used  in chlorosis, and other affections requiring the use
of iron.

  Brandy Mixture. — Take  four fluid ounces each of brandy and cin-
namon water, the yolks of two eggs, half an ounce of  refined sugar,
and three drops of  oil of cinnamon.   Mix them.
   A useful stimulant and nutritive draught, to be*used  in the sinking
stage of low forms of fever.

   Extract  of  Rhubarb  and  Potassa (Neutralizing Extract). — Take
two pounds of the best rhubarb, one  pound each of cinnamon and
golden seal.  Grind or coarsely  bruise the  articles, and  mix them;
macerate them for two days  in one gallon of the best fourth proof
brandy.  Then express the tincture with strong pressure, and add to 
MEDICINES AND THEIR PREPARATIONS.
675
it one fluid dram of oil of peppermint, previously dissolved in a little
alcohol.  Break up the compressed residue  from the press, and place
it in a perculator, and gradually run warm water through it, until the
strength  is exhausted.  Evaporate this  solution to four pints, and
while the liquor is still hot, dissolve in it two pounds of bicarbonate
of potassa, and three pounds of refined sugar.   Continue the evapo-
ration, if necessary, until, when added  to the tincture  first obtained,
it will  make a gallon  and a half, then mix the two solutions together.
  This is a useful preparation for diarrhoea, dysentery, cholera morbus,
summer complaints of children, acidity of the stomach, heartburn, etc.
Dose, one fluid dram.

  Mettauer's Aperient. — Take one ounce  and  a half of pulverized
aloes, four  ounces of  bicarbonate of soda, two  fluid ounces  of com-
pound  spirits of lavender, and two quarts of water.  Place the whole
in a jar, or jug, and let them  stand fourteen days, shaking well once
a day.   Then pour off from the dregs.   It improves by age.
  This preparation was made by Professor Mettauer, and was held
in so high esteem by him, that when he sent it to the London Lancet,
he requested that he might have  the credit of compounding it.  It is
one of the best known aperients for costiveness, — particularly when
connected with bilious dyspepsia.  For  that class of bilious persons
who overeat, and have  acid stomachs, it has great value.  In bilious
cases, the nitro-muriatic acid, taken before meals (the aperient  after
meals) may be usefully associated with it.  In the constipation of
hysteria and hypochondriasis, the fluid  extract of valerian  may  be
added to it.  Dose, from two drams to two ounces.

  Saline  Mixture  (White  Liquid  Physic). — Take  half  a  pound  of
sulphate of soda, and one  and a  half pints of water.  Mix, and  dis-
solve the soda; then add two fluid ounces of nitro-muriatic acid, and
one dram and eight grains of powdered alum.
  Used to allay nausea and vomiting, and as  a cooling purgative;
also, for colic,  diseases of the liver, diarrhoea, dysentery, intermittent
fevers, etc.
  This is one of the  remedies of the Eclectic  school of physicians,
and is  held  by them in high  esteem.   Dose, a tablespoonful in a gill
of water, to be repeated every hour or two, until it causes one or two
evacuations from the bowels.

                          Ointments.

  Ointments are composed of fatty substances, about the consistence
of butter, impregnated with medicine.   All gritty  matter  should be
excluded from them.   To prevent the rancidity to which they are
liable, a little glycerin is now frequently added.

  Ointment of Acetate of  Lead. — Take two ounces of white  wax,
and four ounces of lard; melt them together, and add two and a half
drams  of finely powdered  acetate of  lead; stir constantly till  cold.
This is useful for  burns scalds, ulcers, and excoriations. 
676           MEDICINES AND THEIR PREPARATIONS.
  Ointment of Bayberry. — Take half a pound  each of tallow, white
turpentine, and bayberry, and four ounces of olive oil; melt together
and strain.
  Good for scrofulous and indolent ulcers.

  Ointment of Belladonna. — Take a dram of extract of belladonna,
and an ounce of lard ; mix them.
  A useful anodyne application for painful tumors, neuralgia, etc.

  Ointment of Creosote. — Take half a fluid dram of creosote, and an
ounce of lard ; mix them.
  A useful  application for syphilitic, scrofulous, and cancerous ulcers.

  Compound Ointment of Galls. — Take  six drams of finely powdered
galls, six ounces of lard,  and a dram and a half  of  pulverized opium;
rub them together.
  A valuable preparation in irritable piles.

  Ointment of Red Iodide of Mercury.—Take one  dram of red iodide
of mercury, and seven drams of ointment of white wax; incorporate
them thoroughly together by trituration in a*mortar.
  Used as a dressing for indolent scrofulous ulcers.

  Ointment of Nitrate of  Mercury. — Take  one ounce of mercury,
eleven fluid ounces of nitric acid, nine fluid ounces  of fresh neats-foot
oil, three ounces of lard.   Dissolve  the mercury  in the  acid, then heat
the oil and lard together in an earthen vessel  to  200° F.; then add
the mercurial solution, and stir with a wooden spatula, constantly, as
long as effervescence continues, and afterward occasionally till the
ointment stiffens.

  Milder Ointment of Nitrate of Mercury. — Take  an  ounce of oint-
ment of nitrate of mercury, and seven ounces of lard; rub them to-
gether.
  The first of the above two preparations is the citrine ointment, and is
much and advantageously employed as an  external  application  in
porrigo, impetigo,  psoriasis, and pityriasis.  It is nearly a specific for
inflammation of the eyelids connected  with the  formation  of  scaly
matter about the  lashes.  The second of these two  preparations is
merely a dilution of the first
  Ointment of Oxide of Zinc. — Take half an ounce of oxide of zinc,
and three ounces of lard; rub them together.
  This is a  mild  astringent application in chronic opthalmia, erup-
tions of the skin, sore nipples, and other excoriations.

  Ointment of Poison Hemlock. — Take one dram of extract of poison
hemlock  (Tilden & Co.'s  preparation),  and one ounce  of lard; rub
them together.
  An anodyne application for painful swellings, ulcers, and piles.

  Ointment of Poke. — Take a dram of  the  extract of poke, and one
ounce of lard ; mix them.                              ,
  For malignant ulcers, scald head, itch, etc. 
MEDICINES AND THEIR PREPARATIONS.           677
    Ointment of Stramonium. — Take one  dram of the extract of stra-
  monium leaves, and one ounce  of lard; rub  the extract with a little
  water till it is uniformly soft, and then with the lard.
    Used as  an external application in irritable  ulcers, painful piles, and
  skin eruptions.
    Simple Ointment.— Take a pound  of white wax, and four pounds
  of lard; melt them  together with a gentle heat, and stir constantly
  till  cold.
    Ointment of Rose Water. — Take a fluid ounce of rose water, two
  fluid ounces of oil of almonds, half an ounce  of spermaceti, one dram
  of white wax;  melt together, by means of a water-bath, the oil, sper-
  maceti, and wax;  then add  the rose water, and stir the mixture con-
  stantly till  cold.
    This  is the well known preparation called  cold  cream, and is used
  with much advantage for chapped lips and hands, excoriations, etc.
    Spermaceti Ointment. — Take five ounces  of spermaceti, fourteen
  of white wax, and a pint of olive oil; melt them together over a slow
  fire, and stir constantly till cold.
    A mild dressing for blisters, wounds, and excoriated surfaces.
    Tar  Ointment. — Take a pound each  of tar and suet;  melt the
  suet with a gentle heat, and add the tar to it; then stir constantly till
  they are cold.
    A useful stimulating application to various scaly and scabby erup-
  tions, particularly leprosy and scald head.
    Ointment of White Hellebore. — Take one ounce of powdered white
  hellebore root, four ounces  of lard, and twelve drops of oil of lemons;
  rub them thoroughly together.
    A useful ointment for the cure of itch.
    Ointment of  Wild  Indigo. —  Take  one pound of powdered wild
  indigo root,  moisten  it thoroughly  with alcohol,  and let it  stand
  twenty-four hours; then put it in a percolator, and  add alcohol  as
  long as the liquid which  passes  contains the taste of the root.   Distil
  the alcohol from this filtered tincture until half a gallon of tincture is
  obtained.   Melt one  pound  of fresh  butter, without salt, add the
  above tincture, and  carefully evaporate the rest of the alcohol; stir
  constantly  till cold, after the alcohol has nearly passed off.
    This is one of the preparations of the Eclectics, and is a cleansing,
|  detergent,  antiseptic, and  discutient  ointment, useful in scrofulous,
'  erysipelatous, and malignant ulcers, eruptions of the skin,  etc.

 .  Pile Ointment. — Take  three handfuls each of witch hazel bark,
  white oak bark,  and sweet appletree  bark; bruise or grind them, and
  add to them three  pints of  water; boil down  to one pint, and strain ;
  add to this liquid  half a pound  of lard, and simmer till the water all
  disappears, stirring continually both before and* after  removing from
  the  fire till  it cools.
    This  forms a brick-colored anodyne, astringent ointment, admira-
  bly  adapted to the cure of  pile tumors. 
678           MEDICINES AND THEIR PREPARATIONS.
  Compound Lead Ointment. — Take two and a half pounds of olive
oil, four ounces each of  beeswax  and unsalted butter, and half a
pound of white turpentine ; melt them together, strain, and then heat
to nearly  the boiling point; then  gradually add one pound of red
lead,  stirring constantly till the  mixture becomes black or brown;
then remove from the fire,  and when it  is partly cool, add to it a
mixture of twelve ounces of honey, and half a  pound of powdered
camphor.
  This is a very healing ointment, and is much used for ulcers, burns,
wounds, and skin diseases.

  Compound Sulphur Ointment. — Take one ounce of sulphur, one
dram each of ammoniated mercury and benzoic acid, one fluid dram
each of sulphuric acid and  oil of bergamot, two drams of nitrate of
potassa, and  half a pound of lard.  First, melt the lard with a gentle
heat, then add the  other ingredients, stirring constantly till they are
cold.
  A sovereign remedy for itch.

                             Pills.

  Pills are small masses of medicinal substances, in globular shape,
and of a size convenient for swallowing.   Each pill generally weighs
from three to five grains.  Those medicines which cannot be dissolved
in water,  and are  particularly unpleasant to the taste, are usually
given  in the form  of pill.  Sugar-coated, as now very extensively
prepared by Tilden & Co., from every important medicine, and in a
great variety of combination, they will doubtless  become a very pop-
ular form of taking medicine.   Physicians cannot do better than to
use the pills of the abovenamed extensive manufacturing house.
  The method of making pills is as follows: If the substance to be
worked into  pills be a solid extract, add a few drops of water to it,
and rub it to the right consistence;  if it  be a resin, add to it a few
drops of alcohol; if it be a soft or liquid  substance, rub up with it
some  inert substance, or crumb of bread, or wheat flour, or starch, or
pulverized gum  arabic; if it  be a powder, mix it with some soft
substance, as confection, soap, or syrup, molasse?, honey, or mucilage
of gum arabic.  The materials must  be well mixed and rubbed into
a uniform mass, which should be rolled with a spatula or case knife,
into a cylinder of just the same  size throughout.  This is  to be di-
vided  equally into  the  number of pills required, each  of  which is
rolled  into a spherical form between  the  thumb  and finger, or upon
the palm of one hand by the index finger of the other.
  So many valuable pills are prescribed among the " Recipes," that it
is not necessary here to  add to their number.


                           Plasters.

  Plasters are composed of wax, resins, gums, fats, and oils, and
sometimes medicinal substances, and are spread upon linen, muslin, 
MEDICINES AND THEIR PREPARATIONS.           679
  or leather, — mostly the latter.   When cold they are hard ;  but when
  brought to the warmth of the  human body, they so far soften as to
  adhere firmly to the skin, but do not " run " so as to spread outward,
  and soil the under-clothes.   They are intended generally to excite and
  irritate  the skin; sometimes as mechanical supporters;  and sometimes
  to affect the system by having their medicinal matters  absorbed.

    Belladonna Plaster. — Take  three  ounces  of  resin plaster,  and an
  ounce and a  half  of extract of belladonna, add the  extract  to the
  plaster previously melted by a gentle heat, and mix.
    A useful anodyne application in neuralgia, rheumatic pains,  and
  dysmenorrhoea.
    Compound Capsicum Plaster.— Melt together  half a  pound of resin,
|  and two ounces of beeswax ; to this add one pint of  spirit in which
  two ounces of powdered cayenne, enclosed loosely in a linen bag, has
  been digested one  hour by a gentle  heat; evaporate  the spirit by a
  moderate heat,  and add one ounce of powdered camphor, and  one
  fluid dram and a half of oil of sassafras ;  stir constantly till cold.
    This may be used whenever a stimulating  plaster  is  required.

    Compound Galbanum  Plaster. — Take  two  ounces  of  galbanum,
  three ounces of  burgundy pitch, half an oufhce of resin, half an ounce
  of yellow wax, and four ounces of lead  plaster; melt them  all to-
  gether, over a gentle fire.
    This is a valuable strengthening plaster, and may be  used for weak-
  ness of various  parts, as well^as for scrofulous enlargement of  glands
  and joints.
    Compound Lead  Plaster. — Take  one pound  of lead plaster; melt
  it by a moderate heat, and then add two fluid ounces each of linseed
  oil and  tincture of opium, six  fluid ounces of oil of turpentine, and
  two thirds of a pound of oil of  origanum; stir together till cold.
    Used for burns, scalds, chilblains, etc.

    Compound Resin Plaster.— Take three pounds of  resin, four ounces
  each of beeswax and hemlock  gum; melt the articles together, then
  remove from the fire, and, when nearly cold, add gradually one fluid
  ounce each of oil of hemlock, oil of sassafras, and olive oil, with  half
  an ounce of camphor dissolved  in them, arid half a  fluid ounce of oil
  of turpentine.   Pour the  whole into cold water,  and work  in the
  hands till cold, forming it into rolls.
    This is an excellent  strengthening plaster, useful for rheumatism,
  enlarged joints, glands, and wherever a  weakened part needs gentle
  stimulation and support.
    Spiced Plaster.— Take one ounce each  of powdered ginger, cloves,
  cinnamon, and black pepper; one  dram* of pulverized cayenne;  half
  a fluid ounce of tincture of ginger; and a sufficient quantity of honey.
  Mix the powders, and then add  the tincture and honey, to form a stiff
  poultice.
    This is applied with  great advantage over the stomach in cases of
  nausea and vomiting. 
680           MEDICINES AND THEIR PREPARATIONS.
   Compound Tar Plaster. — Boil  three pounds of tar half  an hour,
 then add one pound and a half of burgundy pitch, one pound of white
 gum turpentine (after having melted them together and strained).
 Stir together, then  remove from the fire, and add ten ounces each of
 finely powdered mandrake root,  bloodroot,  poke root, and Indian tur-
 nip ; mix thoroughly together.
   This is an irritant, rubefacient, suppurative plaster, and is consider-
 ably used by the Eclectics, to produce counter-irritation and revulsion
 in neuralgia, rheumatism, and other painful affections, as well as in
 chronic inflammation of internal organs.   To be spread thinly on soft
 leather, and renewed daily on the same leather.  Four days are re-
 quired, to produce suppuration.   If  it produce great pain or inflam-
 mation, remove it, and apply mutton tallow, or elm poultice.

   Lead Plaster. — Take one pound and a quarter of  very finely pow-
 dered semivitrified  oxide  of lead,  one quart of olive oil, and  half  a
 pint of water.  Boil together over a gentle fire, stirring constantly till
 the  oil and  litharge  unite and form a plaster.  If the water nearly all
 evaporates before the process is completed,  add a little boiling water.
   A useful  plaster for ulcers, burns, excoriated surfaces, etc.

   Red Oxide  of Lead Plaster. — Melt together one quart of olive.oil,
 and one ounce each of  beeswax  and resin ;  heat to the boiling point,
 and then add gradually three quarters of a pound of powdered red lead.
 Stir constantly, and when  the oil has taken up the  lead, the  mixture
 will be brown or shining black ;  then remove from the fire, and when
 nearly cold, add four scruples of powdered camphor, and stir together.
 It should not be  removed from the fire until it has  acquired a proper
 consistence  for  spreading, which may be easily ascertained by allow-
 ing a portion of it to cool  on a knife.
   This is a  valuable plaster  for  scrofulous and syphilitic ulcers, also
 for burns, scalds, and several skin diseases.


                    Poultices. — Cataplasms.

   Bread  and Water Poultice. — Put  the needed quantity  of boiling
 water in a  basin ; throw .in crumbled white  bread,  or cracker, and
 cover with a plate.  When the bread or cracker has  soaked up all it
 will, drain off the remaining  water.  Spread  one  third of  an inch
 thick, and apply.

   Flaxseed Poultices. — Put  boiling water in a basin, and stir in flax-
 seed meal to make a thick paste.  Spread on linen, and apply.

   Yeast Poultice. — Mix half a pint of yeast with one pound of flax-
 seed meal.   Stir carefully while heating.

   Carrot Poultice. — Boil the proper  quantity of carrots  till they are
quite soft.   Strain off the water, mash them td a pulp, and add a little
lard  or sweet oil to prevent them" from getting hard, then spread.  A
good application for malignant and offensive sores. 
MEDICINES AND THEIR PREPARATIONS.           681
  Oat Meal Poultice.—Place hot water in a basin, and stir in oat meal
slowly, while it boils, till the poultice is of the right thickness ; that
is, till it will not run on the rag on which it is spread.

  Indian Meal Poultice. — Made the same as oat meal poultice.

  Arrow Root Poultice. — Mix two or more tablespoonfuls of arrow-
root with a little  cold water, in a  basin, till it is all united with the
water.  Then add boiling water, and stir, till the  whole becomes a
thick paste.
  Slippery Elm Poultice. — Stir ground slippery elm bark into hot
water, and let it swell.  This is a very soothing  poultice for irritable
sores.
  Onion Poultice. — Made in the  same way as the carrot poultice.
This  is quite stimulating, and induces  indolent  sores  to  maturate
more freely.   It is excellent for slow boils.

  Charcoal Poultice. — Take  either the bread and milk, or the Indian
meal poultice, and stir into it one quarter its bulk of finely pulverized
charcoal.  Excellent for thoroughly cleansing a foul sore or ulcer.

  Anodyne Poultice. — Take  half  an ounce  of the extract  either of
foxglove, or  henbane, or  stramonium, or conium, or belladonna, and
mix with it  half a pint  of tepid water.  Then stir in as much flax-
seed meal as will  make a poultice of the right thickness.  Always be
careful not to apply this poultice  where there is much skin off, lest
the  extract used be so much absorbed as to produce poisonous effects.
These poultices allay the pain of cancerous and  other sores.

  Lobelia Poultice. — Powdered lobelia and ground slippery elm bark,
each, one ounce.  Stir these  into  hot weak  lye, to make a poultice.
For wounds, fistula, whitlow, boils, erysipelas, and stings of insects.

  Poke Root  Poultice. — Roast a sufficient  quantity of fresh poke
root in  hot ashes.   When it is quite soft, pound it, and make a poul-
tice.  To be applied to tumors to scatter them, or hasten their suppu-
ration.  To  be removed every four hours.

  Mustard Poultice. — Stir  up a  tablespoonful  of ground  mustard
with a little  water, to the consistence of paste.   Spread upon  linen
or brown paper, and cover with thin muslin, that  the  mustard may
not stick to the skin when the poultice is removed.

                           Powders.

  A single substance used as a  powder is  called a simple powder;
two or more united, a compound powder.  Under  the above head, I
shall  describe only  compound powders.   In preparing compound
powders, the substances, if of different degrees  of hardness, should
generally be  pulverized  separately.  Many powders require to  be ex-
eluded from  the light, which  may be done by covering the bottles in
which they are kept with black varnish. 
682           MEDICINES AND THEIR PREPARATIONS.
  Aromatic Powder. — Take two ounces each of cinnamon and gin-
ger, and an  ounce each of cardamom deprived of the capsules, and
grated nutmeg.   Rub them together  into a  very fine  powder, and
keep in well-stopped bottles.
  The powder is stimulant and carminative, and in cases of weak-
ened digestion, may be given in ten to  thirty-grain doses.

  Compound Powder of Aloes and Canella. — Take a pound of aloes,
and three ounces of canella.  Rub them separately to a fine powder,
and mix them.
  This is the  preparation known as hiera picra, or simply picra.  It
may be used for amenorrhoea, or generally as a bitter to  correct cos-
tiveness, and improve the appetite.
  Compound Powder of Catechu. — Take two ounces each of catechu
and kino, and half an ounce each of cinnamon and nutmeg.  Reduce
all to a fine  powder, mix, and pass them through a fine sieve.
  For chronic diarrhoea, dysentery, etc.  Dose, from fifteen to thirty
grains.
  Compound Powder  of Chalk. — Take half a pound  of prepared
chalk, four ounces of cinnamon, three ounces each of tormentil and
gum arabic, and half an ounce of long pepper.  Rub them separately
into a very fine powder, and mix.
  This powder is warm, stimulant, astringent, and  antacid,  and is
well fitted fordiarrhcea,  not connected  with inflammation.
  Compound Powder of Chalk with Opium. — Take six ounces and a
half of compound powder of chalk, and four scruples  of powdered
opium.-  Mix them.
  The opium in this preparation increases the efficacy of the com-
pound powder of chalk in diarrhoea. Dose for an adult, ten to twenty
grains, and repeated after each discharge.
  Compound Powder  of Golden Seal. — Take two  drams  each of
powdered golden seal, blue cohosh, and helonias, and  mix them.
  Useful in dyspepsia, and chronic inflammation of the mucous mem-
brane of the stomach, etc.  Dose, half a teaspoonful to a teaspoonful,
three or four times a day.
  Compound Powder of  Hydrastin. — Take half  a dram  each, in
powder,  of  hydrastin, leptandrin, rhubarb, and myricin.  Mix tho-
roughly, and divide into thirty-two powders.
   This is tonic and  laxative,  and  is useful  in dyspepsia, jaundice,
chronic inflammation of the bowels,  and during recovery  from  ex-
hausting complaints.   One powder may be  taken  often enough to
produce one movement  of the  bowels  a day.
   Inhaling  Powder. — Take one dram of crystals of nitrate of silver,
and two  and a half drams of lycopodium.   Work  the lycopodium
into a very  stiff paste, with a little warm water, in  which the nitrate
is dissolved.  Spread  this thin in a shallow dish, cover it so as to shut
out the light, and set it where it will  dry; when thoroughly dry, pul-
 verize. 
MEDICINES AND THEIR PREPARATIONS.           683
  I have used this powder with great advantage in many cases of
bronchitis, by directing three or four grains of it to be inhaled once a
day, in an instrument I had constructed for that purpose.   This is the
only really valuable catarrh snuff ever used.   A pinch of it taken once
a day (never oftener)  for nasal catarrh, will often do excellent service.

  Compound Powder of Ipecacuanha. — Take a dram each of pow-
dered ipecacuanha and  opium, and one ounce of sulphate of potassa.
Rub them together into a fine powder.
  This is the well known Dover's powder.  It  is an  admirable  ano-
dyne  and diaphoretic, and is much used in inflammatory complaints,
particularly rheumatism and pneumonia, complicated with low, ty-
phoid symptoms.  Dose, from five to  fifteen grains.

  Compound  Powder of Jalap. — Take half an ounce of pulverized
jalap and senna, one ounce of pulverized bitartrate of potassa, half a
dram of pulverized  ginger,  and ten  grains of pulverized  cayenne.
Mix thoroughly.
  This is a valuable purgative  medicine, and  may be used in most
cases  where a simple cathartic is required.   Dose, half a teaspoonful
to a tablespoonful.

  Compound  Powder of Kino. — Take  fifteen drams of kino, half an
ounce of cinnamon,  and a dram of  dried opium.  Rub them sepa-
rately to a very fine powder,  and mix them.
  This is anodyne and  astringent, and is useful in diarrhoea, etc.

  Compound  Powder of Rhubarb.— Take four ounces of powdered
rhubarb, one pound of magnesia, and two ounces of finely powdered
ginger.   Mix thoroughly, and preserve in well-stopped bottles.
  An excellent laxative and antacid, and well adapted  to the bowel
complaints of children.

  Compound Powder of Rhubarb and Potassa (Neutralizing Powder).
— Take half an  ounce each of powdered  rhubarb^ bicarbonate of
potassa, and peppermint leaves.  Mix thoroughly.
  Valuable  in  diarrhoea,  cholera morbus, dysentery, summer com-
plaint of children, sour stomach, heartburn, etc.

  Worm Powder. — Take one ounce each of powdered white Indian
hemp root (a:sclepias incarnata), mandrake, pink root, and bitter root;
two ounces of powdered balmony,  and four  scruples  of powdered
aloes.   Mix thoroughly.
  A very good remedy for all kinds of  worms.   A teaspoonful of the
powder may be  mixed with a gill of molasses, and a teaspoonful  of
this given to a child every hour or two till it operates. After this,
give a teaspoonful three times a day, for a few  days.


                            Syrups.

  A strong  solution of sugar and water is a simple syrup.  When
the water is  first charged with some medicinal substance, and sugar 
684           MEDICINES AND THEIR PREPARATIONS.
  is added to this, we have a medicated syrup.  Refined sugar should
  always be preferred, in preparing medicated syrups.

     Simple Syrup. — Take two  and a half pounds of refined sugar, and
  a pint of water; dissolve the sugar in the water by heat, remove any
  scum that may arise, and strain while hot.

     Syrup of Almonds. — Take  a pound of sweet almonds, four ounces
  of bitter almonds, three pints of water, and  six pounds of refined
  sugar.  Blanch the almonds,  then rub  them in a mortar to very fine
  paste, and add, during the trituration, three fluid ounces of the water,
  and  one pound of the  sugar.   Mix, the  paste thoroughly with the
  remainder of the water.   Strain with strong expression, add .the re-
  mainder of the  sjigar to the strained liquor, and dissolve by a gentle
  heat.  Strain through fine linen, and after it is cool, put it into bottles,
  thoroughly stopped, and keep  in a cool place.
     This is demulcent, nutritive, and sedative,  and is sometimes added
  to cough mixtures, etc.
     Syrup of Citric  Acid. — Take two  drams  of powdered citric  acid,
  four minims of oil of lemons, and two pints of syrup.   With one fluid
  ounce of the  syrup, rub the citric acid  and oil of lemons, then add'
 • the remainder of the syrup, and dissolve by a gentle heat
     This is much employed as an agreeable  and cooling addition to
  drinks, especially to carbonic acid Vater.   Tartaric acid, being cheaper
  than citric acid, is often substituted for it, and the preparation thus
  made is much sold under the name of lemon syrup.

     Syrup  of Garlic. — Take  six  ounces  of  fresh  garlic,  sliced  and
  bruised, one  pint  of diluted acetic acid, and  two pounds of refined
  sugar.  Macerate  the garlic in ten fluid  ounces of the diluted acetic
  acid, in a glass vessel,  four days, and express the liquor.  Then mix   j
  the  rest with what remains of the acid, and again express, till suffi-
  cient  has passed  to make the whole when filtered measure a pint.
  Then pour the filtered liquor on  the sugar in a bottle, and shake till
  it is dissolved.
     Excellent in the bronchial affections of children.  Dose, a teaspoon-
  ful, for a child a year old.                                            \
|     Syrup of Ginger.— Add two fluid ounces of tincture of ginger to
'  a quart of  simple  syrup; evaporate the alcohol by a gentle heat.
j     This is carminative  and stimulant, and gives tone to the debilitated
!  stomach, removing wind, etc.   It is added to other medicines to im-
|  prove their flavor.
'     Compound Syrup of Hypophosphites. — Take 256 grains of hypo-
i  phosphite of lime, 192 grains of hypophosphite of soda, 128 grains
!  of hypophosphite  of potassa,  96 grains of recently precipitated hypo-
  phosphite of iron, 240 grains of hypophosphorous  acid  solution, 12
  ounces of white  sugar,  half  an ounce  of extract of vanilla, and a
I  sufficient quantity of water.   Dissolve  the  salts of lime, soda, and
  potassa, in six ounces of water;  put the  iron salt into a mortar, and
  gradually add  solution of hypophosphorous acid till  it  is dissolved; 
MEDICINES AND THEIR PREPARATIONS.           685
to this add the solution of the other salts, after it has been rendered
slightly acidulous with the same acid, and then water, till the«vhole
measures nine fluid ounces.  Dissolve this in sugar, with heat, and
flavor with the vanilla.   Without flavoring, this syrup is not unpleas-
ant, being slightly saline, and not at all  ferruginous.   Any other
flavoring may be used, as orange peel, orange flower, or  ginger.  It
is also suggested to physicians that  glycerine  may be used, wholly or ■
partially, in place of sugar, when indicated, six ounces and a half of
glycerine being substituted for twelve ounces of sugar.
  This syrup  has been  much used of late as a  new remedy for con-
sumption, on the authority of Dr. Churchill.   It is elegantly  manu-
factured  by  Dr. James R. Nichols & Co., of this city.  Dose, a tea-
spoonful, three times a day before meals.
  Syrup of Ipecacuanha. — Take one ounce of ipecacuanha, in coarse
powder, one  pint of diluted alcohol, two pounds and a half of sugar,
and one  pint  of water.   Macerate the ipecacuanha in the alcohol
fourteen  days, and  filter;  evaporate the filtered liquor  to six  fluid
ounces, filter again, and add water to make  the liquor measure a pint;
then add the sugar, and proceed  as directed for syrup.
  This is chiefly used in complaints of children.   Dose, as an emetic,
for an adult, two fluid ounces;  for a child a year or two  old, one or
two fluid drams.  As an expectorant, for ah  adult, two fluid drams;
for a child, five to twenty minims.
  Syrup  of.  Lemons. — Take a pint of strained lemon  juice, two
pounds and a half of refined  sugar, and two and a half fluid  ounces
of rectified spirit;  boil the juice ten minutes, and strain; then  add
the sugar, and dissolve.  After  the syrup  has cooled, mix the spirit
with it.
  A cooling and grateful addition to drinks in fevers, and serves to
cover the taste of salts and other purgatives.
  Aromatic  Syrup  of Rhubarb. — Take  two  ounces and a half of
bruised rhubarb, half an ounce each of bruised cloves and cinnamon,
two drams of bruised nutmeg, two pints of  diluted alcohol, and  six
pints  of  syrup.  Macerate the rhubarb and aromatics in  the  alcohol
for fourteen days,  and strain ; then, by a gentle heat, evaporate the
liquor to a  pint, and, while hot, mix it with the syrup previously
heated.
   This  is a  warm cordial laxative, admirably  fitted for the  bowel
complaints of infants.  Dose, a fluid dram, repealed every two hours
till it operates.
  Syrup  of Seneka. — Take four  ounces of fluid extract of seneka, and
one pint of water; mix, and dissolve in the liquid one pound of refined
sugar, and proceed as directed for syrup.
  This is a stimulating expectorant, used in colds, coughs, etc., after
inflammatory  symptoms have subsided.   Dose, for  an adult, one or
two teaspoonfuls, as often as  necessary.
  Syrup  of Squill. — To one  pint of vinegar of squill, add two  pounds
of refined sugar, and proceed as directed for syrup. 
686           MEDICINES AND THEIR PREPARATIONS.
     It is a useful expectorant for coughs  and bronchial affections of
   infant* and children.   Dose, half a dram to a dram.

     Syrup of Tolu. — Take two fluid  ounces of tincture of tolu, and
   one pint of simple syrup; mix, and gently heat the mixture to evapo-
   rate the alcohol.    •
     This is chiefly used to flavor other  preparations.

     Syrup of Wrild-Cherry  Bark. — Place two pounds  and a half of
   coarsely powdered wild-cherry bark in a percolator, and pass through
   it one gallon of water.  Strain this, and dissolve in it  by heat sixteen
   pounds of refined sugar.
     This makes an elegant  tonic and sedative preparation, and is mixed
   with various other articles in prescribing  for dyspepsia, consumption,
   etc.
     Compound Syrup of Partridge Berry. — Take half a pound of par-
   tridge-berry, and two ounces each of helonias, blue cohosh, and high
   cranberry bark; add to them one quart of brandy, and macerate four
   days.   Press out the  brandy ;  and place the herbs in  three quarts of
   boiling water, and boil down to two and a half pints.   Strain, add one
   pound of sugar, and evaporate to two and a half pints.   Remove from
   the fire, and when nearly  cold, add the brandy previously pressed out.
     This is considerably used  by the Eclectic physicians, under the
   name of mother's cordial; and may be usefully employed by all phy-
   sicians in suppression of the menses, painful menstruation, profuse
   menstruation, and habitual abortions.  Dose from one to two ounces,  J
   two or three times a day.
     Compound Syrup of Phosphates (Chemical Food). — Take ten drams
   of protosulphate of iron, twelve drams of phosphate of soda, twelve
   drams of phosphate of lime, twenty drams of phosphoric acid (glacial),
   two scruples of carbonate of soda, one dram of carbonate of potassa,
   sufficient quantity of muriatic acid,  sufficient  quantity of water of
   ammonia, two drams of powdered cochineal, sufficient water to make
i   twenty fluid ounces, three  pounds of sugar, and  fifteen drops of oil
j   of orange.  Dissolve the  sulphate of  iron in  two fluid  ounces of boil-
   ing water, and the phosphate of soda in four fluid ounces of boiling  j
   water.   Mix the solutions, and wash the precipitated phosphate of  J
   iron till the washings are tasteless.                                   j
     Dissolve the phosphate of lime in four fluid ounces of boiling water,  j
!   with  sufficient muriatic acid  to  make a clear solution, precipitate it
i   with water of ammonia, and wash the precipitate.
     To  the freshly precipitated phosphates, as thus prepared, add the
   phosphoric  acid, previously dissolved  in the water.  When  clear, add
   the carbonates of soda and  potassa, and afterwards sufficient muriatic
I   acid to dissolve the precipitate.
     Now add the cochineal mixed with the sugar, apply heat, and when
   the syrup is formed, strain and flavor it.
     This is an elegant syrup, agreeable both to the eye  and  taste, and
!   has been extensively sold and used as a nutritive tonic, in chronic de-
   bility, in cases of broken down constitution, wasting of the flesh, etc. 
MEDICINES AND THEIR PREPARATIONS.           687
j     Compound Syrup of Rhubarb and Potassa (Neutralizing Cordial).—
   Take half a pound each of powdered rhubarb  and bicarbonate po-
I   tassa, and four ounces each of cinnamon and golden seal;  macerate
   for four days in one gallon of best fourth proof brandy.  Express the
i   tincture with strong pressure, and add to it two fluid drams of oil of
I   peppermint, previously dissolved in  a little  alcohol.   Break  up the
j   cake from  the press, place it  in a percolator, and gradually pass
   through it warm water till the strength is exhausted.  Evaporate this
   solution to four quarts, and while the liquor is still hot, dissolve in  it
I   six  pounds of  refined sugar.  Continue the evaporation, if necessary,
|   till  the addition of the tincture first obtained will make three gallons,
   Then add the tincture.
     A valuable  antacid and  laxative in diarrhoea, dysentery, cholera
   morbus, and summer complaint  of  children.   Dose, for  an adult,  a
   tablespoonful,  to be taken as circumstances require.
     Compound Syrup of Sarsaparilla. — Take  a pound  each  of sarsa-
   parilla, yellow parilla, and pipsissewa ; an ounce and a half  of guaia-
   cum; one ounce each of red roses, senna,  and liquorice root; and
   three minims  each of oil of sassafras, anise,  and partridge-berry; di-
   luted alcohol,  five pints, and four pounds of refined sugar.   Grind
   and mix the sarsaparilla, yellow  parilla, pipsissewa, guaiacum, roses,
   senna, and liquorice,  and add to them the  alcohol.  Let the  whole
   stand fourteen days; then  express and filter.  Evaporate by a water
   bath to one quart, and add the sugar.   Lastly, rub the oils in a mor-
   tar  with a little of the syrup, and thoroughly  mix with  the remainder.
j     This is a valuable alterative syrup, and is used for syphilis, scrofula,
i   diseases of the skin,  etc.   It is  much improved by adding half an
i   ounce of the iodide of potassium to  each pint of the syrup.   Dose,  a
I   tablespoonful.
     Compound Aromatic Syrup of Senua. — Take four ounces  of senna,
j   one  ounce  and a half of jalap root, half an ounce of rhubarb, one
J   dram of cinnamon, one dram of  cloves, and  half a dram of nutmeg.
;   Reduce these  articles to a coarse powder; add one quart of diluted
   alcohol.  Let  the whole  stand  two  days, and percolate.  Filter, dis-
j   solve in it one pound of refined sugar, and  add one dram of oil of
i   lemons.
i     An excellent cordial physic.
;     Compound Syrup of Stillingia. — Take a  pound  each of queen's
i   root and turkey corn ; half a pound each of pipsissewa leaves and
;   elder flowers;  and four ounces each of prickly ash berries and carda-
J   mom seeds.   Grind all the* articles, mix, and  place them  in a jar, and
j   moisten them  well  with  alcohol.  Let them stand  two  days; then
   place them in a percolator, and  gradually add hot water till two pints
|   are obtained, which must be strained and  set aside.   Then  continue
   the  percolation so long as there is a sensible  taste of the  spirit.  Re-
   serve this also.   Then continue the percolation till what  is  obtained
   is almost tasteless.   Boil down this last  till the addition of the two
   reserved tinctures will make  two  gallons of the whole.  Now add
   twelve pounds of refined sugar, and make a syrup. 
688           MEDICINES AND THEIR PREPARATIONS.

  This  is one of the Eclectic medicines; and is quite an effective
alterative for syphilis, scrofula, etc.  Improved by adding iodide of
potassium.  Dose, from a teaspoonful to a tablespoonful.

  Compound Syrup of Yellow Dock. — Take two pounds of yellow
dock root, one pound  of the bark of the root of false bittersweet, and
half a pound each of American ivy and figwort.  Make a syrup  ac-
cording to the directions for compound  syrup of stillingia, using six-
teen pounds of sugar, and making two gallons of syrup.
  A valuable preparation for scrofula.   Improved by iodide of potas-
sium.   Dose, a tablespoonful, three or four times a day.

                           Tinctures.

  For a description of the method of making tinctures, see page 588,
 I will simply add here, that an ethereal tincture is one which  is made
 with ether as the solvent instead of alcohol, and an ammoniated tinc-
 ture, one made with water of ammonia as the solvent.
  Simple tinctures, in which only one  medicinal  article is used, are
 made thus:
  Tincture of Aconite. — Take eight ounces of powdered aconite root,
 and one pint of alcohol.  Mix, and let them stand for two weeks, fre-
 quently stirring.'  Then express, and filter through paper.
   Given in fevers and  inflammatory  diseases.   Dose, three drops
 every hour or two in  a little water.
   In the above manner all simple tinctures  are made.   Some medi-
 cines require  alcohol to extract  their  active  principle; some only
 diluted alcohol.
   One Ounce  to the"  Pint of Alcohol. — In preparing  simple t'inctures
 from the following articles, alcohol is used, and one ounce only of the
 medicine is employed to the pint, namely:
   Castor, Saffron, Leptandria.

   One Ounce  to the  Pint of Diluted Alcohol. — In making tinctures
 from the following articles, one ounce is used to the pint of diluted
 alcohol:
   Iodine, Quassia.
 Two Ounces to a  Pint of Alcohol:
   Assafoetida, Camphor, Oil of  Peppermint, Oil of  Spearmint, Ben-
 zoin, Colchicum seeds, Lupulin.

 Two Ounces to a  Pint of Diluted Alcohol:
   Cardamom, Cotton Bark, Cochineal, Colombo, Colchicum, Ergot
 Galls Hemlock, Cubebs, Foxglove, Black Hellebore, Henbane, Lactu-
 carium, Lobelia, Poke,  Shrubby Trefoil, Bloodroot,  Squill, Valerian,
 Bittersweet, Belladonna.

 Three Dunces to a Pint of Diluted Alcohol:
   Peruvian Bark, Rhatany, Poison Hemlock, Sheep  Laurel, Stramo-
 nium, White Hellebore, Yarrow, Prickly Elder, Jalap. 
MEDICINES AND THEIR PREPARATIONS.          689
   Four Ounces to a Pint of Alcohol:
     Nux Vomica, Ginger, Guaiacum, Black Cohosh
11   Four Ounces to a Pint of Diluted Alcohol:
||     Yellow Jessamine, Prickly-ash Berries, Ergot, Matico.
     The following  tinctures embrace those wmich vary from the above
   proportions among the simple tinctures, and also the compound tinc-
   tures :
     Tincture of Orange Peel. — Take three and a half ounces of dried
i   orange  peel, and one quart of diluted alcohol.  Macerate for seven
!   days, express and filter.
!     Tincture of Buchu. — Take five ounces of buchu, and one quart of
   diluted alcohol.  Digest  seven days;  pour off the clear  liquor, and
!   filter.
     Tincture of  Indian  Hemp. — Take of extract  of  Indian  Hemp
   (Cannabis Indica) one  ounce, and one pint of alcohol.  Dissolve the
!  extract in the spirit.   Dose, from twenty to forty drops.

     Tincture of Cantharides. — Take an ounce of bruised Spanish flies,
   and two pints of diluted alcohol.  Macerate for fourteen days, express
   and filter through paper.
     Dose, from twenty drops to a dram, three or four times a day.

     Tincture of Cayenne Pepper. — Take an  ounce of pulverized  cay-
 I  enne, and two pints of  diluted alcohol.  Macerate fourteen days, and
 j  filter thtbugh paper.
     Tincture of Catechu. — Take an ounce and  a half of  catechu, an
 i  ounce of bruised cinnamon, and one pint of diluted alcohol.  Let
   them stand together two weeks, frequently shaking; then express and
 !  filter.
     Dose, from thirty drops to a tablespoonful.

     Tincture of Cinnamon. — Take an  ounce and a half of powdered
 !  cinnamon, and one  pint of diluted alcohol.  Let them stand together
   for two weeks ; express and filter.
     Dose, from one to four teaspoonfuls in sweetened water.

!     Elixir Vitriol. — Take  half a pint  of alcohol;  drop into it seven
   fluid drams of sulphuric acid, and let the mixture stand three days in
|   a close  vessel; then add two drams  of powdered ginger, and three
j  drams of powdered cinnamon.  Macerate seven days, and filter.
I    Useful in diarrhoea, dysentery, etc.   Dose, from five to twenty drops.
!  To avoid injury to the teeth, it should be taken through a quill, or else
   the mouth should be rinsed immediately after  swallowing it.

     Tincture of Lobelia. — Take four ounces of lobelia, and one pint
   each of distilled vinegar  and alcohol.   Macerate two weeks, express
   and filter.
     Dose, as a nauseant or expectorant, from thirty to sixty drops.

     Tincture of Opium  (Laudanum). — Take two and a half ounces of 
690           MEDICINES AND THEIR PREPARATIONS.
opium, and two pints of diluted alcohol.   Macerate fourteen days,
express, and filter  through pa'per.   Dose,  from ten to twenty-five
drops.
  Tincture of Tolu.— Dissolve one ounce of Balsam of tolu in  one
pint of alcohol, and filter.
  Tincture of Rhubarb. — Take three ounces of bruised rhubarb, half
an ounce of bruised cardamom, and a quart of diluted alcohol.  Mac-
erate two  weeks, express, and filter through paper.

  Tincture of Virginia Snake Root. — Take three  ounces of bruised
Virginia snake root, and one quart of diluted alcohol. Macerate two
weeks, express, and filter through paper.
  This is  advantageously added to the infusion of Peruvian bark, in
low states of the system.  Dose, one to two fluid drams.

  Compound Tincture of Aloes. — Take three ounces  of powdered
aloes, one  ounce of saffron, and two pints of tincture of myrrh.  Mac-
erate fourteen days, and filter.                                   «
  This is  the well known elixir proprietatis, or, more commonly, elixir
pro.  It is considerably used in female  disorders, connected with sup-
pressed, retained, or deficient menstruation.  Dose, one  to two fluid
drams.
  Compound Tincture of Assafoetida. — Take half an ounce each of
lupulin,, assafoetida, in  small pieces, bruised  stramonium seeds, pow-
dered valerian root, and one pint and a half of alcohol; macerate two
weeks, shaking frequently, then express and filter.
  This  is anodyne and antispasmodic, and is used  in  epilepsy, St.
Vitus's dance, and hysterics.   Dose, a teaspoonful.
  Compound Tincture of  Benzoin. — Take three ounces of  benzoin,
two ounces of purified storax, one ounce of balsam of tolu, half an
ounce  of  powdered aloes, and  two pints of alcohol.  Macerate two
weeks, and filter.
  This  is used in chronic diseases of the air passages.  Dose, from
thirty to sixty drops.
  Compound Tincture of Cardamom. — Take six drams of bruised
cardamom,  two ounces  of bruised  caraway, five drams of bruised
cinnamon, five  ounces of seeded  raisins, one dram of bruised cochi-
neal,  and two  pints  and a half  of  diluted alcohol.  Macerate  two
weeks, and filter.
  This is a very agreeable aromatic; used  as a carminative, and to
improve other preparations.   Dose, one or two fluid drams.
  Compound Tincture of Catechu. — Take  three ounces of catechu,
two ounces of bruised cinnamon, and two pints  of diluted alcohol.
Macerate fourteen days, express and filter.
   This is frequently  added to chalk preparations for diarrhoea, etc.
Dose, from one to three fluid drams.
   Compound Tincture of Cinnamon. — Take one ounce of bruised cin-
namon, half an ounce of bruised  cardamom seeds, three drams of 
MEDICINES AND THEIR PREPARATIONS.           691
bruised ginger, and two pints  of proof spirits.  Macerate  fourteen
days, express, and filter.
  This is a warm, aromatic tincture, useful in spasms, and debility of
the stomach.   Dose, one to two fluid drams.
  Compound Tincture of Black Cohosh. —. Take one  fluid ounce of
tincture of black cohosh, half a fluid ounce of  tincture of bloodroot,
and two fluid drams of tincture of poke root.  Mix.
  This is used in diseases of the lungs, liver, and stomach.  Dose,
from twenty to sixty drops, three or four times a day.
  Compound Tincture of Blue Cohosh. — Take one ounce of powdered
blue cohosh root, half  an ounce  each  of bruised water  pepper and
ergot, two fluid  drams of oil of savin, and  twelve fluid ounces of
alcohol; mix, macerate for a fortnight, and filter.
  A uterine tonic, used for suppressed and  painful menstruation, etc.
Dose, a teaspoonful, two or three times a day.
  Compound Tincture of Colchicum. — Mix one fluid  ounce each of
tincture of black cohosh and tincture of colchicum seed.
  Used for inflammatory rheumatism and gout.  Dose, ten to sixty
drops.
  Compound  Tincture  of Gentian. — Take  two  ounces of bruised
gentian, one ounce of  orange peel, half an  ounce of  bruised  carda-
mom seeds,  and two  pints  of diluted  alcohol.   Macerate  fourteen
days, express, and filter.
  An elegant  bitter, much used  in dyspepsia, and as  an  addition to
tonic mixtures for a weakened state of the stomach.   Dose, one or
two fluid drams.
  Compound  Tincture  of Golden Seal. — Take one  ounce  each  of
powdered lobelia seed  and golden seal, and one pint of diluted alco-
hol.  Macerate two weeks, express, and filter.
  This is used as a local  application to diseased mucous membranes,
in leucorrhoea, gleet, etc.
  Ammoniated Tincture of Guaiac. — Take four ounces of powdered
guaiac, and a pint and a half of aromatic spirits of ammonia.  Mac-
erate for two weeks, and filter.
  This tincture has considerable reputation in the treatment of chronic
rheumatism.   Dose, one or two fluid drams.
  Compound  Tincture  of Hemlock (Golden  Tincture). — Take  one
ounce  each of powdered balsam of tolu, guaiacum,  gum hemlock,
and gum myrrh, one ounce  and a half of oil of hemlock, one  ounce
of oil  of winter green, and  four  pints of alcohol.   Mix, let them
stand fourteen days, shaking frequently, then filter.
  This  is used by the Eclectics for rheumatism, wind colic, water
brash, soreness of the chest, etc.   Dose, a teaspoonful in a wineglass-
ful of water.
  Compound Tincture of High Cranberry.— Take one ounce of high
cranberry bark, powdered, half an ounce each of powdered lobelia
seed and bruised skunk cabbage  seed, two  drams each  of bruised 
j    C92           MEDICINES AND THEIR PREPARATIONS.                I
|    -------;-------------------------------------------.-----------.   |
j    stramonium seed, powdered bloodroot, and  capsicum, and two pints
i    of alcohol.  Macerate two weeks, express, and filter.
      This is an Eclectic remedy, and is useful in nervous and spasmodic
j    complaints, particularly  hysterics, etc.  Dose, from twenty drops to a   '
;    teaspoonful.

      Compound Tincture of Lavender. — Take  three  fluid drams of oil   I
!    of lavender, one dram and a half of oil of anise, one ounce of pow-   i
    dered cloves, three drams of mace, one  ounce of raisins, two ounces   !
j    of red saunders, and one gallon of Jamaica rum.   Mix, and macerate
    fourteen days ;  then express and filter.
>      This is often used for flatulence, hysterics, and faintness.  Dose
    from one to three teaspoonfuls, in water.

]      Compound Tincture of Lobelia (Dr. J. King's Expectorant Tincture).
j    — Take one ounce each of coarsely powdered lobelia, bloodroot, skunk
    cabbage, wild ginger, and pleurisy root.  Place them in a vessel, and
'    pour over them one  pint of boiling water or vinegar, and cover tightly.
    When  cold, add three pints, of alcohol.  Macerate two weeks, then
j    express and filter.
I      A valuable emetic for  infants and children, in croup, hooping-cough,
!i    bronchitis, and convulsions.  Used also as an expectorant, in coughs,
    pleurisy, etc.  Dose, as an emetic for a child, half  a teaspoonful and
'    upwards.

      Compound Tincture of Lobelia  and Capsicum. — Take  one  ounce
    each of powdered lobelia, capsicum, and skunk cabbage, and one pint
i    of diluted alcohol.   Mix, macerate fourteen days, and filter.
if      A prompt antispasmodic in cramps, spasms, lock-jaw, etc.  Dose,
I    half a dram to a dram.
|j      Compound Tincture of Myrrh (Hot Drops). — Take four ounces of
I    bruised myrrh,  two  ounces of capsicum, and four pints of alcohol.
    Mix, macerate  a fortnight, and  filter.
      Applied externally, and occasionally given internally for distress of
,i    stomach, flatulence, etc.

I      Camphorated Tincture  of Opium. — Take  one dram each of pow-
|j    dered opium and benzoic acid, one  fluid  dram  of oil of anise, two
    ounces of clarified honey, two  scruples of camphor, and two pints of
I    diluted alcohol.   Macerate fourteen days, and filter.
      This is known to all the world as paregoric elixir.  It is an agree-
,    able anodyne and antispasmodic, and a good deal used among chil-
i    dren to allay cough,  and  to relieve pains, diarrhoea, etc.

      Compound Tincture of Peruvian Bark. — Take two  ounces of red
    bark, powdered, one ounce  and a half of  bruised  orange  peel, three
    drams of bruised Virginia snake-root, one  dram  each of saffron, cut,
    and red saunders, rasped, and twenty fluid  ounces of diluted alcohol.   I
    Macerate two weeks, express, and filter.
      This is Huxham's  tincture.   It is an excellent  stomach cordial, and
    is used with advantage in low forms of fever, etc.   Dose, from one to
    four fluid drams. 
MEDICINES AND THEIR PREPARATIONS.           693
     Compound Tincture of Rhubarb (Siveet Tincture  of Rhubarb).—    j
   Take two ounces and a half of bruised rhubarb, six drams of bruised    j.
   liquorice root, three drams each of bruised  ginger and saffron, two
   ounces of refined sugar, and one  quart of diluted, alcohol.   Macerate
   one week, express, and filter.
     A warm, gentle aperient, well fitted for  debilitated states of the
   stomach.   Dose, from a dram or two to an ounce.

     Tincture of Senna and  Jalap (Elixir  Salutis). — Take three ounces
   of senna, one ounce of powdered jalap,  half an ounce each of bruised    j
   coriander and caraway seeds, two drams of bruised cardamom seeds,
   four ounces  of  sugar, and three  pints of diluted  alcohol.   Macerate
   two weeks, express, and filter.                                         |
     This is a warm cordial purgative,  useful  in costiveness, and gout
   attended with debility.  Dose, two fluid drams to an ounce.             j

     Compound Tincture  of  Tamarac  (Bone's Bitters). — Take  three    |!
   ounces each of tamarac bark and juniper berries,  two  ounces of    !
   prickly-ash bark, one ounce and a half each of wild-cherry bark and    i
   seneca snake-root, and half an ounce of tansy ; powder coarsely, and    '
   mix; then add  one  pint  and a  half of whiskey, and let them stand    j
   twenty-four  hours;  then  place  the whole  in a  vapor displacement    j
   apparatus, and  force through the mixture, the vapor of another pint    i
   of whiskey, after which, steam from water enough to make  the tinc-
   ture equal to six quarts.   To this add twelve ounces of molasses, and
   six drams of thoroughly dissolved alcoholic extract of mandrake.
     This is  tonic, diuretic, and aperient   Useful  in  dyspepsia, etc.
   Dose, a tablespoonful three  times a day.                               I

     Ammoniated Tincture of  Valerian. — Take four  ounces  of bruised
   valerian, and one quart of aromatic spirit of ammonia.   Macerate
   two weeks, express, and filter.
     This is used  as an antispasmodic  in hysterics, and other nervous
   diseases.  Dose, one or two fluid drams, in sweetened water.

     Compound Tincture of  Virginia Snake-root (Sudorific  Tincture). —
   Take eight scruples each, in coarse powder, of Virginia snake-root,
   ipecacuanha, saffron, opium, and camphor, and one pint of Holland
   gin, or proof spirit  Mix, macerate two weeks, express, and filter.
     This tincture tends powerfully to induce perspiration, and is used
   for such purpose when it is desirable to procure sleep, etc.  Dose, from
   ten drops to a teaspoonful, every  hour or two, in catnip or balm tea.


|                             Vinegars.

     Vinegar of Lobelia.— Take two ounces of powdered lobelia seed,
   and one pint of distilled vinegar.  Macerate in  a close vessel one
   week ; then express and filter, and add one fluid ounce of alcohol.
     This is useful as an emetic and expectorant;  externally, it is val-
   uable in skin diseases.   Dose, one to four teaspoonfuls.. as  often as
j   necessary. 
694           MEDICINES AND THEIR PREPARATIONS.
  Vinegar of Squill. — Take two ounces of sliced squill, and one pint
of distilled vinegar ;  macerate in a close glass vessel one week ;  then
express, strain, and add one fluid ounce of alcohol.
  This is expectorant and diuretic, and is sometimes used for coughs,
and diseases of the chest.

                       Miscellaneous.

  The recipes of a few popular proprietary medicines are given  here
merely as matters of curiosity.
  Braiulreth's Pills. — Take two pounds of aloes, one pound of gam-
boge, four ounces of extract of colocynth, half a pound of castile soap,
two  fluid drams of oil of peppermint, and one  fluid dram of cinna-
mon.  Mix, and form into pills.
  Brown's  Bronchial  Troches. — Take one  pound  of  pulverized ex-
tract of liquorice, one and a  half pounds of pulverized sugar,  four
ounces of pulverized  cubebs, four  ounces of pulverized gum arabic,
and one ounce of pulverized extract of conium.  Mix.
  Hunter's Red Drop. — Take ten grains of  corrosive  sublimate,
twelve drops of muriatic acid, and one fluid  ounce of compound
spirits  of lavender.   Dose, five  to twenty drops in water, or white
wine, sufficient to produce one evacuation daily, but not over two.
  Ayer's  Cherry  Pectoral. — Take four grains of acetate of morphia,
two  fluid drams of tincture of bloodroot, three  fluid drams each of
antimonial wine and wine of ipecacuanha, and three fluid ounces of
syrup of  wild cherry.   Mix.
  Mackenzie's Ointment. — Take four  ounces of powdered  sulphate
of zinc, one ounce and a half of tar, and one pint of lard; mix, and
boil slowly one hour, stirring all the time.
  For  tetter, scald head, and other diseases of the skin.  To be ap-
plied twice a day, washing the part with castile soap-suds daily.
  Wood's Hair Restorative. — Take four drams of lac sulphur,  two
drams of sugar of lead, and one pint of rose water.  Mix.
  Frey's  Vermifuge. — Take one ounce  of castor  oil,  one ounce of
aromatic syrup of rhubarb, thirty  drops of  oil of chenopodium, five
drops of  croton oil.   Mix.
  Conchlin's Salve.— Take twelve ounces of resin, and one ounce each
of beeswax, mutton, and tallow; melt  together, strain, and work into
rolls in cold water. 
CANKER.
695
                 Canker. — Aptha Communis.

  Very few, if any, standard  medical writers have treated of canker.
In truth, it is only a symptom of various complaints, and not itself a
disease.   It has accordingly been  shut out from medical books.  Fol-
lowing the general practice, I omitted it in this work.  I now regret
the omission, and place it here at  the  end.   It afflicts — yes, afflicts
— sorely afflicts, numerous persons, who, though doubtless affected by
some  constitutional  disturbance,  as its cause, are  not conscious of
any complaint except this single  manifestation — Canker.   You find
not only the disease, therefore, but complaints respecting it, in almost
everybody's mouth — " What shall I do for the canker? " meets  us at
almost every turn.   " I am sorely afflicted with the canker," says one.
" I am literally sick with the canker," says another.   And a third says,
" I can neither eat, nor converse, nor take rest, I am in such pain from
canker in my mouth."   And  these  complaints are not unnatural, for
the sufferings occasioned by this affection are indeed terrible.
   Canker  begins in the form of small blisters, generally upon the
tongue, or inside of the cheeks or lips, which, after a time, break and
form little ulcers, which are oftentimes very sore and painful.   These
ulcers will, at times, not only  multiply, but spread themselves to large
dimensions, going deep into  the  flesh, and becoming painful almost
beyond endurance.   In  many cases, the parts  swell, and  become so
sensitive  and  tender that it is  almost impossible  to swallow the
blandest food.   The  mouth will frequently become filled with saliva,
which runs involuntarily out,  to the great annoyance of the patient.
  Treatment.— Canker  is frequently  dependent on a deranged state
of the stomach and bowels.   When  this  is  the  case, the treatment
may begin with a dose of gentle  physic (12), (15), (19), (26).   If the
stomach be  quite permanently deranged, let this be followed with a
somewhat prolonged use of prescription No. 28, or 37, or of the Neu-
tralizing Cordial.  If the mouth  be  very sore, use a tea of slippery
elm bark, or flax-seed, or a solution  of gum  arabic; and as the in-
flammation subsides, touch the ulcerated patches with the stick nitrate
of silver  (lunar  caustic); or  use gargle No. 201, or 202, or 203, or
205, or 208, or 209,  or  232, or 243, or  244, or sulphate of copper 8
grains, dissolved in two ozs. of water.  A tea made of red  raspberry
leaves, or blackberry roots, may be freely used as  a drink.
  One of the  best remedies  is  creosote.   About ten drops  may be
mixed with an ounce  of mucilage of  gum  arabic, well  sweetened
with loaf sugar.   Of this, a dessert spoonful  may be held for a few
moments in the mouth,  and then  swallowed, from two to  four  times
a day.  Recipe 205 is  not only  useful as a  gargle, but may be re-
duced by adding one pint of  water, and may then be swallowed four
or five times a day, in doses of two tablespoonfuls at a time.
  The diet should always be carefully regulated, and only the more
simple food taken, and at regular meals. 
696                        DIPHTHERIA.
                 Diphtheria. — Diphtheritis.

  During the past year  the  public heart  has been impressed, and
public fears  extensively excited, by  a new epidemic and  contagious
disease, called diphtheria — from  a  Greek word signifying skin.  I
say new disease, for it has been stated that as late as five years ago,
no medical practitioner, either in  England or America, had any per-
sonal knowledge or experience respecting it
   Yet the disease had existed in other countries, at periods of time
more or less widely separated, from quite a remote  antiquity.  Are-
taeus is thought to have described it as early as the second century.
Spain, Italy,  and Sicily felt its ravages  in  the  sixteenth and  seven-
teenth centuries, and   England,  France, Germany, Holland,  Italy,
Sweden, and the United  States about the middle of the  eighteenth
century;  after which it seems to have disappeared, and  been little
heard  of  till quite recently, — so  that the  present  generation of
physicians have to meet it as a new  disease.
  Diphtheria is evidently a contagious epidemic.  It would not, per-
haps, be far out of the way, to  calf it by either of the  following names:
Epidemic  Croup, Malignant  Croup, Contagious   Croup.  Though
originating, it is thought, in certain atmospheric conditions, it shows a
remarkable affinity for particular localities, and exhibits special malig-
nity and fatality in individual families.  Some have thought it to be
caused by the parasitic fungus called oidium albicans, which,  fasten-
ing upon the mucous membrane of  the  throat, causes  the exudation
of matter, which hardens, with the fungus, into a skin, or  membrane.
Those who hold this view, consider  the contagiousness of  the disease
to consist in  the passage of the fungus from one person to another.

  Symptoms.— The  incipient stage of diphtheria is generally only a
slight feeling of illness  lasting for a  few days, more or less, before the
more serious attack.  Sometimes  during this period of indisposition,
there  is  slight  drowsiness or chilliness, followed   by feverishness;
sometimes headache and aching of  the limbs.   Generally, one of the
first things complained of is a little  stiffness or soreness of the neck,
with a pricking sensation about the roots of the tongue.   An  almost
characteristic symptom is  a slightly swollen  and tender condition of
the glands at the angles of the lower jaw.  The tonsils, one or both,
are usually red and swollen, — sometimes  swollen, but not red.   In
young children the redness is  of the rose-color; in older children and
adults, of a crimson  or deep scarlet  The uvula, the velum, the
arches of the palate,  and the back  wall  of  the  pharynx, generally
show the  inflammation.   Swallowing, though  painful sometimes, is
often  easy enough, even  to  the  end of bad cases.  The  pulse is
usually quickened somewhat, and the warmth of the skin is raised a
little, though not greatly, above the  healthy standard.
   In  some  cases, the  above  symptoms  constitute  the whole  of the
complaint—recovery taking  place without serious consequences.  In
others, they  are but the beginning of more alarming indications.  In 
DIPHTHERIA.                        697
such instances they are  followed  by the exudation upon the surface
of fibrinous matter, which hardens into a leathery membrane.  This
membrane, if not broken up and removed, grows thicker and stronger
by additions to  its  under surface, until it  obstructs  the  breathing
and strangles the patient.   The exudation first shows  itself upon the
tonsils, or some  neighboring  part, in the  form of white, gray, or ash-
colored specks or patches, which gradually enlarge or spread until they
meet and form one continuous pellicle.   This membrane sometimes
extends into neighboring parts, as the  back passages to the nose, and
the larynx, wind-pipe, bronchial tubes,  and gullet.  These extensions
make the case all the more dangerous and unmanageable.  1 rimy add
that  there  is great difference in the time occupied by different cases
in running their course, — some reaching a climax only after several
days' continuance,  while others  dash on to a fatal  termination in the
brief space of a  few hours.
  Treatment.— Blisters, and  bleeding,  and severe purging, and what-
ever  else may tend  to  reduce the  system,  are to be carefully and
always avoided.   They invariably do mischief.  The disease  itself
generally  has a  strangely depressing  effect  upon the vital  powers.
Never add  to this depression by any exhaustive treatment.
  Perhaps  no local remedy has found  so much favor with the profes-
sion  as a strong solution of crystals  of nitrate of silver, sixty to  a
hundred grains to an ounce of water.   This  solution  may be applied
with my shower-syringe as described  under  " Throat Diseases."  If
the syringe be  not at  hand,  tie a small piece of soft sponge to one
end of a  piece of whalebone or stick, and, dipping this into the solu-
tion, press it gently upon  the  inflamed surface.  Let  the application
be made  about three times a day.
  The muriatic  tincture  of  iron, one part, mixed with one part of
water,  has  been used by many in the same way with nitrate of silver,
and by some it  is  preferred  to the  nitrate.   In some  cases this tinc-
ture  may be gently spread on, undiluted, with  a camel's-hair pencil.
Hydrochloric acid, one part, and three  parts of honey,  form a mixture
which some have used with great success by applying  it to the thrpat
occasionally with a camel's-hair pencil.
  Chloride of zinc, according to  prescription  210, may sometimes be
applied with advantage; also creosote, prescription 236.
  Gargles  are often used with great  advantage.  The  following is
excellent:  Chlorinated  soda,  one ounce;  muriatic tincture of iron,
half an ounce;  water, six ounces; use every half hour or hour.   The
following is also a good gargle: Chlorate of potash,  half an ounce;
strong  hydrochloric  acid, eighty drops; water, one pint.  One  prac-
titioner speaks of obtaining great success by the use of the  tincture
of black  cohosh, mixed with an  equal quantity of water, and em-
ployed, every few minutes, in  two teaspoonful doses, as a gargle.  Its
use should begin at a very early stage  of  the disease.
  The internal  treatment should consist mainly of  antiseptics and
tonics.  The muriatic tincture of iron is highly praised in this disease,
as well for internal use as for external.   Prescription  73 is a suitable
                  88 
698                        DIPHTHERIA.
form in which to take  it.   If rose-water is not at hand, soft water
may be substituted.   If there be offensive breath, and a tendency to
rotting of the tonsils, a little chlorinated soda, or  chlorate of potash,
may be added to the above: one or the other of these two last-named
articles  may sometimes be taken alone.  The following  is  a good
recipe :  Pulv. guaiacum, two drams; pulv. gum arabic, one-half dram ;
pulv. white .sugar, one dram; water, six ounces:  mix, and then add
chlorate of potash one-half dram.   Let  two  great  spoonfuls of this
be taken  once in two  hours.   The same  dose may  be taken, with
similar  frequency, of the following:  Chlorate  of  potash, one dram;
diluted hydrochloric acid, two drams; muriatic tincture of iron, three
drams;  water, twelve ounces; mix.   This  mixture may also be used
as a gargle.  Should there be great depression and sinking, — as there
often is, — carbonate of ammonia may  be  taken, or muriate of am-
monia (134), or aromatic spirit of  ammonia, prescription 135, leaving
out the laudanum.  Brandy and  wines  are often  used with advan-
tage.   In  cases  of great depression, if  there  be a tendency, to  the
formation of purple spots  upon the  flesh, add ten  to fifteen  drops of
hydrochloric acid to each dose of prescription 73.   The following pre-
scription is likewise a useful one-:  Quinine, diluted hydrochloric acid,
and  muriated tincture  of  iron, each two  drams ;  cinnamon water,
twelve  ounces;  mix.   Dose, two  great  spoonfuls  three times a day.
Or the following: Muriated tincture  of"  iron, ojie   ounce; diluted
hydrochloric acid, two drams; cinnamon water, twelve ounces.  Mix,
and take two table-spoonfuls every four  hours.
   The diet should generally consist of that which  is nourishing and
easily  digested, — as  beef-tea, chicken-broth,  eggs, with  wine, new
milk, arrowroot, cream, etc.  As recovery advances, beefsteak, lamb,
chicken, etc., may be taken.  Many  patients die of pure debility. Let
the diet, therefore, be such  as  to guard against such a  termination of
the complaint.  Let all drinks be  given  warm, as cold drinks tend to
aggravate the complaint.
   When  recovery begins to take place, use all possible precautions
against a relapse.  Let exercise  taken  at  this time   be  gentle, and
not pushed to the extent of great fatigue.  The blood is generally
reduced so low,  that sudden death may result from overdoing.
   Especially, let all cases of this complaint receive  early attention.
Throat ails, generally, while diphtheria is abroad, should have prompt
and careful treatment, and if possible, be removed, for their presence
invites  an attack. 
OLD  AGE,  AND ITS DISEASES.
   Life, like the natural day, has its morning, its noon, and its even-
ing.  Each period has its sunshine  and its  clouds;  its light and its
darkness;  its fair weather and its storms; its joys and its sorrows.
The old do not feel the exhilarating brightness of the morning of life,
nor the fervid strength of its noon ; but they often experience what is
better:  a calm, quiet stillness, and peaceful repose, in its evening.
   There is,  perhaps, no  one thing—certainly  not  many things —
which impress the reflective mind and  tender  heart with more sad-
ness, than  to see an old man, bending low with years, with little or no
self-restraint j the  passions  all untamed, • except  so far  as age has
•quenched their fires ;  fretful, peevish, jealous, complaining;  distrustful
of  the  ways of Providence; doubting the.  integrity  of any  human
being;  surrounded by clouds and darkness  ; and  stepping down  grad-
ually and  reluctantly,  amid a cold, drizly,  sleety rain, into a  dark,
uncheered, and unillumined  grave.
   On the other hand, how unspeakably pleasant it is to see the silver-
haired  pilgrim, in the evening time of life, cheerful, happy, trustful in
God and hopeful of men; the winds and storms of life bringing little
or no disturbance  of  his peace ; bearing the head reverently and  bow-
ing it meekly in  the presence of great  afflictions, and lifting  it up
rejoicingly when blessings fall upon it;  converting, by the soft, sub-
dued, and  beautiful sunshine which  he spreads around him, the very
unpromising  elements  of tile latest autumn into the finest  Indian
summer of life ; and finally sinking  down peacefully to his rest  amid
the  golden evening  sunlight, and leaving the sky, long after, tinted
with colorings more beautiful than artists ever conceived.

              " Why weep ye, then, for him who, having won
                 'I he bound of man's appointed years, at last, —
               Life's blessings all enjoyed, life's labors done, —
                 Serenely to his final rest has passed  :
                While the soft memory of his virtues yet
                 Lingers, like twilight hues when the bright sun is set ? "

   Beside these general reflections, it is proper in this  chapter to con-
template the old from several points of view.

  They are Experienced  Persons, and  we may learn much from  them.
To  be  sure, they have, in  most cases, lost the acuteness  of   their 
700                OLD AGE, AND ITS DISEASES.
senses.   They do  not hear, or see, or taste as sharply as the young,
or even always think as quickly;  yet their judgments are founded on
a large experience ; their decisions, though not as prompt, or emphatic,
or brilliant as those of  younger persons, are more  safe and  reliable.
They are worthy,  therefore, of our respectful confidence.  We may
seek their council and advice, and in most cases follow it with safety.
True, they are apt to  be conservative,  and to distrust new things and
ideas; but these new  things and ideas are matters in which they have
had  no experience — matters which belong to an age subsequent to
their time — matters,  therefore, which  lie outside the sweep of their
active life, and respecting which they should not be expected to judge.
It is no disparagement to them to say that they are not fitted  to judge
of those  new thoughts and discoveries which have swarmed upon the
world since the sun of their life has been sinking low in the western
sky.   But in all those staple maxims and ideas which underlie human
duties, in all ages, the old may safely be taken  as our counsellors.

   Depositories of Family History. — They are the frail depositories
and  keepers of a vast deal  of  valuable family history, anecdote, and
reminiscences of events fast fading from human  recollection.  Few
errors of my own early  life have been so much regretted by me as the
neglect to learn from my aged  relatives, when I had the opportunity,
some of  the more important points in the history of my family.  My
grandfather, Col.  Gideon  Warren, — a first  cousin  of Gen. Joseph
Warren, and a personal friend  of Ethan Allen, — lived in some of the
towns of southern Vermont, and finally spent his last days, and died,
in Hampton,  N.  Y.  .There stands his tombstone to this day, with
the following beautiful words from Young's Night Thoughts engraved
upon it:
               " An angel's arm can't snatch me from the grave ;
                Legions of angels can't confine me there."

These few facts are about the substance of what I know of his his-
tory.  In what town his father settled, who was one of three brothers
who immigrated to this country,  or who were his brothers and sisters,
or what  became of them, I have not been informed, simply because
I did not obtain the information, now so  much desired by me, as I
might easily have done, between  thirty and forty years ago, while
spending a year in Hampton  fitting for college.   An uncle  of mine,
Caleb Warren, was then living  in Hampton,  an  old man.  He had
learned  from my grandfather the full history of the family ;  and from
him I might have  derived knowledge which I should now value above
price — knowledge which I intend yet to  acquire,  if the  pressure of
professional business shall ever be so  lifted from me that I can com-
mand time for the investigation.  But I shall never cease to remember
the fact, or to lament my misimprovement of it, that from this vener-
able relative I might have learned facts and put them on record in one
hour,  which it will cost me  weeks  and months of correspondence,
travel, and the searching of records to  acquire.   I say to all young
persons, value very highly the knowledge of your family history, which 
OLD AGE, AND ITS DISEASES.               7Q1
   you may easily learn from your parents, grandparents, uncles and
   aunts, etc., and esteem those very highly who are able to impart it to
   you.   Soon these living records will be suddenly blotted by the hand
   of death ; and then  no regret for past negligence will enable you to
   repair your loss, if you have misimproved your opportunity.

    The Fathers of our  Race and the Founders of our Institutions.—
   The  aged people who yet linger  among us are our  fathers.  We
   have our existence,  through  God,  from  them,  and from others who
   have preceded them to the silent land.   They educated the present
   race.  All that is valuable in the  moral principle and mental culture
   of the men and  women of this  generation, has been  derived from
   them.  Much of their lives  was spent in training us,  mentally and
   morally, and fitting us for usefulness.
     Not only the fine moral and intellectual characters which are found
I   everywhere, acting like salt and leaven in human society, are the work
i   of their  hands, but society, and  government itself, have been handed
i   down to us by them, with much valuable  instruction as to the means
!   of their preservation.  We can scarcely conceive the amount of obli-
   gation our fathers have laid upon us in giving us these vast blessings.
   The men who have been the means  of bringing us into life ; who have
   educated and trained us ;  who  have preserved  our government and
   passed it into our hands Unbroken  ; who have built and enlarged our
   colleges, established and  improved  our unequalled common schools;
   have founded and endowed our charitable institutions, and thus made
   our  land famous throughout the world, are certainly worthy — those
   of them who are  yet among us — of our constant regard and ven-
   eration.

i    Loneliness of the  Aged. — The old are left, in some sense, alone in
j   the world.  The age in which they had  their active  being has gone
j   by.   The world has slid from under them ; and they stand  far out, as
   it were, on a narrow neck of land  between this world  and the next,
|   from which they hear strange sounds coming to them from the moving
   mass of beings of whom they are  soon  to take leave.   Most of the
   companions with whom  they started in  the journey  of life have, one
   by one, dropped away from their side, and the  younger and 'stirring
   multitude who have come after them, are  moved by new, and to them
   strange,  thoughts  and aspirations.   The  throng of  younger men  is
   driven forward by impulses which they never felt, and in paths which
   they never trod.  Manners, speech, dress, modes of doing business —
   all have changed.   The old-fashioned fire-place, the  stage-coach, the
   spinning-wheel, the hand-loom, the polite yes sir, and no madam, the
   boy's bow and the girl's courtesy to  strangers in  the street, — these
   all — some of them useful and  some of no further value — have dis-
   appeared,  never  more to  be enjoyed  by those  who  so much  prized
   them in their day.
     What wonder  if  at times a sense of loneliness and  desolation
   should steal  into the minds of the aged ?  It  is not without cause 
702
OLD AGE, AND ITS DISEASES.
that they often yield to melancholy reflections.  The young have their
companions, and their sports. The companions of the old have mostly
gone; and for sports they have no agility.  Cut off from the present,
they are  thrown upon the past, and too often look gloomily to the
future.  They should  be sympathized with  and  encouraged.   We
should sit by their side, and talk with them of the manners and events
of other  days.   Their conversation is  often instructive as well as
amusing.   Would we engage  in it with right feelings towards the
old, it would  be to  us a source both of profit and pleasure.  To a
right-minded  person, few things are more pleasurable  than to sit by
intelligent  aged  persons, cozily seated in a  large armed-chair,  and
listen to  their  tales  of personal adventure  and experience.  They
enter  upon such narratives  with so much animation,  and live over
the past  with such evident satisfaction,  that the  benevolent person
would find pleasure in engaging them in that conversation for  this
reason alone.

  Helpless Dependence of the Aged. — No one thing should tend more
to excite  our pity, compassion, and kindly feelings for old people, than
their helplessness and  dependence.  It is  one  of the  best indications
of humanity  to  deal  gently with the  weak.   The  old are in  their
second childhood.   In their day, they have been strong and vigorous
— laboring, many of them, in season and out of season, to support
their families  and gain a  competence.  They have felled the primitive
forests, and brought the soil under  the dominion of the plough  and
hoe; they have constructed  turnpikes and built bridges ; made ships
and sailed them over stormy seas; whitened  every  harbor with the
emblems of commerce; filled every city with the beautiful creations
of art, and the useful  productions of mechanical handicraft; created
systems of education  and philanthropy;  framed strong governments
and worked them,—  in  a word,  have  carried the world upon  their
shoulders, without bending or  giving tokens  of exhaustion.  But a
multitude of  years  have robbed them  of the strength which did all
these things.  They now totter like  a young child.   The brain which
conceived and the arm which executed, are alike feeble.  How proper
that much which is kindly should now be  done for  those who  have
done sp much for us and for the world!  Oh, let the old have a warm
place  in  the  affections!  Supply, as far  as possible, all their wants.
Go with  them, in spirit, into the shadows of evening, within which
they are  retiring, and there hold them up.  Be a staff to  them in
their weakness;  and, if it be possible, when the shades deepen around
them, lift the curtains of the future, and let in upon  them, though
it be never so few, some rays of light from the heavenly world.
   From these general remarks,  I pass to consider —


           The Changes occurring in Advanced Life.

   Growth, maturity, and decline are the three  periods which divide
and measure  human life. 
                   OLD AGE, AND ITS DISEASES.               703

  During growth, the  deposit of new matter takes  place more rap-
idly than the decay or waste which is also going on.
  During healthy maturity, waste and  increase are  exactly equal,
the one taking place just as rapidly as the other.
  The decline of old  age reverses the order of growth, and waste
outstrips addition.  The newly deposited matter comes, but  not  so
rapidly as the old is'cast away.
  Declining' Age  may be said to extend from fifty to sixty.
  Incipient Old Age from sixty to seventy.
  Ripe Old Age from seventy to eighty.
  Decrepitude or Second Infancy from eighty to the end of life.
  During all these periods, particularly during the latter, important
structural and other changes are occurring in the  human  system.
Piles, apoplexy, paralysis, diseases of  the  liver, kidneys, and bladder,
with organic changes of the heart, dropsy, chronic affections of the
breathing organs, gout, etc., frequently appear.

  No fear of Death. — It is  a wise • and merciful provision of Provi-
dence, that  as old  age  advances,  and the natural end of life draws
near,  the dread  of death diminishes.  "As  the  aged gradually lose
their hold upon  life, they do so with less and less reluctance, until
finally they let go willingly, and part from it even with joy.  Persons
passing  from life at the  age of  eighty or upwards, generally  look  J
forward to death with more of pleasure than of fear.   It is one good
reason why it is desirable to live  to great age, that life may come  to
a close without those harrassing fears which so many dread.
        Preservation  of 014  People's Health.

  It is proper here to speak  of the hygiene of old age, or the means of
preserving aged people's health.
  It is natural to desire a continuance of life; and except in the case
of the extremely old, there  is a general wish for  its  prolongation.
Those who are  born of parents who have lived long, are  more likely   j
to attain length  of days than those who have descended from  short-   i
lived ancestors; yet  the influence of correct habits  may add quite as
many years to their lives.                                            I

  Regular Habits. — The old feel  the evil influence of irregular habits
much more than the  young.  It  is seldom that any change of habit
long indulged, is well borne by the aged.  So true is this,  that the at-
tempt to correct some habits of  evil tendency is sometimes danger-
ous to  the  old  so  much  have  they lost  the power of adapting  n
themselves to  change.  The discontinuance  of the  habitual use  of
spirit, or tobacco, or opium by an old person, — though  the use of
either is of  acknowledged evil tendency, will frequently prove fatal,  j
It is almost necessary that the habits  of the aged should  remain  as 
                      OLD AGE, AND ITS DISEASES.

   they are.  What an impressive lesson  this fact gives the young on
j   the necessity of forming good habits in  early life !
      Evep the  hours of  taking meals  should not  be changed in the
   decline of life.   Removing to new climates, and forming new social
j)  relations by  those_advanced in years, is not favorable to length of
 I  days.  Old trees do not often take root and live long when transferred
jj  to a new soil.

      Diet. — The food of old people should of course be easy of diges-
 j  tion.   It is often the case that they bear made dishes such as "hash,"
j   so called, better than plain boiled or roasted meat.   This  can only be
I   explained on the ground that the meat is chopped fine, and is more
   thoroughly cooked.

j      Mode of Cooking  Meats. — This leads  me to  speak  of the  best
j1  methods of cooking meats so that they may be tender.
j!     The flesh of  all  warm-blooded animals is  identical in composition
j,  with that of human beings.   That the  flesh of animals used as food,
11  therefore, may form flesh in  the  human body in the easiest  manner,
 i  none of its  essential constituents or parts should be taken from it
r  during the process of cooking.   If any one  of  its constituents is
ij  extracted, it  will no longer  be like human flesh; and that lost part
|j  will have to be resupplied before it can become a part of the frame of
   man.
      Flesh is composed of two  parts •*— that which can be dissolved, and
!   that which cannot.  The separation  between these two parts is more    j
   or less completely effected in  boiling according to the amount of water    !
   used, and the length of time  employed in the process.
j      In making soup, we have no objection to a separation  between the
j   hard and juicy parts of  the meat, because the latter passes  into the
I:  water and helps form the soup.   Hence the proper way is to put the
i!  meat into cold water when it is put over the fire, and let it come to
 : » the  boiling  point  very  gradually; during which time the juicy part
   has a chance to dissolve out, and, uniting with the water, make rich
!   soup.
      But when  the meat  is to be boiled simply, and eat as boiled meat,
i   we should aim  to retain the juice within it, that we may retain the
   whole of  it.   To do this, we must  put the  meat into water which is
   briskly boiling  over the fire.  The juice of the meat contains a  large
   quantity of  albumen, a  substance just like the  white of egg;  and
   putting the meat suddenly into boiling water almost instantly  hardens
   this albumen all  around  the surface,  just as boiling water hardens
   white of egg, and this  prevents all the  juice of the inner portion of
 i  the  meat from  running  out  into the water and being lost.  Keep the
 I  meat  in the briskly-boiling water a few minutes, then pour in a little
   cold water to reduce the temperature slightly, and keep it in this some-
   what reduced temperature until it is done through.
      Broiling  and roasting  are  pretty generally understood, and are
 !  done well enough where persons are disposed to take pains.  Frying
 !  is an abomination ; and should  be  banished from all civilized house-
   holds.
704 
OLD AGE, AND ITS DISEASES.
705
  Milk is an excellent article of diet for old persons.   Except in some
few cases where it disagrees with the stomach, it is among the very
best. Sometimes, when it disagrees with a weak stomach, a little lime-
water added to it will make all right  Artificial ass' milk, which will
generally set well on aged people's stomachs, may be  made  by dis-
solving one ounce of pulverized sugar of milk in one pint of skimmed
cow's milk.
  Potatoes, beets, carrots, parsnips, and asparagus are healthful; peas,
beans, cabbages, etc., had better not be largely indulged in.
  Ripe Fruits, taken in moderation, are useful;  but should be  eaten
at meal.time — not between meals.  Among these, ripe apples, pears,
peaches, plums,  strawberries,  currents, and grapes  are  luxuries in
which not even the oldest  persons need fear to induldge to a reason-
able extent.
  Plain Puddings and Pies are not entirely objectionable ; but all rich
and high-seasoned articles of pastry, should  be strictly rejected by the
old, as they should, in fact, by all classes.
  Wine, etc. — If any persons in the world may indulge in a little
wine for  their stomach's sake, it is the old.  But even they, if they
have not been accustomed to its use, often get along very well without
it;  and when they can do so it is better, for various reasons, especially
that their example may have a good influence with others. When the
feeble vitality of the aged seems to  require  it, especially if they have
been in the habit of leaning  upon  it, they should be encouraged to
use it.  And if they chance to be poor, and cannot procure it them-
selves, for friends to withhold it from them on the ground of economy,
or from the feeling of grudging stinginess, is  nothing less than inhu-
manity and cruelty.
  To these remarks upon diet, I add: the old should never eat to
excess or repletion.  They should eat slowly, and chew their food very
thoroughly.
  Susceptibility to Cold.— Aged people suffer very much from cold
hands  and feet, and, indeed, from languid  circulation and low tem-
perature  generally.   The  heart,  like all their  other  muscles, has
become feeble, and sends the blood very lazily along the arteries.
The clothing of  the old should be thicker  and warmer than that of
younger people.   We must prevent the  escape of what little animal
heat there is  by flannel worn next to the skin, and by woollen clothes
generally — they  being bad conductors of  heat.  Unless very fleshy,
they seldom  suffer from heat, even when their flannels are continued
through the summer.
  It is during winter nights that  the old  are  apt to suffer most from
cold.   On going  to bed, therefore, they should be warm ;  and in very
cold nights  should have a heated  stone, or a bottle  filled with hot
water, at their feet.  The communication of animal heat, particularly
from the young,  is better even than this to  support the vital energies
of age; and  some writers have recommended that the vital warmth
                    89 
706                OLD AGE, AND ITS DISEASES.
of the old should be kept up by letting the young of our own species
sleep  with them.  The  humanity of this suggestion is very question-
able.  The aged would  doubtless be benefited  by such a proceeding;
but the young would be injured.  Whatever vitality should be gained
by one would be lost by the other.   While a few might be added to
the limited days of the aged, many would be quite as likely  to be
subtracted from those of the  young.  I would much sooner recom-
mend that old people attach to themselves, and take to their bed, an
affectionate, clean,  and silken-haired English terrier dog.  Such  au
animal, usually as clean as a child, would impart warmth and vitality
at night,  and  be a true, affectionate, and  an amusing companion
during  many a  lonely hour  of  the day.   Whatever  may  be said
against this recommendation, — and of course some over-nice people
will object, — I insist that it  is in  every sense far more proper than
the expedient adopted with  King  David, when  he "was  old  and
stricken in years," and after  " they covered him  with clothes, but he
gat no heat." (1 Kings i. 4).

   Mortality in Cold Weather. — Far more of  the  old  people die in
winter than  in  summer, or,  indeed, in any  other  season.   For this
reason, old people should be very careful how they expose themselves
during the coldest days of the winter.
   If  there be any change which the old are likely to  bear with im-
punity or advantage, it is from a cold to a warm climate in their latter
years.  The wealthy Romans, when they grew old, were taken to
Naples.
   Care of the Skin.—Attention to the skin, always important to health,
is very essentially so in  the  latter years  of life.  The scarf-skin of
the old tends to become dry, and peel off.  This may be prevented in
a great measure  by regular washing with tepid water, and rubbing.
If the bath cannot be  endured, not even  the sponge-bath, let friction
alone be employed.  For friction, either the naked hand, a  piece of
flannel, or the  flesh-brush may be used.  In  rubbing the belly,  the
hand should follow the course of  the  large  bowel; that is,  in  the
region of the stomach pass across  from right to left, down on the left,
across on the lower parts of the bowels, up  on the right,  etc.  By
this method, constipation and a windy condition of the stomach and
bowels may frequently be removed, or rendered less distressing.

   Exercise. — Always important, in all periods of life, exercise does not
 lose  its advantages in old age.  But the  aged should always exercise
 with moderation.  The violence used in youth would break the bones,
 and do various kinds of mischief were it indulged by the old.  Carriage
 exercise is very suitable for old people, but  the  more active exercise
 of horse back  riding, walking,  and  even  working in  the garden,
 should not be omitted — bearing always in mind that great fatigue is
 injurious.
   Sleep.__Aged people should get about as  much sleep as nature asks
 for.  They should retire early, and not be  in haste to rise with the 
OLD AGE, AND ITS DISEASES.                7Q7
 dawn.  They require more sleep than  persons in middle life.  Eight
 to ten hours in the twenty-four, is not too much.
   Sleeplessness. — Though the old require  a good deal of sleep, it is
 unfortunate that many of them can sleep but little.  . A large propor-
 tion of persons far advanced in life, complain  of inability to sleep.
 Many old people  deceive  themselves, and really sleep much  more
 than they are  aware.  Yet they often persist that they sleep none at
 all, night after night  Their case is illustrated by an old lady whose
 doctor entered her room and found her sleeping very soundly and
 comfortably.  The noise  of a person  entering the room awoke her
 soon after, when, rubbing her eyes, she turned to the doctor, and said
 all she wanted was sleep, that she  had slept none for a month; and
 unless he could give her something to bring sleep, she must die.
   Medical art, I am sorry to say, frequently fails to bring relief, when
 there is real want  of sleep.   Narcotics should always be avoided if
 possible.  They do too much mischief;  yet  it is necessary, sometimes,
 to resort to them.   Much may be done sometimes by taking an earlier
 or a lighter supper.  Early rising, and exercise  in the open air, will
 often bring sleep at night.   Occasionally a glass of wine, or a  little
 spirit of any kind, taken just before retiring, will bring the needed
 sleep.
  Electricity. — In connection with sleep,  the disturbing and  the  tran-
 quillizing  influence of electricity and magnetism has  received some
 attention within a few years.  A German philosopher  contends  that
 terrestrial  magnetism exerts on persons of a sensative organization  a
 very soothing influence, when placed in proper relations with its cur-
 rents, and  a disturbing  impression when  otherwise situated.   He
 cites cases, to show that lying from east to  west  is so intolerable that
 persons of delicacy cannot  endure it;  while the horizontal position
 from north to south, with the head south,  is  more agreeable;  andmost
 agreeable and  tranquillizing with the head  to the north.  A German
 surgeon is  mentioned in  Reichenback's Memoirs, who always woke
 early in the morning, and turning his head where his feet had  been,
 invariably fell  into a sound slumber, which  was more refreshing  than
 that  of the night.   When he chanced to omit this, he felt ill  all  day.
 Observing  that the head of  his bed was directed  to the south, Reich-
 enback persuaded him to turn it to  the  north ;  and ever after he slept
 soundly till the proper time to rise in the morning.
  Without pronouncing  upon  the  correctness of this  theroy, I will
 simply say  that in  my winter residence in town, the  head of my bed
 is to the south.  I sleep tolerably well;  but  not as well as at my
 summer residence  a little out of town, where the head of my bed is
 towards the north.   How much the stillness  of the country, and the
greater purity  of its atmosphere  may contribute  to this difference,  I
will not pretend to decide. 
708
OLD AGE, AND ITS DISEASES.
            Medical  Treatment of the Old.
  In prescribing medicine for old people, we should bear in mind the
difference between the sexes.  Women in advanced life are less ex-
citable, and enjoy better health, frequently, than in early life.   Old
men,  on the contrary, are more  nervous, in their  latter  years, and
consequently more easily affected.
  The physician cannot rely on the reaction of the system in old age.
He  must do more by his remedies, and depend less upon nature to
help him out of straits.
  The small power  of  rallying  in the  systems  of the  old, puts all
blood-letting, severe purging, etc., entirely out of the question.   The
man is near enough to insanity  who, except in  some very rare case,
bleeds the young.  He who takes a drop of blood from the old. should
be put in a straight jacket and sent to the insane hospital.
  Larger Doses. — The  torpid condition of the system in old age, fre-
quently requires larger doses of medicine to make an impression.
  Fluid Medicines. — Pills and powders sometimes pass through the
stomach and bowels in the same state in which they entered.  Fluids
are  more readily appropriated — especially when the more active me-
dicinal  ingredient is mixed with wine, or some stimulating tincture,
or arromatic water.  These  things rouse up the torpid  stomach and
bowels, and cause the medicine to take effect.
  Medicine by Rectum. — When the disease is situated  in the imme-
diate  neighborhood of  the  lower bowel, as the bladder, etc., it is
sometimes better to  administer  the medicine by injection into the
rectum.
  Suitable Medicines for the Old. — The acids, the alkilies, and the
neutral salts are unsuitable to be  administered much to old  people.
All  metallic medicines must be  given sparingly, and with  caution.
Iodine and iodide of potassium  are not very well borne.  Narcotics
must  sometimes  be used to  some extent.   Harsh and drastic purga-
tives are out of the question, except in  some few instances in which
they may be given sparingly in  connection with compound tincture
of gention, or some other stimulating tonic.  Sulphur  is a valuable
remedy for aged people.   So are the stimulant tonics, bitters, astrin-
gents,  gum-resins, balsams,  etc.,  together with the various carmina-
tives,  as anise, coriander, fennel, cascarilla, ginger, etc.
  Surgical Operations.— Some of the smaller operations in surgery
need not be forbidden in the case of the old; but great operations are
not to be thought of.  There is not recuperative power enough to
bear them.

                   Diseases  of the Old.
  Most of the diseases  which afflict aged people are of course  much
the  same with those which come  upon people at all periods of life. 
OLD AGE, AND ITS DISEASES.                7Q9
These having  all been treated of in the previous pages of this book,
do not require to be gone over particularly again.   There are a fe,w
complaints, however, which are peculiar to  the old, of which  I must
briefly speak.
               Bronchial "FlvLX- — Bronchorrhcea.

    A more than usual amount of mucous expectoration, accompanied
  with cough, is very common with old people — so common that in
  many cases  they think very  little of it, even when the expectoration
  becomes  very  profuse.  This discharge,  however, from  the  mucous
  surface of the bronchial tubes, is very apt to be attended  by shortness
  of breath on making even very slight exertion ; and the whole trouble
  is aggravated in damp weather, and by constipation, and the stoppage
  of leucorrhea in females,  or the  interruption of insensible perspiration
  through the  skin.
    Slow progress.— This  complaint makes very slow  progress, as a
  general  rule, often continuing  many  years without doing any great
  mischief.  It is apt, however, to degenerate into a mischievous con-
  dition in the end; and should,  therefore, as a general  thing, receive
  some attention.
    Treatment. — Attend carefully to the skin.   Keep it in as healthy a
  condition  as possible, by regular  and faithful bathing  and  friction.
  This is of prime importance.
    Care must be had  not to suppress the discharge too suddenly.  It
  may be necessary, at times, to use some expectorant (see expectorants
  among the perscriptions) to make the raising easier.  But when it is
  thoroughly loosened up, we should begin to suppress it by astringent
  inhalations.   For this purpose  Inhalant No. 4 is excellent  It might
  be well, however,  to  begin with the  Inhalant No. 6, which is slightly
  styptic.
    If ulcers on  the legs have recently healed, they should be opened,
  or blisters applied in their vicinity.
    Removal  to  a dry climate is a valuable remedy, provided the cli-
  mate is not too hot, and is healthful in every other respect.
    Other Diseases. — The other  diseases with  which old persons are
  afflicted  are so common  to all  ages, that  I do little more than name
  them, adding a few general remarks. .
    Asthma. — The asthma, or intermittent difficulty of breathing of
  the old, is connected with various other troubles, as chronic inflamma-
  tion of  the  bronchial tubes, air in the lung  tissue, swelling of the
  lungs, enlargement and  dilatation of the  heart, and diseases  of its
j  valves, etc.  It is  also dependent  on impurities of the blood, and is
!  connected with torpid action of the kidneys.  It is impossible,  some-
  times, to say which of these conditions it is dependent upon.  As far
  as may be, however, the oause must be searched out;  and then, while 
710                OLD AGE, AND ITS DISEASES.
the general remedies for asthma must be employed, the  particular
tiding with which it is connected must also receive attention, especially
if it be connected with derangement of the kidneys.
   Asthmatic old people are almost always dyspeptics.  The stomach
and  bowels, therefore, require particular attention.  The warm  pur-
gatives, combined with alkalies, are generally useful:  as rhubarb and
soda, equal parts, or Mettauer's Aperient, with a little tincture of
ginger or tincture  of cayenne in it.  A very valuable preparation is
compound  tincture  of gentian and tincture of columb'o, two ounces
each, one half ounce of tincture of ginger, and  half an ounce of bi-
carbonate of soda.    Mix,  and take a teaspoonful as occasion may
reqnire.
  Apoplexy and Paralysis. — The nervous system bring weakened in
aged people, the way is  opened for greater frequency of attack from
apoplexy  and paralysis.   The  exciting  cause  may be hyperemia,
too much blood ; or anaemia, too little blood.   It may  be general
debility, or gout, or a poisoned state of the blood.
   The treatment is  to be conducted  much on the same principles as
when these diseases occur in younger subjects.
   I pass over numerous complaints which may be said  to be somewhat
more common in advanced  life than at earlier periods.  They are so
fully treated in previous pages of this  book, that it is deemed needless
even  to name them  here.  There  is,  however, one other class of dis-
eases occurring so very often in  old  age, and in so many cases mak-
ing advanced life a burden, that I cannot pass them wholly in silence.
I refer to
   Diseases of the Urinary Organs. —  These  afflict  the old,  not only
very commonly, but very severely.   An old man who  reaches the age
of seventy or eighty without experiencing some serious trouble from
deranged kidneys, diseased  bladder or prostrate gland, or gall stones,
or gravel, or unhealthy urinary deposits of some sort,  may think him-
self greatly favored.
   Treatment. — It is not necessary, here, to go over the whole ground
of treatment.  That is done in other parts  of the book.  I will say,
however, that a surgical operation for stone in the bladder is not often
to be thought of in the case of old people.  Other remedies must be
sought.  And  among these, none hold out so good a chance of relief
as the free drinking  of the  alkaline  bicarbonates dissolved  in water.
This will frequently  dissolve stones formed of uric acid, urate of am-
monia, and triple phosphates.


               Pulmonic Cherry Cordial.

   Wild-cherry bark, ground,  10 pounds;  ipecac root, 20 ounces;
blood root, 24 ounces;  squill  root, bruised, 12  ounces;  pulverized
liquorice root, 5 ounces; cochineal, bruised, 2 ounces ; anise seed, 32
ounces;  fennel seed, 8 ounces;  orange peel, 16 ounces;  acetate of 
. OLD AGE, AND ITS DISEASES.               7J1
morphine, 12 drams; alcohol, 8 gallons; water, 8 gallons ; pulverized,
white sugar, 40 pounds;  sulphuric acid, 1 ounce.
   Directions  for  making. — Grind all the articles to a coarse power,
except those  directed  to be bruised or pulverized, and  put them all
to the alcohol except the wild-cherry bark, the water, the  sugar, and
the sylphuric acid.  Let them  stand one week,  shaking or stirring
thoroughly twice  a day.  Then,  having kept the wild-cherry bark two
days in a covered vessel, with water enough upon it to wet it through,
place it  in a percolator, and run  eight gallons of water through it.
Add this to  the  alcohol and other ingredients.  Let the whole stand
three days longer, stirring as before, twice a day.   Draw off, and filter
through  paper.   Now  add the sugar, and  lastly the  sulphuric acid.
The acid is intended mainly to improve  the  color, by  acting chemi-
cally upon the cochineal.  The color is a fine cherry-red, tinged with
orange.
   I have given the directions for making  sixteen gallons — this being
the smallest  quantity  in which I make it.   Any person can easily
make the calculation for reducing the quantity.
   This is the preparation which I  mentioned on  page 226 of this
book.   Its insertion at the proper place was omitted by mistake ; and
I thought I would not mar the order of the book  by inserting it out
of place.  I  have much regretted this.  Had  I inserted it anywhere,
'it would have saved me the answering of a greater number of letters
than I care to conjecture.
   Upon no  other preparation of medicine I have ever compounded
have I bestowed  as much thought and  care as upon this.   For five
years I was incessantly experimenting, making and trying  new com-
binations ;  and this is  the result   The assertion previously made that
this is the " best cough preparation ever made," I see no cause to
modify in the smallest  degree.   Were it  kept in every apothecary
shop, and were  physicians to  prescribe  in  pulmonary complaints,
adding a little syrup of squill or wine of ipecac when a more expec-
torant effect  is wanted, or  a  little morphine if greater narcotism is
sought, it would save them much trouble in compounding cough syrups,
and give them much more satisfactory results.  I have  compared its
effects, again and again, with  the best other  preparations in use, and
I pledge my  word that it will succeed in  twice as many cases as any
other compound  that  maybe  chosen.   Let  physicians try it; and  I
will be  responsible for  every hair's breadth in which they find this
proportion of successful results abridged. 
PHYSICAL CULTURE. —THE NEW GYMNASTICS.
  In America the noblest interests of the race have  reached unpar-
alleled development.   In  no other country, in no  other  age, has
mental culture been so complete and  universal..  It is an era in the
progress of the race.   The fruits of labor which  in other times and
lands have been wasted upon the abnormal life of the few, have here,
like air and  light, the two great representative gifts of  Heaven, found
their way to the normal life of the million.   The grand  ideal results
of the philosopher's dreams seem within our grasp.
  But in this  hour of triumph  the national life is  jeopardized by
physical exhaustion.  While the admiring world  looks on, our bodies
upon which as a foundation  our higher faculties must rest, crumble'
and give way.  Precocious brains are borne about by doubtful spines;
brilliant talents are linked with dying bodies.
  But in the light which now begins to dawn, this rock in our nation's
pathway is clearly seen, and  the discovery must  result in the adop-
tion  of vigorous  measures.   Already  the leading  educators of the
country are aroused, and to use the language of that veteran educa-
tional  magazine, the  " Massachusetts Teacher,"  " To Dr. Lewis,
more than to any other man, is the country indebted for the present
deep practical  interest in  physical  culture.   He has done a  noble
work."
  And  in introducing the " New  Gymnastics" invented and  de-
veloped by Dr. Dio Lewis, of Boston, it  may  be proper to say that
Dr. Lewis is a regularly educated physician.   From the beginning of
his professional career he evinced the most earnest interest in sanitary
questions.   Located in Buffalo, N. Y., during those memorable cholera
seasons 1849 and 1851, in the midst of an immense practice, he called
public attention to certain preventive sanitary regulations with such
earnestness  and force, that hearty municipal recognition and action
were secured.
   Some years since  the Doctor abandoned  the  practice of his pro-
fession, and entered  the  field as a lecturer upon sanitary science.
Both in this country and abroad all the  great health questions were
ably discussed.  Three winters were devoted to lecturing in our South-
ern States.   In many Southern cities a profound  interest was elicited.
About twenty pieces  of silver plate were  presented to the lecturer by 
PHYSICAL CULTURE.                           713
 the various cities visited.   The  citizens of Richmond, Va., presented
 Dr. Lewis with an entire tea service of splendid silver plate.
   A few years ago, Dr. Lewis began his investigations in the depart-
 ment of gymnastic training.   The public is now pretty well informed
 in reference to  his labors in  this field.  The journals and magazines
 of  the  country  have  spoken out  in hearty commendation of " Dr.
 Lewis's New  Gymnastics."   A few of these notices may  be given.

  " We look upon Dr. Lewis as one of the benefactors of his race." — Grace Greenwood.
  " Success to Dr. Lewis's Gymnasium.  No better institution exists." — The Knickerbocker.
  " It was my privilege to welcome Dr. Lewis  at his very first arrival here, and everything
 since then has only confirmed my confidence in his ability to superintend this system." —
 Rev. Dr. Kirk.
  " We shall look for great results in the physical development of the nation, if this admira-
 ble system should be generally adopted." — Boston Traveller.
  " Every muscle of the body is brought into motion without straining or unpleasant effort.
 Many of  the attitudes are  graceful and striking.  In a word, it is poetry in motion, and
 motion set to music." — N.  Y. Tribune.
  " We are glad to hear that this simple apparatus and ingenious series of exercises are being
 introduced into many of the best schools of  the State." — Boston Courier.
  " The Boston Gymnasium has  sent a graduate to our city who. is teaching  large classes,
 composed of our gravest divines, physicians, and others. Ladies mingle in the happy crowd."
 — N. Y. Times.
  " This sytem avoids the objections of other systems.  I have witnessed its effects in several
 schools, and can say they are all good without exception." — President Felton, in an address at
 Dr. Lewis's Gymnasium, of which he was the presiding officer up to the time of his death.

   He has  recently issued a  handsome volume, known as " The New
 Gymnastics for  Men,  Women, and  Children,"  through   Ticknor &
 Fields — a beautiful  volume, full of illustrative cuts.   The  book  has
 been so generally noticed by the  press of the country that all have
 learned  of  its features.  A single notice or two may be given.

  " Dr Lewis's book is the most practical, sensible work on this subject, extant in any lan-
 guage." — Continental Monthly.
  " Dr. Lewis has.given us far the best and most practical of all publications on the subject
 of physical culture." —N. Y. Independent.

  This vigorous worker in the field of physical education has recently
 established  in Boston  a  Normal  Institute for physical education, in
 which he is preparing  teachers of the New Gymnastics.  About seventy
 persons  of  either sex have already been fitted, and have  gone  out to
 teach.   Nearly every  progressive school in  the  Northern States  has
 more or less of  the New  Gymnastics in its daily drill.  And so far as
teachers can be obtained,  the schools have added a gymnast to their
corps of teachers.   There is room for a  thousand  or ten  thousand
laborers in the new profession.  Persons of either sex may find  in this
calling health, usefulness, and large profit.
  In addition to the New Gymnastics, the graduates go out prepared
                     90 
714                   PHYSICAL CULTURE.
to teach elocution, and to act as guides in all  other departments of
physical culture.   Dr. Walter Channing, Prof. Leonard  the elocu-
tionist, and other well-known scientific  gentlemen assist Dr. Lewis in
fitting the pupils for their important work.  We are  satisfied that
this new profession is to become one of much dignity and importance.
Those who enter the field  early will have  reason to congratulate
themselves.
                THE  NEW  GYMNASTICS.

                        BY DIO  LEWIS, M.D.


  The  apparatus  used in  my  system  of gymnastics  is  all light
This is its distinctive peculiarity.  The dumb-bell weighs from one to
four pounds.   In the system heretofore in vogue, dumb-bells weighing
as much as 150 lbs. have been used.
  Perhaps no other piece of apparatus, common to the two systems,
will so well illustrate the superiority of the new system.
                  Dumb-Bell  Exercises.

  For more than two thousand years the dumb-bell has been in use
as a means of physical culture.  It was highly prized  by the Greeks.
Many advantages are justly claimed in its behalf.  If used in private,
it occupies little space either at rest or in action.  For the same reason
it is excellent in the training of large  classes.   Although not to be
compared with the New Gymnastic  ring, the dumb-bell deserves its
great popularity.
  Among the  Greeks it had a peculiar shape, and in this respect has
undergone many changes, of which something will be said hereafter.
Its  present shape is  well known.   A practical  suggestion upon this
point may not be amiss.  The handle should be at least half an inch
longer  than  the  width of the hand, of such size  as can be  easily
grasped, with  a  slight swell in the middle.   The manufacturer must
not forget there  is a  wide difference between the hand of a little girl
and that of a large man.
  Heretofore dumb-bells have been made of metals.   The weight  in
this country has  usually been considerable.  The general policy  at
present is to employ those as  heavy as the health-seeker can put up.
This is wrong.   In  the great German gymnastic institutes, dumb-
bells were formerly  employed weighing from fifty to one  hundred
pounds but now, Schreber and other distinguished authors con-
demn  such weights,  and  advocate  those weighing from two to five
pounds.  I think those weighing two pounds are heavy enough for 
PHYSICAL CULTURE-                    715
 any man;  and as it is important that they be of considerable size, I
 introduced, some years ago, those  made  of wood.  Every year my
 faith grows stronger in their superiority.
   In  my early experience as a teacher of Gymnastics, I  advocated
 heavy dumb-bells, prescribing for those who could  put up one  hun-
 dred pounds, a bell, of that weight.  As my success had always  been
 with  heavy weights, pride led me to continue their use long after I
 doubted the  wisdom  of  such a course.    For some years I  have
 employed only those made of wood.
   I know it will be said that dumb-bells  of two pounds weight will
 do for women and children, but cannot answer the requirements of
 strong men.
   The weight of the dumb-bell turns entirely on the manner in which
 it is used.  If only lifted over the head, one or two  pounds would  be
 absurdly light; but if used as we  employ them, then one weighing
 ten pounds is  beyond  the  strength of the strongest   No man can
 enter one of my classes, of little girls even, and go through the exer-
 cises  with bells weighing ten pounds each.
   We had a good  opportunity to laugh at a class of young men last
 year,  who,  upon entering  the gymnasium, organized an insurrection
 against the wooden dumb-bells, and through a  committee asked me to
 procure iron ones.  I ordered a quantity weighing three pounds each;
 they used them part of one  evening, and when asked  the following
 evening which they would have, replied. " The wooden ones will do!"
   A just statement of the issue is this : if you only lift the dumb-bell
 from  the floor, put it up, and then put  it down again, of course it
 should be heavy, or there is no exercise; but if you would use it in  a
 great variety  of ways, assuming a hundred  graceful attitudes, and
 bringing the  muscles  into use in every direction, requiring skill and
 followed by a harmonious development, the bell must be light
   There need be no  controversy between the light weight and  the
 heavy weight'party on  this  point.  We of the light weight party
 agree that  if  the bell is to be used as the  heavy weight party uses it,
 it must  be  heavy;  but if as  we use it, then it must  be light.  If  they
 of the heavy  weight party think not, we only ask them to try it.
   The only question which remains is that  which lies between all
 heavy and  light gymnastics, viz: whether strength  or flexibility is to
 be  preferred.   Without  entering upon   a  discussion  of the physi-
 ological principles which underlie this subject, I will simply say that
 I prefer the  latter.  The  Hanlon brothers and  Heenan are, physi-
 ologically considered,  greatly superior to heavy lifters.
   But here I ought to say  that  no man  can be flexible without  a
 good  degree  of strength.  It  is not, however, that kind of strength
 involved in great lifting.  Heenan is a very strong man, can strike a
 blow  twice as hard  as Windship, but  cannot lift seven  hundred
 pounds  nor put up a hundred-pound dumb-bell.  Wm. Hanlon,  who
is  probably the finest gymnast, with the  exception of Blondin,  ever
seen on this  continent, cannot lift  six hundred  pounds.  Such  men 
716                    PHYSICAL CULTURE.
have a great fear of lifting.  They know, almost by instinct, that it
spoils their muscles.
  One of the finest gymnasts in the country told me that in several
attempts to lift five hundred pounds  he failed, and that  he should
never try it again.   This same gymnast owns a fine horse.   Ask him
to lend that  horse to draw before a cart and he will refuse, because
such labor would make  the animal stiff,  and unfit him  for light,
graceful movements before the carriage.
  The same physiological  law  holds true of  man: lifting great
weights affects  him as drawing heavy loads affects the horse.  So far
from man's body being an exception to this law, it bears with peculiar
force  upon him.  Moving great weights through small spaces, pro-
duces  a  slow,  inelastic,  inflexible man.  No matter how flexible a
young man  may  be, let him  join  a circus company,  and  lift the
cannon twice a day  for  two  or three  years, and he will  become as
inflexible as  a  cart-horse.   No matter  how elastic  the colt is when
first harnessed  to the cart, he will soon become so inelastic that he is
unfit to serve before a carriage.
   Men, women, and children should be  strong, but it should be the
strength  of grace, flexibility, agility and endurance ; it should not be
the strength  of a great  lifter..  I alluded to the gymnastics of the
circus. •  Let  all who are curious in regard to the point I am discuss-
ing, visit it.   Permit me to call special attention  to three features
— to the man  who lifts the cannon, to the india-rub.ber man,  and
to  the general performer.   The lifter  and the india-rubber man
constitute the  two mischievous extremes.   It is impossible that in
either there should be the  highest physiological conditions; but, in
the persons  of the Hanlon brothers  who are  general performers, is
found the model gymnast.  They can  neither lift  great weights nor
tie themselves  into knots,  but they occupy a point between these
two  extremes.  They possess  both strength and flexibility,  and
resemble fine,  active, agile, vigorous carriage-horses,'which occupy
a point between the slow cart-horse and the long-legged, loose-jointed
animal.
   With  heavy  dumb-bells  the extent of motions is very  slight, and
of course  the  range  and freedom of action will be correspondingly
so.  This is  a point of great importance.  The limbs, and indeed the
entire body,  should have the widest and freest range of motion.   It
is only thus  that  our performances in  the business or pleasures of
life  become  most  effective.  A  complete, equable  circulation of the
 blood is  thereby most perfectly  secured.  And this, I may remark, is
 in  one aspect the physiological purpose of all  exercise.   The race-
 horse has a  much more vigorous circulation than  the cart-horse.  It
 is  a fact not  unfamiliar with  horsemen, that when a horse is trans-
 ferred from slow, heavy work to the carriage, the surface veins about
 the neck and legs begin at once to enlarge ; when the change is made
 from the carriage to the cart, the reverse is the result,
   And  when  we consider that the principal object of all physical
 training is an elastic, vigorous  condition of the nervous  system, the 
PHYSICAL GULTURE.                    7^7
  superiority of light gymnastics  becomes still  more obvious.  The
  nervous system is the fundamental fact of our earthly life.   All other
  parts of the  organism exist and work for it.  It controls all, and is
  the seat of pain and pleasure.
     The impressions  upon the  stomach, for  example, resulting  in  a
  better or worse  digestion, must be  made through the nerves.   This
  supreme control  of the  nervous  system  is forcibly illustrated in the
  change made by joyful or sad tidings.
     The overdue ship is believed to have gone down with her valuable,
  uninsured  cargo.   Her  owner  paces the wharf,  sallow and wan;'
  appetite and digestion gone.   She heaves in sight!  She  lies at the
  wharf!  The  happy man goes aboard, hears all is safe, and, taking
  the officers to a  hotel, devours with them a dozen monstrous com-
  pounds, with the  keenest appetite, and without a subsequent pang.
     I am confident that the loyal people of this country have  eaten and
  digested, since Roanoke and Donelson, as they had not  before since
  Sumter.
     Could we  have an unbroken succession of good news, we should
  all have good digestion without a gymnasium.   But in a  world  of
  vexation and disappointment, we  are  driven   to  the  necessity  of
  muscle culture, and other hygienic expedients, to give  the nervous
  system that support and vitality which our fitful surroundings deny.
     If we would make our muscle-training contributive in the highest
  degree to the healthful elasticity of our nerves, the exercise must  be
* such as will bring  into varied combinations  and play all  our muscles
  and nerves.  Those exercises which require  great accuracy, skill, and
  dash, are just those which secure this happy and complete  intermar-
  riage of nerve and muscle.   If any one doubts that boxing  and small
  sword will do more to give elasticity and tone to the nervous system
  than  lifting kegs of nails,  then  I  will  give him over to  the heavy
  lifters.
     Another point I take the liberty to urge.  Without accuracy in the
  performance of the feats, the interest must  be  transient.   This  prin-
  ciple is strikingly exemplified  in military training.   Those who have
  studied our  infantry drill have  been struck with  its simplicity, and
  have wondered that men could go through with its details every day
  for years  without disgust.   If the  drill-master  permits  carelessness,
  then  authority alone can force the men through the  evolutions; but
  if he enforce the greatest precision, they return to their task every
  morning for twenty years with fresh and  increasing interest.
     What precision, permit me to ask, is possible in " putting up" a
  heavy dumb-bell ?  But  in the new dumb-bell  exercises there  is
  opportunity and  necessity for  all the accuracy and  skill  which are
  found in the most elaborate military drills.
     I  have been a teacher of boxing and fencing, and I say with con-
  fidence that, in neither nor both is there such a field for fine posturing,
  wide, graceful action, and studied  accuracy, as  is to be found in the
  new series of dumb-bell exercises.
     But, it is said, if you use bells  weighing only  two pounds, you 
718
PHYSICAL CULTURE.
must work an hour to reach the exercise which the heavy ones would
furnish  in five minutes.  I need  not inform those who have practised
the new series with the light bells, that this objection is made in
ignorance.   If you simply " put  up" the light bell, it is true; but if
you use it as herein described and  illustrated, it is not true.   On the
contrary, in  less than  five  minutes legs,, hips, back,  arms, shoulders,
neck, lungs, and heart will each and all  make the most emphatic
remonstrance against  even a  quarter  of  an hour's practice of such
feats.
  At this point it may be urged that those exercises which hasten the
action of the thoracic  viscera  to  any considerable  degree, are simply
exhaustive.  This is another blunder of the " big-muscle" men.  They
seem to think you can determine every man's constitution  and health
by the tape-line; and  that all  exercises whose results are not deter-
minable by measurement are worthless.
  I need scarcely say, there are  certain conditions of brain,  muscle,
and of every other tissue, far  more important than size ;  but what I
desire to urge more particularly in this connection, is the importance,
the great  physiological advantages, of just those exercises in which
the lungs and heart are brought  into active play.  These  organs are
no  exceptions to the law that exercise is  the principal condition of
development.  Their vigorous  training adds  more to the stock of
vitality than that of other  organs.   A man may stand still  and lift
kegs of  nails and heavy dumb-bells until  his shoulders and arms are
Sampsonian j he will  contribute  far less to his  health and longevity
than by a daily run of  a mile or two.
  Speaking in a general way, those exercises in which the lungs  and
heart are made to  go at a vigorous rate, are to be ranked among the
most useful.  The "  double-quick "  of  the soldier contributes  more in
five minutes to his digestion and  endurance, than the  ordinary drill in
two hours.                                                      •
  I have said an elastic tone of the nervous system is the physiological
purpose of all physical  training. If one  may be allowed such an analy-
sis, J would add that we exercise our muscles to invigorate the thoracic
and abdominal viscera.  These in  their turn  support and invigorate
the nervous system.  All exercises which operate  more directly upon
these internal organs,  as, for  example, laughing, deep breathing, and
running, contribute most effectively to the  stamina of the brain and
nerves.  It is only this mania for monstrous arms and shoulders that
could have misled the intelligent gymnast on this point
  But, finally, it is said you certainly cannot deny that rapid motions,
with  great sweep, exhaust more  than  slow motions  through  limited
spaces.  A great lifter said to me the  other day, " Do you pretend to
deny that a  locomotive with a light train, flying at the rate of forty
miles an  hour,  consumes  more  fuel  than  one  with a heavy train
moving at the rate of five miles?"  I did not attempt  to  deny it.
" Well, then," he  added, with an  air of triumph, " what have you
to say now about these  great  sweeping feats with your light dumb-
bells, as compared with the slow  putting  up of  heavy ones ?  "   I 
                          PHYSICAL CULTURE.                    7J9

   replied by asking him another question.  " Do you pretend to deny
   that  when you drive your  horse  ten miles  within an  hour,  before
   a light carriage, he is more  exhausted than  by drawing a  load two
   miles an hour ? "  " That's my doctrine, exactly," he said.  " Then " I
   asked, " why don't you always drive two  miles an hour ? "   " But my
   patients would  all die," replied my friend.   I did not say aloud what
   was  passing in my mind, —that the danger to his  patients  might be
   less than he imagined, — but I suggested that nearly every man, as .
   well  as every horse,  had duties in this life which involved  the neces-
   sity of rapid and vigorous motions;  that were this slow movement
   generally adopted, every phase of human life  would be stripped of
   progress, success, and glory.
     As our artificial training is designed to fit us for the more success-
   ful performance of the  business of life, I suggest  that  the training
   should be, in character, somewhat preparatory for those duties.  If
   you would train a horse  for the carriage, you would  not  do  it by
   driving at a slow  pace before a heavy load.  If you did, the first fast
   drive would go  hard  with  him.
     Just so with a man.   If he is to lift hogsheads of sugar, or kegs of
   nails, as a business,  he  may be trained  by heavy lifting;  but  if his
   business  requires the average velocity and  free motions  of human
   occupations, then  upon  the basis of his  heavy, slow training, he will
   find  himself, in actual life, in the condition of  the dray horse, who is
   pushed before the light  carriage at a high speed.
     Perhaps it is not  improper to add, that, to me, all this talk about
   expenditure  of  vitality  is full  of sophistry.   Teachers and writers
   speak of our stock  of  vitality, as if it  was a vault of gold, upon
   which you cannot draw without lessening the  quantity, whereas, it
   is rather like the mind or  heart enlarged by action, increased by
   expenditure.
     When Daniel Boone was living alone in Kentucky, his intellectual
   exercises were, doubtless,  of the quiet, slow,  heavy character.   Other
   white men joined  him.  Under  the social stimulus,  his  thinking
   became more sprightly.   Suppose that in time he had come to write
   vigorously, and to speak  in the most eloquent, brilliant manner, does
!   any one imagine  that he would  have lost in mental vigor and dash   jj
j   by the process ?  Would  not the brain, which had  only slow exercise   j;
j   in his  isolated life,  become bold,  brilliant, and  dashing, by bold,
j   brilliant, and dashing efforts.
     A farm boy has slow, heavy muscles.  He has been accustomed to   |j
   heavy exercises.  He is transferred to the circus, and performs, after   j;
   a few  years training,  a  hundred beautiful, splendid feats.   He at   i!
   length  reaches the  matchless  Zampillserstation  of Wm.  Hanlon.
   Does any one  think that his  body  has lost power  in  this brilliant   ]|
   education ?                                                          j;
     Is it true that in either  intellectual or  physical training, bold,
   brilliant efforts, under  proper conditions  and limitations, exhaust the   ;
   powers of life ?   On the  contrary, is it not true that we find  in vig- 
720      •              PHYSICAL  CULTURE.
orous,  bold,  dashing, brilliant efforts the only  source  of vigorous
bold, dashing, and brilliant powers ?
  In this discussion  I have not considered the treatment of invalids.
The principles presented are applicable to the training of children
and adults of average vitality.
  In a work upon which I am now engaged, devoted to the " Move-
ment Cure,"  to be published early in 1863, I shall advocate, and for
reasons which will appear in the work, an entirely different policy.
  In the meantime,  I will  rest upon the  general statement, that all
persons of both sexes, and of every age, who are possessed of average
vitality, should, in the department of physical education, employ light
apparatus, and execute a  great variety of feats, which  require  skill,
accuracy,  courage, dash, presence of mind, quick eye and  hand, — in
brief, which  demand a  vigorous and  complete exercise  of all the
powers  and faculties with which the  Creator has endowed us; while
deformed  and diseased  persons should  be treated in  consonance
with the philosophy of  the  Swedish Movement  Cure,  in which the
move'ments are slow and limited.
  It is but justice to the following series of exercises with dumb-bells,
as well  as to myself, to  state that  not only are they, with  two or
three exceptions, my own  invention, but the wisdom of the  precise
arrangement  given,  as well  as the  balance  of  exercise  in all the
muscles of the body and  limbs, have been well proved  by  an ex-
tensive use for several years.
  It must not be forgotten that, in  all the  dumb-bell exercises the
pupil  should, as a beginning position, stand with his heels together,
the toes separated so as to make between the feet a right  angle, and
the arms  hanging by the  sides, with the dumb-bells horizontal and
parallel to each other.
  Not  only in all  the exercises, but  in all the changes from one  exer-
cise to  another,  the pupil must keep time  to  the music.  In the
absence of other  musical instruments, a drum may be  employed to
mark the  time; and even without  this it may be kept by counting
one, two;  one, two;  one, two.
  It must be remembered  that in no case should the pupil bend the
legs at the knee, or  his arms at the elbow, unless it is so directed.
No rule in the dumb-bell exercises is so important as this.  If  it be
forgotten,  exercises with  dumb-bells will loose more than half  their
value.
  No. 1.  The position is shown in Fig. 1.  Thumbs outward.  Bells
exactly horizontal.   Turn the thumb ends of the bells to the hips, and
then ba'ck again to the  position shown  in the  figure.   Repeat ten
times.   Let the change be made with the greatest accuracy.  When
it is well  done, no matter which end is at the hip, a straight rod run
through one  dumb-bell,  lengthwise,  would at  the  same time run
through the centre of the other.
  In this  and all subsequent dumb-bell exercises, the pupil must be
careful not to bend  the elbows.   When exceptions to this rule occur,
they will be plainly indicated. 
PHYSICAL CULTURE.
721
  No. 2.   Position  seen Fig. 2.   Keep the  elbows  pressed  against
the sides, and twist the bells so the ends are exactly reversed.  Be
sure they  are  exactly in line with each other, and the forearms par-
allel.  Repeat ten times.
Figure 1.
Figure 2.
  No. 3.   In passing from No. 2 to No. 3, bring the bells to the chest,
and on the next beat to the position in Fig. 3.  The palms of the
hands are upward.  Bells exactly horizontal  and  parallel to  each
other.  Turn the hands over, knuckles upward.   Bells now exactly in
the same position as before.   Repeat ten times.
Figure 3.
Figure 4.
  No. 4.  In passing from No. 3 to No. 4, bring the bells to the chest,
and on the next beat to the position in Fig. 4.  The palms forward.
                    91 
722                    PHYSICAL CULTURE.
Twist the bells so the knuckles are forward.  Repeat ten times.  Arms
to be kept parallel from first to last
   No. 5.  Position as in Fig. 5.  In passing from  No. 4 to No. 5,
bring the bells to the chest   Twist the  arms so that the bells  are
exactly reversed.
   It will be  seen in  the figure, the palms are upward.   When  the
bells are reversed, the knuckles are upward.   Keep the arms parallel.
Repeat ten times.
   In passing from one exercise to  another, I  have spoken of bringing
the bells to  the chest  They should strike the chest exactly  at  the
point shown in Fig. 6.
              Figure 5.                               Figure 6.

  No. 6.,  Thrust the two bells down by the side of the legs.  Bring
to the  chest,  and thrust them sideways.   Bring to the chest and
thrust them upward.  Bring to the chest and thrust them forward.
   Repeat these four thrusts five times.
   When the down thrust is made, the  pupil must be careful that at
the lowest point the bells are precisely horizontal, and parallel to each
other.  When the side thrust is made, the arms must be horizontal,
the bells  perpendicular and  parallel  to each other.    When  the
upward thrust is made, the arms must be accurately perpendicular,
bells parallel and horizontal.
 . When the forward thrust is executed, the  arms must be exactly
horizontal,  and the bells perpendicular and parallel.
  No.  7.   Raise the right-hand bell from  the side of the leg into the
arm-pit, five  times.   (Fig. 7).   Left,  five times.   Alternately and
simultaneously, five times.
  Be sure that each  time when the bells come into the arm-pits they
are exactly horizontal.
   No. 8.  Passing from No. 7 to  No. 8, bring  the  bells  to the chest;
on the next beat, to the top of the shoulders;  on the next beat carry
up the right, reaching accurately the position seen in Fig. 8.  Repeat
 
PHYSICAL CULTURE.
723
five times.  Left, the  same.   Alternately and simultaneously, each
five times.
Figure 7.
Figure 8.
  No. 9.   Passing from No. 8 to No. 9, bring the bells  to  the chest
(the dotted lines in Fig. 9 show it), then down by the sides ; in all, as
usual, keeping good time to the music.  Now carry the right bell to
          Figure 9.                                Figure 10.
the chest, then up, reaching the position shown in Fig. 9.  Return to
the hip, marking one beat  on the chest  in going down.  Repeat  ten
times.  Left, the same.  Alternately and simultaneously, ten times.
  No. 10.   Bring the bells to the chest.   Strike  out the right one in 
724                     PHYSICAL CULTURE.
front, arm precisely horizontal, bell perpendicular.  (Fig. 10).   Re-
peat twenty times.  Left, the same.  Alternately and simultaneously,
twenty times.
   As usual, keep the chest well forward, and the shoulders drawn far
back.
   No. 11.   Holding the bells  in the position seen in Fig. 11, bring
them with great force into the position seen in the dotted line, forty
times.  In beginning  this elbow-thrust backward, it is  well  to  first
raise the bells a foot, that they may be brought back with more force,
and more directly into the position seen in  the dotted lines.  But in
carrying them forward again, it should  be first into the position seen
in the figure.
                                                 Figure 12.
  No. 12.  Stamp the left foot, then the right, then charge out into
the position  seen in Fig. 12.   Make sure that the leg behind, in
this and all subsequent charges,  is kept  entirely straight,  while the
one forward is placed as shown in the figure.  Holding the  arms as
illustrated, force the entire person into the position of the dotted lines,
five times.  There should be  no motion in the  shoulder joints.  Tlie
chest is puMed far forward, and the shoulders drawn well back.  These
directions are  applicable to all charging exercises, in which a different
course is not plainly indicated.
  It will be observed that the charge in No. 12 is exactly sideways.
  Rise to the  perpendicular again, stamp the right foot, then the left
and lastly charge out on the left side, and repeat the performance of
the right side^ye times.
  No. 13.  Rise to the perpendicular, stamp with the left foot, then
with the  right, then  charge out  as  shown in  Fig. 13.  Under the
directions given in No. 12, sink five times.
  Same on the left side, of course with the intermediate stamping.
  No. 14.  After the regular stamping, the pupil should charge in the
manner illustrated in Fig. 14.   Sink five times.
  Same on the left side.
 
PHYSICAL CULTURE.                        725
In this, as in Figs. 12 and 13, the charging is exactly sideways.
Figure 13.                              Figure 14.
  Na 15.   Stand upright, hands by the side.  Raise the right hand,
as shown  in  Fig 15, five times.  Left, the same.  Alternately and
simultaneously, five #mes.
Figure 15.                          Figure 16.
  In this  the  arm is carried up with a quick, strong effort, and ar-
rested at  the  horizontal  line, precisely as  if it  had struck a rock.
When  it is  brought back to the side again, it is with the same force
and sudden arrest.   This and the next one  are among  the  most
severe of the dumb-bell exercises.
  No. 16.  Assuming the  position seen in  Fig.  16,  force back  the 
726                    PHYSICAL CULTURE.
right arm, as seen in the dotted line, five times.  Left the same.  Al-
ternately and simultaneously, five times.
  The arm must not be bent at the elbow.
  The directions given in  No. 15, in  regard to  force and  sudden
arrest, are applicable to this exercise.
Figure 17.                                 Figure 18.
  No. 17.  Beginning as in No. 15, with the arms hanging, combine
the two exercises^ Nos. 15 and 16, in one sweep, reaching the position
of the dotted  line in Fig. 16.  Repeat five times.   Left hand the
same.  Alternately and simultaneously, five times.
  No. 18.   Stand upright, arms hanging.   Raise the right arm to 
PHYSICAL CULTURE.                    727.
the horizontal,  at  the  side, with the palm up.  Repeat five times.
Left, the same.   Alternately  and simultaneously,  five times.   The
position of one of the arms is. seen in Fig. 17.
  No. 19.   Having the arms  extended  at the sides as shown in Fig.
18, raise the right arm to the position seen in  the dotted line, five
times.  Left, the same.   Alternately and simultaneously, five times.
  In raising the dumb-bells over the head, be careful that they are in
such a position that, when the two are  up together, they are exactly
horizontal and parallel  to each other.
  No. 20.   Beginning  as  in No. 18, arms  hanging, combine Nos. 17
and 18, in one sweep,  each arm  five times.   Alternately and simul-
taneously, the same.
            Figure 21.                             Figure 22.

  No. 21.   Standing upright, arms hanging, charge  into the position
shown  in  Fig. 19;  remaining thus, thrust the  arms  in  front, in  a
horizontal line, five times, alternately and simultaneously.  Rising to
the perpendicular, stamp with the right foot, then the left, then charge
out with the left foot, and repeat the exercises with the arms.
  It will be seen by the figure that  the leg behind is kept entirely
straight and rests  on  the  toe.  The special point in  this exercise
is to reach the dumb-bell as  far forward as possible.
  No. 22.   Standing as represented in Fig. 20, force the right arm
into the position  shown in the  dotted  line, five times.  Left the
same.   Alternately  and simultaneously, five times.
  In this exercise keep the  body as erect as possible.
 
728
PHYSICAL CULTURE.
                            No. 23.  Having the arms perpendicular
                          over the  head, perform the  same exercise
                          as in the last number, with right hand, left
                          hand, then alternately and simultaneously.
                            No. 24.  Placing the feet in position  of
                          Fig. 21,  raise the arms with great force
                          from the hanging position to that seen  in
                          Fig. 21.  On the next beat bring the arms
                          to the  position  seen  in Fig. 22;  on the
                          next to that  seen in Fig. 23; on the next
                          beat sweep back to the position  seen  in
                          Fig. 22;  then to the position seen in Fig.
                          21.   Repeat five  times.  Stamp right and
left, then step out with  the  left foot, then  swing the arms over the
head, performing the same exercise on the left side.
  In this exercise neither arms nor legs should be bent
  No. 25.  Stand erect,  arms horizontal in front  and parallel  to each
other.   Carry the right hand backward  in the horizontal plane (Fig.
24) as far as possible; return it.  Repeat ten times.  Left the same;
alternately and simultaneously, ten times.
Figure 23.
Figure 24.
Figure 25.
  No. 26.  Standing erect, arms hanging, stamp with the left foot;
then with the right;  then  charge into  the  position seen in Fig. 25,
and  thrust the arms in a  direct line upward, alternately and simul-
taneously, ten times.  Assuming the erect position, drop the arms by
the side, stamp the right  foot, then the left,  and charge out  on the
left side; repeat the exercise with the arms.
  In this exercise, it will be seen, the leg behind  is straight, that
charged forward, considerably bent. 
PHYSICAL CULTURE.
729
No. 27.   As  in nearly all other exercises,  begin with  the heels
Figure 26.
Figure 27.
together, body erect, chest forward, shoulders back, arms hanging,
dumb-bells horizontal and parallel  to each other.   Step diagonally
          Figure 28.                               Figure 29.

backward with the right foot, as seen in  Fig.  26,  and  repeat the
exercises in No. 26.   Same with the left foot
                    92 
730                    PHrSICAL CULTURE.
  In this exercise the forward leg is kept straight, that behind is bent
as much as possible.                                      %
  No. 28.  Bells on the chest.  Carry the right arm out at the side,
thrusting it as .far  back as possible;  suddenly bring it back  to the
chest in a circle as if grasping a large body standing in front.  Repeat
five times.   Left hand, same.   Alternately and simultaneously, same.
                             In this exercise  the arms  should be
                           kept in the horizontal plane, and  should
                           in the performance of the exercise enclose
                           as large  an  armful  of  the  imaginary
                           objects as possible.
                             No.  29.  Standing erect, arms hanging
                           at the  side, suddenly turning the body to
                           one side as far as you can twist it with-
                           out moving the feet,  carry the arms to
                           the position seen in Fig. 27.  Bring them
                           back to the sides, while at the same time
                           you bring the body to the first position.
                           Swing the arms up on the other side,
                           and so continue, alternating twenty times.
                             No.  30.  Standing erect, arms hanging,
                           brings the bells  to the chest, then to the
                           floor, as shown in the dotted line in Fig.
                           28; then rising, bring the dumb-bells again
                          * to the chest, and oh the next beat thrust
                           them as far upward as possible, rising on
                                 Repeat twenty times.
the toes
Figure 30.

then back to the chest
Figure 31.
No. 31.  Standing erect, dumb-bells on the shoulders (not on the 
PHYSICAL CULTURE.
731
chest), thrust the Tight arm out at the side as seen in Fig.  29, ten
times.  Left, the same.  Alternately and simultaneously, the same.
  No. 32.   Standing erect, arms hanging, carry the arms to the hori-
zontal  in front; then to the position over the  head seen in Fig. 30;
now down to  the horizontal again, and then to the floor  as seen in
the dotted line.   Repeat ten times.
  In this exercise there must  be no  bending at the knees or elbows.
  No. 33.   Standing erect, arms hanging, charge out with the right
                                Figure 32.

foot, and sweep the left arm as shown in Fig. 31; on the next beat
return to the first position.  Repeat five times.  Same on the left side.
Alternately, five times.
  No. 34.   Standing erect, arms hanging, without moving the  body
carry the right foot out sideways, lifting it from the floor, and bringing
it back to the other foot, without bending  the  knee, five times ; then
charge into the position seen in Fig. 32, and return to  the first posi-
tion, five times.
  The arm  which is brought  over the head must be carried in a
direct line from the  side to the  position  over  the head,  and not
brought toward the front of the body in  its passage up or down. 
732                    PHYSICAL CULTURE.
                      Bag Exercises.

  The use of small bags filled with beans, for gymnastic exercise,
was suggested to  my  mind  six years  since^ while attempting to
devise a series of games with  large rubber  balls.   Throwing and
catching objects in certain ways, requiring skill and presence of mind,
affords not only good exercise of the muscles of the arms and upper
half of the body, but cultivates a quickness of eye and coolness of
nerve very desirable.   Appreciating this, I employed-large  rubber
balls, but was constantly annoyed at the irregularities resulting from
the difficulty in catching them.   When  the balls  were but partially
inflated, it was observed  the hand could better seize them.   This at
length suggested  the bean bags.  Six years'  use  of these bags has
resulted in the adoption of the following, as the best size and shape.
  The material is  a strong bed-ticking.  Bags for young children
should be, before sewing, seven inches square ; for  ladies, nine inches;
for  ladies and gentlemen exercising  together, ten  inches; for gentle-
men  alone, twelve  inches.  Sew them  with strong linen or silk
thread, doubled, nearly three  quarters  of an  inch  from the edge,
leaving a small opening at one corner to pour in the beans.  Fill the
bags  three quarters full, and they are ready for use.   If used daily,
once  in two weeks they should be emptied and washed.  To allow
them to be played with after they are soiled, is pretty sure to furnish
much dust for the lungs of the players,  beside soiling the hands and
clothes.  There cannot be too much care exercised in  regard  to this
point of cleanliness.  Before the beans  are used  the first time, they
should be rinsed with water until it runs  from  them quite clean, when
they must be dried; and every month or two afterwards this  cleans-
ing should be repeated.
  The dirty  carelessness with which these bag exercises are gener-
ally managed, makes them- a positive nuisance.
  Premising  this indispensable  preparation and care  of the bags,  I
shall  now  proceed to give those exercises which  I  have found best
adapted to schools and the gymnasium.
  Fig. 1 represents a series of hoops  lashed between two  strong
                                   ropes  and stretched across the
  ^'S.  Stm\ /"\ / ' \ /*,K\   room, the ropes fastened  on the
 /    \l     n     A    A    )   s^e °^ *ne room mto staples, and
 V  y V , y V , y V,y V.V   on the other running through pul-
               Figurel               leys.  By these means  the ropes
                                  may  be drawn very taut.  It is
well to fasten the staples and  pulleys into slides, that  the hoops may
be altered for persons of different ages.
   Nearly all the exercises with  bags are greatly improved by throw-
ing them throw the hoops.   It will be observed the cuts represent the
player as throwing the bags quite  high.  This has reference to the
hoops.  But the bags may be  thrown between the players without
the hoops. 
PHYSICAL CULTURE.                   733
  No. 1.   Arrange yourselves in two classes.   Classes  face  each
other, six feet  apart.   Members of one class will each have a bag.
The other class will have no bags.  Each person will play with the
one standing exactly  opposite.  Hold the bags under your  chins.
Figure 2.                            Figure 3.
(Fig. 2).   When one gives the word, each couple is to throw its bag
backwards and forward ten times, counting both ways.  At the  be-
ginning of this and the following exercises, the leader will announce
how many times the bag is to be thrown.
Figure 4.            Figure 5.               Figure 6.
  Each couple will  play as rapidly as possible, and as each finishes,
the two players will hold up their hands, and cry out  the  number in
a loud voice.  Now ready!   One, two, three ! !   The bag is always
to be thrown from the chest, never to be tossed from the lap.
  No. 2.   Same as the last, except  the bag is thrown and caught
with the right hand.   The position is well shown in Fig. 3. 
734                    PHYSICAL CULTURE.
.  No. 3.  Same as the last, but  with the  left  hand.   When the
right hand throws, the partner's right  hand must catch, and so with
the left.
  No. 4.  In this  one, the  bag is  thrown with both hands, from the
position seen in Fig. 4.                      •
Figure 7.                Figure 8.             Figure 9.
  No. 5.  Same as the last, except the bag is thrown with the right
hand, as shown in Fig. 5.  The unoccupied hand in this and all other
single-handed  bag exercises is to be held on the corresponding side,
with the arm akimbo.
  No. 6.  Same as the last, except with the left hand.
  No. 7.  The bag  is to be thrown over the head from the position
seen in  Fig. 6.
          Figure 10.                Figure 11.              Figure 12.
     No. 8.  To be thrown from the position seen in Fig. 7, with the
i   right hand.   The one who catches must receive it, while the left hand
   grasps the arm in the same way.
   3 No. 9.  Same as the last, only using the left hand.
     No. 10.   Standing with your right  side toward your partner, hold
 
PHYSICAL CULTURE.                    735
the bag on the point of the elbow, being sure to keep the fore-arm
vertical (Fig, 8); throw from this position the number of times  an-
nounced by the leader.   To be caught in the hands.
  No. 11.   Same as  the last, except  the left side is turned, and  the
bag is thrown from the left elbow.
  No. 12.   Hold the bag as represented in Fig. 9, and toss to your
partner.  He will of course return it in the same manner to  you, and
thus it will be tossed backward and forward the number of  times in-
dicated by the leader.   As in all the other exercises thus far given,
each couple upon reaching the indicated number, will hold up their
hands and cry out that number in a loud voice.
  No. 13.   Turning your right side to your partner, throw from the
Figure 13.              Figure 14.             Figure 15.
position represented in Fig. 10.   Your partner catches the bag, stand-
ing in the same attitude.
  No. 14.  Same as the last, except you turn your left side to  your
partner, and throw  with  the left hand, either without bending the
knees, as seen in Fig. 11, or bending them, as.seen in Fig. 10.
  No. 15.  Again turn your right side to your partner, and throw the
bag from the position seen in Fig. 12.
  No. 16.  Same as the last, except, turning the left side, you throw
with the left hand.
  No. 17.  Turn your back to your partner, and bend backwards, so
that you can see him.  He bends back, so that  he may see you, and
then you throw the bag to him  as represented  in Fig. 13.  Always
cry  ready ! that he may not be  kept waiting too long  in an uncom-
fortable position.
  No. 18.  Face  your partner,  and  throw from the position repre-
sented in Fig. 14, holding the bag on the back of the hand.
  No. 19.  Same as the last, except the left hand is employed.
  No. 20.  Face your  partner, and throw the bag around the  back
and over the opposite shoulder, as shown in Fig. 15.
  No. 21,  Same as the last, except you use the other hand. 
736
PHYSICAL CULTURE.
  No. 22.  Each couple having  ten bags, you throw to your part-
ner, and  he catches as  many as he can hold, folding his arms.  (Fig.
16).   This one will not ordinarily be played in class, as the  number
of bags will scarcely be sufficient.
  No. 23.  The two  classes will stand as represented in  Fig.  17.
Place ten bags on a chair or box at the feet of the first player of each
class.  The leader gives the word, one, two, three ! and the two classes
compete in passing the bags over their heads backwards, to  the foot
of the class, when they whirl round and immediately pass them back.
The class which  has the entire ten on  the chair or box at its head,
first, counts  one in the game.   It is usual to make the game  three,
five, or ten.
Figure 16
Figure 17.
  No. 24.  Let the two classes face each  other again, and pass  the
bags as in the last, except that they are carried along in front and as
high as the chest, being#careful not to stoop forward.
  No. 25.  Let the  bags  be  all placed at the head  of one of  the
classes.  We will call this* class No. 1; the other, class No. 2.  The
first player in class No. 1, throws a bag to the first player in class  No.
2, who throws it back to the second player  in class No. 1, who throws
it back to the second player in class No. 2, who, in turn, throws it to
the third player in class No. 1, and so on, working it down  to the foot
of the class.
  But one bag is not allowed to make the trip alone ;  all follow,  one
after another, in  rapid succession.
  In  this gEfme,  the  bags  are all thrown  from the chest  with both
hands, as represented some pages back, in  No. 1 of the bag exercises.
  No. 26.  The whole company may now be divided into  trios, each
trio playing with three bags, as represented in Fig. 18.  Each  one
throws the bag to the player at his right hand, and at the  same time
catches the bag thrown from the player at his left. 
PHYSICAL CULTURE.                   737
  To secure the proper distance between
the  players  for this  game, they  should
take each  other by the hands, and pull-
ing  hard, they will have the right position.
Each player must look constantly at  the
one from whom he  receives the bags, and
never for a moment at the one to whom
he throws.   If they forget this rule,  the
bags will soon fall to the floor.
  No. 27.   Same  as  the last, except  the
bags are passed the opposite way.
  No. 28.   The company is again divi-
ded into couples, and each couple plays
with two,  three, four, or more bags.   A
throws a bag with  his  right  hand to  B,
who catches  it with his left hand, and
immediately changing it  to  his right,
throws it  back to A, who  catches it
with his left, and who, changing it to his right, throws it back again
to B {Fig. 19).  Two, three, four, or five bags can be made to  per-
form this circle between two players at the same time.
Figure. 19.
  The bags, in this as in all the other bag exercises, except one, should
be thrown, and not tossed.
  No. 29.  Same as  the last, except the bags are thrown with the
left, and caught with the right hand.
  No. 30.   Now the players will stand in two classes again, the classes
to be six feet apart, and the players in each party to be six feet from
each other. Place six bags on a chair at the head of each class. Upon
the word one, two, three ! the first player in  each class seizes a bag
and runs with it to the second player, who carries it to the third, who
in turn rushes to the fourth, and  so  on to the foot of the class.  But
one bag is not allowed to make the journey alone.  One at a time, the •
               93
 
738                   PHYSICAL CULTURE.
whole six are hurried onward. Instantly, and without any signal, they
are sent back to the head of the class in the  same order.  The class
which has its six bags on the chair at the head of the class first, counts  j
one in the game.
Exercises  with  Rings.
  This series of exercises is entirely new, and beyond all comparison,
the best ever devised.  Physiologists and gymnasts  have everywhere
bestowed upon it the most unqualified commendation.   Indeed  it is
difficult to conceive any other possible series so complete in a physio-
logical point of view, and  so happily adapted to  family, school, and
general use.
  If  a man were as strong as  Sampson, he would find  in the use of
 
PHYSICAL CULTURE.                    739
a straight fine drawn through the entire hall, on which all the players
stand, and placing the left foot at right angles with the right foot, as
seen in the figure, pull hard and  twist the right arm hard from right
to left and left to right ten times, keeping time to the music.
  Be careful in  this, as in all other exercises with the ring, to draw the
shoulders well back and keep the head erect.
  No. 2.  Same as the last, but using the left hand, with the left foot
forward.
Figure 3.                           Figure 4.
  No. 3.  Join  both hands with two rings,  and place the right toe
against your partner's right  toe, as in No. 1, being sure  to keep  the
foot which  is behind  at  right angles with the one in front (which I
             Figure 5.                             Figure 6.

may say here, is to be looked after with much care through this whole
series, whenever it  is possible), then pull hard, ten times, and twist
the arms, keeping time to the music.
  No. 4.  Exactly the same as  the last, but with the left foot forward.
  No. 5.  Without letting go the rings, turn  back to back, place the 
740                    PHYSICAL CULTURE.
outside of your left foot against the same of your partner, in the same
way you would push against the wall of the  room, and pulling hard
in the position represented in Fig. 3, twist hard ten times, keeping
time to the music.
  No. 6.   Same as the last, but with the right foot behind.
  No. 7.   Turn face to face, raise the hands  as high as  you can over
the head, and, standing about two feet and a half apart, bring the rings
down to the floor without bending the knees, as represented in Fig. 4,
ten times, and all  the following exercises ten times.   In the perform-
ance of this you must not bend the elbows, which you can. avoid doing
               Figure 7.                           Figure 8.

by carrying the rings outward at each side.   (In the ring exercises,
when your pupils, standing their faces toward each other, turn their
backs, see that they do not let go the rings).
  No. 8.   Standing as in  the last exercise, but only two feet apart,
place the rings in  the  position seen in Fig. 5.  Now as the arms on
one side rise, the arms on the other side fall, keeping time to the music.
Be careful not to bend the arms at the elbows,  which of course can
be prevented in this as in many other exercises, by carrying the hands
outward at the side.  In this exercise a great deal of force should be
used, so that when the  ring is carried up on one side, it goes far be-
yond the perpendicular line, the bodies of the players bending freely.
  No. 9.   Same as the last, except the two  rings go up  and down
simultaneously.
  No. 10.   Standing as in the last two exercises, the hands hanging
down as  low as may be, and keeping them in the same relation to
each other, swing them from side to side as far as you can.
  No. 11.   Same  as the  last, except that instead of swinging the
hands from side to side, they make a complete  circle, being carried
over the head, as well as down between the bodies of the players.
  No. 42.  Same as the last, except the' circle is made the  opposite
way. 
PHYSICAL CULTURE.
741
  No. 13.   Back to back, as seen in Fig. 6, thrust the rings up with
great force, each player keeping his two arms exactly parallel.
  No. 14.   From  the same position seen in  Fig. 6, thrust the rings
out sidewise, as in all the other exercises, ten times.
  No. 15.   Same  as the last, except the rings are thrust downward
by the hips.
  No. 16.   The last three, consecutively,  ten times.
  No. 17.   Take the position seen in Fig. 7 ; your partner the same.
The inside of your  left foot to the inside of his left.   Draw your left
hand as far back past your left  side as possible, dragging your partner's
right hand  after it   At the same time he has done the same thing
with his left  Do the same with your right hands.  And so continue
to alternate.  Do this strongly, pushing your hand past your partner's
side as far as  possible, at the same  time  pulling his hand as far past
yours as possible.
  No. 18.   Same  as the last, except the right foot is forward.  Be
sure in this, as in  all others, that your two feet are at right angles.
  No. 19.   Same  as the last  two, except the feet go with the" hands.
When you thrust your right hand forward, the right foot goes forward
too.  When the left hand goes forward, the left foot goes with  it
  If this be well done, the feet and hands making long sweeps to the
Figure 9.                            Figure 10.
music, it not only presents a fine, animated appearance to the specta-
tors, but brings all the muscles of the body and limbs into fine play.
  No. 20.  Back to back, touching  each  other's heels.  Each  lunge
out with the right foot in the direction  the toe  points, the feet being
at right angles, and raise the hands over the head so they touch, thus
reaching the position seen in Fig. 8.  Now back, heels together, arms
at the  side, lunge out with  the left feet in the same way, and thus
alternate, keeping time to the music.
  No. 21.   Standing as represented in  Fig. 9, your partner the same,
with the inside of his left foot to the inside of your left foot, and hold-
ing the rings  as  shown  in the figure, push them vigoruusly toward 
742                    PHYSICAL CULTURE.
your partner, simultaneously thrusting them past his body as far as
possible.  He pushes them back in the same manner, and so on.
  No. 22.  Same as the last, except the right foot is pushed forward,
instead  of the left.
  No. 23.  Stand back to back, heels all together; both step out side-
wise in  the same direction as far as  you can reach, and  at the same
instant raise the hands on  the same  side as high as you  can, then re-
turning  to the upright position, hands by your sides, charge out at the
other side in a similar manner.   When this has been done both ways,
as in every other exercise, ten  times; the leader  cries " alternately,"
and  you continue to change sideways as  before, only in opposite
directions as represented in Fig. 10
             Figure 11.                           Figure 12.
       »
  No. 24.  Standing face to face, two feet apart, charge sideways as
in the last exercise, and as  seen  in Fig. 11.   In alternation with this,
charge the opposite way.   After the  regular  number of times, the
teacher cries " alternately," and  you charge out sideways with  your
right foot in opposite ways, as seen in Fig. 12 ; alternate with the left
foot.
  No. 25.  Standing back to back, charge, your faces both in one di-
rection', with bodies fronting the same, as shown in Fig. 13.  When
the teacher cries ^change ! " you must change sides with each other,
still facing in the same direction. Keep  time to the music with your
feet, when  changing sides,  and as soon as you make .the change, go
on with the charging, using, of course, the other hands and feet.
  No.  26.  Joining only with your right hands, and  standing apart
far  enough to make the arms straight and horizontal between you,
charge as seen in Fig. 14 ;  the left hand and foot the same.
  No.  27.  Joining with both hands, charge right and left alternately,
each time, as represented in Fig. 14.
  No.  28.   Stand, each with his own heels  together, as seen in Fig.
15, and perform the exercise exhibited in the  figure.   As the  hands
 
PHYSICAL CULTURE.
743
on one side go up, the hands on the other go down.  So alternate the
regular number of times, when you will do the same simultaneously,
the hands on both sides rising and falling together.
Figure 13.                          . Figure 14.
  No. 29.   Standing as seen in Fig. 16, except that  the inside of the
right foot should  be  exhibited as pressing against the inside of your
partner's right foot, you draw back from each other as far as you can,
Figure 15.                             Figure 16.
and then  come up, touching each other's chests, all without bending
the elbows.
  No. 30.   Same, with the left foot forward. 
744                    PHYSICAL CULTURE.
  No. 31.  Standing as seen in Fig. 17, draw far away from each
other, keeping the arms  precisely horizontal.  Immediately approach-
ing each other again, touch the  shoulders as in the figure, and so con-
tinue ten times, keeping time to the music.
  No. 32.  Same as the last, with the feet changed.
                 Figure 17.      •                  Figure 18.
  No. 33;   Standing face  to face, raise the hands on one side  as in
Fig. 18.   As these hands are brought down to the side, raise those on
the other side in like manner, and so alternate ten times.
  No. 34.   Back to back, and raise the arms on one side as in Fig. 18,
but carry the hands completely over the heads and down on the other
side of the  body.   Alternate with the arms on the other side, ten
times.
          Figure 19.                             Figure 20.
  No. 35.   Carry the hands all  over together, as seen in Fig.  19.
Change thus from side to side, twenty times, always keeping lime to
the music.                                                 .
  No. 36.   Turn face to face, and now back to back, and again lace
 
PHYSICAL CULTURE.                   745
to'face, and so continue to change, alternating the sides toward which
you turn.
  No. 37.  Perform  the exercise seen in Fig. 20, being sure that you
draw the arm  of  your partner  directly into  your axilla or armpit
After  alternating twenty times, then  draw the arms back and forth
simultaneously, ten times.
  No. 38.  Join right hands with your  partner with one ring, and
stand apart so  that your arms are straight and horizontal.   Advance
your right foot  two feet, keeping the two feet at a right angle.  Now
push your' chests as  near together as you can, without bending your
knees  or elbows, as seen in Fig. 21.   Now drawing the arms back to
the horizontal  on  the next beat of the music, carry the  hands  down
as low as possible  without bending knees or elbows on the next beat.
Now back to the horizontal, and then up as high as  possible, and  so
continue ten times.                ,
  No. 39.  Same with the left  hands, the left foot being pushed for-
ward.
  No. 40.  Join the right hands again, holding them in the horizontal
position.   Now push them sidewise as far as possible without bend-
ing knees or elbows.   On the next beat bring  the arms back  to the
straight line between you, and now carry them sidewise the other way,
and so continue ten times.
  No. 41.  Left hands the same.
  No. 42.  Join right hands again.  Instead of thrusting  the  hands
directly upward, or sidewise, carry them obliquely upward, and after
bringing  them back to the straight, horizontal line, carry  obliquely
downward, and so  continue ten times, being careful not to bend knees
or elbows.
  No. 43.  Still use the right hands, and carry them obliquely upward
the other  way, and downward the other way.
  Nos. 44 and 45.   Same with the left hands.
               94 
746                    PHYSICAL CULTURE.
  No. 46.  Back to back, and place the outside of the left foot against
the outside of your  partner's left foot.   Right foot  well  forward.
Now raise the hands over the head as seen  in Fig. 22 (I see the artist
has not placed the outsides of the left feet  against each other, as he
should have done), and draw away from each other, bending the knee
          Figure 23.                               Figure 24.
of the  leg which  is pushed  forward, and thus sink down somewhat.
As you come back, touch your  shoulders against those of your part-
ner, and thus repeat ten times.
   No. 47.  Same, with a change of feet.
   In the  last two exercises, as you draw away, you must not pull on
the rings a  single ounce.   If this be forgotten, your backs  may be
hurt.
   No. 48.  Face  to face, join the right hands, and place the tips of
                       the  right toes against each other, and the left
                       feet at right angles two feet behind.   Whirl
                       the right hands, making as large a circle as
                       possible without bending the elbows or knees.
                       After whirling ten times one way, then whirl
                       ten times the other way.
                         No. 49.  Same with left hands.
                         No. 50.  Back to back, two feet apart, each
                       with his own heels together. Raise the  hands
                       as high as possible  over the head, and bring
                       them down as seen in Fig. 23, five times.
                         No.  51.   Join  the  right hands, and turn
                       your right side toward your partner, keeping
                       the right arms straight  between you.  Both
                       must now step straight forward with the right
                       foot as far as you can reach, while the right
arms are kept horizontal, as seen in Fig. 24.
   No. 52.   Face the opposite way, and use the  left arms  and feet in
the same manner.
Figure 25. 
PHYSICAL CULTURE.                    747
     No. 53.  Stand as shown in Fig. 25.   Pull  your arms directly  for-
   ward, which  of course will  draw your  partner's  arms directly back-
   wards.   Then he draws yours backwards in like  manner, and so
   continue ten  times.
     No. 54.  Back to back, your shoulders touching your partner.  Arms
   perpendicular, over the head.  Draw your right arm directly forward.
1   Simultaneously with  this your  partner does  the  same thing.  Now
   the left arms the same;  and so continue to alternate, ten times.  And
   last, draw both of  your arms forward; immediately your partner does
   the same, and so continue to alternate, ten times.
     These are not  a quarter of the possible exercises with  the rings;
|   but, after  a  long use of them, with much study and  innumerable
j|   experiments, I believe this  series gives the best  variety, and is suffi-
ij   ciently extended.   Besides, this  series is admirably calculated to de-
ji   velop those particular muscles which are almost universally deficient
j!   in the people of the United States.
                  Exercises  with  Wands.

     A straight, smooth stick, one inch in diameter and four feet long
   (three feet for children), with round ends, is known in this gymnasium
   as a " Wand," and is highly prized.  It is used to cultivate flexibility,
   and is equally useful to persons of all ages and degrees of strength.
     As a stiff, inflexible condition of the ligaments and muscles con-
   nected with the  shoulders is the principal obstacle in  the way of
   beginners, and as the wand  is the best known means  to remove this
   stiffness, it should be made  prominent during the first few weeks or
   months of training.              «
     It is perhaps unnecessary to say that the symmetrical development
   of the upper half of the body turns entirely upon the freedom  with
   which one can use the shoulder joint.   This is sufficiently obvious
   when  we reflect  that exercise of the body above the  waist depends
i   upon the arms, and of course upon the degree of freedom with which
i   we can use  the arms.
     While  it cannot be denied that certain muscles about the shoulders
   and chest may be developed to any degree, and  the shoulders remain
i   drooping and stiff, it is quite as undeniable that general and symmet-
!   rical development of that part of  the body  (which is almost univer-
   sally distorted and deficient among Americans), can be achieved only
   by complete liberty about the shoujder joint, through which as a ful-
|   crum or centre, all considerable training of the upper part of the  body
   is derived.
    I had pursued  the study of Gymnastic Culture but a short time,
   before I saw the great importance of the wand, in a system of training
   adapted to the American people. 
748
PHYSICAL CULTURE.
  I have  invented a very extended series of these exercises, some of
which are here described and illustrated.
  No. 1.  Divide the wand into.three equal parts with the hands, and
hold it as represented in Fig. 1.   Thrust it downward close  by the
legs with much force, and again bring it up by the chin, holding the
elbows high, as seen in  the figure, and so continue twenty times.
           Figure 1.                         •       Figure 2.

  No.  2.  From the position seen in Fig.  1, carry the wand directly
upward as high as you can reach, and back to the chin, ten times.
  No. 3.  From the highest position of No. 2,  bring the wand down
to the knees and back again, twenty times, without bending the elbows.
              Figure 3.                          Figure 4.
  No. 4.  Holding the wand high over the head, bring it down on the
back of the neck, ten times, as seen in Fig. 2.
  No.  5. x Same  as the  last, except every second time the wand is 
PHYSICAL CULTURE                       749
brought down to the chin, being careful that every time  that the
wand is carried ^.upward, it is carried as high as pos-
sible, and with much force.
  No. 6.   Hands over the head, but this time at the
ends of the wand, as seen in Fig. 3, and now bring it
down behind as seen in  Fig. 4, twenty times, being
very careful not to bend the elbows.
  No. 7.   Same as last, except that every second time
the wand is brought down to the knees in front.
  No. 8.   Hold  the wand  directly overhead, hands
grasping the ends, and carry it from side to side (Fig.
5), being very careful not to bend the elbows, and yet
the wand must come to the perpendicular on either
side.
  No. 9.   Hold  the wand directly in front, and per-
pendicular, with  the hands in the middle of it, six
inches apart, and the arms as nearly horizontal as pos-
sible.  Keeping the  arms stiff, whirl  the wand from
side to side as far as you can.
  No. 10.   Standing erect, heels  together, put the wand out  with
your right hand midway between two lines, one of which runs directly
forward, and the other at right angles with this, at  your side ; which
direction we shall call diagonally forward.  Let the wand rest on the
floor, at a  point  removed as far from your feet as possible, keeping
Figure 5.
          Figure 6.                              Figure 7,
your body and the wand perpendicular, and the arm horizontal.   The
elbow must not be bent.   Step out as seen in Fig. 6, the foot passing
behind the wand, as seen  in the figure.  In doing this you must not
bend the elbow, nor must  you move the wand.  It will  be seen  that
the shoulders scarcely move, the motion being confined to the legs and
lower part of the body.   Charge thus ten times.
  No. 11.  Same as the last, but with left hand and foot.
  No. 12.  Stand erect.   Carry the ,wand out with the left hand di-
agonally forward, as far  as you can reach.   Step  out  to the wand 
750
PHYSICAL CULTURE.
with the left foot.  Let the foot remain there.   Now the body is to
rise and fall as far as possible.   (Fig. 7).  Don't bend the knee of the
right leg.   Keep the shoulders and head well back.
  No. 13.  Same as the last, on the right side.
  No. 14.  Stand as seen  in Fig. 8.   Thrust the arms straight for-
ward, and  back again to the chest, ten times, keeping the wand all
the time perpendicular.
  No. 15.  At the conclusion of the last exercise, when the arms  are
thrust forward, bring the wand into the  position  seen in Fig. 9.  Then
carry it right back to the position  seen in front, with the arms straight
and horizontal.   Now bring it down on the left  side, and so continue
ten times to each side.
  No. 16.  In concluding  the  last, when the  arms are extended in
Figure 8.                   Figure 9.               Figure 10.
front, bring the hands and wand to the position seen in Fig. 8. Carry
it diagonally forward and upward on the left side, as seen in Fig. 10.
Bring it back to the chest  again, and  thrust it out on the right side.
Alternate twenty times.
  No. 17.   As you thrust out the wand on the right side, step out the
foot in the same direction.  Be sure it  is neither forward nor at  the
side, but diagonally forward.  (Fig. 11).  Alternate between the right
and left side twenty times.
  No. 18.   Same as the last, except that the wand goes to the right as
the left foot charges to the left, and  the left arm and wand to  the left,
while the right foot charges to the right.
  No. 19.   Same as the last, except when the  right  foot  charges di-
agonally forward,  the wand is  made  to point  diagonally backwards
over the left shoulder, and vice versa.
  No. 20.  Same as the last, except  when the right foot  charges 
PHYSICAL CULTURE.
751
diagonally forward, the wand is made to point diagonally backward
over the right shoulder, and when the left foot charges diagonally for-
ward, the wand is made to point  diagonally backward, over the left
shoulder.
  No. 21.   Same as the last, except the feet charge diagonally back-
ward.  As the left foot charges thus, the wand is made to point diag-
onally forward, on the right side,  and vice versa.  (Fig. 12).
  No. 22.   Same as the last, except when the left foot charges diag-
onally backward,  the wand is made to  point diagonally forward  on
the left side, and when the right foot charges diagonally backward, the
wand points diagonally forward, on the right side.
  No. 23.   Same as the last, except when the left foot charges diag-
onally backward, the wand points diagonally backward on the same
             Figure 11.                           Figure 12.

 side.   And  when the right  foot charges diagonally backward,  the
 wand points diagonally backward, on the same side.
   No.  24.   Same as the last, except when the left foot charges diag-
 onally  backward, on its own  side, the wand points diagonally back-
 ward on the right side, and vice versa.
   It must not be  forgotten that in  all these compound exercises, in-
 volving the action of the arms and  legs, the wand is always held  at
 an angle of forty-five degrees above the horizontal; and that in every
 case in  passing from one charge  to another, the wand is brought  to
 the position represented  in Fig.  8.   Without this it would be im-
 possible to keep time to the music.  Let the steps be as long  as
 possible.
   No.  25.  Wand horizontal over the head,  as seen in Fig.  3.   As in
 almost all the wand  exercises, be  careful  not to bend  the elbows.
 Turn the wand round so that the right hand  comes exactly in front,-
and the left hand exactly behind.  Bring the left in front and the right
behind ; so change twenty times.
  No. 26.  Hold the wand horizontal over  the  head,  with the right
 
752                     PHYSICAL CULTURE.
hand in front and the left one behind.  Make, by the side of the body,
the motion seen  in  paddling a canoe.   Each time carry the wand
so far back that it shall be perpendicular.  Do this ten times on the
right side; then ten times on  the  left; then alternately  ten  times.
Each time, as  the wand is  brought over the head, it must be made
horizontal, with one  hand exactly in front, and  the other behind, and
as it is brought behind the body, it must be made perpendicular.
   No.  27.  Charge diagonally  forward with the  right foot; wand
in the same direction.  Left foot diagonally forward ; wand the same.
                                Left  foot diagonally  backward;
                                wand the same.  Right foot diag-
                                onally backward ; wand the same.
                                Having thus  gone  all around, be-
                                gin again with  the left foot  and
                                go  round  the other way  in  like
                                manner.
                                  No. 28.  With both  hands take
                                hold at the end of the wand.  Hold
                                it horizontal in front.   Carry it di-
                                rectly backward  without bending
                                the arms, as  seen in Fig. 13.  (I
                                see the artist  has tipped the figure
so far that the centre of gravity is lost).
   No.  29.  Heels together.  Wand directly in  front,  resting on the
floor, and perpendicular.  Arm straight.  Step the right foot forward to
the wand, and  back to  the other foot, five times.   Left foot the same.
   No.  30.  Step the right foot backward as far  as  you can reach
(Fig. 14), and  bring it back to the other foot, ten times.   Same with
the left foot.
   No.  31.  Carry the right foot forward to the wand.  Returning, do
Figure 14.                          Figure 15.
 not stop by the other foot, but  carry it backward as far as you can
•reach.  Now forward to the wand again.   Make this long sweep ten
 times.  Left foot the same.
   No. 32.   Seizing the upper end of the wand with both hands, as
 seen  in Fig. 15, carry the right foot forward to the wand, and the left
 
PHYSICAL CULTURE.
753
foot back as far as you  can reach.  Change them at a  single jump,
and so continue ten times.
  No. 33.*  Hold the wand in the position seen in Fig. 9, on the right
side, with the right hand at the lower end, and the left hand  at the
upper.  Change it to the left side, with the left hand at the lower end,
and the right hand at the  upper; so  change from side to side, ten
times.
  No. 34.   Begin the  same as in the last, except the wand is held on
the back of the right shoulder instead  of the front.   Carry it now to
the back of the left, and so alternate ten times.
  No. 35.   Beginning at the front of the right shoulder,  as in No. 32,
carry it to the front of the left shoulder.  Then to the back of the left
shoulder, and now to the back of the right shoulder.   Go thus around
the body five times.
  No. 36.   Begin at the front of the left shoulder, and go around the
body the other way five times.
Figure 16.
Figure 17.
  No. 37.   Hold the wand on the front of the right shoulder.  Carry
it to the back of the left shoulder.  Back  again to the front of the
right shoulder.  Repeat ten times.
  No. 38.   Begin at the  front of the left shoulder, and alternate with
the  back of the right shoulder.
  No. 39.   Again putting the wand in front, on the floor, perpendicu-
lar,  with the  right  hand  seizing the upper extremity, and the arm
straight, step the right foot forward to the wand.   Bring it back to the
other foot.  Now step sideways to the right as far as you can reach.
Bring it back to the  other foot  again; now step backward as far as
yon can reach.   Bring it back to the other foot.   Still using the  right
foot, step sideways to the left as far as you can  reach, passing  it by-
the  left leg behind (Fig  16), now back to the other foot again.   Pass
it to the left again, in front of  the left leg (Fig. 17), and bring it back
to the other foot.   Continue this rqjind five times.
                 95 
754
PHYSICAL CULTURE.
  No. 40.  Same with the left arm and leg, five times.  In all this the
wand must not lose its perpendicularity.
  No. 41.  Stand upright, with the the heels together, seize'the wand
at its middle, with the right  hand, and  hold  the arm horizontal in
front — wand perpendicular.  Keeping the arm in the horizontal place,
whirl it round the body, making a complete circle, but do not stir the
feet.  Same with the left hand, ten times.
  No. 42.  Grasp the middle of the wand with both hands, and whirl
as in the last, as  far as you can, ten times.
  No. 43.  Same as the  last, except  the wand is  held  horizontal, in-
stead of perpendicular.
  No. 44.  Seizing the wand  as  seen in Fig. 18, step backward  and
forward over it with the right and left foot, ten times.
Figure 18.                             Figure 19.
  No. 45.  Stand upright, heels together, grasp the wand at the ex-
treme ends and hold it behind  the  body, keeping the arms straight
The right hand high up, and the left hand low down.   Now swing
the left hand high up, and the right low down, and  so  continue to
change the relative positions of the end of the wand, without bending
the elbow, ten times.
  No. 46.  Charge the right foot diagonally forward, as seen in Fig.
19, five times.  Now the left foot with the left hand raised high, five
times.   Alternate five times.
  No. 47.  Same as the last, except that when charging with the right
foot, you raise the left hand high, and vice versa.
  The wand  exercises from this point are performed in couples, and
while marching.
  No. 48.  Marching as represented in  Fig. 20, leap  sideways as far
as possible, first one foot, and  then the other, without  losing your
relation to each other.
  No. 49.  Putting the two wands together, and holding them as rep-
resented in Fig. 21, leap sideways as before, being sure  to keep the 
PHYSICAL CULTURE.                   755
shoulders back, and so leaping together, that the two will move as one
person. Be sure to keep the arms quite perpendicular over the shoulders.
Figure 20.                         Figure 21.
  No. 50.  One person walking directly behind the other, take hold of
the  extreme  ends of the wands, and then allow the hands to rest on
the shoulders.  Marching in this way, at the word of command, " Up,"
raise the wands as high as you can, and as the right foot goes forward
thrust the right hand as far forward as possible, the left one at the same
time being pushed as far back as possible (Fig. 22), and as the left foot
comes forward, reverse the hands. 
756                    PHYSICAL CULTURE.
  No. 51.  Same as the last, except the right hand goes forward with
the left foot, and the left hand with  the right foot.  In all these you
must not bend the elbows, except when you are told to bend them.
  No. 52.  Still keeping your arms  perpendicular, carry both of your
hands forward as far as you can reach with your right foot, and as you
step  your left foot forward, carry both hands as far back as  you can
reach, and thus continue for ten steps.
  No. 53.  Same as the last, except that the hands go forward with
the left foot, and backward when the right foot goes forward.
Figure 24.                             Figure 25.
     No. 54.   Bring the hands to the shoulders, and as  the right foot
   steps forward, raise the right hands as high as you can reach.  When
   the  left foot goes forward raise the left hands, and bring down the
I   right hands, and so continue to alternate ten times.
     No. 55.   Same as the last, except the right hands  go up as the left
'   feet go forward, and the left hands with the right feet
j     No. 56.   The two hands go up  simultaneously with the  stepping
   forward of the right feet, and come down as the left feet go forward.
     No. 57.   Same as the last, except the hands go up  as the left feet
   go forward, and down as the  right feet go forward.  Be sure in the
   last four exercises that the arms go up and down quite  vertically.
     No. 58.   Put the two wands together, and  take  hold of them with
   one hand, as represented in Fig. 23, and  marching side by side, leap
  .sidewavs right and left, keeping the wand as high as you can reach.
     No. 59.   Partners change sides and repeat the same. •
     No. 60.   Carrying the wand as in Fig. 23, as you step forward with
   the  ri^ht foot, bring the wand down so as to strike yonr right leg with
   the  hand, and then as your left foot goes forward, carry the wand back
   to its vertical position, and so  continue ten times. 
PHYSICAL CULTURE.                    757
  No. 61.   Change sides with your  partner, and do the same again,
only bringing your wand down as the left foot goes forward, and rais-
ing it as the right foot goes forward.
  No. 62.   Cross the hands on the two  wands  placed  side by side,
but instead of holding them over the  head, as  in  Fig. 21, let them
hang down in front, and carrying them  thus, leap from side to side.
  No. 63.   Walking one in front of the other, and extending the arms
horizontally, being careful not to bend the elbows, carry the right for-
ward as far as possible with the right foot, as represented  in Fig. 24,
and simultaneously with this, carry the left  foot backward as far  as
possible.   When  the left foot comes forward, let the left hand come
forward too, and thus alternate.
  No. 64.   Same as the last, except that the  right hand comes for-
ward with the left foot, and vice versa.
  No. 65.   The  same,  simultaneously with  the  right foot and with
the left foot.
  Be careful in the performance  of  the last four, that you  keep the
arms exactly horizontal from first to last.
  No. 66.   Walking one in front of  the other, with the wands  hang-
ing in  the hands  on either  side, carry one up  as  high as you can
reach, as  in Fig. 25, and then  as  the  other foot goes forward, carry
up the other while the first is brought down.
  jVo. 67.   Same as last, except the right arms goes up as the left
foot goes forward, and vice  versa.
  No. 68.   Simultaneously up, with the right foot forward, ten times,
and the same with the left foot.
  It is perhaps  unnecessary to repeat that every  motion  with the
wands  is  to be  done to music.   In making  the changes from one
exercise to another, this rule must not be forgotten.
  It must not be forgotten  that the  feet, in  every exercise, are  to  be
kept at right angles with each other.
                    Gymnastic  Crown.

  Bearing burthens on the head results in an erect spine and an elas-
tic  gait.   Observing persons who have visited Switzerland, Italy, or
the Gulf States,  have  observed a  thousand  verifications of  this
physiological law.
  Cognizant of the value of this feature of gymnastic training, I have
employed, for this  purpose, within the last twelve years, various sorts
of weights, but have recently invented an iron crown, which I think
completely satisfactory.  The accompanying cut gives a good idea of
its general form.  I have them made to weigh from three to one hun-
dred pounds.  The crown is so padded within, it rests pleasantly on
the entire top of the head, and yet so arranged that it requires skill
to balance' it  It is beautifully painted, and otherwise ornamented. 
758                    PHYSICAL CULTURE.
  The following  suggestions are important in wearing the crown :
Wear it five to fifteen minutes,  morning and evening  Hold the body
                             erect, hips and shoulders thrown far
                             back, and the crown rather on the front
                             of  the head, as  shown  in the  cut.
                               Walking up and down stairs while
                             wearing the crown is good, if the  low-
                             er extremities are not too much fa-
                             tigued by it.  When walking through
                             the hall or parlors, turn the toes,  first,
                             inward as far as possible ; second, out-
                             ward; third, walk  on  the tips of the
                             toes; fourth, on the heels; fifth on the
                             right heel and left toe ; sixth, on the left
                             heel and right toe ; seventh, walk with-
                             out  bending the  knees; eighth, bend
                             the  knees, so that you are  nearly sit-
                             ting on the heels while walking ; ninth,
                             walk with  the right leg bent at the
                              knee, rising at each step on the straight
 left leg ; tenth, walk with the left leg bent, rising at each step on the
 straight right leg.
 . With these ten different  modes of walking, the various muscles of
 the back will receive the most invigorating exercise.
   All persons, of both sexes and of every age, who have round should-
 ers or weak  backs, are rapidly improved by the use  of the gymnastic
 crown.
                  The  Pangymnastikon.

  The Germanic  nationality has been  redeemed from political and
social degredation by gymnastics.  I could mention  a score of emi-
nent German writers and patriots who  freely admit that the physical
invigoration of the German people, through the universal practice of
gymnastics, was the foundation of the  subsequent  moral revolution.
The soul  is so interwoven  with and dependent  upon  the  body,
that when the body is sick the soul must suffer with it  If the foun-
dation give way, the superstruction must soon fall ;  and while the ex-
istence of a good foundation does not necessitate a superstruction, the
latter cannot exist without the former.
  Gluttony, drunkenness, licentiousness, and  other vices  so  under-
mined  the  German constitution, that adventurers  and  tyrants  found
Germany an easy prey.    Gutsmuth, Jahn, Eiselen, Opiess, and their
fellow-workers  turned  back the tide of physical  degeneration  and
death.   Inspired with the noblest patriotic instincts, they gave their
lives to the introduction of gymnastics as an integral part of the na- 
PHYSICAL CULTURE.                   759
tional education.   They clearly saw in a physical redemption, the
foundation of a political redemption.  The great German heart turns
to-day toward these great gymnastic reformers as the salvation of
their noble nationality.
  It may be justly claimed that among all the great and good patriots
who have devoted themselves to this momentous task, the great Schre-
ber of Leipsic was the most eminent  He was a voluminous author,
and the most  remarkable of his productions was the Pangymnastikon.
He was in the habit of speaking of this invention and the book describ-
ing it as the most important of his contributions to the cause of physical
culture.
  That, work I have translated, and reproduced the  108 cuts complete.
The entire work with the cuts is published in my work known as the
" New Gymnastics," published by Ticknor &  Fields, Boston.
  I will here say, that whoever desires to put up, for home use, a
Pangymnastikon, after Schreber's design (and without doubt it  is the
best means for  home training ever devised),  can obtain  detailed de-
scriptions of this apparatus, by sending  a request to that effect to Dr.
Dio  Lewis, Box 12, Boston, with a stamp to pay the return postage.
With a complete illustrative cut, and' full descriptions in text, there
will be no difficulty in understanding the invention.
               School-Desks  and  Seats.

  A  radical change in school furniture is needed.   The seats and
desks now used compel an attitude which results in a stooping form.
           Figure 1.                               Figure 2.

The other day I stood an hour in the street and saw more than five
hundred persons pass, not one of which was erect.  Bending over the
 
760
PHYSICAL CULTURE.
desks in our  schools would  make lis crooked if we were  made  of
spring-steel.   The desk tops should be so arranged that it can  be
raised nearly to the perpendicular before the face of the pupil, and the
book held in such a position  which compels him to sit with head and
shoulders well drawn back.
  Fig. 1 exhibits a fruitful source of stooping shoulders.
  Fig. 2 shows a better desk and  the improved position of the  pupil.
  Fig. 3 is  a model desk.   The  top can be  raised to any desired
Figure 3.
Figure 4.
height, or let down to nearly the horizontal for writing exercises.   On
the desk top will be seen a bar which supports the book.   This can
be  moved at pleasure and  has a pair of fingers which will hold the
book in any position.
  Fig. 4 shows two support-bars, an  arrangement which must prove
most convenient to students of the  languages, and to those who  have
occasion to consult a dictionary while reading.  The seat is easily ad-
justed to any desired height.
  The new Book-holder, patented Dec. 9, 1862, is destined to play an
important part in the prevention of  the round-shoulder deformity, and
its  certainty to produce, erect forms will be seen upon an examination
of the cut.  It  may be used upon the ordinary desk, and is made to
hold one, two or three books  in  a much  better position than by the
desk.   It is exceedingly light and pretty.   The inclination can easily
be altered by raising the hook  attached to the strap.  The fingers, im-
perfectly shown, keep the  book open, and thus dispenses with the^use
of the hands.   There is no chance in its use to sit stooping without
bringing the face in direct contact with the book.  When we remem-
ber how many  years children  are engaged over their books, the great
importance of this invention will be appreciated.  It is cheap, and not
liable to get out of order.  Those wishing to procure  such a holder
can send to Dr. Warren, Boston. 
PHYSICAL CULTURE.                   761
 History  of  Gymnastics in the  United  States.

   I do not purpose a general history of the Physical Culture Move-
 ment in this country.  I shall speak  of only one feature.  I refer to
 the efforts to introduce physical education into young ladies' semi-
 naries.   A consciousness of its need was deeply felt.  Thoughtful ed-
 ucators  know that education meant a preparation for  the duties of   \
 life; and they saw the graduates  of these institutions,  pass from the   j
 school into hopeless invalidism, not in rare instances, but  as a rule.  As
 the phrase goes, their " education was finished," but  they too were   j
' finished.  Their spines were unable to support their learned heads.
   Anxious fathers and mothers  besought school  managers to give   I
 their daughters' bodies a chance  for life.   Willing to  respond, they «
 announced, " Physical culture receives, in  our  institution, careful at-
 tention," etc.  Generally they had no  conception of what was meant
 by physical culture,  and  of course accomplished nothing.  The girls
 under their  charge who  needed two  or three hours of daily  unre-
 strained, romping, laughing, and vigorous muscle training, were made to
 walk in solemn procession through the school grounds under a picket
 guard of maiden  ladies, on proper days,  and once or  twice a week   j
 they were conducted through a series of dull calisthenic arm-motions,
 under corsets and long dresses.  No wonder they " got through" with
 pale faces, drooping  shoulders, and ruined health.
   I hazzard nothing in saying that the physical training given in ninety-
 nine  hundredths  of  the  female seminaries in the country has no
 value.  How much benefit would  be derived from musical training in
 these same schools if they employed a person who had no comprehen-
 sion of  harmony ; or of  mathematics, who had never learned  the
 multiplication table; or of reading and spelling, who did not know the
 alphabet ?  Physical education must be placed  on  the same  basis as
 moral and intellectual training, and competent teachers employed;
 otherwise it  will  as  certainly fail as would the efforts to introduce
 pianno music, without a teacher who knew how the touch the keys so
 as to bring forth harmonious  sounds.
   Parents and teachers are beginning to understand this.  Patrons of
 schools now loudly demand that a three  years course they give their
 daughters shall  improve, shall  educate, instead  of spoil their bodies.
 A true change has begun.  The graduates  of the Normal Institute for
 Physical Education  are in eager demand.
   Only two  years ago, the principal  of one of the most celebrated
 ladies' seminaries in the country wrote me a letter, of which the follow-
 ing is an extract: "  I wish you would indicate the day  on which you
 can give me  an hour or two with the least inconvenience to yourself.
 I am determined to  introduce your entire system, and as I know noth-
 ing of it, you must give me a good lesson."   He thought it was a
 science which could be  learned  in  two  hours.   Two years have
 passed away, and the same  institution employs a lady teacher, thor-
                  96 
762                    PHYSICAL CULTURE.
oughly trained, from my school, at an expense of $650 per year.   Un-
der her management all the young ladies of the institution devote more
than an hour daily to thorough bodily training.  What is now wanted
is  ten thousand teachers.  Young  men and  women can  enter no pro-
fession more favorable, useful, and profitable.  Those who would pre-
pare for this important work, should come  to Boston,  either on  the
second of January or the fifth of July, and enter the Normal Institute
from which they can, with average capacity, graduate in ten weeks,
prepared to enter a noble and remunerative profession.
   I cannot close this brief consideration of the history  of our efforts to
introduce gymnastics into ladies' seminaries, without  alluding to one
or two successful attempts.
   Rev. George Gannett, Pemberton Square, Boston, has a first-class
seminary for young ladies.   He has recently added a  large hall to his
already extensive establishment, with almost sole reference to physi-
cal training;  and  he is pushing  the work with commendable zeal.
During more than  two years I have had charge of this  important de-
partment in Mr. Ganneti's institution, and  can say that his earnest-
ness is constantly increasing.
   The Maplewood Institute at Pittsfield, Mass., under the charge of
Rev. Mr. Spear, is carrying on the same work with energy.
   The fine private  school located at West Newton, Mass., under the
management of N. T. Allen, Esq., is thoroughly alive in this vital de-
partment  During more than  two years I  have had supervision of
physical education in Mr. Allen's school.
   Graduates  of the Normal School for  physical education are  en-
gaged in  many of the first young ladies'  seminary in the country.
"The friends of a true education have  occasion  to rejoice and take
courage. 
PRESCRIPTIONS.-RECIPES.
   These prescriptions are numbered, and referred to by corresponding
numbers in the treatment of the various diseases.  This arrangement
saves the trouble of  writing out each  prescription  every time it is
wanted under the several  disorders.   When there are several recipes,
each of which  is  suitable in a certain stage of a complaint, this plan
affords  the  means of  referring to them all in a little  space, by simply
giving their numbers.   The doses named are always for  grown per-
sons, unless it is otherwise stated.
   Great pains have  been taken  in preparing these prescriptions.   A
considerable portion of them are  the favorite recipes of the most dis-
tinguished physicians, the world over.
   The classification of these recipes under separate heads, is necessa-
rily very imperfect, and  has been attempted only to  make it more
easy for me to refer to them while writing the  book.   The classifica-
tion could only be applied to a part of them,  however; the rest  are
indiscriminately mixed.


                       Pukes.   Emetics.

   1.  Pulverized Ipecac, 1  scruple;  pulverized  cayenne, 10 grains; water, 2
ounces.  Mix.  To be taken at a draught.
   2.  Pulverized Lobelia, 1 oz.; pulv. blood root, \ oz.;  pulv. seneka, 1 scru-
ple ; pulv. ipecac,  6 drams; pulv. cayenne, 4 scruples.  Mix.   An excellent
emetic in all cases where one is required.   Dose. — One-half teaspoonful in
warm water, and repeat every fifteen minutes three or four times.
   3.  Wine of Antimony, 1 dram; wine of ipecac, 1 oz.   Mix.
   4.  Tartar Emetic, 1 grain;  pulverized ipecac, 1  scruple.  Mix.  To be
taken in a wine-glassful of sweetened water.

                     Purges.   Cathartics.

   5.  Precipitated Sulphur,  15  grains; magnesia, 1  scruple.  Mix.  To be
Jaken each night at bedtime, for costiveness and Bleeding piles.
   6.  Confection of Senna,  2  ozs.;  cream of tartar, 1  oz.; sulphur, 1 oz.;
syrup  of ginger  enough to make a stiff paste.  Mix.  A piece as large as a
nutmeg is to be taken as often as necessary to keep the bowels open.  One ot
the very best remedies for piles. 
764                   PRESCRIPTIONS. — RECIPES.
   7. Rochelle  Salts, 2  drams;  bi-carbonate of  soda, 2  scruples ;  water, \
pint.  Mix.  To this mixture  add 35 grains of  tartaric  acid, and take the
whole foaming.   This is the recipe for  Seidlitz powders.
   8. Calcined Magnesia,  1 dram; water,  2 ozs.  Mix.   To be  taken at a
draught.
   9. Sulphate  of Magnesia, (epsom salts), 2 drams; freshly roasted  coffee
in coarse powder, 2 ,-cruples; hot water, 4 ozs. Mix and toil for three minutes,
and strain.  This may be sweetened, and taken every morning for habitual cos-
tiveness, or repeated once in three hours, if an immediate effect is desired.
   10.   Castor Oil, 1 oz.;  the yolk of one  egg; put together, and add, simple
syrup, £ oz.; peppermint water, 2 ozs.  Mix.  To be taken at a draught, after
being well stirred or shaken.
   11.   Sulphur, 1 dram; cream of tartar,  2 drams.  Mix.  To be taken in
syrup or molasses.
   12.   Rhubarb, 10  grains ; calcined magnesia, \ dram.   Mix.  To be taken
in syrup or molasses.
   13.   Powdered Senna, % dram ; powdered jalap, 10 grains; powdered cloves,
10 grains; Mix.  To be taken in sweetened water.
   14.   Powdered Jalap, 10 grains;  cream  of tartar, 2 drams.  Mix.  To be
taken in syrup or molasses.
   15.   Fluid Extract of Senna and Jalap, 2  drams;  infusion of  cloves, 2
ozs.  Mix.  To be taken at a draught.
   16.   Castor  Oil,  1 dessert spoonful; oil of turpentine, 1 dessert spoonful.
Mix.
   17.   Castor  Oil,  1 dessert spoonful; magnesia,  1 dessert  spoonful.   Rub
together into a paste.  By this combination, the taste of the oil is almost en-
tirely concealed, and children will take it without opposition.
   18.   Sulphate   of Magnesia, 1 oz.; cream of tartar,  1 oz.;  pure water,
1 pint.   Mix.   A  wine-glassful occasionally.
   19.   Compound Extract  of  Colocynth, \ dram; blue pill, 8 grains.    Mix,
and divide into 8 pills.
   20.   Epsom Salts, 2  ozs.; tartar emetic, 1 grain; spearmint water,  1 pint.
Mix.
   21.   Senna,   3  drams ; salts, £ dram ; manna, \ dram ; fennel seed, 1 dram;
boiling  water, £  pint.  Macerate for  one hour in  a covered vessel, and strain.
Take a teacupful once in four hours, till it operates.
   22.   Aloes,  2 scruples ; carbonate of potassa, 15 grains ; decoction  of barley,
I pint.   Mix, and rub together.
   23.   Sulphur,   1  teaspoonful;  cream of tartar, 10 grains; saltpetre, 5 grains.
Mix.  To be taken at a dose.
   24.   Manna,  2 drams;  fennel water, 1  oz.  Mix.  One dessert spoonful,'
as a cathartic for an infant.
   25.    Compound Infusion of Senna, 4 ozs.; caraway water, 2 ozs.; tartrate
of potassa, 2 drams; manna, 1  dram.   Mix.  A tablespoonful for a child, to
relieve costiveness.
   26.    Calcined Magnesia, 1 scruple;  pulverized rhubarb, 1 scruple; pulver-
ized ipecac, 1 grain.   Mix.  Give one-fourth of this daily. 
PRESCRIPTIONS. — RECIPES.                   765
     27.  Epsom  Salts, 2 drams ;  dissolve in pure water, 1 oz.  Then add sweet
   spirits of nitre,  2 drams ; laudanum, 10 drops.   Dose. — A teaspoonful, to be
   repeated according to circumstances.
     28.  Pulverized  Rhubarb, 1 scruple ; leptandrin, 10 grs.; calcined magnesia,
   2 scruples ; pulverized cinnamon, 10 grains.  Mix.  Three or four grains every
   third hour, to a  child of six months.

     29.  Compound  Extract of Colocynth, \ dram ;  extract of jalap, 15 grains.
   Mix.  Make 12 pills.   Two or three pills will  produce active operation of the
   bowels.

     30.  Pulverized  Senna, 2  drams ;  bicarbonate  of potassa, 2  ozs.;  pulver-
1   ized  cayenne, 10 grains; pulverized jalap,  1  dram.   Mix.  Divide into  12
   parts.  One part for an adult every four hours till it operates.

     31.  Pulverized   Gamboge, 12  grs.; pulv. scammony, 12 grs.; elaterium, 2
   grs.; croton oil, 8  drops; ext.  of stramonium,  3 grs.   Mix.  Make  12  pills.
   One pill is a dose, repeated every hour until it operates.

     32.  Pulverized Scammony, 12 grs.; pulv. gamboge, 12 grs.; pulv. colocynth,
   8 grs.; castile soap,  4 grs.; oil of anise, 5 drops.  Mix.  Make 12  pills.  One
   pill, repeated every  three hours till it operates.

     33.  Pulverized  Scammony, 6 grs.;  croton oil, 4 drops ;  pulv.  loaf sugar, 16
   teaspoonfuls.  Rub  well  together  in a mortar.  Give  one teaspoonful every
   hour or two, to a child 7 years old, till it operates.

     34.  Leptandrin, 1  dram; podophylfin, 1 scruple;  scutillarine, 2 drams;
   pulv. cayenne, 1 scruple ; pulv. loaf sugar,  4 ozs.   Rub together  for some time
   in a mortar.  Dose  for an adult, ^ of the above.

     35.  Pulverized Rhubarb, 2 scruples ; bicarbonate of potassa, 1 scruple ; ext.
   of nux vomica,  5 grs.   Mix.  Make 20 pills.   One pill twice a day.

     36.  Leptandrin, 1  dram;  podophylfin, 1  scruple; apocynin, 1  scruple;
   ext. nux vomica, 6 grs.; castile soap, 1 dram.   Make 30 pills.  One pill every
   night.

     37.  Sweet Tinct. of Rhubarb, 4 ozs.; bicarbonate of soda, 2  drams.  Mix.
   From a teaspoonful  to a tablespoonful, as occasion may require.

     38.  Pulverized  Rhubarb,  2  ozs.; bicarbonate of potassa, 1 oz.  Mix.  Of
   this take enough to  produce one movement of the bowels per day.

     39.  Leptandrin, 30 grs.;  podophyllin, 10 grs.;  pulv. cayenne, 10 grs.; ext.
   nux vomica, 6  grs.; quinine, 12 grs.   Mix.   Make 24 pills.   One, two, or
   three times a day.

     40.  Podophyllin, 15 grs.; leptandrin, 2 scruples; cream of tartar, 5  scru-
   ples.  Mix.   Divide into 10 powders.   One is  a dose.

     41.   Comp. Powder of Jalap, 1 oz.;  cream of tartar, 1 oz.  Mix.   One tea-
   spoonful is a dose, to be taken in sweetened water.
     42.   Pulverized   Charcoal, 1£ drams; pulverized rhubarb, 2  scruples; pul-
   verized ipecac,  6 grains;  extract  of hyoscyamus, 12 grs.  Mix.   Divide into
   12 portions.   Give  one every three or  four hours.
     43.   Pulverized  Blood-root, 1 dram  ; pulv. rhubarb, 1 dram;  castile soap, 2
   scruples.   Mix, and divide into 32 pills.  Take one morning and night.  Ex-
   cellent for costiveness. 
/66                   PRESCRIPTIONS. —RECIPES.
   44.  Rochelle, 14 drams ;' magnesia, 11 drams; powdered charcoal, 8 drams.
 Mix.  Dose.—A heaping teaspoonful in dyspepsia and  costiveness, with foul
 breath, etc.

   45.  Pulverized Rhubarb, 8 grs.; pulv. guaiacum, 8 grs.; galbanum, 2 grs.;
 pulv. ipecac,  2  grs.  Mix.   Make 8  pills.   Take one to two pills night and
 morning.  For a weak stomach, and a bilious condition.


                       Tonic  and  Cathartic.

   46.  Podophyllin,  4 grs.; leptandrin, 8 grs.;  quinine, 8 grs.; ext. nux vom-
 ica, 2 grs.  Mix.  Make 16 pills.  One, two, or three pills, at bed time, accord-
 ing to the requirements of the case.
   47.  Sulphate of Iron, 1 scruple;  pulverized  aloes, 2 scruples.  Mix, and
 make into 20 pills.  One pill twice a day.   An excellent remedy, in chlorosis,
 when the bowels are confined.
   48.  Carbonate  of Iron, 1  dram; pulverized rhubarb, ^ dram;  pulver-
 ized aloes, £ dram; extract of hops, \ dram.  Mix. Make 30 pills.  One pill
 three times a day.
   49.  Fluid Extract of Senna, 1 dram;  compound  fluid extract of gentian,
 ■^ dram ;  fluid extract of  ginger, -^ dram ; aromatic spirits of ammonia, £ dram.
 Mix.  To be taken in a wine-glassful  of sweetened water.
   50.  Aromatic Syrup  of Rhubarb, 1 oz.; tincture of Colombo, 1  oz.  Mix.
 Dose. — Two teaspponfuls three times a day.
   51.  Compound Infusion of Gentian, 6 ozs.; epsom salts, 4 drams;  diluted
 sulphuric acid, 16 drops.  Mix.   A table spoonful every six hours.
   52.  Blue  Pill, 10 grs.; pulv. gum  arabic, 5  grs.;  magnesia, 1  dram;
 white sugar,  5  grs.; comp.  infusion of gentian, 1£ ozs.;  water, IJ ozs.; tinct.
 of ginger, IJ ozs.  Mix.   From a teaspoonful to a tablespoonful to be taken
 night and morning.
   53.  Pulverized Peruvian Bark, 1  oz.; pulv. rhubarb, \ dram ; pulv. muri-
 ate of ammonia, 1 dram.  Mix.   Divide into eight powders.  Take one three
 times a day.
   54.  Oxide of Zinc, 2 drams; magnes., £  oz.; quinine, 1 scruple.  Mix.
 Divide into 32 powders.  Take one four times a day.
   55.  Aloes, 1 oz.;  gentian, 1 oz.; orange peel,  1 oz.; juniper berries, 1 oz.;
 aniseed, bruised, 1 oz.; gin, 1 pint.  Mix.   Macerate two weeks, and strain.
 Dose. — A tablespoonful.   Good for bilious habits.


                       Carminative  Physic.

   56.  Manna,  1 oz.; aniseed, bruised, 1 dram;  boiling  water, J pint.  Mix.
 Let the mixture stand for half an hour, then strain, and add three drams of
 carbonate of magnesia so as to  make a perfect mixture.  Take a  wine-glass
 full every two or three hours, till it operates.  For the drum-head state of the
 bowels.
   57.   Thoroughwort,  2  ozs.;  ginger and cloves, each, £ oz.; ext. dandelion,
 4 ozs.; water, l£ pints.  Boil to  one-third, and  add sugar,  1£ pounds, and
• brandy, \ pint.  An excellent cordial cathartic to act upon the liver. 
 PRESCRIPTIONS. —RECIPES.                    767
___^___________-----------------------*
                                Tonics.

   58.   Chamomile Flowers, £ oz.; cold water, 1 pint.  Macerate for one hour
and strain.  A wine-glassful to be taken several times a day.
  •59.   Sulphate of  Quinine, 15  grains;  diluted  sulphuric acid, 15 drops;
compound tincture of cardam., 3 drams ; tincture of  hops, 3 drams ; compound,
infusion of roses, 6  ozs.  Mix.   A teaspoonful two or three times a day, in
chlorosis.
   60.   Diluted Sulphuric Acid, 2 drams ; syrup of  orange peel, 2  ozs.; cinna-
mon water, 1 oz.  Mix.  A  teaspoonful or two in  a wine-glass of water two
or three times a day.
   61.   Carbonate of Iron, 1 dram; extract of gentian, 1 dram.  Mix.  Make
30 pills.  One pill two or three times a day.
   62.   Sulphate of Quinine, 12 grains; aromatic  sulphuric acid, 24 drops;
syrup, 1 oz.; peppennint water, 1 oz.  Mix.   In intermittent fever, take one
tablespoonful once in three hours.   Ordinarily, one teaspoonful is a sufficient
dose.
   63.   Compound Infusion  of  Gentian, 8 ozs.; nitro-muriatic acid, 30 drops.
Mi*.  Take one tablespoonful three times a day.

   64.   Bicarbonate  of Soda, £ oz.; compound  infusion of gentian,  4 ozs.;
tincture of Colombo, 1 oz.;  syrup of orange peel, £ oz.  Mix.   Take a table-
spoonful three times  a day.
   65.   Sulphate of  Quinine, 1 scruple ; alcohol,  4 ozs.;  sulphuric acid, 5
drops;  Madeira wine, 1 quart.  Mix.  Two wine-glassfuls a day.

   66.   Rasped Quassia, 2 drams ; cold water,  1 pint.   Macerate twelve hours,
and strain.
   67.   Quinine, 1 scruple; alcohol, 4 ozs.;   sulphuric acid, 5 drops.   Mix.
Take a teaspoonful three times a day.
   68.   Arseniate of Iron, 3 grains; extract  of gentian, 2 drams;  pulver-
ized liquorice, 1 dram.   Mix.   Make 20 pills.  Take  one pill three times a
day.  If the  eye-fids become inflamed,  discontinue for a few  days, and then
begin again.
   69.   Soft Water, 3 ozs.; quinine, 10 grains ;  diluted sulphuric acid, 10 drops;
simple syrup, 1 oz.   Mix.   A teaspoonful every two or three hours.
  70.   Quinine, 10 grains; diluted  sulphuric acid, 10  drops; white  sugar,
4 drams ;  cinnamon water, 4 ozs.; tincture of kino,  2 drams.  Mix.  One tea-
spoonful every three hours.
  71.   Tartrate of Iron, 40 grains ;  soft water, 2 ozs.; syrup of ginger, £ oz.
Mix.   20 to 40 drops every three hours.
  72.   Potassio-tart. Iron, 4  scruples ;  quinine, 4  scruples ;  alcoholic ext. of
black cohosh, 4 scruples.  Mix.   Make 48 pills.
  73.  Rose  Water,  6  ozs.; syrup of  orange  peel, 1  oz.; muriated  tinct. of
iron, 1  oz.   Mix.   For an adult, one teaspoonful in a wine-glass ol water
after each meal.
  74.  Precipitated  Carbonate  of Iron, 30 drams j  ext. of conium, 15 drams j 
768                  PRESCRIPTIONS. — RECIPES.
»----------______________________________:____________________________,
syrup of balsam  of Tolu, 6 ozs.; oil of cinnamon, 12 drops ;  oil of lemon, 12
drops ; alcohol, 2 ozs.; water, 1 pint; brandy, \ pint; loaf sugar, 4 ozs.   Mix.
Give from one to three tablespoonfuls three or four times a day, in insanity.

  75.   Citrate of Iron, 1 dram ; sulphate of  quinine, 1 scruple ; ext. of nux
vomica, 8 grs.  Mix.   Make 32 pills.  One pill three times a day.

  76.  Nitric Acid, I dram;  hydrochloric acid, £ dram; com p. infusion of
gentian, 1 \ ozs.   Mix.  One teaspoonful in water is a dose.

  77.  Sulph.  Quinine,  1  dram; tartaric acid, 6  grs.; water, 1 drop.   Mix.
Make 30 pills.   Dose. — One pill, to be repeated as often as needed.

  78.  Diluted Nitric Acid, 4 drams; diluted muriatic acid, 4 drams;  syrup
of orange peel,  1 dram; water,  1 \ ozs.   Mix.  One teaspoonful in a wine-
glass of water, taken before meals.


                  General  and  Nerve  Tonics.

  79.   Valerianate of Quinine, \ dram; ext. of  black cohosh, 1 dram; ext
of ladies slipper, 2 drams.   Mix.   Make 60 pills.   Take one pill, every one,
two, three, or four hours, according to the urgency of the case.
  80.  Iron  by  Hydrogen,  24 grs.;  sulphate of morphia, 1 gr.; ext. of nux
vomica, 5 grs.  Mix.  Make 24 pills.   For an adult, one pill three times a day.
  81.  Ext. of Scullcap, 2 drams ; ext. of chamomile, 2 drams ; ext. of boneset,
1 dram; quinine, 1 dram;  pulv. cayenne, 1 scruple; oil of valerian, £  dram.
Beat well together and make  90 pills.   For  an adult, one pill every two or
three hours.
  82.   White  Vitriol, 1 dram; ext.  of nux vomica, 8 grs.  Mix.   Make  32
pills.  One pill three times a day.          »
  83.   Strychnia, 2 grs.; ext. of aconite, 16 grs.; ext. of hyoscyamus, 16 grs.;
quinine, £ dram.   Mix.  Make 32 pills.   One pill three times  a day.
  84.   Citrate of Iron, 1 dram ; trisnitrate of bismuth, 1 dram ; sulphate of
quinia,  1  scruple;  ext. of nux vomica, 6 grs.  Mix.   Make  32 pills.  Take
one pill three times a day.

            Nerve   Tonics and  Antispasmodics.

  85.  Strychnine, 2  grs.; ext. belladonna, 5  grs.; alcoholic  extract of black
cohosh, 2 scruples.  Mix.   Make 40 pills.  One pill four times a day.
  86.  Strychnine,  2  grs.; diluted  phosphoric acid, 1  oz.; peppermint  water,
3 pints.  Dissolve the strychnine in the acid ; then add the peppermint  water.
A tablespoonful to be taken  three times a day, in palsy, dyspepsia,  neuralgia,
and  in most  states of the nervous system requiring tone.  Also in  fever and
ague.
  87.  High  Cranberry Bark, 1 oz.;  skunk cabbage root,  £ oz.;  scullcap,
£ oz.;  cardamom seeds, 2 drams ; pulv. cayenne, 2 drams.   Put these to a pint
of wine, shake well every day  for three  or four days.  A tablespoonful four
times a day.
  88.  Distilled  Water, 2 ozs.; valerianic acid, 1  oz.; subcarbonate of am-
monia enough  to  neutralize the  acid;  then add  alcoholic  ext. of valerian, 2
scruples.  A teaspoonful three times a day.  For Neuralgia. 
PRESCRIPTIONS. — RECIPES.
769
    89.  Ext.  of Valerian,  12 grs.; ext. of hyoscyamus,  12 grs.;  oxide of
  zinc, 21 grs.  Mix.  Make 12 pills.  One pill twice a day.
    90.  Sulphate of Morphia, 2 grs.;  cyanide of potassium, 4 grs.; ext. of
  valerian, 4 grs.   Make 24 pills.  One pill three times a day.

    91.  Ext. of Hyoscyamus, \ dram;  sulphate of morphia, 3  grs.; strych-
  nine, 2 grs.; pulv.  cayenne, £ dram ; sulphate of zinc, 15 grs.  Make 30 pills.
  Take one four times a day.   Excellent in'neuralgia.

    92.  Ext. of Hyoscyamus,  \ dram;  valerianate of zinc, 1 scruple.  Mix.
  Make 30 pills.  Take one, two or three times a day, for neuralgia of the  face.
    93.  Ext. of  Hyoscyamus,  \  dram; valerianate  of iron, 1  dram.  Mix.
  Make 30 pills.  Give from one to three a day.  For neuralgia, in its various
  forms.

    94. Tinct. of Black  Cohosh, 2  ozs.; tinct. of scullcap, 2 ozs.  Mix.   One
  teaspoonful from two to five times a day.

    95.  Alcoholic Ext. of St.  Ignatius's Bean, 30 grs.; pulv. gum arabic,  10
  grs.  Make into 40 pills.   Take one pill three times a day.
    96. Simple Syrup, 1 oz.;  prussic acid, 1 drop.  Mix.  A teaspoonful morn-
  ing and evening.   If no  dizziness  or sickness is produced within forty-eight
  hours, repeat the  dose three times a day.   This  is  for a child six months
  old; add  one drop more of the acid for each additional year of the child's age.
    97.  Comp. Pitt of Galbanum,  1  dram ; comp. pill of valerian, 1 dram. Mix.
  Divide into 40 pills.  One or two pills three times a day.
    98.  Sidphate  of  Zinc,  1  dram;  comp.  galbanum pill, \ dram;  ext.  of
  hyoscyamus, 1 scruple.  Mix.  Make 32  pills.   One  pill  three times a day.
  For St. Vitus's dance.

    99. Dioscorein,   12 grs.;  pulv. camphor, 4 grs.;  pulv.  cayenne,  12 grs.;
 white sugar, 1 scruple.  Mix.   Divide into four powders.  Give one every  15
 minutes.

   100.  Ext.  of High  Cranberry  Bark, 1  scruple; cypripedin, 1  scruple;
 aletridin,  1 scruple; pulv. cayenne, 1 scruple.  Mix.  Make 20 pills.   Take
 one pill an hour after each meal.


                    Alteratives   and  Tonics.

   101.  Iodide of Potassium, 1 oz.; compound infusion of gentian, or infusion
 of quassia, 6 ozs.   Dose. — A tablespoonful,  for secondary and tertiary syphi-
 lis, and other complaints.  A teaspoonful for a child.
   102.  Iodide of Iron, \ dram ; compound  tincture  of Colombo, 1 oz.;  pure
 water, 7 ozs.   Mix.  A tablespoonful three times a day.
   103.  Syrup of Iodide  of Iron, 1 oz.  Thirty drops three  times a day, in
 water.   An excellent remedy in chlorosis, and all other low states of the blood
 connected with scrofula.


        Expectorants  and Cough Preparations.

  104.  Tartar Emetic, 1 grain ; boiling  water, 10 drams.  Mix.  Take one
teaspoonful every two hours.
                    97 
770                  PRESCRIPTIONS — RECIPES
  105.  Infusion of Senega, 4 ozs.; syrup of ipecac, 1 dram ; syrup of squills,
3 drams ;  tartar emetic, l£ grains.   Mix.  A teaspoonful every ten minutes.
  106.  Tincture  of Lobelia, £ oz.; syrup  of squills, £ oz.   Mix.   Twenty
drops four or five times a day for a child two years old.
  107.  Peppermint Water, 6 ozs.; epsom salts, 1 oz.; tartar emetic, 1 grain,
Mix.   Two tablespoonfuls every four hours.
  108.  Hydrocyanic Acid, 25 drops;  wine  of ipecac, 2 drams; syrup of
tolu, 1 oz.; soft water, 3  ozs.  Mix.  A teaspoonful  four or five times a day.
An excellent remedy in hooping cough.
  109.  Tinct. Blood-root, 1  oz.; laudanum,  2 drams ; wine of ipecac, 4 drams;
syrup of tolu, 2 ozs.   Mix.   Dose from 30 to 60 drops four times a day.
  110.  Tinct. Blood-root, 1 oz.;  sulphate  of morphia, 1£ grains; tinct.  digi-
talis, £ oz.; wine of antimony, \ oz.; oil  of wintergreen, 10 drops.  Mix.  Dose
from  20 to 40 drops twice  or three  times a  dav.  Excellent for a hard, dry
cough.
  111.  Tinct. of Lobelia, \ oz.;  tinct. of blood-root, 2 ozs.;  oil of spearmint,
\ dram; molasses, 5 ozs.  Take one-half a teaspoonful as often as needed.
  112.  Syrup of Tolu,  1 oz.; syrup of squills, \ oz.; wine of ipecac, 2  drs.;
paragoric, 3 drs.; mucilage of gum arabic, 1£ ozs.  Mix.  Take a teaspoonful
occasionally.
  113.  Tinct. Blood Root, 2 drams ;  syrup of tolu, 1 oz.;  mucilage of gum
arabic, 3 ozs.; diluted hydrocyanic acid, 40  drops ; sulphate of morphia, 2 grs.
Mix.  Dose, from one to two teaspoonfuls.

                            Carminatives.

   114. Bruised  Cloves,  2  drams;  boiling  water, 1  pint. Macerate for two
hours  in a covered vessel, and strain.  A wine-glassful to be taken occasion-
ally.
   115.  Comp. Tinct. of Cardamom, 2 ozs.; comp. tinct. of lavender, 2  ozs.;
comp. tinct. of gentian, 2  ozs.  Mix.  One  teaspoonful at a  time, as  occasion
may require.

                   Narcotics  and  Anodynes.

   116. Extract of Hyoscyamus, 1 scruple;  gum camphor, 1  scruple; Dover's
powder, 1  scruple.  Mix, and make into 20 pills.   Dose. — One twice a day,
for painful menstruation.
   117. Powdered Camphor, 12  grains; powdered  castile soap, 12 grains;
powdered  opium,  12 grains; syrup,  2  scruples.  Mix.  Make into  12  pills.
Take one every hour till the effects of opium are experienced.
   118. Laudanum, \ oz.;  wine of ipecac, £ oz.; spirits of nitric aether,  £ oz.
Mix.  One teaspoonful every hour, till narcotic effects are observed.
   119.  Camphor, 2 drams; chloroform, 1 dram ; the yolk of an egg.   Mix,
and rub together; and  then  add, tincture of opium, 1 oz.; aromatic spirits of
ammonia, 1 oz. Mix well.   Take one  teaspoonful every hour until it proves
anodyne.
   120.  Camphor, \ dram;  extract of opium, 6 grains; mucilage of gum
arabic, 2 scruples.   Make 10 pills. 
PRESCRIPTIONS. —RECIPES.                  771
   121.   Chloroform, 2 ounces; compound sulphuric ether, 2 ozs.; laudanum,
 2 ozs.;  tinct. cayenne,  1£ ozs.; hydrocyanic acid, diluted, £ oz.   Mix.  Dose.
 — Half a teaspoonful every three hours till anodyne effects are experienced.

   122.   Ext. of  Belladonna, 10  grs.;  hydrocyanic  acid, 40  drops; tinct.
 Colombo, 1 oz.; simple syrup, 1 oz.; soft water, 2 ozs.  Mix.  One teaspoonful
 three or four times a  day.   Excellent in gastralgia and irritable  dyspepsia.
 Also in asthma.
   123.   Ext. of Belladonna^ grs.; pulv. ipecac, 10 grs.; confection of roses,
 2 grs.   Mix.  Make 30 pills.  Take 1 pill twice a day.

                Diaphoretics  and  Sedatives.

   124.   Tinct. of American  Hellebore,  1 dram ; tinct. of black cohosh, 2 ozs.
 Mix.  Take  one  teaspoonful from three to  six times a day.  Excellent for
 Neuralgia.
   125.   Pulverized Gum  Arabic, 1 scruple ; soft water, 2 ozs.;  sweet spirits of
 nitre, \ oz.; tinct. of veratrum viride, 20 drops.  Mix.   Give half a teaspoon-
 ful every half hour.
   126.   Pulv. Blood-root, 2 drams; pulv. golden seal,  2 drams; pulv. sumach
 berries, 2 drams ;  pulv. bayberry bark, 2 drams.  Mix.  Make an infusion in
 a pint of hot water, and give a tablespoonful every half hour.   To  produce
 perspiration.           •
   127.   Pulverized Camphor, 2 grs., pulv. nitrate of potash, 2 grs.; pulv.
 opium,  1 gr.   Mix.  Make  two powders.  Take one on  going to bed, in
 rheumatism.

                             Diuretics.

   128.   Tincture  of Digitalis,  1  oz.;  syrup  of squills, 1 oz.  Mix.  Ten
 drops for a child 7 years old every four hours.

   129.   Nitrate of Potassa,  2 scruples; water, 1 quart.   Mix.   Flavor to
 suit

   130.   Infusion  of Digitalis, 4 ozs.; acetate of potash, 2 drams; sweet
 spirits of nitre, 2  drams ; cinnamon water, 1^ ozs.  Mix.  A tablespoonful
 every four or five  hours.

   131.   Spirits of Mindererus, 2  ozs.; sweet spirits of nitre,  1  oz.  Mix.
 Take one teaspoonful every three hours.

                           Refrigerants.

   132.   Cream  of Tartar, 2 scruples;  water,  1 quart.   Mix.   Flavor to
 suit.
   133.   Bicarbonate of  Soda, 30  grains; water, 6 ozs.  Mix.   To this mix-
 ture add 25 grains of tartaric acid, and take the whole foaming.

                            Stimulants.

   134.   Muriate  of Ammonia, 1 oz.;  soft water, 9  ozs.   Mix.   Take one
table spoonful three or four times a day. 
772                  PRESCRIPTIONS. —RECIPES.
  135.  Aromatic Spirits of Ammonia, 2 drams ;  ether, 1 dram; laudanum,
20 drops;  spirits of camphor, 1 dram.  Mix.   Half a teaspoonful as often as
required.

                            Alteratives.

  136.  Proto-iodide of Jfercury, 10 grains ; extract of opium, 5 grains.  Mix.
Make 20 pills.   Take one pill night and morning.
  137.  Biniodide of Mercury, 5 grains ;  extract of conium, 2 scruples.  Mix.
Make 20 pills.   Take one pill night and morning.
  138.   Compound Infusion of Sarsaparilla, 1 pint;  iodide  of potassium,
\ oz.   Mix.  Take a teaspoonful after each meal.
  139.   Compound Infusion of Sarsaparilla, 1  pint;  corrosive sublimate,
4 grains.  Mix.  Take a teaspoonful  four times a day.
  140.   Compound Infusion of Gentian, 4  ozs.; iodide of potassium,  \ oz.
Mix.   One teaspoonful after each meal.
  141.  Iodide  of Arsenic,  5  grains; soft water, 1 pint.   Mix.  One tea-
spoonful three times a day.
  142.  Blue Pill, 12 grains; pulverized ipecac,  3  grains; extract of  hyos-
cyamus, 4  grains.  Mix.  Divide into  12 parts, one  to be given  every  three
hours.
  143.  Pulverized Blood  Root, 1  scruple;  iodide  of arsenic,  2  grs.; ex-
tract of cicuta,  2 scruples.   Mix.    Make 40  pills.   One pill three times a
day.
  144.   Iodide  of Potassium,  1 dram;  water, -| oz.   Mix.  Thirty  drops
to a child 7 years old, every hour.
  145.   Comp.  Syrup of Stillingia, 1 pint; iodide of potassium,  1 oz.  Mix.
A tablespoonful after each meal.
  146.  Fluid  Ext. of  Sarsaparilla, 4 ozs.;  fluid ext. of pipsissewa, 1 oz.;
water, 1 quart;  iodide of potassium, 2 ozs.  Mix.   Take a tablespoonful three
times a day.
  147.  Bicarbonate  of Potassa, 3 drams ; water, 4 ozs.  Mix.   Add a  table-
spoonful of the solution to the same quantity of lemon juice, previously mixed
with a tablespoonful of water.  To be taken foaming, several times a day.
  148.  Blue Pill, ^ dram; extract  of henbane,  1 scruple.  Make 10 pills.
One pill at night.
  149.  Mercury with Chalk, 1  dram; extract of conium, 1 scruple.   Make
into 8 pills.  Take one pill night and morning.
  150.   Corrosive  Sublimate, 4  grains ;  extract opium, 5 grains.  Mix, and
make into 20 pills.  Take one pill night and morning.
  151.   Iodide  of Potassium,  1 dram;  syrup of  sarsaparilla,  4 ozs.  Mix.
Take two teaspoonfuls three times a day.

                            Astringents.

  152.   Sugar of Lead, 2 scruples ;  opium, 1  scruple ; conserve of red  roses,
1 scruple.  Beat into a mass, which is to be divided into  30 pills.  Take one
every hour, until narcotic effects are observed. 
PRESCRIPTIONS. — RECIPES.
773
    153.  Dover's Powder, \ dram ; prepared chalk, 1 scruple.   Mix, and divide
  into 12 equal powders.
    154.  Chalk  Mixture, 4 ozs.; tinct. of catechu, \ oz.;  laudanum, 1 dram.
  Mix.  Dose, in  diarrhoea, two to four teaspoonfuls three times a day.

    155.  Oil of Turpentine, 1 dram; mucilage of gum arabic, 1 dram ; simple
  syrup, \ oz.; cinnamon water, 2 ozs.  Mix.   To be taken at a draught.

    156.  Sugar of Lead,  16 grains; prepared chalk, 1 dram;  pulverized ipecac,
  4 grains; pulverized  opium,  2 grains.  Mix.   Divide into  1 o portions, one to
  be given every three or four hours.

    157.  Sugar  of Lead, 8 grains ;  vinegar, 8  drops;  white sugar, 1 dram;
  soft water, 1 oz.   Mix.   A teaspoonful three or four times a day, until the dis-
  charges are abated.

    158.  Prepared Chalk, | dram ; pulverized ipecac, 3 grains.  Mix.   Make
  12 powders.  Give one, two or three times a day.

    159.  Pidverized  Catechu, 2  drams;  bruised cinnamon,  ^ dram;  boiling
  water, 5 ozs.  Steep in a covered vessel for one hour, and strain.  A teaspoonful
  every two, three, or four hours, according to age, nature of the case, etc.

    160.  Soft  Water, 1 oz.; sugar of lead, 5  grains;  vinegar, 6  drops; loaf
  sugar, 3 drams.  Mix.  A teaspoonful every hour or two.

    161.   Tinct. of Catechu, \ oz.; laudanum, 2  drs.; spirits of camphor, 2 drs.;
  tinct.  of myrrhaj, 2  drs.; tinct. of cayenne, 2  drs.   Mix.  Dose,  from half a
  teaspoonful to a teaspoonful, for diarrhoea.

  \ 162.  Syrup of Orange  Peel,  1  oz.; acetate of morphia, 2 grs.; tinct.  of
  cmnamon, 6  drs.; tinct. cardamom, 2 drs.   Mix. Dose. — A teaspoonful.  A-
  valuable remedy in diarrhoea.


                         Counter-irritants.

   163.  Tincture of Spanish Flies,  1 oz.; olive oil, 2 ozs.; alcohol, £ pint.
 Mix.   To be applied externally, watching the effect, so as not to produce a
 blister.

   164.  Water of Ammonia, 1 dram; olive oil, 1 oz.   Mix.   Apply to the skin.

   165.   Mustard^ Powder, 1 tablespoonful.   Mix with a little  water to make
 a thick paste.   Then spread  upon  a piece of brown paper or  cotton cloth,
 and cover its surface with a piece of thin muslin to prevent  the mustard from
 stickmg to the flesh.   Place  it  upon the sore or painful part, and keep it on
 fifteen or twenty minutes,  or till a good degree of redness is produced.

   166.   Vinegar of Spanish  Flies,  1 oz.; spirits of camphor, 1 oz.   Mix.
 To be rubbed gently upon the  skin.   If applied freely, and rubbed thoroughly
 in, it may produce a blister.
   167.   Yellow Wax, Rosin, Lard, each, 6 drams.  Melt  over a slow fire, and
 then stir in  slowly, when at a very moderate  degree of warmth, 1^  drams of
 pulv. Spanish flies, to make  an ointment.
  168.   Water of Ammonia, strong, 1 oz.; alcohol, 1 oz.   Mix.  Wet a piece
of cotton cloth, and lay it upon the painful part, and cover  it with flannel to
prevent evaporation. 
774
PRESCRIPTIONS. — RECIPES.
                             Ointments.
  169.  Mercurial  Ointment,! oz.;  extract of belladonna, 1 oz.;  extract of
henbane, 1 oz.; camphor, 10 grains.  Mix.   For external use.
  170.  Extract of Belladonna, £ dram;  lard, £ oz.   Mix.  To  be rubbed
on the neck of the womb in painful menstruation.
  171.  Prussia Acid, 2 drams ; sugar of lead, 1 dram ; cocoa-nut oil, £  oz.;
lard, 1 oz.  Make an ointment.
  172.  Neapolitan Ointment, 2 drams ;  extract of belladonna, 1 dram.  Mix.
  173.  Extract of Belladonna, 15 grains; lard, 1 oz.   Mix.
  174.   Sulphuret  of Lime, 1 dram;  camphor, in powder, 15  grains; lard,
1 oz.  Make an ointment.
  175.  Elder-Flower Ointment, 1  oz.;  oxide of zinc, 1  dram.   Make an
ointment.
  176.   Oxide of  Zinc, 1 dram ; spermaceti ointment, 1 oz.  Mix.
  177.  Napthaline, 2  scruples; lard,  1 oz.   Make  an  ointment.  To be
spread upon linen, and applied to the diseased skin night and morning.
  178.   Mild Nitrate of Mercury Ointment, 3 drams ; sugar of lead, 16 grains;
rose-water ointment, 1 oz.
  179.   Laudanum, \ dram ; sulphur, \ dram; oxide of zinc, 1 dram; oil of
almonds, 1 oz.; lard, 3 ozs.  Make an ointment.
  180.   Olive  Oil, 4 ozs.; white wax,  2 drams.  Melt these together, and
then add honey, 2 drams ; croton oil, 20 drops.
  181.  Elder-Flower Ointment, 1  oz.; pulverized  blue  vitriol,  1 scruple.
Make an ointment.
  182.  Purified Beeves' Marrow, or lard, 6 drams;  oil of sweet  almonds, 2
drams ;  pulverized Peruvian bark, 1  dram.  Mix.
  183.  Pulverized Sulphate  of Copper, 10 grs; extract  of Spanish flies, 5
grs.;  lard, 1 oz.  Mix.  Rub into the scalp.
  184.  Iodide of Lead, 1 dram; lard, 2 ozs.   Mix.   To  be rubbed on the
surface.
  185.  Iodide of Potassium, 1 dram;  lard, 2 ozs.  Mix.
  186.  Basilicon Ointment, 1 oz.; red precipitate, 1 dram.  Mix.
  187.  Iodide of Potassium, £ dram ; lard,  1 oz.   Mix.
  188.   Veratria, 4 grs.; lard, 5 drams.   Mix.
  189.   Tobacco Leaves (fresh and sliced), 10 ozs.; diluted acetic acid, 4 pints;
basilicon ointment  13 ozs.  Boil  the tobacco in the acid, strain, and evaporate
the decoction to six ounces.   Add this to the  basilicon ointment heated, and
stir till cold.  For gathered breasts.

                             Liniments.
  190.   Sweet Oil, 1 oz.;  strong water of  ammonia,  1 oz.   Mix.  To be
rubbed on with a piece of flannel. 
PRESCRIPTIONS. — RECIPES.                   775
   191.  Lime Water, 2 ozs.; flax seed oil, 2 ozs.   Mix.  Apply outwardly.

   192.  Olive Oil,  1 oz.;  solution  of potassa, 2 drams;  strong mercurial
 ointment, 1 dram.   Mix.
   193.  Olive Oil, 4  ozs.; oil of amber, 2 drams ; oil of rosemary, 2 drams.
 Mix.
   194.  Spirits of Turpentine, 1 oz.;  linseed oil, 1 oz.; lime water, 1  oz.
 Mix.  For external use.
   195.  Oil of Hemlock, 2 drams; oil of origanum, 1 dram; camphor, 1 dram;
 opium, 1 dram ; alcohol, 4  ozs.  Mix.
   196.  Soap Liniment,  2 ozs.; chloroform, 1 dram.  Mix.

   197.  Tinct. of Aconite-root, J oz.; opium liniment, \ oz.   Mix.  For neu-
 ralgia, etc.  Apply a tea-spoonful to the painful part.

   198.  White Soap, 12 ozs.; camphor, 6 ozs.; oil of rosemary, l£ ozs.; alco-
 hol, 4 pints;  opium, 3 ozs.   Mix and filter.   An  excellent  liniment, acting
 at times like a charm in the removal of local pains.

   199.  Sulphuric Acid,  1 dram; spirits of turpentine,  1  dram; olive  oil,
 3 drams.  Mix the oil and spirits of turpentine  first, then gradually add  the
 sulphuric acid.  A valuable liniment for chilblains.  To  be rubbed on two or
 three times a day.

                Washes, Lotions, Gargles, etc.

  •200   Bruised White  Oak  Bark,  1 oz.; water, IJ pints.   Boil  down to a
 pint, and strain.  To be used as a wash.
   201.   Borate of Soda or Borax, 2 drams ; water, 4 ozs.  Mix.   To be used
 as a lotion. •
  202.   Alum, 2 drams ; water, 4 ozs.  Mix.   To be used as a lotion.
  203.   Tannin, 1 scruple ; water, 4  ozs.  Mix.   For external use.
  204.   Biborate of  Soda, \ oz.; rose water, 6 ozs.;  sulphate of morphia,
 6 grains.  Mix.  To be used as a wash in itching of the female privities.
  205.   Chlorinated Soda, 1  oz.; water, 12 ozs.  Mix.  Rinse the mouth with
 it two or three times a  day, but do not swallow.
  207.  Rose Water, 5 ozs.;  sugar of lead, 8 grains ; sulphate of  zinc, 8 grs.
 Mix.

  208.  Rose Water, 4£ ozs.; nitrate of silver, 2 grains.   Mix.

  209.  Sulphate of Zinc, 8  grain's ;  tannin, 1 scruple ; water, 5 ozs.   Mix.

  210.   Chloride of Zinc, 6  grains ; soft water, 2 ozs.   Mix.

  211.  Nitrate of Silver,  10 grains ; soft water, 1 oz.  Mix.

  212.   Corrosive Sublimate, 5 grains ; soft water,  1 pint.  Mix.

  213.  Alcohol,  1 pint;  soft soap of potash, 1 pint.  Dissolve and filter, then
add  oil of citron,  1  oz.   Mix.  It will answer a good purpose  if the oil of
citron be  omitted.
  214.  Nitrate of Silver, 2 scruples; nitric acid,  12  drops ; soft water, 1 oz.
Mix.  Apply  with a piece  of lint tied to the end of  a stick. 
776                  PRESCRIPTIONS. —RECIPES.
  215.   Copperas, 1 oz.; soft water, 1 pint.   Mix.
  216.  Alcohol, l£ ozs.; rose water, 4 ozs.   Mix.
  217.   Corrosive Sublimate, 6  grains;  spirits of rosemary, 1  oz.;  alcohol,
1 oz.;  emulsion of bitter almonds, 6 ozs.   Mix.
  218.   Solution of Sugar of Lead, 12 drops ; laudanum, 1 dram ; water, 4 ozs.
Mix.   To he applied externally only.
  219.   Nitrate of Silver,  l\ drams ;  soft water, 1 oz.  Mix.
  220.   White Vitriol, 1 dram ; rose water, 3 ozs.  Mix.   Apply outwardly.
  221.   Hydrocyanic Acid,  4 drams ;  sugar of lead, 15 grains ; alcohol, 4
drams ; water, 7 ozs.   Mix.  Apply externally.
  222.   Corrosive Sublimate, 5 grains ; almond mixture, i pint.  Mix.  Apply
externally.
  223.   Rose Water, 4 ozs.; pulverized borax, i oz.; sulphate  of morphine,
6 grains.   Mix.   To be applied to the parts many times a day.
  224.  Sugar of Lead,  2 . drams;  laudanum, 1  dram; soft water, £ pint.
Mix.  For external use.
  225.  Corrosive Sublimate,  5 grains ;  cologne, 2  ozs.; soft  water, 6 ozs.
Mix.  For external use only.
   226.  Acid Nitrate of Mercury, 1 dram; soft water, 4 ozs.  Mix.   Apply
every second day.
   227.  Sugar of Lead,  3  grains;  soft water, 1 oz.  Mix.  As a  wash in
inflammation of the mouth in infants.
   228.  Mucilage of Gum Arabic, 1 oz.; syrup of orange peel, £ oz.;  chloride
of lime, 15 grains.  Mix.
   229.  Decoction of  Peruvian  Bark,  3 ozs.;  syrup of orange peel, 1 oz.;
 chloride of soda, 1 oz.   Mix.
   230.   Creosote, 4 drops;  mucilage of gum arabic, \  oz.; camphor water,
 8 ozs.   Mix.
   231.   Vinegar, 1 dram; alcohol, 3 drams ; simple syrup, 1 oz.; water, 3 ozs.
 Mix.
   232.   White Oak Bark, 1 oz.; water, 1 pint.   Boil away  one quarter, and
 strain; then add  alum,  1  scruple.  Apply to the parts with a soft sponge, or
 dossil of lint, several times a day.
   233.  Hydrochloric Acid, \  dram; honey,  1 oz.;  rose water, 1 oz. Mix.
 Apply three or four times  a day.
   234.  Sulphate of Copper, \  dram;  soft water,  1 oz.  Mix.  To be ap.
 plied twice a day to the ulcers in gangrene of the mouth.
   235   White Vitriol, 1  dram ;  soft water,  2 drams.   Mix.   Then add honey,
 2 drams ;  tincture of myrrh, 2 drams.  To be applied twice a day to the ulcers
 in gangrene of the mouth.
   236   Creosote, 1 dram;  alcohol, 1  dram.  Mix.  To be appfied, with a
 camel's  hair pencil, to  the  gangrenous ulcers of the mouth after running a
 lancet through the sloughs.
   237  Acid Nitrate of Mercury, \ dram ; soft water, 1 oz.   Mix.  To be in-
 jected into the throat with the shower syringe, or applied to ulcers with a pencil. 
PRESCRIPTIONS. — RECIPES.                   777
   238.  Rose  Water,  4 ozs.;  sugar of lead, 2  drams.  Mix.   For external
 use.
   239.  Rose Water, 2  ozs.; sugar of lead,  1  scruple.  Mix.   For external
 use.
   240.  Tincture  of Arnica,  £ oz.; cold water, 4  ozs.  Mix.   For external
 use.                                     .
   241.  Tinct. Blood-root,  2  ozs.;  solution chloride of Soda,  2 ozs.;  tinct.
 henbane, 2 ozs.  Mix.
   242.  Bucket of Warm Water;  cayenne pepper, pulverized, 1 tablespoonful;
 ground mustard, 2 tablespoonfuls.   Mix.   As a foot bath in  suppression, etc.
   243.  Chlorate of Potash, J oz.; strong hydrochloric acid, 40 drops ;  water,
 1 pint.  Mix.  An excellent wash for chronic fetid ulcers, — soon converting  a
 foul ulcer to a healthy-looking one.  A good gargle.
   244.  Powdered Golden Seal, 1 dram;  powdered  cranesbill, 1  dram;  pow-
 dered witch-hazel bark, 1 dram.  Mix.   Pour upon these half a pint of boiling
 water.   Let them stand till cold.  To swab an ulcerated throat in scarlet fever,
 and for other purposes.
   245.  Pulv. Cayenne, 1 dram; salt, 1 dram; boiling water, 1  gill.   Mix, and
 let them stand fifteen minutes.   Then add  one gill of vinegar.   Let them stand
 ah hour, and strain.   Put a teaspoonful in  a child's mouth once an hour, in ma-
 lignant scarlet fever.

                              Injections.

   246.  Castor Oil, 1 gill; pulv. cayenne, 10  grs.; molasses,  1 gill;  table
 salt, 1 teaspoonful; warm water, 1 pint.   Mix.

   247.  Senna Leaves, 2 drams.   Steep  in a pint of water.  Then add one
 ounce of epsom salts, and strain.  A quarter of this may  also be taken as  a
 brisk purge.

   248.  Castor Oil, 2 ozs.; tinct. prickly ash  bark, h oz.; comp. tinct. of
 Virginia snake root, 2 drams; infusion of boneset and senna,  equal parts, £ pint.
 Mix-

   249.  Castor Oil, 1 oz.; salts of tartar, £ oz.;  warm water, l'pint.  Mix.

   250.  Epsom Salts,  1  oz.;  senna leaves,  \  oz.; pulv.  cayenne, 10  grs.;
 boiling water, 1 pint.  Let the water  stand upon the senna and cayenne 15
 minutes.  Then pour it off, and add the salts.

   251.   Thoroughwort,  1  oz.;  senna,  1  oz.; lobelia, \  dram;   cayenne, 10
 grs.;  epsom salts,  1  table-spoonful; molasses, \ pint; boiling water,  1 pint.
 Make a strong decoction of the herbs, and  then add the salt and molasses.
   252.   Wine  of Ipecac, 1 oz.; spirits of turpentine, 1 oz.; caBtor oil, 1 oz.;
 molasses, \ pint; warm water, \ pint.  Mix.
   253.   Flax Seed Tea, £ pint;  laudanum, 40 drops.  Mix.
   254.   Nitrate of Silver  Crystals, 10 grains;  corrosive  sublimate,  5  grs. f
sugar of lead, l£ drams;  white vitriol, IJ drams; soft water, 6 ounces.   Mix.
An injection for certain  forms of whites, etc.
   255.   Bruised Galls, \ oz.;  two large  poppy  heads ; water, 1  pint.   Boil  a
quarter of an hour, and strain.   For piles.
                     98 
778
PRESCRIPTIONS — RECIPES.
  256.   Common Salt, 1 oz.; chamomile flowers, \ oz.; pulv. aloes, 1  dram.
Boil the chamomile and aloes five minutes, in one pint of water, then strain, and
add the salt.

                     Hair Oils, Washes, etc.

  257.   Cologne, 2 ozs.; tincture 6*f Spanish flies, 2 drams ;  oil of rosemary,
10 drops ;  oil of lavender,  10 drops.  Mix.  Apply cautiously.  If soreness
pf the scalp is produced, omit for a short time.
  258.   Castor  Oil,  2£  pounds; strongest  alcohol,  2^ pints ; pulv. Spanish
flies, £ oz.; oil of burgamot, 2£ ozs.; otto of roses, 20 drops.   Mix.   Let them
stand for a few days, and filter.   A superior preparation for keeping the hair
from falling, and to prevent dandruff.
  259.   Tinct. Benzoin, comp., 2 drams; tinct. Spanish flies, 2 drams ;  castor
oil, 6 ozs.; oil burgamot, 1  dram; oil of cassia  or verbena, 15  drops; strong
alcohol, 9£ ozs.  Mix.  As a hair wash, better even than the above.

  • 260.   Slaked  Lime, 2 drams; bicarbonate  of soda, 3 drams; lard, 2 ozs.
Mix.
  261.   Slaked  Lime, 1 oz.;  bicarbonate of potassa, 2 ozs.; charcoal in pow-
der, 1 dram.  Mix.   Apply to the parts, and wash  off when dry.  Keep in
well stopped bottles.
   262.   Slaked  Lime, 4  ozs.; orris  powder, 1 \ ozs.  Mix.   Apply to the
parts, and wash off when dry.
   263.   Spanish  White, \  pound; litharge, \ pound; slaked lime,  £  pound.
Mix.  Pulverize in a mortar.   To be kept dry.   When used, mix with water
to a paste  the thickness  of  cream.  Spread on the hair and lay over it a wet
cloth over night.
   264.  Sulphur, 1  oz.; sugar of lead,  1 oz.; rose water, 4 ozs.  Mix.  Ap-
ply to the hair.
   265.  Nitrate  of Silver,  1  dram;  nitric  acid, 1  dram;  soft water, 1 pint;
sap green, 3 drams; pulverized gum arabic, 1 dram.  Mix.   Keep  well corked.
   266.  Hydrosulphuret of Ammonia, 1 oz.; liquor potassa, 3  drams;  soft
water, 1  oz.  'Mix.   Apply this with a tooth brush 15 or 20 minutes.  Then
brush the hair over with the following: — nitrate of silver, 1 dram  ; soft water,
2 ozs.; using  a clean  comb to separate the hair.


                           Miscellaneous.

   267.  Wine of Spurred  Rye, 2 ozs.   Dose. — One teaspoonful  three times
a day.   For profuse menstruation from a relaxed state of the womb.

   268.  Sulphate of Iron,  1  dram;  sub-carbonate of potash, 1 dram.   Mix,
and make into 38 pills.   One pill twice a day, and gradually increasing  to four
a day, in chlorosis.
   269.  Sulphate of Iron,  1  dram;  extract of hops, 15  grains; extract of
poppies, 15 grains; oil of cinnamon,  15  drops.  Mix, and make into 24 pills.
One  pill two or three times a day.
   270.  Oxide  of Zinc, 2 drams; ext. of cicuta, 2 scruples. Mix.  Make
48 pills. 
PRESCRIPTIONS.-RECIPES.
779
  271.  Pulverized Savin, 1 scruple; sulphate of copper, 1 scruple.   To be
sprinkled on venereal lumps or tumors, called condylomata, on the female geni-
tals, or elsewhere.
  272.  Balsam of  Copaiva, 1 oz.;  oil of cubebs, 2 drams; laudanum, 1
dram;  mucilage of gum arabic, 2 ozs.; sweet spirits of nitre, £ oz.; compound
spirits  of lavender, 3 drams; camphor water, 4 ozs.;  white sugar, 2  drams ;
oil of partridge-berry, 5 drops.  Mix.  Take a table-spoonful three  or  four
times a day.  For gonorrhoea.
  273.  Balsam of Copaiva, 1 oz.; pulverized cubebs, 2 ozs.; essence of pep-
permint, 30 drops.  Make a thick paste, like dough.
  274.  Pulverized Borax, 1 oz.; pulverized white sugar, 1 oz.  Mix.  A little
to be dissolved on the tongue.
  275.  Pulverized Borax, J bz.; honey, 4 ozs.  Mix.
  276.  Hydrochloric Acid, 1 dram ;  honey, 1 oz.   Mix.  For touching large
curdy patches in sore mouth of children.
  277.  Pulverized Ipecac, 3 grains ; precipitated sulphur, 2 scruples ; extract
of hyoscyamus, 6 grains.   Mix.   Divide into 12 parts.   One to be taken every
three or four hours.
  278.  Pulverized Belladonna-root, 5 grains; compound ipecac,  powder, 10
grains; precipitated sulphur, £  dram; white sugar, 2  scruples.  Mix.  Make
20 powders.  One every three hours to a child two years old.

  279.  Pulverized Alum, 25 grains; extract of cicuta, 12 grains; syrup of
red poppies, 2 drams ;  spearmint water, 3 ozs.  Mix.   A dessert-spoonful every
six hours for a child two or three years old.
  280.  Camphor, 1 dram; sulphuric ether, 1  oz.   Mix.   Ten drops every
half hour.
  281.  Pulverized Rhubarb,  1  scruple;  mercury with  chalk, 10  grains;
aromatic powder, 5 grains.  Mix.   Divide  into 10 powders.   One every four
or five hours.
  282.  Pulv. BloooWoot, &  to 1  oz.;  chloride of zinc, \ to 2 ozs.; watet,
2 ozs.  Add enough wheat flour to make a paste as thick as  molasses.
  283.  Sal. Volatile, \ dram; camphor water, 1 oz.   Mix.
  284.  Tinct.  of Nux Vomica, \  oz.; tinct. aconite,  2 drams; volatile tinct.
of guaiacum, 2 drams.   Mix.  Thirty drops every three hours.
  285.  Tinct.  of Black  Cohosh,  2 ozs.; tinct. of  digitalis,  2 drams.   Mix.
One teaspoonful from two  to five times a day.
  286.  Barberry  Bark, 1 oz.;  pipsissewa herb, 2 ozs.; wild cherry bark, 1
oz.; bitter-root,  1  oz.   Mix.  Infuse for several  hours in  4  pints of water.
One tablespoonful three or four  times a day.
  287.  Horse   Radish  Root, 1 oz.; bayberry bark, 1 oz.; barberry bark,
1 oz.;  wild cherry bark, 1 oz.;  prickly ash bark, 1 oz.  Reduce t^ whole to a
coarse  powder, and infuse for several hours in 4 pints of cider.  A tablespoon-
ful three or four times a day.
  288.  Mercury,  95 parts;  balsam of storax, 48 parts ;  diacaton Plaste^J12
parts; wax, rosin turpentine, each,  16 parts; ammonia, bdellium each, o parts,
olibanam and myrrh, each, 5 parts i saffron, 3 parts; spirits of lavender, 2 parts.
Mix, and spread. 
780                  PRESCRIPTIONS. —RECIPES.
  289.   Populin,  20 grs.;  sanguinarin, 10  grs.; pulv. white sugar, 30  grs.
Rub well together, and divide into  16 powders.  Take one four times a day.
At the same time use prescription 73.
  290.   Ptelein, 24 grs.; hydrastin, 24 grs.; ext. of belladonna, 3 grs.;  ext
of nux vomica, 2 grs.  Mix.  Make 24 pills.  Take one three times a day.

  291.   Strychnia,  2 grs.; pulv.  cantharides, 4  grs.;  pulv.  arnica  leaves,
1 dram.  Mix.  Divide into 32 powders.   One to be taken three times a day.
  292.   Wine of Colchicum Seeds,  1 oz.; fluid ext. of dandelion, 1 oz.  Mix.
One teaspoonful three times a day.
  293.   Willow Bark, 1 oz.;  boiling water, 1 pint.   Boil  for ten minutes, and
strain.  Dose. — A wine-glass full once in three  hours.
  294.   Canada Balsam,  1 dram;   slaked  lime, 1  dram.   Mix, to form a
paste.   An excellent remedy for tooth ache, when pressed into the cavity.
  295.   Tinct.  Black Cohosh, 1  oz.; iodide of potassium, 2 drams; syrup of
ipecac, 1 oz.;  spring water,  2 ozs.   Mix.   A teaspoonful  three or four times a
day, in rheumatism and cell-dropsy.
  296.   Tinct.  Black Cohosh, 1 oz.;  tinct. myrrh,  6 drams;  laudanum, 1
dram; tinct. cayenne, 1 dram.   Mix.  Take 30 or 40 drops four times a day,
for dropsy.
  297.   Solution  Chloride of Soda, 6 drops; water, 2 ozs.   Mix.  To be
taken at a draught.  A sure remedy for offensive breath from  deranged stom-
ach.
  298.   Cream of  Tartar, \ oz.;   fresh  lemon peel, bruised,  4  ozs.; Loaf
sugar, 4 ozs.; boiling water, 3 pints.   Mix, and, after standing a while, strain.
  299.   Citric  Acid, ^ dram; bi-carbonate of potassa, \ dram; lemon syrup,
1 oz.; soft water, 6  ozs.;  epsom salts, 1 oz.  Mix.  Two table spoonfuls, to be
repeated every four  hours, if necessary.
  300.   Hard  Wood Ashes,  1 quart; common  soot, ^ gill; water, 6 pints.
Digest, settle, and filter.  Take one tablespoonful three times a day, in acidity
of stomach.
  301.   Peppermint Water, \\ ozs.; wine of colchicum-root, ^ oz.; sulphate
of morphia,  1 gr..;  magnesia, 1 scruple.   Dose. — One teaspoonful three or
four times a day.  Excellent for rheumatism.
  302.   Cream of  Tartar, 1-L ozs.;  sulphate potassa,  \ oz.;  pulv.  squills,
2 drs.;  tartar  emetic, 2 grs.  A teaspoonful of this mixture to be taken four or
five  times a day, in dropsy.
  303.   Pulv. Alum, \ dram;  white  precipitate, 1  grain.  Rub  these well to-
gether,  and  place  the powder  in a bottle;  then  add 1\  drams  of glycerine.
Shake the bottle until the  mixture is of the consistence of cream, and repeat the
shaking whenever it is about to be  applied to the skin.  For external use in
erysipelas.
  304.   Copaiva, 5  drams; yolk of one  egg;  gum  of extract of opium, one
grain; water 7 ounces. Mix.  To be used as an  injection several times a day in
gonorrhoea.
  305.   Tannin, 3  grains ; ext. belladonna, f grain ; ext. conium, 2 \  grains;
infusion of senna, 3  ozs.;  fennel water and syrup of marshmallow, each 1£ ozs.
Mix.  A tablespoonful to be taken  every  two hours, in chronic bronchitis, and
other complaints. 
PRESCRIPTIONS.—RECIPES.                    781
   306.  Glycerine, 1 dram; tannin, 1 dram.   Dissolve the  tannin  in the gly-
 cerine.  Excellent for sore nipples, and for chaps and excoriations generally.
   307.  Collodion, 1 oz.;  venice turpentine, £ oz.; castor oil, 2 drams.  Mix.
 To be apphed outwardly, for chilblains and chaps.   For cancer, manganic acid.
 Not as painful as other caustics.
   308.  Sulphate of Copper, 2 grains; wine  of opium, 1 dram; soft water 2
 drams.  Mix.  Apply freely with a soft camel hair brush, three times a day, for
 purulent ophthalmia.
   309.  Pure Acetic  Acid, 2 drams;  soft water 3 ozs.; simple syrup, 3  drams.
 Mix.  A teaspoonful  is  to be  taken  every three hours, in scarlet fever, at the
 same time usirig sheet baths with tepid water.
   310.  Compound tincture of Peruvian Bark, 4 ozs.; citrate of iron 44 grains ;
 citric  acid, 20  grains.  Dissolve the  citric acid in the tincture, and then the
 citrate of iron.   After a few days, filter.   Dose, one to two teaspoonfuls.
   311.  No. 1.   Gallic acid, 10 grains ;  dissolve in alcohol, 2 drams; water,  6
 drams.  No. 2.   Crystals of Nitrate of Silver, \ dram; water h oz.  Dissolve
 and add strong liquor  of ammonia, till it becomes clear; then add powdered gum
 arabic, and  dilute, if necessary, to 6 drams.   This will  color  black; to color
 brown, reduce it.   An excellent hair-dye.  Use the common directions, where
 there is a No. 1 and No.  2.
   312.  Epsom Salts, 2 drams ; magnesia, 1 scruple; syrup of  ginger, 1  dram ;
 spearmint water,  11  drams.  Mix.  To  be taken at a draught.  This will be
 retained  by the stomach,  when most other things are rejected.
   313.  Diluted Nitro-Muriatic Acid, 2 drams ; sweet spirits of nitre, 2 drams ;
 simple syrup, \ oz., water 1\ ozs.  Mix.   Two tablespoonfuls are to be taken
 three times  a day.  Excellent in dyspepsia,  with nasty  tongue,  and inactive
 fiver.

   314.  Rose Leaves, 1 scruple; boiling  water, 8  ozs.; diluted nitric acid, 2i
 drams.  Mix.  After standing half an hour, strain, and use as a wash for ulcers".
   315.  White  Vitriol, 1  dram ; water, 1 pint.   Mix.  To be  used as a wash for
 ulcers, etc.

   316.  Citrate of Iron  and Strychnine, 1 dram; syrup of orange peel, 2 ozs.;
 soft water, \ pint.  Mix.   Give one teaspoonful three times a day in neuralgia,
 and in other cases in which a nerve tonic is needed.
   317.  Aloes and Soap Pill, 10 grains.   Divide into two pills ; or, compound
 pill of aloes, 10 grs.   Divide into two pills.

   318.   Compound Colocynth Pill, 2\ scruples ; castile soap, 9 grs.; oil of anise,
 2 drops.  Mix, and make 12 pills. Two to be taken at bed-time.
   319.   Compound tincture of Senna, 2 drams; epsom salts 2 drams ; diluted
 sulphuric acid, 8 drops ; spirits of nitric ether, £ dram ; infusion of rhubarb, 10
 drams.  Mix.   To be taken at a draught.
   320.   Sulphate of Iron, 2 grs.; epsom salts, 2 scruples ; diluted sulphuric acid,
 10 drops; compound  tincture, 1  dram;  syrup of  poppies, 1 \  drams; pimento
water, 9 drams.   To be taken at a draught twice a day.
  321.  Pulverized Rhubarb, 12 grains ; carbonate of magnesia, 10 grains ; aro-
matic spirit of ammonia £ dram ; syrup of ginger, 1 dram ; spearmint water, 10
drams.  Mix.   To be taken at a draught.
  322.   Comp. infusion Senna, 5 drams; infusion rhubarb,  5 drams; comp 
782                  PRESCRIPTIONS.—RECIPES.
tincture cardamom, £ dram ;  syrup, l£ drams.  Mix.  To be taken at a draught,
by dyspeptic persons.
  323.   Carbonate of Soda, 10 grs.; aromatic spirit of ammonia, \ dram ; tinc-
ture of orange peel, 1 dram ; syrup of orange peel, 1 dram ;  compound infusion
of gentian, 10 drams.  Mix.   To be taken at a draught twice a day.

  324.   Trisnitrate  of Bismuth, 1 dram;  comp. tragicanth powder, 2 drams;
compound tincture cardamom, £ ounce; tincture of ginger, £ ounce; spearmint
water, 7 ounces. Mix. Two tablespoonfuls to be taken twice a day, in dyspepsia.

  324.   Trisnitrate of Bismuth, 6 grs.; bicarbonate of soda, 6 grains; pulver-
ized cayenne, 1 grain.  Mix.   This quantity to be taken twice a.day, in dyspep-
sia, with acidity of the stomach.
  325.   Solution of Acetate of Ammonia, \ ounce ; tincture of orange peel, 1
dram; syrup of orange peel, 1 dram ; tincture of cayenne, 20 drops ; comp. infu-
sion of orange peel, 6 drams.  Mix.   The whole to be taken to relieve head-
ache,  after intoxication.
  •326.   Magnesia, 15 grains; solution of potassa?, 15 drops ; comp. tincture of
senna, 1 dram; comp. infusion of senna, 6 drams;  syrup of ginger,  1 dram;
comp. infusion of orange peel,  \  ounce.  Mix.  Taken  at a draught, as an
aperient, in sick and billious headaches.

   327.   Aromatic Spirit of Ammonia, 1 dram ; tincture of  columbo,  1 dram;
infusion of columbo, 10 drams ; syrup of poppies, 1 dram.  Mix.  To be taken
at a draught, three times a day.
   328.   Diluted Sulphuric Acid, 15 drops ; diluted hydrochloric acid, 10 drops;
tincture of orange peel, 1 dram; comp.  infusion of gentian, 6 drams;  syrup of
poppies, 1  dram.   To be taken at a draught, three times a day, half an hour
before meals.
   329.   Diluted Nitric Acid, 12 drops ; diluted hydrochloric acid, 8 drops; in-
fusion of cascarilla, 11 drams; syrup of poppies, 1 dram.  Mix.  To  be taken
at a draught, twice a day.
   330.   Blue Pill, 4 grs.; comp. pill of rhubarb, 4 grs.; ext. hyoscyamus, 2 grs.
Mix.   Make two pills; one pill to be taken at night.

   331.   Ext. Hyoscyamus, 2J grs.; pulv. camphor, 2£ grs.   Mix.  Make two
pills; one to be taken when  the pain is most severe, in nervous headache.

   332.   Comp. Tragacanth  Powder, 8 grs.;  oil of lemon,  3 drops;  camphor
water, 11 drams ;  comp. tinct. cardamom, £ dram; tinct. hyoscyamus, £ dram;
chloroform, 15 drops.  Mix.
   333.   Tinct. Hyoscyamus, \ dram; aromatic spirit of ammonia, \ dram ; syrup
of orange  peel, \ dram ; peppermint water, 10 drams.  Mix.   In nervous and
hysterical cases.
   334.   Soap Liniment^ 2\  ozs.; liquor ammonia, \ dr.; laudanum, \ oz. Mix.
Make a liniment.
   335.   Comp. Pill of Colocynth, 7 grs.; ext. of colchicum,  2  grs.; oil of cara-
way,  1 drop.  Mix, and make two pills.  To be taken at bed-time in rheumatic
headaches.
   336.   Chloride  of Zinc, 6 ozs.; pulv. bloodroot,  2 ozs.;  myrtle wax, 1 oz.;
water of extract  of opium,  6  drams; extract of conium, 6  drams.  Mix, and
make an ointment. 
PRESCRIPTIONS—RECIPES.                    783
    337.   Iodide of Lead, 1 scruple; glycerine, 1 dram; spermaceti oifitment, 2
  ozs. Make an ointment.
    338.   Rhubarb Pulv., £  oz.; spearmint herb, pulv. £  oz.; pulv. cascarilla, \
  oz.; pulv. bicarbonate of "potassa, £ oz.;  pulv. wild cherry baric, £ oz.;  Mix,
  and pour on one quart of  hot water.  Let this stand till cold, and add half a
  pint of brandy.  Dose half a wineglassful.
    339.  Ext. Belladonna, 6 grains ; pulv. ipecac, 10 grains ; confection of roses,
  2 grains.   Mix.  Make 30  pills, one pill to be taken twice a day.

    340.  Dioscorein, 12 grains; pulv. camphor, 4 grains; pulv. cayenne, 12 grains;
  white sugar, 1 scruple.  Mix.  Divide into four powders.  Give one every fifteen
  minutes.
    341.  Leptandrin, 12 grains ; geranium, 12 grains ; myricin, 12 grains.  Mix.
  Divide into twelve powders, of which one may be given three or four times a
  day.
   342.  Quinine, \ dram; pulv. catechu, 1 dram; pulv. opium, 15 grains.  Mix.
  Make 32 pills.  Give one pill three times a day.
   343.  Compound Syrup of Rhubarb and Potassa, 4 ozs.; tincture of prickly
 ash berries, 1 oz.; essence  of peppermint, 1 dram; paregoric, 4 drams.  Mix.
 A  tablespoonful should be  given  every hour  until it operates gently on  the
 bowels.

   344.  Pulv. Camphor, £ dram; pulv. opium, 16 grains ; pulv. cayenne, \ dram.
 Mix.  Make 16 pills; one every hour, in cholera.

   345.  Rhubarb, 4  ozs.; black cohosh root, 2 ozs.;  wild  cherry bark, 2 ozs.;
 geranium, 2 ozs., coarsely powder them, and mix.   Add two pints of brandy
 and two pints  of water.   Let the  mixture stand five or six days, stirring often,
 and then strain.   Add four pints of water to the dregs, boil slowly to two pints,
 strain, and add to this the  previous tincture.   Sweeten with loaf sugar. Take
 a tablespoonful every one, two, or three hours.

  346.  Beth  Root, 1 oz.; geranium, 1 oz.; blackberry root, 1 oz.;  wild cherry
 bark, 1 oz.; cinnamon, 1 oz.  Powder the whole,  and add to them  IJ  pints
 brandy, and 1 \ pints water.  Let  them stand several days, stirring frequently.
 Add  sweetening if preferred.  Dose.  One or two teaspoonfuls every two or
 three hours.

  347.  Raspberry Leaves, 1 oz.;  geranium, 1  oz.; blackberry root, 1  oz.; lep-
 tandra root, 1 oz.  Mix, and make three pints of strong decoction.  Dose.   A
 teaspoonful every hour.   Suitable  for a gargle.

  348.  Sugar of Lead,  24 grains;  vinegar, 1 dram;  syrup of poppies,  1
 oz.; rose  water,  3 ozs.;  soft water, 4 ozs.   Mix.  Dose, one or two table-
 spoonfuls.
  349.-  Potassio-tartrate of iron, £ oz.;  syrup of orange peel, 1 oz.;  water, 4
 oz.   Mix.  Take two teaspoonfuls three  times a day.

  350.  Geranium, golden seal, marshmallow, wild indigo root, rosemary, each
 half an ounce.  Mix, and make one pint of strong infusion.  After straining,
 add two drams powdered borax, and one gill of honey.  An excellent astringent
 gargle.
  351.  Dover's Powder, 15 grains;  leptandrin, 5 grains.   Mix.  Divide  into
ten  powders.   One every three hours, for a child. 
784                  PRESCRIPTIONS.—RECIPES.
  35$?.* Dover's Powder, 15 grains , calomel, 5 grains.  Mix.  Divide into ten
powders.  Give one every three hours to a child in croup.
  353.  Hydrochlorate of ammonia, £ oz.; diluted acetic acid, £ oz.;  alcohol, \
oz.; camphorated mixture, 15 ozs.  Mix. A good  scattering wash  for hydro-
cele, etc.
  354.  Chloride of  soda, nitrate of potash, and  hydrochlorate  of  ammonia,
equal parts, and water enough to dissolve them.  Mix.  An excellent freezing
mixture. 
PRONOUNCING  DICTIONARY.... GLOSSARY.
   Ab-do'men.  The belly.
   A-ce-tab'u-lum.  The socket for the head
 of the thigh bone; an ancient vessel for hold-
 ing vinegar.
   Ab-dom'i-nal  cav'i-ty.  The cavity  of
 the belly.
   Ad-duc'tor.  A muscle which draws one
 part of the body towards another.
   Ab-sor'bents.   Glands and  vessels  which
 absorb or  6uck up substances  from within,
 or without; also,  medicines which, though
 nearly or quite inactive themselves, absorb,
 or combine with acid matter in the stomach
 or bowels.
   A-cro'mi-on.  That part of the scapula, or
 shoulder-blade, which unites  with the collar-
 bone.
   Al-bu-gin'e-a.   The white of the eye.
   Ai/ter-a-tives.  Medicines  which gradu-
 ally reestablish health, without sensibly in-
 creasing  the circulation, or augmenting the
 perspiration, urine, or other excretions.
   Ai/ve-o-lar.  Relating to the  sockets  of
 the teeth.
   Al'vine (Al'vin).  Relating  to the intes-
 tines, as alvine discharges, — discharges from
 the bowels.
   A-mor'photjs.  Having no regular form.
   Am-ni-ot'ic Lio/uid.  The fluid surround-
 ing the fetus in the womb.
   An-.es-the'sia.  Suspended sensibility.
   An-as'to-mose.  The uniting  of arteries
 and veins by joining their mouths.
   An-chy-lo'sis.   A stiff or useless joint.
   An-i-mai/cc-ls:.  Animals so  small that
 they can only be seen  with a microscope.
   An-<e'mi-a.  Privation of blood; a com-
 paratively bloodless state.
   An'o-dynes.   Medicines  which  diminish
 sensibility,  abate pain,  and induce  sleep.  It
 should always be remembered that  anodynes
 when frequently, and long taken, lose their
 influence in disease.
  Ant-a'cids.   Preparations which neutral-
 ize acidity of the stomach and bowels.
  Ant-ai/ka-lies. Agents which neutralize
 alkalies.
  An-ta-phro-dis'i-acs. Agents which les-
 sen or blunt the sexual propensities.
  An-thel-min'tics.   Medicines which des-
 troy and expel worms.
  An'ti-dotes.  Medicines which counteract
and destroy the effects of poison.
  An-ti-pe-ri-od'ics.  Medicines which pre-
vent or cure diseases of a periodical character.
  An-ti-phlo-gis'tics.  Medicines or diet
which remove or appease inflammation.
                      99
  An-ti-spas-mod'ics.  Medicines which pre-
vent or allay spasms, commonly called cramps.
  An-ti-syph-i-lit'ics.   Medicines  which
cure syphilis.
  An-ti-sep/tic.  Whatever checks or coun-
teracts putrefaction.
  An-ti-scor-bu'tics.  Articles which  pre-
vent and cure scurvy.
  A-pe'ri-ents.  Medicines  which  gently
open the bowels.
  A-pho'ni-a.  A loss of the voice.
  Aph-ro-dis'i-acs.  Medicines supposed to
excite and promote the sexual appetite.
  A-pon-eu-ro'sis.   The  membranous ex-
pansion of tendons and muscles.
  A-re-o'la.  A colored circle, as  the circle ,
around the nipple.
  Ar-o-mat'ics.  Medicines  which  have a
grateful, spicy smell, and an  agreeable, pun-
gent taste.
  As-phyx'i-a.  Suspended  animation; ap-
parent death.
  As-then'ic.  Relating to  debility; or to
disease marked by debility.
  As-trin'gents.  Medicines which have the
power to constringe or pucker up the tissues
of the body, and thereby check discharges.
  At'ro-phy.  A wasted condition; leanness.
  Ax-ii/la.  The arm-pit.
  Aus-cul-ta'tion.  The art  of detecting
disease by listening to the sounds of the lungs,
heart, etc.
  Au-top/sy.  Personal inspection, — used in
the sense of a post-mortem examination.
  A-zote'.  Nitrogen; one of the  constitu-
ents of the atmosphere.
  Bron'chi-a. The pipes which convey the
air through the lungs.
  Bcr^a; Mu-co'sa.   Small sacs, situated
under tendons, about the joints, containing a
sticky fluid.
  Cai/cu-lus.  A  solid,  unorganized body
formed  in the kidneys, or bladder, and called
a stone.  The plural is calculi.            .
  Cap'ii.-la-ry.  Small; resembling a hair.
  Cap'sule.   A membraneous bag, enclos-
ing a part.                   ....    j
  Car'ti-lage.  Gristle attached to the ends
of the bones.           ,. .     ...     .
  Car-min'a-tives.  Medicines which expel
wind from the stomach and bowels, and allay
the pain caused by it.
  Ca-thar'tics.  Medicines which purge the

b0CVER;vix.  The neck.  Cervix Wter-i.  The
neck of the womb.
  Car'di-ac.  Relating to the heart. 
786
GLOSSARY.
   Car'pal.  Relating to the wrist.
   Cat-a-me'ni-a.  The  monthly flow of fe-
 males.
   Ca-titar'sis.  Purging.
   Cath'e-ter.  A tube for  drawing off the
 urine.
   Cel-lu'lar.  Relating to cells.
   Cer'e-bral.  Relating to the brain.
   Cha-lyb'e-ate.  Containing iron or steel.
   Che-mo'sis.   A swelling of  the eye, in
 which the eye projects,  with a depression in
 the centre.
   Cho'la-gogue.  A medicine which causes
 a discharge of bile.
   Clo'nic  Spasms.  Spasms which are  rigid
 and relaxed alternately.
   Col-li'qua-tive.  This term is  applied to
 excessive and exhausting discharges.
   Co-los'trum.  The first secretion of milk.
   Co'ma.  Profound stupor,  or sleep.
   Con'dyle (kon'dil).  A knob;  applied to
 certain projections of bones at joints.
   Con'flu-ent.  Not distinct;  running  to-
 gether.
   Con-gen'i-tal.  Existing at  the time of
 birth.
   Con-ges'tion.  Distention  of parts by an
 accumulation of blood in them.
   Con-junc'ti-va.  The membrane which
 covers the eye and lines the eye-lid.
   Con'tra-In'di-ca-ted. Not indicated; the
 opposite implied.
   Cord'ials.  Medicines which  have a grate-
 ful, warming,  and exhilarating effect upon the
• stomach.
   Coun'ter-Ir'ri-tants.   Articles which by
  irritating one part, withdraw blood from, and
  relieve another.
   Cri'sis.  The turning point of a disease.
   Cu'ti-cle.  The epidermis; the scarf-skin.
   De-cid'u-a.  A thin, external  membrane,
  within the womb, thrown off after child-bear-

  in£-              „ •  •
   De-liq'ui-cm.  Fainting.
   De-mul'cents.  Medicines  of a softening
  nature, which correct acrid conditions, and, by
  their  bland effects, soothe  inflamed and irri-
  tated parts.
   De-ple'tion.  Diminishing the fulness of
  a part or parts, as by purgatives, or bleeding.
   De-squa-ma'tion.  Separation of the skin
  in  scales; scaling off.
   De-ter'gents. Medicines which cleanse.
   Di-ag-no'sis.  The art of determining the
  nature of diseases.
    Di-a-pho-ret'ics.  Medicines which pro-
  mote sweating.
    Di-ath'e-sis.  Any  particular disposition,
  state, or habit of body.
    Di-u-re'sis.  Copious flow of urine.
    Dil'u-ents.  Watery drinks, which increase
  the fluidity of the blood, and render several of
  the secretive and excretive fluids less viscid.
    Dis-cu'tients.  Medicines which  scatter,
  resolve,  or disperse tumors.
    Dis-in-fec'tants.   Articles which purify
  or cleanse infected places.
    Di-u-ret'ics.  Medicines  which increase
  urinary  secretions.
    Dras'tics.  Strong and violent purgatives.
    Dysp-nce'a.  Difficulty of breathing.
    E-me'sis.  Vomiting.
    E-met'ics.   Medicines  which  cause  the
  stomach to reverse  its  action, and throw its
  contents up through the mouth.
  Em-men'a-gogues.  Medicines supposed to
have the power of exciting or increasing the
menses.
  E-mol'lients.   Those  substances  which
have the power of softening  or relaxing the
animal fibre, when applied externally.
  En-dem'ic Dis-eas'es.   Diseases prevail-
ing in certain localities or districts.
  Ep-i-dem'ic Dis-eas'es.  Diseases extend-
ing over a large extent of country.
  Ep-i-glot'tis.   The  cartilage, which, in
the act of swallowing, shuts  down upon the
top of  the wind-pipe, and prevents food from
going into the breath-passage.
  Ep-is-pas'tics.  Substances which inflame
the skin, and raise the cuticle, and cause what
is called a blister.
  Es-cha-rot'ics.  Articles which burn, cor-
rode, disorganize, and destroy the animal tis-
sues, causing what  is   called an eschar, * or
slough, which is dead matter,  and falls off.
  Ex-pec'to-rants. Articles which act upon
the  system, so as to make the discharge of
mucas and other substances from the air-tubes
more easy.
  Er'rhInes.  Substances which cause sneez-
ing, and a discharge  of mucus from the  nose
when snuffed.
  Es'char.  The dead part, killed by caustic,
or mortification, which falls off; a slough.
  Ex-fo-li-a'tion.  A  scaling off, as a piece
of dead bone.
  Fau'ces.  The back part of the mouth.
  Fe'brile.  Belonging to fever.
  Fe'ces.  The matter  discharged from the
bowels.
  Feb'ri-fu-ges. Medicines which assuage
or remove fevers.
  Fla'tus.  Wind, or rather, gas, in the stom-
ach or bowels.
  Fol'li-cle.  A little bag or sac.
  Fo-ra'men.  A hole, or opening.
  For-mi-ca'tion . A sensation like the creep-
ing of ants.
  Fcr-fu-ra'ceous.  Branny, or scaly.
  Gang'li-on.  An enlargement in the course
of  a nerve.
  Gax'grene.  Mortification; partial death.
  Gas'tric.  Belonging to the stomach.
  Ges-ta'tion.  The period of pregnancy.
  Glot'tis.  The opening into the wind-pipe,
covered by the epiglottis.
  Gran'u-lar.  Like small grains.
  Gran'u-la-ted.   Covered with granula-
tions.
  Gran-u-la'tion.  The filling up or cover-
ing of a wound, or ulcer, with small, red eleva-
tions,  looking like grains.
  PLe-mop ty-sis.   liaising  blood  from the
lungs.
  He-mi-cra'ni-a.  Pain on one side of the
head.
   FLem'or-rhage.  A flow of blood.
  HjEM-or-rua'gic  Having a tendency  to
bleed.
   He-pat'ic.  Belonging to the liver.
   Hy-per-ca-thar'sis.   Excessive purging.
   Hy-per'tro-phy.  An unnatural enlarge-
 ment of an organ, without change of structure.
   Hyi'-not'ics.  Medicines which cause sleep.
   Icii'or (Ik'or). A thin, watery, and acrid
 discharge.
   In-tkr-cos'tal.   Between the ribs.
   Lar'ynx.  The top of the wind-pipe; the
 cavity which contains tho vocal ligaments. 
GLOSSARY.
787
  Lax'a-tives.  Medicines which render the
bowels a little more relaxed than natural, but
.do not purge.
  Lig'ate.  To secure with a ligature.
  Lig'a-ture.  A cord, or thread.
  Lo'chi-a.  The bloody discharge from  the
womb for some time after child-birth.
  Lo'chi-al.  Relating to the lochia.
  Lymph.  A whitish fluid  contained by the
lymphatic vessels. .
  Lym-phat'ics.  The vessels which  carry
lymph.
  Mac-er-a'tiox.  The act of softening or
soaking a thing by letting it  stand in water.
  Mac'o-l^;.  Colored spots; blemishes.
  Ma-la'ri-a.   Noxious gases from decom-
posed matter.
  Mam'ma.  The female breast.
  Man-dib'u-lar.  Relating to the jaw.
  Mas-ti-ca'tion.  The act of chewing.
  Mas-tur-ba'tion.  The act of exciting the
 genital organs with the hands.
■  Men'stru-um.  Any solvent, or vehicle.
  Met-a-car'pus.   The  hand between the
 wrist and the fingers.
  Me-tas'ta-sis.  The changing of a disease
 from one place to another.
  Met-a-tar'scs.  That part of the foot be-
'tween the ankle and the toes.
  Mi-as-mat'ic. Partaking of the nature of
 miasm.
  Mu'co-pu'ri-form.   Composed  of  both
 mucus and pus.
  Mu'co-se'ko-i.ent.   Composed  of  both
 mucus and serum.
  Nar-cot'ics.  Medicines which relieve pain
 and produce sleep.
  Nau'se-ants. Medicines which cause sick-
 ness at the stomach, or a disposition to vomit.
 They are often used as expectorants.
  Nos-ol'o-gist (Nose-ol'o-yist).   One who
 explains and classifies diseases.
  Nu'cle-us.  A central spot.
  Nu-cle-o'lus.  A spot within a nucleus.
  Or-thop-nce'a. Great difficulty of breathing.
  Os U'ter-i.  The mouth  of the womb.
  Os-si-fi-ca'tiox.  The formation of bone.
  O'vdm. An egg.  O'va. Eggs.
  Pa-pil'la.  A red, elevated point upon the
 tongue, or elsewhere.  Certain diseases make
 these points more prominent.
  " Par-a-cex-te'sis.  The operation of punc-
 turing the chest, or the abdomen, for the pur-
 pose of drawing off water.
  Par-a-phle'gi-a.  Paralysis of the lower
 half of the  body.
  Par'ox-ysm." A fit of disease taking place
 periodically.
  Par-tu'ri-ext.  Bringing forth, or giving
 birth.
  Par-tu'ri-ents.  Medicines which promote
 child-bed labor, by causing contractions of the
 womb.
  Par-tu-ri'tion.  Child-birth.
  Pec'to-rals. Medicines intended  to  cure
 or relieve diseases of the chest.
  Pel'vis.  The bony cavity, or basin, at the
 lower part of the body, containing the womb,
 abdomen, rectum, etc.
  Per-i-ne'um. The part, or space, between
 the  anus and testicles.
  Per-i-os'te-um.  A thin, hard membrane,
 covering the bones.
   Per-i-os-ti'tis.  Inflammation of the pen
 osteum.
   Per-i-to-ne'um.  A serous membrane lin-
 ing the cavity of the belly, and folded over
 most of the organs contained in it.
   Pet-e'chi-^e.  Purple spots which appear
 upon the skin in low fevers, looking like flea-
 bites ; called also ecchymoses.
   Pha-ge-den'ic.  Corroding,  eating, — ap-
 plied to ulcers.
  Phalanges. The bones of the fingers and
 toes.
  Phar'ynx.   The upper part of the throat.
  Piileg-mo'nous In-flam-ma'tion. Inflam-
 mation marked by redness, heat,  ani pain,
 and a tendency to form matter.
  Prog-no'sis.   The art of foretelling  the
 termination of diseases.
  Pty'a-lism.  Salivation.
  Pri'a-pism.   A  continued erection  of  the
 penis from exciting, morbid causes.
  Re-frig'er-axts.  Medicines which lessen
 the heat of the body.
  Re-lax'ants.  Medicines which relax  the
 tension of the muscles.
  Re-mis'sion. A lessening or mitigation of
 the severity of the symptoms of a disease.
  Res-o-lu'tion.   Dispersion  of an inflam-
mation before pus  is formed.
  Re-vul'sives.   Medicines or appliances
which remove a disease by causing a deter-
mination.to some other part.
  Ru-be-fa'ciexts.  Applications which  ex-
cite the skin, causing the blood to flow to it,
and making  it red.
  Sa'nies.   A thin fluid  discharged from ul-
cers, having  some  of the properties of pus and
blood.
  Sed'a-tives.   Medicines which  diminish
 the action of the heart and nerves, and which
 are used when  we wish to  allay  any excited
 action in the system.
  Se'rous.  Watery.
  Scro'tlm.   The bag which contains  the
 testicles.
  Scyb'a-la.  Hard, round  lumps in the feces.
  Si'a-la-gogues.  Medicines which increase
 the flow of saliva.
  Slough  (Sluff)   Any part of the body
 killed by mortification, or caustic, and cast off.
   Sper-mat'ic Cords.  Two cords, composed
 of nerves, veins, and arteries, descending, one
 on each side, from -the abdomen into the scro-
 tum, and suspending the testicles.
   Squa'mous.  Scaly; having scales.
   Sor'des.  The dark matter deposited upon
 the lips and teeth, in low fevers.
   Ster'num.   The breast-bone.
   Ster'tor.   Noisy breathing, as in  apo-
 plexy.  Snoring.
   Ster'tor-ous.  Snoring and  noisy, as ap-
 plied to breathing.                       •
   Stim'u-lants. • Medicines which increase
 the activity of the system.
   Sto-mach'ics.   Medicines which  support
 and renovate the stomach, making its action
 healthy.
   Stru'ma.  Scrofula.
   Styp'tics.  Substances which, when ap-
 plied externally,  have the power to constringe
 or pucker  up bleeding  vessels, and stop the
 loss of blood.
   Sub-cu-ta'ne-ous.   Under the skin.
   Sub-max'il-la-ry.  Under the lower jaw.
   Sub-sul'tus Ten'di-num.   Slight twitch-
  ings of the tendons, which occur in low forms
  of fever. 
788                               GLOSSARY.
  Su-do-rif'ics.   Medicines which cause a
flow of perspiration, rather more free than
that produced by diaphoretics.
  Sup-pos'i-to-ries.  Solid medicinal sub-
stances, of a conical or cylindrical  shape,
which  are placed in  the rectum for the pur-
pose of relieving constipation and the piles,
and for removing stricture.
  Syn'co-pe.  Fainting; swooning.
  Te-nes'mus.  A painful bearing down in
the lower bowel, and a distressing desire to go
to stool.
  To^cs.  Medicines which gradually give
tone and strength to weakened organs, or to
the whole system.  Some act upon the ner-
vous system, and some upon the other tissues,
by condensing, hardening,  and invigorating
them.
  Tor'mi-na.  Griping pain.
  U-re'ters.  The tubes  which convey the
urine from the kidneys to the bladder.
  U-re'thra. The canal which conveys the
urine from the bladder out of the body.
  U'ter-us.  The womb.
  Vag'i-na (Vadg'i-na).  The  passage  from
the external genital organs to the womb.
  Va'ri-cose Veins.  Veins which are mor-
bidly enlarged, and present along their course
soft, knotty, purplish tumors.
  Ver'ti-go. Dizziness; giddiness.
  Ve-si-ca'tion.  Blistering.
  Vi'rus.  Poison; contagion.
  Vis'cus.  A liver, stomach,  kidney, heart,
or any organ  within one of the cavities of the
body.
  It is believed that the hard words introduced into this book, and not contained in
the above Glossary, are nearly or quite all explained at the places where  they are
used. 
INDEX.
 Abdominal Cavity, Diseases
  of,
 Abies Canadensis,
  "   Excelsa,
  "   Picea,
 Abortion,
 Abscesses,
 Absence of Menses,
 Absorbent  Vessels,
 Acacia Catechu,
 Accidents ou Water,
   "     bv Poisoning,
 Acetate of  Copper, poisoning

   "   " Lead, poisoning by, 498
   "   "   "   Ointment,   675
Acetum,
Achillea Millefolium,
Acid, Acetic,
  "   Citric,
  "   Diluted Hydrochloric,
    Alumen,
2621 Amaurosis,
Amenorrhoea,
American Hellebore,
    "■     Ipecacuanha,

    "     Valerian,
Ammonia, Aromatic Spirit of, 594
    "     Carbonate of,      593
    "    Muriate of.        593
    "    Poisoning by.      496
    "    Solution of Acetate
PAOE
 592
 486
 354
 592
 693
 593
 665
658
676
              Hydrocyanic,
   "     "    Nitric,
   "     "  Sulphuric,
   "   Nitro Muriatic,
   "   Tannic,
   "   Tartaric,
  Aconite,

     «   S?no?fby'
  Aconitum Napellus,
  Acorus Calamus,
  Adipous Sarcoma,
  Affections of Chest,
     "    " Head.
     "    " Stomach and
               Bowels,
 Affusion, The,
 Age, Influence of,
 Ague Root,
   "   Fever and,
 Air Cells or Vesicles,
   "  "  Enlargement of,
   "  in Chest,
   "  Swellings,
   "  and Ventilation,
 Albumen,
 Albuminuria,
 Alcohol,
 Alder, Tag,
 Aletris Farinosa,
 Aliments, Fluid,            568
 Allium Cepa;               636
   "    Sativum,            616
 Almonds,                  591

 *iJ  J,?7rnPof>          684
 Almond Mixture,            674
 A nus Kubra,               658
 Aloes                      592
      Comp. Tinct. of,       690
      and Canella, Compound
       Powder of,          682
Alpinia Cardamomum,      604
Althaa Officinalis,           631
Alum,                      692
                of,
        "     Water of,
    Ampelopsis Quinquefolia,
    Amusements,
          "      Games for,
                 Lighter,
          "      Want of,
    Amygdalus Communis,
         "     Persica,
    Auagallis Arvensis,
    Anasarca,
    Anatomy,
        "    ofBones,
    Anchylosis,
    Aneurisms,
    Aneurismal Tumors of Heart,
    Angina Pectoris,
    Anise,
    Ankle, Dislocation of,
    Anthemis Nobilis,
471 Anthrax,
674 Antidotes of Poisons,
6<4 Antimony,  Poisoning by,
    Antipathies,                 660
    Aorta,                        37
    Apocynin,                   597
    ApocynumAndrosaemifoIium, 597
    Apoplexy,                   160
    Apparent Death from Various
      Causes,                    494
    Apple Water,                681
    Apthas,                      399
    Aqua Calcis,                 628
    Arachnitis,                   153
    Arachnoid,                    45
               Inflammation of,  153
Asarum Canadense,
Asclepias Incarnata,
    "    Syriaca,
    "    Tuberosa,
Ascites,
Asiatic Cholera,
Aspidum Filix Mas,
Assafoetida,
           Comp. Tinct. of,
Asthma,
Atmosphere, Pressure of,
Atropa Belladonna,
Atrophy,
Attendants, Unhired,
Aurantii Cortex,
Auricles,
Ausculation,
Aralia Hispida,              613
  "  Racemosa,            652
  "  Spinosa.              645
Arbutux, Trailing,   "       658
Argenti Nitras,              634
Aristolochia Serpentaria,     660
Arnica,                     594
  "    Montana,           694
Aromatic Powder,           682
    "    Spirit of Ammonia, 594
Arrow Root,                694
   "     "    Gruel,         581
Arsenic,                    497
Arsenical Solution,           653
Artemisia Absinthium,       664
Arteries,                     36
    "    Pulmonary,          37
    Balm,
      "   ofGilead,
    Balmony,
    Balsam "Copaiva,
       "    Tolu,
    Balsamodepdron Myrrba,
    Bandages, Wet,
    Baptisia Tinctoria,
    Barberry,
    Barbers' Itch,
    Barley,
       "    Coffee,
    Barosma Crenata,
    Barrenness,
4341 Basilicon Ointment,
496; Bath, Cataract,
      "   Cold Foot,
      !'   Douche,
      "   Eye and Ear,
      '•   Half,
      "   Head,
      "   Hose,
      "   Leg,
      "  Mouth or Oral,
      "   Nose,
      "   Plunge,
      "   Shower,
      "   Sitz,
      "  Towel and Sponge,
      "   WadingFoot,
      "  Warm Foot,
      "  Wash-Tub,
      "   Wave or Sluice,
      "  Cold,
      "   "  Effects of,
      "   Hot,
      "   "  Effects of,
      "  Tepid,
      »   "    Effects of,
      "  Vapor,
      «  Warm,
      "    "    Effects of,
    Baths of the Ancients,
      "   Cold,
      "   Division of,
      "  Names of,
      "  Neglect of,
 662
 657
 6Q9
 641
 317
 290
 630
 594
 690
 243
 108
 612
 253
 659
 637
  36
 210

 694
 695
 595
 695
 695
 634
 649
 662
 695
 149
  77
 679
 601
 371
 667
 534
 539
 633
 540
 635
 636
 634
 636
 541
 640
 536
 634
 537
 638
 640
 640
 637
 635
 642
 543
 542
 544
 642
 643
 642
 642
 644
 103
 105
641
104
104 
790                                      index.
Baths, Reaction after,        107
  "   Shower,              106
  "   Sponge,              105
  "   "V apor,                106
  "   Warm,                106
Bathing and Cleanliness,     101
       •Sea,                 514
Bayberry,                   596
          Ointment,         676
Bean, St. Ignatius's,         656
Beans,                   70—78
Bearberry,                  5^5
Beds and Bedding,       96—553
Beef Tea,                    582
  '• Essence of,             5S2
Beets,                        79
Beeves' Galls,                596
Belladonna Atropa,          612
    "      Ointment,        676
    "      Plaster,          679
    "      Poisoning by,    499
Benzoic Acid,                596
Benzoin,                    590
   '•    Comp. Tinct. of,     690
Berberis Vulgaris,           595
Bethroot,                    597
Bile iu Stomach,              64
Biliary Calculi,        9     268
Bilious Colic,                284
  ''    Remittent Fever,      411
Bismuth,                    697
    ■'    Nitrate of,        ■  597
    "    Subuitrate of,       597
    ,:    Trisnitrate ot,       597
    "    White Oxide of,     597
Bitter Root,                 597
Bittersweet,                  5971
Black Alder,                 598'
  "  Cohosh,               598
  "     '•   Comp. Tinct. of, 691
  "  Root,                  609
  "  Willow,               599
Blackberry,                  598
Bladder,                      34
   "  Acute Inflammation of, 297 ]
   "  Chronic   ••      "  298
Bleeding from Kidneys,      302
    "      "   Nose,         491
    "      "   Wounds,      493
Blenorrhagia,                331
Blistering Plaster,           667
Blood in Scrotum,           474
Bloodroot,                  599
Bloody Flux,                292,
Blue Cohosh,                599
  "    "    Comp. Tinct. of,  69J
  " Disease,                408
  " Flag,                   600
  " Pill,                    600
Body, Structure of the,        14
  "   Chemical Properties of,   14
   "  Physical     "     "   16
  "   Vital        "    "   18
Boiled Flour,                582
Boils,                       433
Bones, Anatomy of,           18
  "   Diseases of,           465;
   "   Death of,             465'
  "   of'Head,               20
   "   " Trunk,              21!
   "    " Upper Extremities,   22!
   '■   " Lower    "         24
   li  Time required for unit-
        ing,                 447
   "   Unnatural Growth of,  465
   "  Ulceration of,         465
   "   Uses of,               26
Boneset,                    600
Borax,                      652
Bowel, Falling of,           405
Bowels, Affections of,        577
   '•   Acute Inflammation of, 281
   "   Chronic   "       "  2S2
   "   Looseness of,     289-403
Brachial Plexus,              47
Brain,                       44
                           PAGE
Brain, Abscess of,«    •      J55
   "   Dropsy of,            158
   "   Enlargement of,       156
   "   Exercise of,            58
   "   Fever,                153
   "   Health of,             57
   "   Induration of,         155
   !;   Inflammation of,      153
   "   and Nerves, diseases of, 152
   "   Old People's,           59
   "   Overworking,          59
   "   Shrinking of,         1.07
   "   Softening of,          154
   "   Tumors of,            155
Bran, decoction of,           57H
Brandy Mixture,             671
Bread and Water Poultice,    080
breast Bone, Fracture of,     452
   ••   Broken,       •        3^*
   "   Intiamtnation of,      3>*
Breathing, Objects of,         1'*
   "     Philosophy of,     108
Bright's Disease of Kidneys,  299
Broken Bones,               446
Bronchial Tubes,              35
         Consumption,      211
Bronchitis, Acute,           231
    "     Chronic,          233
Bronchocele,                4".3
Bruises,                     46-1
Bubo,                  321-329
Buchu,                      601
   "   Tinct. of,             689
Buckhorn Brake,            601
Buckthorn,                  601
Buckwheat,                   79
Bugleweed,                  602
Bunions,                    467
Burdock,                    602
Burgundy Pitch,             602
Burns,                      435
Butternut,                   602
Cabbage,
   "    Skunk,
Calamine Cerate,
   "     Prepared,
Calamine Praeparata,
Calcined Deer's Horn,
Calculus,
Calf s Feet Jelly,
Calico Bush,
Calomel,
Calx,
  "   Chlorinata,
Camphor,
    "    Liniment,
         Water,
 79
651
666
66G
666
602
315
5*3
633
602
628
628
603
671
673
Camphorated Soap Liniment, 672
Canabis Indica Tinct. of,     689
Canada Balsam,             6031
   "   Fleabaue,            603
   "   Snake Root,         6H2
Cancer,                     469
   "   of Mouth,            400!
Cancrum Oris,               400]
Canella,                     6031
   "   Alba,                603
Canker Lettuce,             648,
Cantharis Versicatoria,       654
Cantharides, Tinct.  of,       689'
Capillaries,  '                 371
Capsicum Annuum,          605
    "     Plaster, Comp.,  '   679!
Caput Obstipum,             480
Caraway,                   603
Carbo Ligni,                606
Carbuncle,                  434
Cardialgia,                  276'
Cardamom,                 604
          Comp. Tinct of,   690
Carditis,                    255]
Care of Children,            391
       Teeth,               401
Caries,
Carrots,
455-491
     79
                          PAOK
Carum Carui,                60S
Cartilage, Arytenoid,         41
    "     Crycoid,          41
    "     Thyroid,          41
Carvophillus Aromaticus,     607
Cascaiilia,                  004
Caseine,                     16
Cases Treated,               203
Cassia Acutifolia,            650
  "  Buds,                 607
Castor,                      604
   '•   Oil,                  604
Castoreum,                  604
Catalepsy,                  168
Cataplasms,                 680
Cataract Bath,               534
Catarrh,                     189
Catarrhal Opthalmia,         484
Catechu,                     604
   "    Tinct. of.            689
   "    Comp. Tinct. of,     690
   "    Comp. Powder of,   682
Catnip,                      604
C'aulophyllum Thalictroides,  599
Caulophyllin,                600
Cayenne  l'epper,             tj(>6
    "     "     Tinct. of,    689
Ceanothus Americanus,      647
Celaudyne,                  605
Cerates,                     66<i
Cerebellum,                 44
Cerebrum,                  44
Cerevisiae  Fermentum,        664
Cessation  of'Meuses,          382
Cetaceum,                  654
Cetraria lslandica,           621
Charing,                     492
Chalk,                      605
  ''  Mixture.              674
  "  Comp. Powder of,     691
  ''  Comp. Powder of, with
        Opium,             682
Chamomile,                 606
Charcoal,                   606
Chelidonium Majus,          605
Chelone Glabra,             595
Chemical  Food,              686
    "     Injuries,           435
Chenopodium Authelminti-
  cum,                      664
Cherry, Wild,               661
Chest, Affections of,          574
  "  Air in,                236
  "  Diseases of,           209
  "  Water in,             237
Chicken Water,              583
duckweed, Red,             647
Chilblains,                  468
Child-Bed Fever,            387
Children;Care and Diseases of, 391
    "   Nursing Sick,       394
    "   Weaning of,         392
Cbimaphila Umbellata,       641
Chloroform,                 606
Chlorotbrmum,              606
Chlorosis,                   300
Choice of Sick-Room,         651
Cholera. Asiatic,             290
   "    Infantum,          404
        Morbus,            290
Chorea,                     169
   "   Chronic,             170
Choroid Coat,               49
Chyle,                      64
Chyme,                     64
Ciliary Processes,            49
Cimicifuga Racemosa,        698
Cimicifugiu,                 599
Cinciioua,                  639
Cinchonia,                  639
Cinnamon,                  607
          Tinct. of,         689
     '•    Comp. Tinct. of,   690
Circulation, Organs of,       36
Cirsocele,                   478
Citric Acid, Syrup of,         684 
INDEX.                                      791
 Citrus Limonum,
 Clap,
 Cleaning the Teeth,
 Cleanliness,
 Cleavers,
 Clergymen's Sore Throat,
 Climate,
 Clothes Catching Fire,
 Clothing,
    "    Color of,
    "    Cotton,
    "    Hair as,
    "    Linen,
    "    Porous,
    "    Silk,
    "    Tight,
    "    Woollen,
 Clover,- Red,
 Cloves,
 Clovus,
 Clysters,
 Coccus Cacti.
 Cocculus Palmatus,
 Cochineal,
 Cochlearia Armoracia,
 Cod Liver Oil,
 Coffee,
   "   Barley,
   "   Crust,
   "   Milk,
 Colchicum Autumnale,
     "     Comp. Tinct. of,
 Cold, Effects ol,
  "  Foot Bath,
 Colds,
 Colic,
   "  Bilious,
   "  Painter's,
   "  Wind,
 Colica  Pictonum,
 Colitis,
 Colocynth,
 Colodion,
 Colombo,
 Colon,
 Coltsfoot,
Colt's Foot,
Comfrey,
    "     Comp. Wine of,
Common Silk Weed,
Complonia Asplenifolia,
   page |
    627 Corn, Indian,
    831 Cornea,  •
    503   "    Inflammation of,
100, 555 Corneitis,
    607
    191
     71
    496
     98
    100
     99
     99
     98
    100
     99
110, 111
    99
647
607
620
607
 84
579
579
585
632
691
436
539
Corns,
Cornu Ccrvin.T Ustum,
Cornus Florida,
   "   Servicea,
Corrosive Sublimate,
 49
485
485
145
602
613
657
78 Dislocations of Hip Joint,    461
609 Disturbed Sleep,
Knee Pan or
  Patella,
Knee Joint,
Lower Jaw,
Shoulder
  Joint,
Wrist,
Poisoning by, 497  Dizziness,
     Corydalis Formosa,
     Costiveness,
     Cotton,
     Coup de Soliel,
     Cow Pox,
     Coxalgia,
     Cramp Bark,
     Cramps.
  7 i Cranesbill,
 145  Cranial Nerves,
 6711 Crawley,
 607 ! Cream of Tartar,
 608 j Creosote,
        ''    Ointment,
     Creosotum,
     Crocus Sativis,
     Croton. Eluteria,
       "    Oil,
       "     "  Liniment,
       "    Tiglium,
     Croup,
     Crow Corn,
     Crural Phlebitis,
     Crust Coffee,
205  Crusted Tetter,
405  Cubebas,
284  Cubebs,
285  Cucumber, Wild,
282  Cucumis Colocynthis,
285  Culvers  Root,
292  Cupri Subacetas,
608  Cupri Sulphas,
608  Cuprum,
608  Cyanosis,
 32  Cypripedin,
608  Cypripedium Fubescens, 626, 665
662  Cystine Deposits in Urine,    311
608  Cvstirrhcea,
673  Cystitis,
609
657  Dancing,
659 Dock. Yellow,
286 Dogwood,
6101    "      Poisoning by,
1621    "      Swam]),
136 Domestic Management of the
4661  Sick-Room,
619! Doses,
    Douche Bath,
            Pail,
    Dover's Powder,
    Dragon Root,
    Dress, Wet.
    Drink, Pleasant,
    Dropsy of Belly.
            " Cells,
       "   General,
    Dry Pimples,
    Driinkaid's Delirium,
    Dura  Mater.
      "    "   Inflammation of,
    Dwarf Elder,
    Dysentery.
        '•    Chronic,
579 Dysmenorrhea,
142 Dyspepsia,
 171
 610
 45
 610
 643
 611
 676
 611
 648
 604
 611
 672
 611
401
 4P3
 463
 458

 459
 460
 1S2
 lsl
 664
 612
 499
 657

 551
 5NS
 r.:>3
 634
 6H2
 621
 530
 579
 317
 318
 318
 144
165
 45
 152
613
292
293
367
271
272
274
Comp. Fractures,        446—455  Dandelion,
  "   Infusion of Catechu,   670  Datura Stramonium,
  "      '•     " Gentian,   670  Deadly Nightshade,
  "      "     " Geranium, 670  Deafness,
  "      "     »' Parsley,   670  Death of Bones,
  "      "     "  Senna,    670  Decoction of Bran,
Comp. Infusion of Trailing     Decoctions,
  Arbutus,                 671  Deformities of Spine,
656
612
490
465
Compresses,
Confections,
    "   Aromatic,
    "   of Catechu, Comp ,
    "   of Senna,
Congestive Fever,
Conium Maculatum,
    li   Poisoning by,
Conserves,
Constipation,
Constitution,
      "     Idiosyncrasy of,  121
Constitutional Differences,    217
649 Dehsler's Cerate,
668 Delivery,
668 Delirium Tremens,
668 Dementia,
668 Dens Leonis,
412 Derbyshire Neck,
641 Diabetes,
499 Diarrhoea,
668     "     Chronic,
286 Dictionary,
120 Diet,
         in Disease and Convales^
           cence,
Causes of
Treatment of,
Urinary Deposits in, 272
                    81

                   488
                    51
                    61
                   492
                   490
                   490

                   167
                   142
                   139
                   644
                   482
                   450
Dyspeptics,

Ear, Affections of,
  "  Drum of,
  "  External,
  "  Foreign Substances in,
  '■  Wax in,
Earache,
    Eclectics,
298 Ecstasy,
297, Ecthyma,
   ! Eczema,
 921 Effervescing Draught,
612! Egyptian Ophthalmia,
    Elbow, Fractures of,
Joint, Dislocation of, 460
Consumption
209 Difficult Teeth. Cutting,
A General Disease, 220 Digestion,
     "    Bronchial,
     "    Causes of,
     •'    Tubercular,
Contused Wounds,
Contusions,
Convolvulus Scammonia,
Cookery for Sick Room,
Copiafera Officinalis,
Copper,
   '•    Subacetate of,
   «    Sulphate of,
Corallorhiza Odontorhiza
     217     "     Table,
215—218  Digestive Organs,  .
     212  Digitalis Purpurea,
     441  Dioscorea Viflosa,
     464  Diospyros Virginiana,
,     650  Diseases,  General,
     578     "    of Children,
     595  Dislocations,
     6091    "      of Ankle Joint,
609
609
6101
                    Elder,                      613
                      "   Dwarf,               613
                    Elecampane,                613
                668 Electro Magnetism,          613
                478 Electuaries,                 008
                607 Electuary,  Lenitive,          668
                381 Elixir Salutis,               693
                155   "   Vitriol,               689
                176 Elm,  Slippery,               652
                612 Emphysema,                234
                473 Encephalitis.                163
                301 Encephaloid Tumor,         470
            289—403| Encysted,      "            471
                2891 Endocarditis,               255
                717 I Enlarged Veins,             475
            228, 5641 En on \ mus AtropurpureuB,   661
                    Enteritis,                   281
                564 Eneuresis.                   305
                401 Epiga-a lfepens,             668
                 61 Epiglottis,                   41
                 69     "     Inflammation of,  207
                 31 Epilepsv,                   167
                614 Epileptic Fits,               167
                662 Epistaxis,    -                491
                639 Ergot,                       655
                570 Eirgeron Canadense,         601)
                391 Eruptions, Scaly,            143
                 457 Erysipelas,                  136
                 463 Erythema,                  138
  BonesofHead, 461 Erythematic Stomatitis,      398
" dollar Bone,    459 Essences,                    669
" Elbow Joint,    4601 Essence of Beef,             6S2 
792
INDEX.
PAGE
 601
 600
 646
 593
 646
  51
 492
Eupatorin,
Eupatorium Perfoliatum,
    "      Purpureum,
Euphorbia Ipecac,
Eupurpurin,
Eustachian Tube,
Excoriation,
Exercise,
    "   Active and Passive, 89—93
    "   Excessive,            89
    "   In-door,              93
    "   Mental Cooperation in. 94
    "   Out-door,         93—229
    "   Pleasurable,        89—94
    "   Regular.
    "   for Students,
    "   When to take,     89-
    "   for Young Women,
Exhalants,
Exostosis,
Extracts,
    "      Fluid,
Extracts of Rhubarb and Po-
  tassa,
Eyebrows,
Eyelashes, Disorder of,
Eyelids,
    "   Inflammation of,
Eye, Coats of,
  ''  and Ear Bath,
  "  Foreign Bodies in,
  "  Glibeof,
  "  Humors of,
Faba Sancti Ignatii,
Fainting,
Falling of Bowel,
   "   "  Womb,
   "   over of Womb,
False Grape,
  "   Joints,
  "   Measles,
  "   Sarsaparilla,
  "   Unicorn,
Fat
Fatty Tumor,
Favus,
Fel Bovinum,
Felon,
Female Diseases,
Ferr-,
Fern Ammonio Citras,
  "   Citras,
  "   Iodidum,
  *•'   Lactas,
  "   Oxidu-mHydratum,
  "      "    Nigrum,
  "   Pbosphas,
  "   et Potassa? Tartras,
  "   Protoxidum,
  «   Pulvis,
  "   et Quinse Citras,
  "   Subcarbonas,
  "   Sulphas,
  "   Syrupus Iodidij
  '•   Tiuctura Chlondi,
 Fernim,
 Feruiiculus,
 Fever,
   •'   and Ague.
   "   Bilious Remittent,
   "   Congestive,
   "   Intermittent,
   "   Lung
40
                             PACE
   Flaxseed,                   614
   Flies, Spanish,               654
   Flour, Boiled,               682
   Fluid Aliments,             668
         Extracts,              669
         Nutritive,             586
   Fluor Albus,            353,390
   Folded Wet Sheet,           531
   Follicles,
   Follicular Inflammation of
     Mouth,
   Fomentations,
   Food,
     "  Albuminous,
     "  Amount of,
     "  Animal and Vegetable,
     '•  Articles of.
     "  Azotized and Non-azo-
          tized,
     "  Choice of,
     "  Cost of.
     "  Digestibility of.
     "  Fatty,
     "  Heat-generating.
     "  Nature and Destination
          of,
     "  Nutritive,
     "  in Old Age,
     "  Organic,
     "  Starch  and Sugar as,
     "  Tables of Value of,
     "  in Youth and Manhood.
 49 Foot Bath, Cold.
   i  u    n   Warm.
656  "  Fractures of.
181 Fore Arm, Fractures of,
405 Foreign Bodies in Eye,
368 Fowler's Solution.
368 Foxglove,
693 Fracture*,
    Gelseminin.
    Gelseminum Sempervirens,
    Gengivitis.
    General Diseases.
      "    System. Diseases of.
    Gentian.
      "    Comp. Tinct. of,
    Gentiana Lutea.
    Geranium Maculatum,
    Gill-over-the-ground,
3991 Ginger.
669';   "    Wild.
 611   "    Syrup of,
 74| Ginseng.
Glands.
PAOS
 605
 661
 400
 570
 409
 615
 691
 615
 610
 617
 615
 662
 684
 616
   40
   50
   43
   31
   31
   43
447
138
652
618
 16
471
151
596
467
339
657
6.3
623
6'13
623
623
623
644
625
624
624
                             Lachrymal,
                             Oil.
                        "    Parotid,
                        "    Submaxillary,
                        "    Sweat,
                      Glauber's Salts.
                      Gleet.
                      Glossary,
                      GlottiSj Spasm of.
                      Glycerin,
                      Glycerrhiza Glabra,
                      Goitre,
                      Gold,
                      Golden Seal,
                        •«     "  Comp. Powder of, 682
                        "     »    '•  Tinct. of,  691
                        «     "    "   Wine of,   673
                      Golden Tincture,
                      Gonorrhoea,
                      Gossypium Herbaceum,
                      Gout,
                   .. Granulation,         .
                  653| Grass, Star,
                  614 Gravel*
                  442   "    Root,
Compound,        455   "    Urio Acid,
of Bones of Foot,   455' Green Sickness,
 "   "   "Nose,   447! Griffith's Myrrh Mixture,
 " Breast Bone,    452, Ground Ivy,
 " Collar Bone or     |   "     Rice Milk,
     Clavicle,     4481 Grubs or Worms.
 "Elbow         4501 Gruel. Arrow Root,
 "Fore Arm,     450|   "   Rice,
 " Hand aud Fin-        "   Sago,
     gers.         451'   "   Water,
 " Haunch Bones     , Guaiac, Ammoniated Tinct.
     or Pelvis,     452:  of.
 M Knee Pan.     454 Guaiacum,
 " Leg,           455 Gullet, Foreign Bodies in,
 " Lower Jawi    448 Gum Arabic,
 " Ribs>          451,  "  Hemlock,
 " Shoulder Blade, 449   "  Sweet,
 » skull.          447 Gums. Inflammation of,
 " Thigh Bone.    452 Gunshot Wounds.
   Upper Arm Bone.449 Gymnastics,
721
402
616
628
473
616
616
331
610
417
442
655
306
646
308
360
674
617
582
148
581
580
681
680

691
617
493
617
617
658
400
442
  91
Wrist,
623 Freezing_Mixtures,
624 French Decimal Weights,
625'    "   Milk Porridge,
625 Frost Bite,
625 Frost weed,
451,
505 Haemastasis,
589 Hasmatocele.
682 Hamiatoxylon  Campechia-
436!   num,
6141 Hematuria,
617
474
629
622 Fumigation of infected places 504'Hair. Disorders of,
                      433  Fungus Hematoidcs
                      409 I
                      413 | Galbanum Plaster, Comp.,
                      411  Galium Aparine,
                      412  Gall Bladder,
                      413   " Stones,
                      240  Galls.
Pernicious Intennittent.412,  "  Comp, Ointment of,
Refreshing Drinks in.   579  Gamboge.
                      410 | Gangrene of Mouth,
                      242  Garget,
                      613  Garlic,
                       15:    "  Syrup of,
                      614' Gastric Fever of Infancy
                      502    "   Juice,
                      451 Gastritis.
                      496 Gastrodyma,
                      408 Gaultheria Procumbens.
                      658 Gelatine,
150
618
635
653
     Typhoid,
  "     "     Lung,
Feverfew,
Fibrine,
Figwort,
Filling Teeth,
Fingers, Fractures of.
Fire, Clothes Catching,
Fits,
Flag, Sweet,
470 ' Hair Cap Moss,
   | Half Bath.
679 Hammamelis Virginlca,
607 Hand. Dislocation of Bones
 33,        of,                 461
208   "  Fractures of,          451
615 Hardback,               •  618
676 Hardleaf Golden Rod.     •  618
615 Haunch Bones. Fractures of. 452
400 Hazel, Witch,              663
642 Headaches,                 183
615, Head. Affections of.         574
G*4\  "   Bath,                536
4061  "   Water in.            157
 62 Hearing, Organs of,           51
269 Heart,                       86
277    "  Diseases             246
663    "  Altered Sounds of,   248
 16'   "   Aneurismal Tumors of. 252 
INDEX.
793
Heart, Atrophy of,           253  Hypophosphites.Comp. Syrup
      Bone and Cartilage in, 253 i  of,
      Dilatation of Ventricles   | Hyssop,
        °f,                 250  Hyssopus Officinalis,
  "   Displacements of.      261  Hysteria,
  "   Enlargement of Ventri-    I Hysterics,
        cles of,             248
  "   Fatty Degenerations of, 252  Ice Plant,
  "   Hypertrophy and Dila-    ' Iceland Moss,
        tation of,            251  Ichthyocolla,
  "   Impulse of,           247  Icterus,
  "   Induration of,        252  idiocy,
  "   Inflammation of,      256  Ignatia Amara,
  "   Inflammation of Lin-      Ileum,
        ing of.
  "   Neuralgia of,
  "   Percussion of,
  "   Polypus of,
  "   Shrinking of,
  "   Softening of,
  "   Sounds of,
  "   Valves of,    f
Heartburn,
Heart-case, Acute Inflamma-
            tion of,
   "      Chronic Inflamma
            tion of,
   "      Water in,
Hedeoma Pulegiodes,
Helianthemum Canadense,
Helianthus Annuus,
Hellebore, White,
Helonias,
   "     Dioica,
Hemicrania,
Hemiphlegia,
Hemlock, Comp. Tinct. of,
   "     Gum,
Hemorrhoids,
Henbane,
Hepar,
Hepatica Americana,
Hernia,
Herpes,
Hiccough,
High Cranberry,
255 Impetigo,
260 Incised Wounds,
248 Incubus,
261 Indian Corn,
253    "   Hemp,
252    "     "   Tinct of,
247    "  Turnip,
256 Indigestion,
278 Indigo, Wild,
    Infancy of Being,
253 Infants, Gastric Fever of,
          Milk for.
Iron, Tartrate of, and Potassa, 626
  "  Tincture of Muriate of,   625
  "  Valerianate of,          626
Ischuria Renalis,
Isinglass,
    "   Jelly,
Itch,
  "  Barbers',
  "  Jackson's,
Itching,
   "   of External Parts,
Ivy, American,
  "  Big,
  "  Ground,
  "  Poisoning by,
254   "   Summer Complaints of, 404
259 Inflammation,
638 Inflammatory Blush,
614 Influenza,
657 Infusion of Malt,
661 Infusions,
613 Inhalants,
618     "    Objects of,
172 Inhalation, Atmospheric,
162 Inhaler, Medicated Vapor,
691 Inhaling Powder,
617 Injections,
2^7     "    Chemical,
618     "    Mechanical,
645 Insanity,
628     "   Causes of,
476     "   On  one Subject,
139 Instrument,  Tonsil,
180 Interalgia,
619 Intermarriages,
nip Joint, Disease of,
Comp.Tinct of, 691  Intermittent Fever,
1:p
Dislocation of,
Hippuric Acid in Urine,
Homoeopathy,
Homoeopathic Remedies,
Hooping Cough,
Hops,
Hordeolum,
Horehonnd,
    "      Water,
Horsemint,
Horseradish,
Hose Bath,
Hot Drops,
Houseleek,
Humid Tetter,
Humulus Lupulus,
Huxham's Tincture,
Hydatids Uterine,
Hydrangea,
    "      Aborescens.
Hydrargyri Chloridum Mite,
           Pillulae,
466 Intestines,
461 Introduction,
313 Inula Helenium,
  7 Iodide Potassium,
608 i Iodine,
403 J Iodinum,
619; Ipecacuanha,
481
590, 670
    221
    223
    227
    223
    682
545, 671
    435
    437
    173
    177
    175
    2(r2
    282
     57
    413
     32
      5
    613
    622
    622
    622
    622
    Jackson's Itch,
    Jalap,
      "   Comp. Powder of,
    Jamestown Weed,
621 j Janipha Manihot,
271 Jaundice,
662! Jaw, Fractures of Lower,
 62!   "  Dislocation of "
406 Jejunum,
580 Jelly, Calf's Feet,
         Irish Moss,
4251   "  Isinglass,
1381   "  Tapioca,
205 Jerusalem Oak,
579 Jessamine, Yellow,
              Comp. Powder of,
       "     Svrup of,
       "     Wine of,
620! Ipomcea Jalapa,
620 Iridin,
634; Iris,
692  "  Inflammation of,
620  "  Versicola,
139! Irish Moss, Jelly of,
619 Iritis,
Hydrastin, Comp. Ppwder of, 682
Hydrastis Canadensis,
Hydriodate Fotassa,
Hydrocele,
Hydropathy,
Hydropathic Treatment,
Hydropericardium,
Hydrophobia,
Hydrocephalus, Acute.
     "         Chronic,
Hydrothorax,
Hygiene,
Hyoscyamus Niger,
     "      Poisoning by,
Hypertrophy of Lungs,
Hypochondria,
Iron,
626
699
139-
149
149
146
370
693
633
617
499

149
626
683
656
659
267
448
458
 32
683
681
681
681
664
664
 25
666
447
602
602
626
626
649

633
Joints,
  "   Diseases of,
  "   False,
Juglandin,
Juglaus Cinerea,
Juniper,
Juniperis Communis,
Juniperus Sabina,
Kalmia Angnstifolia,
  "    Latifolia,           633
Kidneys,                    34
   "    Acute Inflammation
          of,               294
   "    Chronic Inflamma-
          tion of,          296
   "    Bleeding from,     302
   "    Bright's Disease of, 299
King's Evil,                419
Kino,                      626
  "   Comp. ""owder of,     683
Knee Joint, Dislocatian of,   408
  "   Pan,     "       "   403
  "    "    Fractures of,    454
Kramcria Triandra,         647
Ammonio-Citrate of.
Black Oxide of,
Citrate of,
  "    " and Quinia
    Labor,          .           381
    Labyrinth,                   51
 49 Lacerated Wounds,          441
485 Lachrymal Canals,           60
600     "     Glands.           60
681     "     Sac. Inflammation
485             of.            482
622 Lacteals,                    32
623, Lnctuca Sativa,             627
623 Ladies' Slipper,         626, 005
623 Lappa Minor,               602
623 Laryngeal Shower Syringe,  195
Comp. Mixture of,
Hydrated Oxide of,
Iodide of.
Lactate of.
Per Salt of,
Phosphate of,
Powder of.
Precipitated Carbonate
  of.
Protoxide of,
Solutions of Protoxide
  of,                   624
Sulphate of,            625
Syrup of Iodide of,      625
Syrup of Iodide of, and
  Manganese,          625
Strvchnia, 023  Larygismus Stridulus,
674 Laryngitis, Follicular,
623 Larynx,
623    "   Inflammation of,
623 Laudanum.
624|     '•      Poisoning by,
624 Laurel, Narrow Leaf,
6241   "    Sheep,
   1 Laurus Sassafras,
624 Lavender, Comp. Tinct. of,
624 Lead,
   I   "  Acetate of,
         Ointment, Comp.,
         Palsy,
         Pipes,
         Plaster,
           "    Comp,
402
192
 40
192
689
499
633
633
627
627
164
680
679
100 
794
INDEX.
Leaders, Conservative,
Leg Bath,
 "  Fractures of,
Lemon,
  "    Svrup,
  "    Water,
Lemonade,
Lenitive Electuary,
Leouurus Cardiaca,
Leopard's Bane,
Lepra,
Leprosy,
Leptandra Virginica,
Lettuce,
Leucorrhoea,
Liberality,
Lichen,
Life,
  "  Root,
Lily, White Pond,
Lime,
  "  Chloride of,
  "  Water,
Liniments,
PAGE

  11
455
627
685
579
580
594
143
143
611
627
353
 10
144
 52
62
    Masturbation,
    Materia Medica,
    Matico,
    Mattery Pimples,
    Meadow'Caboage,
       "    Saffron,
    Measles,
       "   False,
    Measures,
       "     Domestic,
    Meats,
    Meatus Auditorus,
       "    Inflammation of,
    Mechanical Injuries,
    Medicated Waters,
       '•      Wines,
    Medicine,  Progress of,
       "     Chest, Articles for,
    Medicines,
661! .Medulla Oblongata,
628 Melancholy,
628 Melanosis,
628 Melissa Officinalis,
671 Menispermum Canader.se,
Linimentof Ammonia, Comp  671  Menorrhagia,
    "   Camphor,           671. Menses, Absence of,
    "   Camphorated Soap,  672 j   "    Cessation of,
    "   Comp Camphor,    6711 Menstruation,
    "   Croton Oil,
    "   ofOpium,
Linum Usitatissimum,
Liquidamber Styraciflun,
Liquor Ammoniae,
   "       "      Acctatis,
Liquorice,
Liriodendron Tulipifera,
Liver,
Acute Inflammation of, 264 Milk,
6721      "       Painful,
6721      "       Protuse,
614 Mentha Piperita,
658    "   Virides,
593 Mesenteric Disease,
694 Metritis,
628 Mettauer's Aperient,
659 Micotianum Tabacum,
 33 Midwifery,
  "   Chronic   •■        "  265
  "   of Sulphur,            645
Liverwort,                  628
Lobelia,                     628
   "    Inflata,              628
   "    Tinct. of,            689
   "    Comp. Tinct. of.
   "    and Capsicum, Comp
         Coffee,
         for Infants,
         Leg,
         Porridge,
         Sickness,
         and Soda Water,
692 Milkweed, Swamp,
         Tinct of,
   "   Vinegar of,
Lobelin,
Local Palsy,
Locked Jaw,
Logwood,
Looseness of Bowels,
Lumbar Plexus,
Lung Fever,  •
Lungs,
  '•   Hypertrophy of,
  "   Swelling  of,
Lupulin,
Lupus,
Luxations.
Lycopus Virginicus,
Lye, Poisoning by,
Lymphatics,
Lypemania,

Macula;,
Magnesia,
    "    Carbonate of,
    "    Sulphate of,
    "    Usta,
Magnesia? Carbonas,
    "    Sulphas,
Male Fern,
Malignant Pustule,
Malt, Infusion of.
Mammary Abscess,
Mandrake,
Mania,
   "   a Potu,
Manna,
Maranta Arundinacia.
Marshmallow,
Marsh Rosemary,
Marubium Vulgare,
Mastich,
163
        Mind, Derangement of,
        Mindererus, Spirit of,
        Miscarriage,
        Miscellaneous.
        Mitchella Repens,
    166 Mitral Valves, Diseases of,
    629 i Mixtures,
289, 403, Modus Operandi of Water,
     47 Momordica Elaterium,
    240 Monarda Puuctata,
     35 Monkshood,
    235 Monk's Hood,
    235 Monomania,
    620 Monotropa Uniflora,
    144 Monsel's Styptic,
    457 Morphia,
            '•   Acetate of
            "   Muriate of,
            "   Sulphate of,
            "   Valerianate of,
        Morphine,
            "    Poisoning by,
    629 Mortification,
    630 Mother's Cordial,
    630     "   Marks,
    629! Motherwort,
    630! Mountain Laurel,
    630' Mouth or Oral Bath,
    6301    "   Inflammation of,
    434    "  Follicular Inflamma-
    5791         tion of,
    388    "  Gangrene of,
    P30: Mucus,
    175 Mullein,
    156 Mumps
    130 Muriate of Soda,
    594 Muriatic Acid, Poisoning by,
    631 Muscaj Volitautes,
    631' Muscles,
    619    "    Action of,
    631 •   "    Number of»
PAGE
 33fi
 586
 632
 142
 651
 632
 131
 138
 587
 589
  77
  61
 489
 437
 672
 673
 5-9
 687
 686
  45
 174
 470
 594
 665
 356
 354
 362
 340
 357
 356
 638
 654
 407
 367
 675
 658
 377
  74
 585
 580
 387
 581
 278
 584
 657
 173
 594
 380
602j
174

146
207
653
                          PAGI
Muscles, Shape of,           27
Mustard,                   633
   "   Volatile Oil of,     633
Myrica Cerifera,            696
Myricin,                    696
Myristica Moschata,         635
Myrosperuum Toluiferum,   695
Myrrh,                     634
   "   Comp. Tinct. of,      692

Naptha,                    634
Napthaline,                634
Nasal Catarrh,              189
  •'   Duct,                 50
  "   Shower Syringe,      196
Necrosis,                   4H5
Nepeta Cataria.             604 .
   "    Glechoma,          617
Nephritis,                  294
Nerve Root,                665
Nerves, Cranial,              45
   "    Dfteases of Brain and, 152
   "    Optic.               48
   "    Pain in,             171
   "    of Skin, Disordered, 146
   "    Lymphatic,          47
Nervous Disease,             60
   "   System,          44-62
   "      "    Sympathetic, 60
Nettle Rash,                137
Neuralgia,                  171
          of Heart,         ,26U
Neutral Mixture,            644
Neutralizing Cordial,       687
      "      Extract,       674
      "      Powder,        683
Nevus.                     146
New Jersey Tea,             647
Nightmare.                182
Nitrate of Mercury Ointment, 676
   "    of Potassa,          635
   "        "   Poisoning by, 498
   "    of Silver,           634
Nitre,                     635
  "  Sweet Spirit of,     635, 654
Nitric Acid, Poisoning by,   498
  "   Ether, Spirit  of,      664
Nose Bath,                640
  "  Bleeding from,        491
  "  Foreign Substances in, 492
  "  Fractures of,          447
Nurse,                     657
  "   Activity of,           659
  "   Age  of,               657
  "   Education of,         659
  "   Habits of,            659
  "   Health of,            658
  "   Strength of,          557
  "   Temper, etc., of,      668
Nursing Sore Mouth,        388
Nutmeg,                   635
Nutrition Table,             67
Nutritive Fluid,             685
Nux Vomica,               635

Oak, White,                661
Oats,                       77
Oil Glands, Disordered,     148
 "  ofCajeput,             635
 "  of Turpentine,           636
Ointments, .               675
Olea Europae,                636
Oleum Cajuputi,             635
   "   Morrhuae,            607
   "   Olivse,               636
   "   Ricini,               604
   "   Terebintbinae,         636
   «   Tiglii,                611
Olive Oil,                   636
Omentum,                   34
Onanism,                   336
One Idea Men,                5
Onion,                      636
Ophthalmia Catarrhal,       484
      "      Egyptian,       482
      "      Purulent,       482 
INDEX.
795
Ophthalmia of Children,
     "      Scrofulous,
     "      Tarsi,
Opium,                     636
  "    Camphorated Tinct. of, 692
  "    Liniment,
  "    Poisoning by,
  "    Tinct. of,
Opodeldoc,
Orange Peel,
   "    "   Tinct. of,
Orbits,
Orchitis,
Origanum,
    •'     Vulgare,
Ornus Europea,
Osmunda Regalis,
Otalgia,
Otitis,
Otorrhoea,
Ovaries, Inflammation of,
Ovaritis,              t
Oxalic Acid, Poisoning by,
   "   Deposits in Urine,
Oxide of Zinc Ointment,
481
672
499
689
672
 50
333
637
637
630
601
490
490
       31
      191
      474
      475
      387
      686
Trine, 310
  224,640
      153
      209
       91
       12
Pack, Half,
  "   Wet Sheet,
Pail Douche,
Painter's Colic,
Palpitation,
Palsy,
  "   Lead,
  "   Local.
  "   Shaking,
Panada,
Panax Quinquefolium,
Pancreas,
Papaver Somniferum,
Papulous Scall,
Populus Candicans.
Paracentesic Instrument,
Paralysis.
Paraphlegia,
Pareiroric Elixir,
Parrilla,  Yellow,
Paronychia,
Parotitis,
Parsley,
Parsnips,
Partridge Berry,.
   li      "   Comp. Syrup
                 of,
Patches,  Colored,
Patella, Dislocation of,
   '■    Fracture of,
Patients, How to Examine,
Peach,
Pear Leaf Wintergreen,
Pearlash, Purified,
Peas,
Pediluvium,
Pelvis, Fractures of,
Pemphigus,
Pennyroyal,
Pepper, Water,
Peppermint,
Pericarditis,
Peritoneum, Acute Inflamma-
              tion of,
      "     Chronic Inflam-
              mation of,
Peritonitis,
Pernicious Intermittent Fe
  ver,
Persimmon,
Perspiration,
Perspiratory Tubes,
Peruvian Bark,
    "      " Tinct. of,
Petrolium,
Petroselinum Sativum,
Pharmacy,          „   .
Pharyngeal Shower Syringe, 196
Pharyngitis,
      "      Follicular,
287
678
594
144
142
138
640
 61
PAGE |
 483 Pharynx,
 484'     "    Inflammation of,
     Phlebitis,
         "    Chronic,
     Phlegmasia Dolens,
     Phosphates, Comp Syrup of,
     Phosphatic Deposits in
     Phosphorus,
     Phrenitis,
 637 I Phthisis,
 6891 Physical Development,
     Physician, True,
     Physiological Laws,
     Physiologists,
     Phytolacca Decandra,
     Phytolaccin,
     Pia Mater,
      "    "  inflammation of,
     Picrama Excelsa,
 489' Pigeon-berry,
 350! Pile Ointment,
 350 Piles,
 498 Pills,
 311 Pimpinella Anisum,
 6761 Pimples, Dry,
        "    3Iattery,
 530'    "    Watery,
 528 Pink Root,
 534 Pinna,
 285 Piper Angustifolium,
 269 Pipsisse<Wi,
 162 Pistacia Lentiscus,
 164 Pityriasis,
 103 Pix Liquida,
 164 Plantago Major,
 580 i Plantain,
 616 Plasters,
 33, Pleurisy,
 636!    "   Root,
 142'Pleuritis,
 595! Plumbi Acetas,
 5<>6 Plumbum,
 162 Plunge Bath,
 103 Pneumonia,
 692     ••     Typhoid,
 605 Pneumothorax,
 467; Podophyllum Pellatum,
     Poison Oak,
        "   Hemlock,
        "      "     Ointment,
     Poisoned Wounds,
     Poisoning Accidents,
     Poisons, Antidotes of,
        "    Vegetable,
     Poke,
       "  Ointment,
     Polygala Senega,
     Polygonum Punctatem,
     Polypus,
         "    of Heart,
         "    of Womb,
 640] Polytrichum Juniperum,
 452'Pompholix,
 141 Poplar,
 638 Porridge, Milk,
 661     "    French Milk,
 638 Porrigo,
 253 Potassa,
             Acetate of,
             Bicarbonate of,
              Bitartrate of.
              Carbonate of,
              Chlorate of,
              Citrate of,
               "     "  Solution of, 644
              Solution of,          644
     Potassse, Citratis, Liquor,
       "    Liquor,
       "    Nitras,
       "    Sulphas,
       "    Tartras,
     Potassii Bromidum,
       "    Cyaneuretum,
       "    Iodidum,
       "    Sulphuretum,
     Potassium,
         "    Bromide of,
         "    Cyauuret of,
         "    Sulphuret of,
  8! Potatoes,
642  Poultices,
642! Powders,
 45; Pox,
153  Prejudices,
6461 Preparations,
642       "      of Medicine,
677] Prepared Calamine,
o«"     "    Chalk,
     Prickly Ash,
           Elder
     Prince's Piue.
     Prinos Yerticillatus,
     Prognostics,
     Prolapsus Ani,
        "     Uteri,
6321 Pronouncing Dictionary,
641  Prunus Virginiana,
631 Prurigo,
143   "    of Vulva,
658 Pruritis,
641 Prussic Acid, Poisoning by,
6411 Psoriasis or Salt Rheum,
678 Ptelia Trifoliata,
2381 Ptercorpus Marsupium,
               Santatinus,
641
207
637
 79
637
146
463
454
122
638
648
643
 79
279
280
279
412
238'Ptisan, Suet,
627 Ptosis,
627 Puerperal Fever,
636 Pumpkin Seed,
    Punctured Wounds,
    Purple Disease,
    Purpura Hemorrhagica,
    Purtussis,
    Purulent Ophthalmia,
240
242
236
630
642
640
102
102
639
692
640
637
666
191
1911
442
496
496
498
642
676
650
661
471
261
365
618
141
659
581
682
150
642
613
643
643
643
643
644
PAOK
 644
 644
 635
 644
 644
 644
 645
 622
 645
 644
 644
 645
 645
  79
 680
 681
 320
 500
 666
 686
 666
 605
 645
 645
 641
 598
 561
 405
 368
 721
 661
 144
 370
 146
 499
 143
 651
 626
 647
 583
 482
 387
 646
 441
 423
 423
 403
 482
                                        of Children, 483
                       Pyrethium Parthenium,       613
                       Pyrola Rotundifolium,        648
                          "   Round Leaved,        648
                       Pyrosis,                      277

                       Quassia,                     646
                       Queen of the Meadow,        646
                       Queen's Root,               646
                       Quercus Alba,               661
                           "    Iniectoria,           615
                       Quinia, Sulphate of,          639
                          "    Valerianate of,       639

                       Rabies,                      165
                       Kamollissement,             15-1
                       Rectum,                      32
                       Red Chickweed,             647
                         "  Clover,                 647
                         "  Iodide of Mercury Oint-
                              ment,                 676
                            Pepper.                 605
                            Oxide of Lead Plaster,   680
                            Ozier,             .      667
                            Root,                   647
                            Rose,                   647
                            Saunders,               647
                            Willow,                657
        " Arsenite of,6531 Refreshing Drinks in Fevers, 579
and Soda, Tartrate of, 6531 Reproduction of Lost Parts,  442
                    644 Resin Plaster, Comp.,        679
                    6441 Respiratory Organs,           35
                    643! Rest and Sleep,              95
                    6531 Restorative Wine Bitters,    673
                    6431 Restoratives,                584
                    643 Retention of Urine,          304
                    6431 Retina,                      49
                    644iRhamnus Catharticus,       601
   "   Sulphate of,
   "   Tartrate of,
Fotassse, Acetas,
   "   Arsenitis, Liquor,
   "   Bicarbonas,
       Bitartras,
       Carbonas,
       Citras, 
796
INDEX
Rhatany,                    656
Rheum "Palmatum,           64S
Rheumatism, Acute,         416
     "       Chronic,        417
Rhubarb,                    648
    "   Aromatic Syrup of,  684
    "   Comp. Tinct. of,     693
    "     "    Powder of,   683
    "   and Potassa, Comp.
          Powder of,        683
    "   and Potassa, Comp.
          Syrup of,         687
    "   Sweet Tinct. of,     693
    "   Syrup of,            684
    "   Tinct. of,
Rhus Glabrum,              657
  "  Toxicodendron,        642
Ribs, Fracture of,            451
Rice,                        78
  "  Gruel,                  680
Ricinus Communis,          604
Rickets,                     407
Ringworm,                  151
Rochelle Salts,              653
Rosa Gallica,                647
Rose Rash,                  138
  "  Red,                   647
  "  Water Ointment,        677
  "  Willow,                657
Rosemary,                  648
Roseola,                    138
Rosemarinus Officinalis,
Rotting of Teeth,
Round Leaved Pyrola,
Rubbing Wet Sheet,
Rubeola,
Rubus Villosus,
Rudbeckia Laciniata,
Rue,
Rules for Using Water,
Rumex Crispus,
Running and Leaping,
Rupia,
Rupture,
Ruptures of Tendons,
Ruta Gravelus,
Rye,
  "  Spurred,

Sacral Plexus,                47
Saffron,
Sage,
    Scrofula,
    Scrofulous Ophthalmia,
    Scrophularia Nodosa,
    Scrotum, Blood in,
       "     Water in,
    Scullcap,
    Scurvy,
    Scutellaria Laterifolia,
    Sea Bathing,
    Seasickness,
    Secale Cornutum,
    Secretion, Organs of,
    Seidlitz Powders,
    Self Pollution,
6901 Semilunar Valves, Disease of, 256
    Sempervirum Tectorum,
    Seneca Oil,
    Senecin,
    Senecio Aureus,
    Seneka,
       '•    Syrup of,
    Senna,
      "  and Jalap, Tinct. of,
    Sensations,
       "      Agreeable,
       ',      Unpleasant,
    Sexual Diseases,
Shaking Palsy,
Sheep Laurel,
Shingles,
Prevention of, 335
             164
             633
             139
648 j Shoulder Blade, Fractures of,  449
             Joint, Dislocation of,459
                                534
                                651
                                 55
                                394
                                651
                                555
                                578
                                656
600
648 Shower Bath,
531! Shrubby Trefoil,
131 '-
698
658
648
548
664
 90
141
476
465
648
 78
655
Sick, Care of,
  " Children, Nursing,
  " Room, Choice of,
  "    "   Cleanliness in,
  "    "   Cookery for,
  "    "   Darkening of,
  "    "   DomesticManage-
             ment of,       651
  "    "   No Cooking in,  652
  "    "   Prejudices  and
             Antipathies in, 660
  "    "   Sofa or Easy Chair
             in,           662
  "    "   Temperature of,
  "    "   Unhired  Attend
             ants in,
     Tea,
Sago Gruel,
Samt Ignatius's Bean,
Sal Ammoniae,
Salep Powders, Comp.,
Saline Mixture,
Salix Nigra,
Salt,
  "  of Tartar,
Saltpetre,
   "    Poisoning by,
Salvia Officinalis,
Sambucus Canadensis,_
Sanguinaria Canadensis,
Sanguinarin,
Sapo,
Sarsaparilla,
Sassafras,
Savin.
Scabies,
Scalds,
Scaly Eruptions,
Scammony,
Scarification,
Scarlatina,
Scarlet Fever,
Sciatica,
Scilla Maritima,
Sclerotic Coat,
Scoke,
Scorbutus,
Comp. Syrup of, 687
False,
Wild,
    6491 Sight, Organs of,
    6781   "  Long and Short,
    581'   "  Weakness of,
    656 Silex Alba,
    693 Simple Ointment,
    680]   "    Syrup,
644, 675 Sinapis Alba,
    699 i Singultus,
    653 Sippets,
    643 Sitz Bath,
    635 Skin,
    498    •'  Color of, Disordered,
    6491   "  Diseases,
    613;   "  Nerves of,  Disordered,
    699;   "  Offices of,
    699 Skull, Fractures of,
    662 Skunk Cabbage,
    649 Sleep,
652
652
649
Amount of,
Disturbed,
Natural Position for,
Preparation for,
rAOE
 419 Small Spikenard,            652
 484 Smart Weed,                661
 614 Smilax Officinalis,            649
 474 Snake Root,                 650
 473 Snakeroot, Virginia,         660
 650 Soap,
 421 Soda, Bicarbonate of,        652
 650   '•   Borate,                652
 544   "   Sulphate of,            653
 278   "   Sulphite of,            653
 655 Sodae, Bicarbonas,           652
  40    "   Boras,                652
 653    "   et Potassae Tartras,    653
 330    "   Sulphas,              653
           Sulphis,              653
 620 Sodii Chloridum,            653
 640 Sodium,                    652
 627    "     Chloride of,         653
 627 Solanum Dulcamara,
 650 Solidago Rigida,,             618
 685 Solomon's Seal,              653
 650 Soluble Tartar,              644
 693 Sore Nipples,                389
  64 Soup, Vegetable,             582
  55 Spanish flies,               654
  56    "      " Liniment,      672
 320    "      " Poisoning by,   499
     Spasm of Glottis,            402
     Spearmint,                 664
     Speculum,                  346
     Spermaceti,                 664
          "     Ointment,        677
     Spice Plaster, Comp.,        679
     Spider's Web,               654
     Spigelia Marilandica,        640
     Spikenard, Small,           662
     Spinal Cord,                 46
        "     "  Diseases of,      159
        '•      "  Inflammation of, 169
     Spinal Nerves,               46
     Spine, Deformities of,        478
     Spirit of Nitric Ether,        654
     Spiritus Athens Nitnci,  635, 654
        " Ammonia: Aromaticus, 694
     Spircea Tomentosa,          618
     Spleen,                      54
        •'   Acute Inflammation of, 266
        "   Chronic   "       "  266
  6551 Splenitis,                   266
     , Sponge,                    665
  659 | Spongia,                   655
   48 Sprains,                    461
  486! Spurred Rye,                655
  485 Squill,                      655
  6631   "   Syrup of,             685
  677    "   Vinegar of,           693
  684 Squinting,                 487
  633 Squirting Cucumber,        662
  180 St. Anthony's Fire,          136
  678 St. Ignatius's  Bean,         666
  537 St. Vitus's Dance,           169
   42 Stagger Weed,              659
  146 Star Grass.                 655
  130 Statici  Caroliniana,         631
  146 Sterility,                   871
  102      "    Causes of,          374
  447 Stiff Joint,                 468
  651 Stillingia Sylvaticus,        646
   951     "    Comp  Syrup of,
   97 Stomach,
182
 32
676
 64
649; Sleeping Apartment,
139
435
143
650
442
132
132
173
656
 48'     "     "
642 Slippery Elm,
421 Small Pox,
Rooms,
  "   Bedding in,
  "   Beds in,
  "   Fire in,
  "   Night Dress in, 97
  '•   Open Fireplace
        in,          96
  "   Open Windows
        in,          96
      Small,        109
                   652
                   134
        Affections of,
   "    Bile in,
   "    Acute Inflammation
          ot;               269
   "    Chronic  Inflamma-
          tion of,           270
   "    Movement of,        63
   «    Pipe,                31
   "    Spasm or Cramp in, 277
Stone in Bladder,           316
Storax,                    656
Strabismus,                 487
Stramonium,               656
      "     Ointment,      677
      "     Poisoning by,   499
Strychnine, Poisoning by,   499 
INDEX.                                     797
Strychnos Nux Vomica,      635
Stye,                       481
Styrax Officinale,            666
Sudorific Tinct.,             693
Suet Ptisan,                 683
Sugar of Lead, Poisoning by, 498
  'p   of Milk,              226
Sulphur,                    656
   "   Ointment, Comp.,    678
Sulphuric Acid, Poisoning by, 498
Sumach,                    657
Summer Complaint of Infants, 404
Sunflower,                  657
Sunstroke,                  162
Super Carbonate of Soda,     652
   "   Tartrate of Potassa,     643
Suppression of Urine,         803
Suppuration,                 429
Supra Renal Capsules, Disease
  of,                        258
Surgical Diseases,            425
Swamp  Dogwood,           657
   "     Milkweed,           657
Sweat Glands, Disordered,    46
Sweet Fern,                 657
   "   Flag,                 658
   "   Gum,                 658
   "   Oil,                   636
   "   Spirits  of Nitre,   635, 654
Swelling of Lungs,           235
Sycosis,                     149
Sympathetic Nervous System, 60
Symphytum Officinale,        608
Symplocarpus Faetidus,       651
Symptoms, Table of,          122
Syncope,                    181 ]
Synovial Degenerations,      466
Syphilis,                    320
Syringe, Laryngeal Shower,   195
   "   Nasal        "      196
   "   Phryngeal    "      196
Syrups,                      683
Tag Alder.                  658
Tamarac, Comp. Tinct. of,    693
Tanasetum Vulgara,          658
Tansy,                      658
Tapioca,                    659
   "    Jelly,               681
Tar,                        653
 "  Ointment,               677
 "  Plaster, Comp.,          680
Taraxacum,                 612
Tea and Coffee,               84
 "  Beef,                    682
 "  Sage,                   578
Teeth,                       29
  "   Care of,               500
  "   Cleaning of,           503
  "   Composition of,         30
  "   Cutting, Difficult,      401
  "   Diseased,              603
  '•   Filling,               602
  "   First,                  603
  "   Names of,               80
  "   Number of,             29
  "   Origin of,               29
  "   Rotting of,            600
  tJ   Use of,                 30
Tela Araneae,                654
Temperaments,              118
      "     Abdominal,     119
      "      Cephalic,       118
      "     Medication and, 119
      "     Muscular,       119
      "     Thoracic,       119
Temperature,                665
Tendons, Ruptures of,        405
Tetanus,                    166
Tetter,                      139
  44   Crusted,              142
  "   Humid,               139
Thigh Bone, Fractures of,    452
Thimbleweed,               658
Thornapple,                656
Throat Diseases,             188
 Throat Diseases, Instruments
  for Treatment of,          195
 Tic Douloureux,            172
 Tight Dressing,          101, 111
 Tinctures,               690,688
 Tissues,                      16
 Tobacco,                    658
 Toe Nail, Ingrowing,         491
 Tolu, Syrup of,
  "  Tinct. of,              690
 Tonsil  Instrument,           202
 Tonsils, Acute Inflammation
         of,                201
   "    Chronic  Inflamma-
         tion of,            202
 Toothache,                  501
    "    Tree,              645
 Towel  and Sponge Bath,      538
 Tracheitis,                   193
 Trailing Arbutus,            <
 Trance,                     168
 Travelling,              112,280
    "     Seasons for,       113
 Trees, Cultivation of,         110
 Trefoil, Shrubby,            651
 Trifolium, Pratense,          647
Trillium Pendulum,          697
Trumpet Weed,              646
Tulip Tree,                   659
Tumeric,                    659
Tumors,                     468
   '•   Encysted,            471
   "   Fatty,              671
Turkey Corn,                459
Turner's Cerate,              667
Turnips,                      79
Turpentine Liniment,         672
Tussilago Farfara,           608
 Tylosis,                     145
 Tympanitis,                 283
 Tympanum,                  51
    "     Inflammation of,  490
 Typhoid Fever,              410
    •'   Lung Fever,         242
    "   Pueumouia,         242

 Ulceration and Ulcers,       431
     "     of Bones,         465
 Unhired Attendants,         659
 Unicorn Root,              655
 Union by First Intention,     439
 Unnatural  Growth of Bones,  465
 Upland Cranberry,          695
 Upper Arm Bone, Fractures
of,
Urate of Ammonia in Urine,  312
Ureters,                     34
Urethra,                    35
Uric Acid Gravel,            308
Urinary Deposits,            306
   "    System,             34
Urine, Cystine Deposits in,    314
  "   Examination of,       307
  "   Hippuric Acid Deposits
        in,                  313
  "   Inability to hold,      305
  "   Oxalic Deposits in.     311
  "   Phosphatic Deposits in, 310
  "   Retention of,          304
  "   Suppression of,        303
  "   Urate of Ammonia in, 312
Urticaria,                   137
Uteri Prolapsus,             368
Uterine Hydatids,            366
Uva Ursi,                   595
Uvula, Elongation of,        200
Vaccina,
Vagina, Inflammation of,
Valerian,
    "   Comp. Tinct. of,
Valeriana Officinalis,
Valves, Mitral,
   "   Semilunar,
   "   Tricuspid,
Varicella,
136
369
669
693
659
136
Variocele,                  478
Variola,                    134
Varioloid,                  135
Varix,                      475
Vegetable Poisons,           498
    "     Soup,             682
Veins,                       37
  "  Acute Inflammation of,  474
  "  Enlarged or Varicose,   475
Venereal Diseases,           320
Ventilation,          57,108, 653
     "     in Sick-Room,    110
Ventricles,                   36
    "     Dilatation of,      250
    "   *  Enlargement of,    248
Veratrin,                    592
Veratrum Album,           661
    "     Viride,            692
Vervain,                    659
Verbascum Thapsus,         433
Verbena Hastata,            659
Verdigris, Poisoning by,      497
Vermes,                    293
Verruca,                    146
Vertigo,                    181
Vessels, Absorbent,           38
Viburnum Opulus,           619
Vinegar,                    660
Vinegars,                    693
Virginia Snakeroot,          660
   ^'      "    Comp. Tinct.
                  of,        693
    "      "    Tinct. of,    690
Vision, Imperfect,            486
Vocal Cords,                 41
  '•  Organs,                40
Vomiting,                  277

Wafer Ash,                  651
Wahoo,                     661
Walking,                     90
Warts,                      145
Wash Down,                639
  "   Tub,                  637
Water,                       85
  "  Accidents on,         496
  "  Apple,                581
  "  Barley,               678
  "  Brash,                277
  "  Camphor,             673
  "  Chemical Nature of,    86
  "  in Chest,             237
  "  Chicken,             683
  "  Cochituate,            87
  "  Division of,            86
  "  Gruel,                680"
  "  in  Heart Case,         269
  "  Horehouud,           660
  "  Impure,                88
  "  Impurities in,          86
  **  Lemon,               579
  "  Milk and Soda,       684
  "  Modus Operandi of,    546
  "  Pepper,               631
   "  Properties of,          87
   "  Rain,                 87
   "  Rice,                 678
   "  Rules for Using,       648
   "  Salt,                  88
  "  in Scrotum,           473
  "  Schuylkill and Croton,  8T
Waters, Medicated,          672
Watery Pimples,            138
Wave or Sluice Bath,        635
Wax,                       661
Weaning,                  392
Wens,                      471
Weights,                    688
        French Decimal,     589
Wet Bandages,              649
  "   Dress,                  630
  "   Sheet, Folded,           631
  "    '•  Pack,             628
w\,  J"   KubbinS»         631
Wheat,                     . 77
    "   Flour, Unbolted,       71 
798                                    INDEX.
                         FAOE
Whey, Alum,               583
  "   Mustard,             583
  "   Orange,              584
  "   Rennet,              583
  "   Sweet,               584
  "   Tartar,               583
  "   Vinegar,             583
  "   with Tamarinds,      584
  "   Wine,               584
White Hellebore,            661
  "      "     Ointment,   677
  "   Indian Hemp,         657
  "   Liquid Physic,        675
  "   Oak,                 661
  "   Pond Lily,           661
  "   Poplar,              659
  "   Swelling,             466
  "   Vitriol, Poisoning by,  498
Whites,                 353,390
Whitlow,                   467
Wild Cherry,               661
  "     "   Bark, Syrup of,  686
  "   Cucumber,            662
  "   Ginger,              662
  "   Indigo,              662
  ''      "   Ointment.      677
  "   Sarsaparilla,          652
  "   Snow Ball,           647
  "   Turkey Pea,          659
  "   Woodbine,           593
  "   Yam,                662
Willow,                    663
Wind Colic,                282
Windpipe,                   35
    "    Foreign Bodies in,  493
    "    Inflammation of,   193
Wine Bitters, Restorative,    673
  '•  of Comfrey, Comp ,     673
  "  of Golden Seal, Comp., 673
  "  of Ipecacuanha,        673
Wines, Medicated,           673
Wingseed,                  651
Winter Green,              663
Witch Hazel,               663
Wolfsbane,                 663
Womb and Appendages,      343
  "  Falling of,             368
  "    "    over of,        368
  "  Inflammation of,        367
  "  Inflammation of Neck of, 346
  "  Polypus of,            365
Worm Powder,             683
Worms,                    293
Wormseed,                 664
Wormwood,                664
Wounds, Bleeding from,     493
    "   Contused and Lacer-
          ated,            441
    "   Derangements from, 166
    "   Gunshot,           442
    "   How to Unite,      440
    "   Incised,           438
    "   Poisoned,          442
    "   Punctured,         441
    "   Rules for Examin-
          ing and Dressing, 440
                          PAGE
Wrist, Dislocation of,        460
   "   Fractures of,          451
Wry Neck,                 480

Xanthoxylum Fraxineum,   645

Yam, Wild,                662
Yarrow,                   664
Yeast,                     6<!4
Yellow Dock,               664
   "    "  Comp. Syrup of, 688
   "   Fever,              415
   "   Jessaminej           664
   "   Ladies' Slipper,      605
   "   Parilla,              665

Zinc,                       665
  "  Acetate of,             665
  "  Chloride of,            665
  "  Iodide of,              665
  "  Oxide of,              665
  "  Precipitated  Carbonate
       of,                   666
  " Sulphate of,            666
  "  Valerianate of,          666
Zinci Carbonas Praccipitas,   666
  " Chloridum,            665
  " Iodidum,              665
  " Oxidum,              665
  " Sulphas,               666
  " Valerianas,            666
Zingiber Officinale,          615
ADDITIONAL  INDEX.
Acne, Spotted,              148
Ague Cake,                 266
Alteratives,                 772
Anidrosis,                  147
Anteversion of Womb,      368
Anaemia,                   259
Apoplexy and Paralysis,     710
Asphyxia,                  494
Asthma,                    709
Astringents,            439,772

Belly Ache,                 282
Big-ivy,                    633
Black Vomit,               415
Breathing Murmurs,         212
Bronchial Flux,             709
.    "      "  treatment of, 709
Buffy Coat,                 426
Calvities,
Canker,
Care of the Skin,
Carminative Physic,
Carminatives,
Catarrh of Bladder,
Carthartics,
Caustic Potassa,
Chalk-stones,
Chancre, Sloughing,
    "    Gangrenous,
    "    Eating,
    "    Indurated,
Changes occurring in
  Advanced Life,
Charbon,
160
695
706
766
770
298
763
642
418
821
321
321
321

703
434
Chicken-pox,               135
Children's Sore Mouth,      399
Chromidrosis,               147
Coaptation,                 444
Convulsions,                672
Comedones,                 148
Compression,               439
Coryza,                    131
Cough Preparations,         769
Counter-extension,          444
    "   irritation,          428
    "   irritants,           773
Cupping and Leeching,      428

Depositories of Family
  History,                  700
Diaphoretics and Sedatives,  771
Diet, Milk,                 664
  "  Cream,                666
                           566
                           567
  "  Fish,
  '•  Fruits,                667
  "  Vegetable,             667
Diet for the Old,             704
Diphtheria,
Diseases of the Old,
Diuretics,
Dropsy of Brain,
Dumb-bell Exercises
696, 697, 698
        708
        771
        168
        714
Egophony,                 239
Electricity,                 707
Endosmosis,                319
Engorgements, State of,      241
Emetics,                    696
Epsom Salts,                639
Exercise,                   706
Exercises with Wands,       747
Expectorants,               705
Exosmosis,                 319
Extension,                 444

Falling Sickness,            167
Female Weakness,           353
Fistula,                    430
Fluctuation,                429
Freckles,                   147

Gangrene,                  430
Gargles,                    775
Gymnastic Crown,           757

Helpless dependence of the
  Aged,                    702
Hcemidrosis,                147
Hepatization, Stage of,       241
Hectic Fever,               427
History of Gymnastics in the
  United States,     %       761
Hives,                     135
Honey Diseases,             142
  "    Scab,                142
Horn-pox,                  136
Hypo,                     179

                           147
Idrosis,

Leucorrhoea,
Leeching,
Ligature.
Liniments,
390
428
438
774 
INDEX.                                     799
                          PAGE!
                            702 Pin-worm,
                            775 Plastic Lymph,
                               Plain Puddings and Pies,
Medical Treatment of the Old,  708 Presbyopia,
Loneliness of the Aged,
Lotions,
 Metastasis,
 Milk,
 Milk Crust,
 Milk Weed,
 Mole of Cooking Meats,
 -Holes,
 Mortality in Cold Weather,
 Myopia,

 Narcotics and Anodynes,
 Night Nurse,
 No fear of Death,
 Nympho-mania,

 Oil-Nut,
 Ointments,

Papillae,
Paracentesis Thoracis,
Pectoriloquy,
 416 Prescriptions,
 705 Presvervation of Old People
 142   Health,
 609 Provisional Callus,
 704 Puerile Respiration,
 147 Pulmonic Cherry Cordial,
 7061 Pussy Willow,

     Radius,
 770  Ragwort,
 552  Recipes,
 703  Red Gum,
 370 Red Softening,
    Refrigerants,
602 Regular Habits,
710 Retroversion of Womb,
    Ripe*Fruits,
145
240 Salt Rheum,
240 Scall,
PAGE I
  293 School-desks and Seats,
  426 Sinus,
  705 Sleep,
 488 Sleeplessness,
 763 Slough,
's    Southern Prickly Ash,
 7031 Spider Mark,
PAGE
 759
 430
 706
 707
 428
 645
 146
 771
 332
 43'J
 410
446 Stimulants,
212 Stricture,
710 Styptics,
599 Sudamina,
    Suitable Medidinesfor thc'G.'d,708
451 Sun Hent,                   139
627 Susceptibility to Cold,        7U5
763 Sutures,                     439
144 Sweat-drops,                410
241
7711 The Fathers of our Race, etc. .701
703|The New Gymnastics,
6381 The Pangymnastikon,
7051
   1 Urinary Organs, Diseases of,
143
1421 Wine, etc.,
714
768 
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