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THE
HOUSEHOLD   PHYSICIAN;


                  FOR THE USB OF


   FAMILIES, PLANTERS, SEAMEN, AND TRAVELLERS.

                    BEING A


       BRIEF DESCRIPTION, IN PLAIN LANGUAGE,

                   OF ALL THE


DISEASES OF MEN, WOMEN, AND CHILDREN,

                    WITH THE

     NEWEST AND MOST APPROVED METHODS OF CURING THEM.


                     BY

            IRA WARREN, A. M., M. D.
          FELLOW OF THE MASSACHUSETTS MEDipAL SOCIETY, ETO.


                ILLUSTRATED
     BY THIRTY-SIX FIGURES ON EIGHT SPLENDID COLORED LITHOGRAPH PLATE8,
           AND TWO HUNDRED AND THIRTY-SIX ENGRAVINGS.


                  BOSTON:
       BRADLEY, DAYTON, & Co.,
             20 WASHINGTON STREET.
  SAN FRANCISCO: R. OUY McLELLAN,
             305 MONTGOMERY STREET.
                    1 864. 
                   VoBA



      Entered according to Act of Congress, in the year 1859, hy
                    I K A  WARREN,
In the Clerk's Office of the District Court of the District of Massachusetts.
      Entered according to Act of Congress, in the year 1SR3, by
                    IRA  WARREN,
In the Clerks Office of the District Court of the District of Massachusetts.
   ELECTROTYPE!) ASD PRINTED DT
W. W.  D A A P E K ,  ANDOVER, MASS 
PREFACE.
   This book is written for the people.   It is based on the assumption that ev-
ery 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 acquir-
ing, 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 consequently less perverted, than those  who claim
more refinement and a higher place in the social scale.
   " All men," says Hippocrates, one of the  great fathers of medicine, " ought
to be acquainted with the medical art.  I believe that knowledge 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.   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 withhold this from him, is another form of the
old oppression, which  decreed knowledge and power to the few, and ignorance
and obedience to the many.
   In accordance with  the design of the work, it has been written in  plain, sim-
ple 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.
   In preparing this book, a  great  number of authors have been carefully con-
sulted,  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 Hydro-
pathy, the  Management  of the Sick-Room, the symptoms  of Diseases, and, as
in all medical works,  a portion  of  the recipes, it  has all taken  shape, coloring,
character, and  language, in my own mind.   In dealing with each disease, 
IV
PREFACE.
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 work 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.  Of the colored  lithographs, there  are Thirty-six Figures on eight
splendid plates.  They are inserted at great expense, and add  much to  the
value of the book.
                                                                 I. W.
    No. 3 Avon Place, Bobtoh.
SECOND  PREFACE.
  The  Household Physician was written in the belief that the people were
ready and waiting for a popular medical work based on liberal principles ; and
that sixteen thousand copies have already found a welcome home, in as many
American families, is a sufficient evidence that the belief was well-founded.  I
say welcome home ; and with very little stretch of modesty I might emphasize
the word, for  the  popularity of the  book has far outrun the  author's hopes —
many persons assuring himself and the publishers that fifty or one hundred dol-
lars would be  no  temptation for them to part with  the copy  they have if they
could not obtain another.   So large  a sale of a five-dollar book in  these war
times, with the demand constantly increasing, has been quite unexpected.
  For these evidences of public favor the author is not ungrateful or  unmindful
of corresponding duties on his part.   A chapter is now  added, therefore, on
" Old Age and its Diseases " — a subject never before introduced into any pop-
ular treatise on medicine,  and very  rarely, indeed,  into any  medical book.   I
have taken great pains in  preparing  it, and sincerely hope that many Fathers
and Mothers will, in future years, be kindly remembered in consequence of the
suggestions it contains.  I  also have the pleasure to present, from the pen of
Dr. Dio Lewis, a very  valuable contribution upon his new popular Gymnastics,
illustrated with many cuts.
  With these and some smaller additions, — improvements I think I may call
them, — I submit the work again to the popular judgment
                                                                 I.  W.
No. 3 Avow Place, June, 1863. 
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 «f 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 less 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 fts 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 events, 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 treating 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,
heaLh-impariing agent, was anything but creditable to the profession.
  It is now admitted by all  sensible  men that water, cold and warm,
used ai proper times  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 attest.
  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 
ft              GENERAL INTRODUCTORY REMARKS.
it, that  the  Eclectic physicians had in so many instances supplanted
ihe "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, k is mortifying that the remedies which  those 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 know 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
small 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 1  seful in a Dejrree. — 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 of the    i
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 ca<« exert any remote action ^n the animal  economy, a
remedy must be absorbed.
   Before  it con be  absorbed, it must be r oluble in  the fluids of the
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

  wTiat 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 w'th 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 exclusivcness seems
 nciifKT wise nor modest.   When the professors of the healing art can
 hoard 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, they
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
their light into our atmosphere without first coming down and joining
the solar system.

  Conservative Leaders. — There  are no 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 light 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; and 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 ad vice.
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, thcy
will  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 lifers 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, we 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  pupil's.   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 in'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 of
those who believe -L^"g kind of reading  fosters quackery! 
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 several 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 flesh 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 wroven 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 merabranes^and serves to moisten and
defend them from injury.
  I-V.t 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 acul 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 uses 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 it lines, while the other
is folded back upon and around the contents of the cavity, which are
lefr 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 Fihrous 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  deltoid muscle to the bone of the upper arm,  about
two-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
             na. 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 worka
 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 IVervous 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; lo, the  haunch bone; 16, the sacrum; 17, the hip joint-
 ly ihe thigh bone; 19, the knee cap (patella);  20,  the knee joint;
kl, the iibula; 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.
  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 water, — and the phosphate and carbonate of lime will
all be removed, while the bone will remain the same in  shape.   It
                 Fio. 3.                 will  now be comparatively
                                      soft, and may  be  bent, or
                                      even tird into a knot, with-
                                      out breaking.   Place a simi-
                                      lar bone in the  fire for a few
                                      hours, and it will ako 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,
ffty-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 ihcface.
   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-li'sr, and hence called vitreous.
   The middle layer has the name oidiploe.  Its spongy nature deadens
the jar from a blow inflicted upon the outer table. In 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 fiont 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
Fig. 5.
  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 inferioi
                                         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, and 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,
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 vertebrae 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
               j-IG. s.                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 of 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 w^hich 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 unrtes ; 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
Fig. 10.
     5
  The eight bones of the wrist or carpus are ranged in two rows, and
b<Jng 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 four
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.
Fig. 9.                     Fig. 11.
 
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     Fw.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  ranp-e of
            the toe-bones.
              The tarsal and metatarsal bones are put together in the
            form of an arch, the spring of wThich, when the weio-ht of
            the body  descends upon it  in walking, prevents injury to
            the organs above.  (Fig. 14.)
              The phalanges 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.
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.
Fw.14
 
26                         ANATOMY.
  There  are other  smaller sacks connected with the joints, called
bursa mucosa?.  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. 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.  They
hold up and retain the other parts in their proper places.   They 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 eye, 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.
Fig. 17.
 
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  thiis 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^^^^w^   small space.  (Fig.  20.)
    *^"^^^^^    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.)                ^^^1111111111^
     In other  instances,  the fasciculi form  circular    ''S^ssIiP^
   muscles, — orbiculares, ox  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
   food or drink through the                   Fig. 24.
   gullet of a cow.  Figure
   24 is a section of the gul-
   let: a, b,  show the circu-
   lar fibres ; c, the longitudinal.
     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, ill 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-
 
ANATOMY.
29
etratcd 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-
                                     D  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 Jower 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 decay 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 Gland 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-
Fig. 28.
Fig. 29.
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 surrounds 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
laid 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 point 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
 smalt 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
 cacum, 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.
  The 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
Fig.
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 vertebrae
                         like a fan.   The  bowels  are attached  to
                         its edge,  and are held  b^y 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 Gall-Blsidder  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-
                  Fig. 32.                   vary glands.  It lies trans-
                                         versely across 1 he back wall
                                         of the abdomen, behind the
                                         stomach.  It secreves a fluid
                                         called the pane re a! ic juice,
                                         a peculiar kind of saliva,
                                         the office of which is lo
                                         emulsion  fat, so  that  the
 
34                         ANATOMY.
lacteals can absorb it  This  fluid is carried by a duct, and  poureci
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 corrosivencss 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 Lung's 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 columnce
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 chorda? tendince, pass from the floating
edge of these to the columnae carneae, 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
ivhich  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 parte 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
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
             FlG 35              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. 38.
-\ W> ,-r-H^S^s
Fig. 36.
Fig. 37.
I1'
  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 ;  f 1, 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
d&ct,  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 cricoid1
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.
Breathing 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, e, 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;
anduto 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 skim 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-
quently no feeling, it appears to be
a  simple covering to protect  the
true  skin from injury by external
agents.   It  is thickest  on  those
parts most exposed to friction.
   The scarf-skin is the production
of the true  skin, — an  exudation
from it  in  the  shape  of  a fluid
which is spread out as a thin layer,
and dries up into flattened scales.
The cuticle is composed chiefly of
these  scales, and is constantly be-
ing rubbed off as scurf,  while new
layers are forming underneath.
   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
rele 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 j  c, c, d, d, the true skin ;  e, e, e, fat cells,
fi fifi sweat tubes.
                                             Fig. 46.
               Fig. 44.                             4
  The lymphatics are very numerous in the skin, beside  which there
are oil glands and tubes, and sweat glands and tubes.
  The Oil Glauds 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
1673 
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, called 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.
Fig. 47.
 
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  Arachnoid  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, glossopharyngeal 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.
   Fif sures 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  Jo  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
the cord, surround-
ed  by its  sheath.
 B, is the spinal nerve, formed by the union of the motor and sensitive
 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.
Fig. 49.
 
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. 60.                                Fig. 51.
  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 therm 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 Co;it is a fibrous membrane,covering 'he largest portion
 
ANATOMY.
49
of the globe.  To this the muscles are attached.  It is the 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. 64.                             Fig. 55.
  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, wiih an  alkaline reaction, and a spe-
cific gravity a little greater than distilled  water.
                                 7 
50
ANATOMY.
  The Crystalline Ilr.mor 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
the 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-
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-
                      lal angle of the eye, by two small tear points,
                      >.'hich communicate with the sac at the upper
                      [)art 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
              no. 58.               and partly  cartilaginous, which
                                  goes from the pavilion of the ear
                                  to the drum of the ear.

                                    The  Drum of the Ear (mem-
                                  brana 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
K1		SJiaiBsBSmi	
Pi ^1 ivS	i		
Bj	sSjfc£!		
Fig. 59.
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 mem-
brana  tympani;  k, the tym-
panum ;  e, the bones  of the
ear; b, the  semicircular ca-
nals ; /, the  cochlea;  //, the
vestibule ;  t, 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.
 
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.   (Fi^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*
                    fig. so.                  mon  Janguag*1'   ]t 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,
                                          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.
 tern 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 wTarding 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  stronger 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 efTjoyment  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 Tses  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-
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.
GO
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, wc 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                          HYGIENK.
 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 schill-
 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 clue allowance must be ma4e.

   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
that 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.

    \eed 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.
   AVere  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 1o be blessed
with  an old-fashioned  chimney and  fire-place, the effects  upon the
nervous svstem of the children was deplorable.   Many of the  dis-
eases wluch 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.

  IVeed  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  eai'ly  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 health 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 rnornino-, 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 sabicct 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 Blooil. — 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  nofc 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 cases, it does.
  The result is, that, at least, every other  person has some nervous
disease, which makes life a misery rather than a blessino-.  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 Coaling ? — 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 cin
 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
 bodies are  constantly changing.  Old particles of matter, when they
 a re  worn out, leave their places and are thrown  out of the system.
 Were this the  whole of the matter,  our bodies  would soon  waste
 away, and  that would be the end of us.  But as fast as the old mate-
 rials are thrown away, new ones take their places; and it is  solely
 out of our  food  that these new materials are formed.
   In order  that the  food  may be well digested, it'must first be broken
 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
 j;lands, and mixes with the food, forming with it a soft mass.  In this
 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 oi
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 too 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 tiie 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 yaa-rrip  (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 beyond
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- 
 jury rather than benefit  This should teach us to be careful that our
 food be only reasonable in amount.

   Sot 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 hy 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 hour 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 sentlv
 with the sick.                                   ^ &         5   *

   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 m the State of Michigan, had a large part of his sick- 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
 g-ow together, preferring rather to fasten themselves to the borders of
 tie breach in the side, thus leaving the passage open.   A  kind of cur-
tain grew down over this, which prevented the food from  faring ou'
Dr. Beaumont, taking advantage of this  state of  things,  instituted a
series of valuable experiments, ^y 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 gastric juice,  and reducing it to a
    pulpy mass, called chyme.   This, as fast  as it is properly prepared,
    pisses through the pylorus into the upper bowel, or duodenum, called
    also the second stomach.
      Ckyme. — 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
1    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 i6  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 in the Stomich.— 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 of the Chyle. — The  chyle  being  separated  from the
    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.  Those little vessels arc called
    lacicclc, 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 upon its surface,  for ab-
    sorbing the chyle, and at the bottom
    of which, the lacteals take their rise.
      In these  lacteals, and in the mesenteric glands, the chyle is gradu-
 
HYGIENE.
6S
ally changed, so  as to  approach nearer and  nearer to  the nature
           i^ w             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 ccecum; 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
suffers, 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.

   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 fourth is the gelatinous, ox 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 moie
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 povver 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,......91!
 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 axe 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  winch  it is digested and  assimilated.  If an article,
having  a  great  deal of nitrogen,  and being  very  nutritive, is with
great dMheulty  reduced i„ 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-generatin<r,  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, ete.  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 " 56
Barley meal, Barley, Rye, - -Buckwheat, -	119 - 130 111 - 108		64 " 65 37 " 37 44 " 47 43 " 44
Indian Corn,	138	u	65 " 66
Rice, -	- 171	u	85 " 86
Peas,	69	«	38 " 39
White Beans,	- 59	u	37 " 38
10	46	In Barley, 10	57
10 -	- 57	In Rice, 10 -	- 123
10	50	In White potatoes', 10	86
10 -	-• 130	In Blue potatoes, 10	- 130
  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,
In Rye meal,
In Oatmeal,
In Buckwheat,

  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  oreat 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.
G9
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.......
Tcout, salmon, fresh. .

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.......
Preparations.
Boiled .
Boiled .
Boiled .
Boiled .
Fried. .
Raw. . .
Broiled.
Boiled .
Raw. . .
Raw. . .
Boiled .
Raw. ..
Broiled.
Boiled .
Boiled .
Raw. . .
Roasted
Boiled .
Roasted
Baked .
Boiled .
Roasted
    "    domesticated
 Potatoes, Irish.......
 Parsnips...........
 Pig, sucking........
 Meat hashed  with) Tir     ,
  vegetables......\ Warmed..
 Lamb, fresh........Broiled. . .
 Coose............Roasted . .
 Cake, sponge.......Baked . . .
 Cabbage-head.......Raw.....
 Beans, pod.........Boiled . . .
 Custard...........Baked . . .
 Chicken, full-grown . . Fricasseed
 Apples,  sour, hard . . . Raw.....
 Oysters, fresh.......Raw.....
 Bass, striped, fresh. . . Broiled. . .
 Beef, fresh, lean, rare Roasted . .
  "   steak.........Broiled. . .
 Corn cake.........Baked . . .
 Dumpling, apple.....Boiled . . .
 Eggs, fresh.........Boiled soft
Mutton,  fresh.......iBroiled. .  .
         "  .......iBoiled . .  .
Time.

Ii. m.
1 —
1 —
1 —
1 30
1 30
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
 3  —
--%
Articles.
Pork, recently salted
Soup, chicken.....
Oysters, fresh.....
Pork, recently salted
Pork steak........
Corn bread.......
Mutton, fresh......
Carrot, orange.....
Sausage, fresh.....
Beef, fresh, lean, dry
Bread wheat, fresh. .
Butter...........
Cheese, old, strong. .
Eggs, fresh. . . ; ... .
Preparations. I Time.
Flounder, fresh. . ..
Oysters, fresh.....
Potatoes, Irish ....
Soup, mutton.....
  "  oyster......
Turnip, flat......
Beets...........
Corn, green, and beans
Beef, fresh, lean.. .
Fowls, domestic .  . .
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  ..........
Raw. . ..
Boiled . .
Roasted.
Broiled. .
Broiled. .
Baked . .
Roasted .
Boiled ..
Broiled. .
Roasted .
Baked . .
Melted. .
Raw.. . .
Hard boiled
Fried.. .
Fried. ..
Stewed. .
Boiled . .
Boiled ..
Boiled . .
Boiled ..
Boiled . .
Boiled . .
Fried. . .
Boiled . .
Roasted .
Broiled. .
Boiled ..
Boiled . .
Fried. . .
Boiled . .
Fried. . .
Boiled . .
Roasted .
Boiled . .
Boiled ..
Fried. . .
Roasted .
Boiled . .
Boiled . .
   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 quan-
  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 l>xygen, 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 this 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-formin«
 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  workin*
 men, who are obliged to make  great use  of their  muscles.   Om
 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 and peas are an im-
 proper diet   They contain no  phosphorus, in the shape of phospha-e
 of lime;  and no brain can work hard without a due supply of phos-
 phorus, which forms a part of its substance.

   Unbolted Wheat Flbur.—= 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, aboiu: 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 fat?.  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
day* 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 conies 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-produein<*
 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.  H 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 durino-  the
first  days, if  the  affliction  be heavy, partake very sparingly of °food
 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 Youtli 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 A«*e, 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 will
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 
/4                          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.

   Oxe 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 wi'h  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.
            FlG- 65.                             Fio. 66.
  Albuminous Gronp.— Albumen,  fibrine, casein, gluten, and  lugu-
min, all enter into the substance of  animal and vegetable bodies and
are ail composed of the same elements, namely, 48 parts carbon • J3(j
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 proteinaceous 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 ca/led
 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 3J5 to ^fa 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 valm- of article* of food arrange,! according to their proportion* of
    nutrient  matter in each of the four groups of elements concerned in vital change^
Mkal.
  Wheat flour
Rye meal

Barley meal
Oat meal
Wheat bran
Git A INS.
  W!ieat
  B irley
  Oats......
  Rye ......
  Indian Corn
  Buckwheat
  Rice.....
Tod Plants.
  Beans---
  Peas.....
Roots.
  Potato
  Turnip
  Carrot
  Beet (mangold wurtzel)
    Long red
    Shorfred
    Su<?ar beet
  Parsnip
Lkaf.
   Cabbage
   'l'he  following  tables  have an admirably  practical  bearing  upon
economy in food:
100 lbs.
Barley,.......
Beans,.......
Beets,........
Buckwheat,
Carrots,.......
Corn.........
Oats,........
Peas,.........
Potatoes,.....
Turnips (field),.
Do. (Swedish),.
Wheat  Flour, .
Wheat  Bran, . .
Cheese,*.....
Cheese,t.....
Muscle-forniiug
  Elements,
    iu lbs.
* Whole milk.
t Pkim-mi'k
14
26
 2
 8
 li
12
17
24
 2
 n
 24
11
18
28
45
Fat-forming
 Elements,
   iu lbs.
   ~64T
    42
    12
    54
    10
    77
    66
    52
    19
     9
    12
    79
     6
    27
     6
Relative Propor-
 tion of each,
    in lba.
   1 to 44
   1 to li
   1 to 6
   1 to 61
   1 to 6?
   1 to 64
   1 to 4
   1 to 2\
   1 to 84
   1 to 6
   1 to 54
   1 to 7
   1 to J
   1 to 1
    1 to 5
15
10
CO
25
 3
 6
•20
 8
 4
 2
 2

 55 
HYGIENE.
77
        Articles.              (out.

Barley,................  Si 50 per bu.
Beans,................j   2 50   "
Corn,.................   1 10   «
Oats,.................     68   "
Peas,..................   2 00   «
Potatoes,............•. .j   1 50   "
Turnips................     50   "
Flour (fine),............  12 00 per bbl.
Flour (unbolted),........  11 00   "
  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.                   1

  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.   During 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 several 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 economical diet.

  Cabbage. — 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 Romqn
 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 way, 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 disiin-
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 hot 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, fot 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  mixed 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 maivs 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 
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 rquch 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.
   Mans 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 blan.ed  and thrown aside for 
HYGIENE.                           83
 what the dishes have done.  The doctor is called in, and assured that
 the dear chH|l 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,  if,  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 cat 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 olden 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 cne  constitution, as well as most  admirable  control over
 his appetite.  Mr. Addison said, « When I behold a full table set out
m 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 abo\it 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  iu the use of  these  articles, and  then con- 
HYGIENE.
85
structcd 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 coflce 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,
cither  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  ancient? 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,
t hey 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 Fhiladelphians 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  Crofou  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 of 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 the 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 fhe air, and shake it, that it
may re-absorb from the atmosphere, what it has lost, and thus recover
its taste.

  Rain Water is the Result of Distillation on a large scale, and wouid
be insipid, like other distilled water, only that, after being distilled eff 
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 Jove  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.

   Aximal life is conditioned upon exercise.   Without  it health can-
not exist, or life itself  be continued for any great length of  time. 
  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
ofl* by sitting in a draft of air.  Very serious consequences often fol-
low this practice.

  ]\'ot 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.
  To 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  iu
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
 ot  better tnings.                                           °     °

   Moderns 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
Ion-MeH'true XT' ^ took™as-- to ensure health and
need not  and thn, M     * dU° "^ t0 the Welfare of th? f^ure,
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 bee^
the practice, to  the manifest physical injury of the^fce 
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 to 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 assthetical 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 wiiich 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 cf
 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, iust re-
 covering from  il ness, who  cannot endure walking or riding on horse-
 back it is valuable, particularly if taken in an open carriagl.  But for
 those who have more strength, it is less desirable than many other ex-
 ercises.  I rue, 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 ordej
his carriage to the door at the time when increasing  wealth  enables
him to retireTrom 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; for, 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 creaturej'auda
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 we 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 constifu- ,
 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 lives 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.   I hat 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-
 1011, temperature, and  cleanliness of the room we occupy during the
 hours of  repose  as to the parlors, or drawing-room,  or any  other

 cT'familio    Tl Tet h™ ^^  ^ this "  the ^exal practice
 o  famihcj.  The  smallest room in the house is commonly set  apart
 for the bed and its nightly occupants.                    J      H

 It ThnnblTTT™ ShOUM, h^e, a S°°d  Nation, 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
 flii   !C,bd'°CCUpifd b^two P^ons, is as much as should ever be




Persons who have poor circulation, and are feeble, had better ha™ a 
96
HYGIENE.
little fire in the bed-chamber, in cold weather.  For those  in  good
health, a cold room is preferable.

  Open Win-lows 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
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 oft* foul air.  But many persons board  up this
cutlet  as if bad air were a friend, with whom they could not think of
parting.  At the same time, they will 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 lrii 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,  hi 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 two.  Cotton is best, too, for those who sufier with
rheumatic affections.   For external covering, comfortables arc objec-
tionable, because they do not let the insensible perspiration  pass  oft
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 w:;h
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.   // 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.  Ii;
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 iv-
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 sunper.
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, 
93                          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 limes.
   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
      .no.67.        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  whk h it is composed, are
 
HYGIENE.
99
 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
        fig. 68.        °^ l'nen> DUt Aa* 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-       Fr(j 69
 ficd 310 times.  It is not possible for  some per- ot»^mihrb
 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
 tne year  round   It does not  readily  absorb moisture, and is  a dry
 warm, and wholesome material for clothing.                       7'

   Hair. —Though not precisely in the line of these remarks, hair mav
 as well be introduced here.   Wool is in fa'ct hair.  Every part  of  the
 skin, with the  exception of that  upon  the soles of the LTand  he
 palms of the hands, „ intended to produce hairs.   On most parts of

 Uoonte'lS Z the°? ^h^' ^ ™"* ab™ the "^
 Upon tilt head and the face, they grow to considerable length.
*  Hair,  ike wool, is a bad conductor of heat; and, as growing upon

 ThJiflM   «   ' '?  d°Ubt,CSS intended for ™™  ^ful purpose
 That it  was designed as a warm covering, can hardly be doubted
 I he beard, when perm.tted to grow, is a natural respirator, guarding
 
100                         HYGIENE.
the lungs against cold  and dust.   Mr. Chad wick 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-     FlQ 70
ored rather than ridiculed.  For those who do not suffer p^§l§S^SS^|S   I
from  throat or lung complaints, especially if they are ^^^^S^^   ;
getting advanced in life, it  may not be thought worth ^^^&^^S[5
while to abandon the razor.  Yet the change would not *^#i&£ftii&*\   :
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 white.
   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.
                                                                    i
   Clothing should be Porous.— All articles used for garments,  should
be pbrous, 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.  Shoos made
of this material, soon cause the feet to become  damp and  cold.  The
dampness  is occasioned by the insensible perspiration, which  cannot   I
escape through the rubber.   Such shoes worn in the open air, should
be immediately taken  off 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 are 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 walk 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 th'ey 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 proportion
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 would 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 araon"
those who mean to be intelligent
  rIhe 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 wclf
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
man is  seven millions.
   The 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-eight  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 Opeu. — 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 and 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 seek 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  be  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 Sfedes, 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 thoise
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 an I 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 cne 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 which
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, baplisleium.
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 cooling room
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 vapor 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 the  bathers  undressed and
dressed at pleasure.
   All these  apartments were double, the two wings being appropri-
ated to the sexes.

  Open to ail.— 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 m rags.
Thousands believed, and thousands do to this  day, that to torment
flie 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
tie maintenance of the public health.   To a considerable extent, the
oody 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 be 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 first 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  une-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 hearth.

   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 the  bath 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 habitually 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  hirnself 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  applicatiou 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 of 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
 vertebra?, strikes  some  powerful blows over the fleshy and  muscular
 parts, 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.                                                     ^

  Restorationi of the Batli 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 bolh of body and of mind; for  the morals of any
 people will rise where the use of the bath is regular  and  habitual.
 I he  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 Sis

t "e 1 bTbu Zn't0 aU """^  people'even thouSh [t should «™"
tunes be abused by excess, as all good things are.
  A  people wnh clean hands, and clean bodies/and clean health, will

                     lo.iuness ior 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 gettino- 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 bade to
the  left heart, and  by this is driven  through the arteries into evevy
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
                      body 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-
                      cells 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.

  KiTect  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 ordinary size, take in, ot
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 wrdi 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
brca.h, is not only spoiled, but it spoils something more than another
pint wuh 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 iorty lcet an hour; and in eight  hours, the usual time spent in
tie sleeping room, it  amounts  to  one thousand nine  hundred  and
twenty cubic feet  During the  hours of sleep, therefore, one p ar 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-
dred 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 bed-
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-1  The animal consumes the non-ni-
nitrogenized 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.
trogenized substances, sugar, starch, and
gum.
  TnE 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.
 Ihis is  particularly necessary in  large cities.  Every  narrow street
even m Boston, should be lined with trees.  For their absence, thou-
sands of men  women, and qhildren have died sooner than  they other-
wise would.   We want them stretching up their arms to all  our win-

we7xhale1VC U* °Xysen' ^ t0 ^ t0 themselves the carbonic acid


enough a^'~^ ^ TY * inJUred ** "ot b™thi»S a"
enough, as well as by inhaling that  which is impure.   It is therefore
 re'hXdownTih ^ 1U"f b?T™S tightnesses.  If the ribs
arc held do  n by the dress, but little air can get into the luii",  and

( w .1., tic healt.i is injured in two ways; the blood is not vitalized by
c>:0-geii received, and it is poisoned by carbonic acid retained        * 
HYGIEXB.
  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 arc apt
to acquire the habit of drawing the air very little into the lower part
of the lungs.   This should be counteracted by taking  long 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
112 
HYGIENE.                         113
similar twenty years ago, would  have been compelled to pine a£
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 same 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, from their  power to provoke laughter, among the most powerful
up-builders of  health.
  The Games of Whist, 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,
 fieetness, 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 outside 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 of 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 life, we must come back to the
simple* paths of nature. 
TEMPERAMENTS, CONSTITUTION, AND  SYMPTOMS.
     Man has thinking^warming, nourishing, and moving powers.   For
   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 Lungs  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

tution 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, manliood, 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, when
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
1o, 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.
  4. Tonic spasm of the trunk.
  2. Distorted features, altered  position,
and} impaired motion of limbs.
  3. Irregular and perpetual motion.
  4. Entire and absolute immobilib/.
  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. yitus'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 lung  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 ma^ia.
  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.
    1. Convulsions.   Paralysis of one-half
the body.  Dislocation  of bones of neck.
Swelling of glands of neck.
    2. Chronic  hydropholus.    Enlarged
brain.
    3. Erysipelas.  Small pox.
    4. Typhoid fever.
    5. Swelling  of heart.   Congestion of
brain.
    6. Acute  inflammation of peritoneum.
Exposure to  severe cold.
    7. Chronic disease just before death.
  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.
  15. 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.
2,. Nostrils dilating forcibly and rapidly.
 i. Itching of nostrils  in <>l,;umn
 :  t'""1 "3 ""*"ng rorciDiy and ra
28.  Itching of nostrils in children
    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
 Bnght's disease, during  recovery.
   18.  A low and deficient state of blood.
   19.  Jaundice.
   20.  Cancerous disease.
   21' J!001* circulation in the veins.   Chol-
 era.  Typhus fever.   Blue disease.
  22. Mania and idiocy.
  23. Intolerance or dread of b>ht
  24. Orbicularis palpebrarum. ° Paralysis
ot the muscle which closes the eye
  25. Injury of the third pair of nerves.
  J,'  £Stru,ctltm of the lachrymal duct
  ll.  ihmculty of breathing
  28.  Worms in the bowels?
The  Tongue.
which  may partially be taken off with a
scraper, — also, clammy mouth. 
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
peels off, leaving  the  tongue smooth, red,
and tender.
  4. Tongue slightly white from small white
points, and sometimes eovered 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  hypochondrium (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 in 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.
   11. Spasmodic asthma.   Obstruction in
 larynx and windpipe.
   12. Abdominal inflammation.   Inflam-
 mation of diaphragm.


Belly.

   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.


 Organs.

   1. Stone in bladder.  Masturbation.
   2. Stone in kidneys.
   3. Hydrocele.  Hematocele. Sarcocele.
The Belly.
                        Private Organs.

1. Enlarged penis in children.         I   1. Stone
2. Drawing up of testicles.               2. Stone
3. Enlargement of scrotum.           I   3. Hydro
The Limbs.
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.


                   •The N

 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.  '
  1.  Paralysis.
  2.  Softening of the brain.
  3.  Defective circulation of blood.
  4.  Rheumatism.   Water in the joints.
White swelling.
  5.  Paralysis.
is  System.                 *

    1. Acute  inflammation Of  brain  and
spinal marrow.  Fevers.  Hysteria.
    2. Phlegmonous inflammation.
    3. Enlarged internal organs.  Internal
tumor.   Effusion ^>f  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.   Caneer.
    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.
   14. Most diseases. 
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.  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
close of life.
  1. Cartilages turned to bone.  Pleura
hardened.  Distortion from 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.  First stage of acute  diseases  of the
lungs.
  2.  Decline of acute diseases of air pas-
sages and lungs.
The  Breathing.
The  Cough.
  1. Hollow and barking cough.

  2. Sharp, ringing cosgh.
  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 liaving a metalic or  ringing
sound when listening with the stethoscope. I
  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.
The  Expectoration. 
,   TEMPERAMENTS,  CONSTITUTION, AND SYMPTOMS.       127
   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.
   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.
  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. Pain darting from front part of chest
to between  shoulder blades.
  5. Constant pain between the shoulders.
  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  Tongue trembling  and  dry, and di-
minished in size.
  2. Voracious appetite.
   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. Acute bronchitis.

  2. Acute bronchitis.

  3. Pleurisy.

  4. Consumption.

  5. Consumption.  Greensickness. Othev
chronic diseases.
  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.   Activo
bleedings.  Lead colic, etc.
  6. Affections characterized by debility.

  7. Inflammatory diseases.  Hemorrhages.
  8. Apoplexy.  Sometimes in disease5 of
heart
  1.  Typhoid and other low fevers.

  2.  Pregnancy.    Hysteria.    Insanity.
Sometimes in dyspepsia.
Pain.
The  Pulse.
Relating  to  Digestion. 
128
TEMPERAMENTS, CONSTITUTION, AND  SYMPTOMS.
3.  Diminished appetite.
4.  Increased thirst.
Thirst gone.
Vomiting.
 7.  Pain increased by pressure.
 8.  Pain relieved by pressure.

 9.  Urgent desire to 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.
   3. In most acute diseases.
   4. Acute  affections  of  stomach  and
bowels.
   5. Cerebral disease, with coma.
      Early pregnancy. Colic.  Disease of
       Inflammation of stomach.  Hernia.
      Inflammation of internal  organs.
      Over-distention of bowels.  Neural-
      Colic.
      Dysentery.  Sometimes in diarrhoea.
      Diarrhoea.   Cholera.
      Chronic inflammation of colon.
      Constipation.   Colic.  Cancer  of
stomach.
  13. Deficiency of bile.
  14. Too much bile.
  15. Bile from children after taking cal-
omel.
      Dysentery.
      Melsena.
      Bleeding piles.
      Asiatic cholera.
      Iron taken in medicine.
      Dysentery.  Diarrhoea.
      Diabetes.  Consumption.
   6.
brain.
   7.
   8.
gia.
   9.
  10.
  11.
  12.
16.
17.
18.
19.
20.
21.
22.
Worms.
23.  Diseases attended by debility.
The  Urine.
  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. 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.
The Perspiration.
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.
  1. Acute rheumatism.  Decline of acute
inflammations and fevers, behig 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. 
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.
  9. Low temperature.
 10. Cold hands and feet
17
  1. Fevers.
  2. Inflammation.
  3. Headache.
  4. Disease of brain.
  5. Inflammation in chest
  6. Consumption.
  7. Typhus fever.

  8. Beginning of fever.
  9. Poor circulation.
 10. Nervous diseases.  Dyspepsia.
state of the blood.
Low 
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 perforin.  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-1
•    frj
w
fin

E-i




§
CO
&
m	■7
H	
^ M	
^	a.*"
H	
 
SKIN DISEASES.
131
   Such as are marked by inflammation of the derma and mucous
membranes, with constitutional symptoms of a specific kind, and
   Such as are distinguished by inflammation of the derma, without
constitutional symptoms of a specific kind.

      Congestive Inflammation  of the  True  Skin.

   The First of these Groups, — those  characterized by inflammation
of the cutis, with constitutional symptoms of a specific kind, — embraces
measles, scarlet fever, varioloid, small-pox, and cow-pox.

                      Measles.—Rubeola.

   Measles is an acute inflammation of the entire skin, both external
and internal, associated with an infectious and contagious fever.
   Symptoms. — The disease sets in with chills, succeeded by burning
heat,  listlessness, languor, drowsiness; pains in  the  head, back, and
limbs; frequent pulse; soreness of the  throat; thirst, nausea, vomit-
ing, frequent dry cough  and  high-colored  urine.  These symptoms
increase in violence for four days.  On the third day jbhe eyes become
inflamed, cannot bear the light, and pour fourth a profusion of  tears.
This  last  symptom is called coryza.   The nose likewise discharges a
large  quantity  of watery secretion, and sneezing  is frequent.   The
larynx, windpipe, and bronchial tubes become inflamed, and  hoarse-
ness, soreness of the breast, etc., are the result.
   The redness of the skin and breaking out appear about the fourth
day, and produce heat and itching.   This breaking out is character-
ized by a patchy redness, which, on close inspection, is found to consist
of numberless minute red points and  pimples, collected into patches
in the shape of a half or quarter  moon.   They appear  first on the
forehead and front of the neck, then upon the cheeks and around the
nose  and  mouth.  On the fifth day  they reach their height in this
region, and  then  appear  upon the body and arms, and on the  sixth
day, upon the legs.  The color of the  skin when  the  inflammation is
at its height, is of a bright raspberry red.   The decline of the rash
takes  place in the same order in which it  comes out.   The redness
fades  on the sixth day upon the face ;  on the seventh, upon  the  body
and limbs;  on the eighth, upon the backs of the  hands.   The coryza,
the hoarseness, and the cough, decline about the seventh day, while a
diarrhoea comes on about the eighth or tenth, — showing that  the in-
flammation  of the mucous membrane is  subsiding.  When  the in-
flammation disappears, the whole scarf-skin peels off in the form of a
scaly  scurf.   The artist has given a good picture  of the disease in the
beautifully colored lithograph, Plate  I, Fig. 1.   This plate is admi-
rably  done.
  Treatment.— When  the disease  is  mild and regular in its  course,
scarcely anything will be required, except mild diet, slightly  acid
drinks, with flax-seed  tea, slippery  elm,  or some  equivalent, to  quief
the cough.   Sponging with tepid water, if done with frequency,  mod. 
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 cool 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 aad 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 water 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 wrarm 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 scoopcd-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*vell 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 suffers,
   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
   fo 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 
I 3G                      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.  That 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, vnthout constitutional symptoms of a specific kind, are
Erysipelas, Nettie-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, loes
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 scat of 
■ERYSIPELAS.
PL 3.
Fig. f
Fig. 2.
\ 
 
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
 wiiich  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 case 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, pour 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 with 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).

                        Itch.—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.               Fio. 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 sldn— 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 iu 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, pompholix, 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
hen'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 fpr 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  smaD
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
(176) (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 wTell-formcd
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.

   Tins 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
arc useful.  Laxatives or tonics  may be  employed, according -to the
indications, — frequently laxatives first, and tonic's  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 nap-
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 pjmples, 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, pi a dull  red or  salmon-color,  and  partially transparent.
When pressed under the finger, these elevations are found  to be soft,
and when the fingef  is removed, they are  flat and whitened.   They
generally appear on the face, and particularly the nose. 
SKIN DISEASES.
145
Fig. 76.
  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,
                           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,
                          Jto  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 papillce.   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 siee  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
w^
^ 
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 arc 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.

   Itching. — 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. — Macula.  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 
■ ■ ■ ■'  ■ ■■-^^MaaNHHpaamiHi
LUPUS  NON EXE.DEWS.
Pi 4.


X-BSt"--  i"'
^^ Bu/fi.rf* LUh. Bosto, 
 
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 pigm(   -
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 of 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
railed 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
iittle 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            Fia-"
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. 80.
  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
teaspoonful 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 acne,— only differing from it in its location.
It appears chiefly on tne 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. 
150                       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 tne 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."

  Porrig'O. — 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 enclose 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  papillae, 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 mnch 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.

   In 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 th-
at id 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.

  Of Sensation there  are various disturbances, perversions, and 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 stxong, fibr/ms 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.

  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 intense 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
car, 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 light, 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  froin 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 oik, 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, when 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
rhn 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
 muy 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 oi 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. *»« 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; afoul 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 noise1 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, (64J (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 applied over 
DISEASES OF THE BRAIN AND NERVES
159
 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
 occurring in the lower.

            Inflammation  of  the Spinal Cord.

   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 ofsuffocation ; 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 aqtion 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 affecrion 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, the 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 iri advanced life.
  The Forerunners of apoplexy are headache, vertigo, slight attacks
of palsy, double vision or seeing two  objects when  ther.e  is but one,
faltering speech, inability to remember certain words, sometimes a
sudden  forgetfulness  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 
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;  and, if
any tendency £o eold 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 "£ass
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
callech"  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. 
   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

                    Hydrophohia.—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 stiff-
 ness, during  which he suffers  great  depression of spirits,  he passes
 t.iree  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
t 
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 chickweed,  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 is
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 Jong-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 Fits.

   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.   I„
 a  short time more  he recovers, and is apparently well   These attacks
 come again and again, and at irregular intervals.

 r.Jn«! ''u-ir' f°rm °f the disease;  there  is another class  of
 cases i„ which the symptoms are much  lighter, - there being no tuV-
 gescence of the face, no foaming at the mouth,  no cry,  no* ™nvul
 fi'ed Waze Tff? * *udde\and brief ^pension of coLi«a
 r^ve^ry £ "peedy?g    C°nfUS1°n' °' * ^  fr°m ^ °f which  the

 ffesrtXSfo7dTi^rre,nUmrU^~as WOrms' ^turbance from indi-
 vous rritth>n  e  LfT^ andubow^^ difficult teeth-cutting, ner-
m^tv^oTdl^U    ■    °r b>\symPa%> ^xual excesses  and
masturbation, disease or injury of the  brain or spinal  marrow  ffall
stones in  the excretory duct of the liver, stone ox^xayeTtnThe  ffd- 
1C8
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 frdVn
 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
 (onsciousness, 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.

               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 carrv
 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 ola serpents, and the jaws snap together like  a fly-trap.   The
 ower limbs, are in a  state of perpetual diddle ;  the feet shuffle with

 d^n^da^ef "^  ^ ^ ^ ™ * ™*M With a Ceaseless
   It is supposed by some that the disease consists in a partial palsy
JjJrl  ^T***  The ^11 in that case not being abLto
contiol the  palsiedi 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
a're 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 causes 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
external  force, 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 ot 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.
Fig. 82.
 The pain is generally of a peculiarly darting, piercing character.  The
 patient sometimes calls it tearing  paio.  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,
 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.
   Foi 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 man's 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 world has gone
back to chaos. 
174           DISEASES OF THE BRALN 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
airything, 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 betrays 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 mflarrvd 
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  physical 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 always 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 are, 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 
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 ; — 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, iu 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 their 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 proper
 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 thes^
 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 irear 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,
 hypf), 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 blood  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
 (he organs of sense; and they are no more wonderful than that the
 iriind should  perceive personal danger, poverty, and death itself, when
 none of these things are impending.
   These persons are subject to fainting turns, wtien 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 
ISO           DISEASES OF THE BRAIN AND NERVES.
the liver and stomach, costiveness, sedentary habits, excessive venerea)
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,
must be forbidden.  .
  But little medicine will be required.  If tliere 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 mklriff, 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, to wards 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 Head.— 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
 nio-ht-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 by 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.   I he 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, vomiting comes, and relief is obtained.

      Bilious  Headache. — This is most common in summer and autumn.
   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.

   Megrims. — This is most frequent among females.   It 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,  seldom lasting
 long, but  being of a sharp, piercing character, like that 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.   The  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 dose 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,  he 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 btood 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  (324) (326).  When it occurs after a debauch, take recipe
 325.

   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 do well, 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 night, 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 offthe 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).                                   v  ' 
DISEASES t>F 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. 
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
nine or larynx, is Laryngitis.  In the windpipe, or trachea, it is Tra-
cZis.  In the.  bronchial tubes, it is  Bronchitis.   As the .bronchial
 ubes exist nowhere except in the lungs, below  the A™» * «£
windpipe, there can be  no Bronchitis in the throat   Nevertheless, it
il 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, tne
 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
hollow tree with the top turned downward, — the larynx and trachea
representing the trunk, and the bronchial 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
frequentlv 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  swallotv, 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 fair 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
 svringe, 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 nasal 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.

  Tins disorder made  its appearance  in this country in  1830, and the
attention of the profession was first drawn to it,  as a distinct disease,
m IN,-.  Some have supposed its origin to  have had a hidden con-
nection  with the epidemic  influenza, which  spread over the civilized
world in lh30, and affected all  classes  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 Throat.  It was soon found, however, to
attack aliclasses 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 geneTal 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 i n
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 by 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 ereat
 exertions to meet the wants of their position.  The extremely trying
 circumstances in which they are often placed, too, in these excMnS

  !idr\aLqhUeeStlv°nS ^ ^  Md ****** l°  ^ «d"?
  e vkTtw'e IeigA h.eaVlly UP°n *??' SPirit8'  and Sreatly depress
pubic minded tt   wvn T add t0 this the "le «tate  of the
public mind, and the  shifting, fugitive character of a clexsvman's

Snfi^^^r^MO? ^^ t0 P0WandrSto
causes P^£B^^


o^cle^^^ 
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
it when once e tablished; 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 af
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 maans 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 Night. — 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,  they
  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 instu-
  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,  the 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
 niinute 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 atny 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\ery 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
sponge 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.

  Ilave Superseded the  Probang. — In my own practice the syringes
have superseded the probang altogether.   My reasons may be briefly
stated.  Lhave 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 my
 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
 18od, the Lancet contained an article  under the head of "  New  Inven-
 tions,'' which began by describing Dr. Green's Probang, then "Dr. Ira
 Warrens  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

 o\iZ°rZ \la  Kg   1S artide ? ?e Lancet' no one  would ^fer 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
 no  be learned from the article.   And yet the facts are, that the Editors
 ^n'LS^the0 ^ ^^ °f ™ Coxet-, who employed"
 mine which the S ^Tt"1- ^^ ^ a mi^rable imitation of
 mine, which the editors call his invention, — saying nothing about his

 eS,:^: ft^rthe mamier in wh4 Ly «;Lt

sidl to slot' U^X&*Xl irfT " Hatttned fr°m

sphere.  If the  sphere rs wholly removed, as the cu/In  theXr.ce 
193                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 be 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'  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               Fio.m.
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 fox 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 nitrate 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
 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, bv 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 not 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-
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.

   Ix  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 
20£                 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,               FlG. 86.
which,   when  open,   leave   a        [Patented January 17, 1854]
proper  space for  drawing  the                        ^—^
tonsil between them.   Two pol- /-!^!*!!=aa!a9>^          _jfe=*CS=***^
ished guards which I formerly hQ    /^^^^^eT^^^^'^''^^5'8'^
had made of steel, but now of H^cUlfiJ^^^H^^^^ii    ■
German silver, protect the upper  —                 ^f^NA^^y
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 consequence^ 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  Throat Diseases. -1 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
iu treating them enables me to say, emphatically, they  are generally
curable.                                       „     .   .n T
   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, you 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 wfiarf 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 week 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 be 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 whole 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 througK 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 THE 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
the 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 boneget, 
  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 not 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.

    Tins 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
  all ended 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.                                               l
   Hot fomentations applied externally, and filling the room  with
 steam, as recommended  in cases of croup, would be useful.


                     Mumps.—Parotitis.

coIfiZu^T  aPTP,?arS most,often am™g  children ; but as it is not
confined to them, I have not placed it among their complaints.

rJ!mV<m*'~ Jt bn^"S Tith soreness and stiffness in the side of the
 amfiff  3  1T    g* °f thG Par°tid Sland 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
 costiveness,  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 Vir-
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 whom 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 to 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  aiid rough  dnes, it is  not so good  as the stethoscope, repre-
sented by Fig. 87.  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.
Fig- 87.
Fig.
   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  I 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.                           FlQ-w
  The Mamillary  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-Mamillary 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 the 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 the 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, moi&t, 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  anV.ells, — these having been
pressed together, or obliterated bv 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
bettor 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 t<he 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 froma 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
emjity,  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
  parLicles composing the body to a state of motion ;  the  latter inclines
  them to a position of rest.
    la vegetative life there is motion in one direction  only, so to speak;
  that,  is, motion  which tends  to the opposite of motion, namely, rest.
  la 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 undisturbed.  In a tree,  a  layer of matter once  deposited,
  always remains.   Hence there is growth as  long  as the  tree lives.
  Tiiere 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 enefgy,
  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
 toe body increases in weight, and acquires  that state in  which  the
 blood corpuscles abound, and the tendency, if to disease at all, is to
 t.iat 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
 t.iere is too much motion.  The nutritive particles, instead of tending
 to a state of deposit for  the  re-suppiy of waste matter, become  fu<*£
 tive in  their habits, perpetually fleeing, like  convicts escaped  from
 prison.   Introduce  this power, in excess, into  the vegetable kingdom
 an. 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 ot 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 TEE 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
daz£le 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.
   0 
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 \vell 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 into 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 iu
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 tha
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 function, 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 hxick-makers,
and  lazy brick-foyers;  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 01' THE CIIT-ST.
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 mod-js 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.  He 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
sweating 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,"  (tubercJes 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 CHEST.
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 staternent 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 arc  not
 well put together, and arc more easily taken apart than those of  the
 adventitious tubercular tumors ; and if \ye would restore these  vessels
 to their natural  activity, we must improve assimilation, and knit the
 nnloving molecules into a firmer  brotherhood.  We must make  the
 (lcsh 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 fourlh 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."   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
 a?id  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 ago, 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  commonSense
 mind as eminently reasonable and  necessary.
   I shall speak of inhalation, therefore, very earnestly, not as a pallia-
 five 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 and in simple bronchitis, the  bronchial
 tubes almost aways suffer some physical change.  The mucous mem-
 brane fining these tubes  is generally softened.  At other times the
 tubes become enlarged through their whole length, so that many of
 them, from 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 I
    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 qf  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 tcaspoonfuls, to be inhaled  ten or  fifteen minutes,  in about
a gill of hot water.
   The ethereal tincture of conium is made bv 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-Hemorrhagic 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 tlirough 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
  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
pi-oeess.   They should be used from three to six times a day, the in-
halation continuing from ten to fifteen minutes.
   Cither Inhalants.— Great numbers of other articles have been  used,
which I have not 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 Inhaler. — 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 *oon 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
long tube to fill the  vacuum,  and breaking out at the  bottom, sets
223
i 1 •' i w \ A	■ -A	^Hre^^^^-
	=\— i= i.. i	
	ir~~ yy-.*|	
 
DISEASES OF THE CHEST.
I    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-
i    tient  from being  literally burned up  by oxygen, the blood must be
1    de-oxydated as fast as possible.
!      Wliile 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
I    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
I    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
j    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
I    this test, most remedies must finally come), I will mention that  tar-
I    trate of antimony and potassa arrests the circulation in the pulmonary
    arteries, — which  fact gives a  complete and. luminous view of its
I    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 phosphoric 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  growth 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,.....1.686
                            0.066
                          -  1.134
                            3.328
                          -  1.052
                            0.667
                          -  0.114
                            0.073
Sulphuric Acid,
Phosphoric Acid, -
Potassium,
Sodium,    -
Oxygen,  -
Phosphate of Lime,
Phosphate of Magnesia,
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,
ar.d 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
                                 29 
22G
DISEASES OF THE CHEST.
ground of a  very free use of alkalies, — particularly in the form of
bath in sr.

  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 power 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 Coug'h.— 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-nitrale 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'"  r
 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 th*
 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 thin-  by
producing spasmodic contraction of the extreme bronchial tube^aixl
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 haemorrhagic 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),  axe 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 (fasciae) 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 on 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  fc 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 4he 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  the 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 more 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 liv-
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 miPd 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 generaliv 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-roof, 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 oold, and damp 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
 the  lower end.  The  powder  is               fiq.m.
 poured  into the receiver, which is        [Patented March 16, 1852]
 placed  in the  larger  tube,  and
 twirled between the  thumb  and
 finger while inhaling.
   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. 
£^ti                  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 added 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 consists in a collection of 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  an  ether  as its* o-use. 
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.—l?leuritis.

  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 lungs 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
tmall.
  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, arid 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 walls 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 vib:ation 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 will 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 tlie 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;
il 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 off 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
bv 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.
   A* 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  temperature uneven, the  tip and edge of the
 tojigue 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 — coining 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. 
214
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 scries 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 bronchial  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
but 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
diseases above named.  There  is great irritation of the eyes, with
sneezing, and  a  free discharge  from  the nose.  There is tightness
across the chest, difficulty of breathing, and a pricking sensation in
the throat.   These symptoms often  appear in great  severity, 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., while in blossom;
which emanations come in contact with the mucous lining of the eyes,
nose and throat, producing very  great and teasing irritation.
  Treatment—One  of the best remedies for this troublesome com-
plaint is to avoid the cause, by removing, during the  flowering and
haying season, to some large city, or, still better, close down  to  the
sea-shore, where  flowers and  hay do not grow.
  Of medicines, the tincture of  lobelia, taken in moderate doses, is a
very good remedy.   Quinine and iron, given in combination (75), are
valuable preparations.   Strychnine and nux  vomica, in  connection
with iron, or otherwise  (316), (83), (84), (85), 86), (95), are very use-
ful.   Iodide of potassium (101), (138), (140) is also worth a trial.
Another very good remedy is the chloride of lime, or the chloride of
soda,  placed in saucers about the sleeping-room.  Pieces of  cotton
cloth may also be dipped in one of these solutions, and hung about
the apartments of the house.  The  hands and face may likewise  be
washed, once or twice a day, in  a weak solution.
  The oxide of zinc, and the extract of nux  vomica, made into pills,
two grains of the zinc to half a grain of the extract to each pill, 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 well-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
I  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  way through the whole life, resting not, day or night,
we cannot wonder that it gets out of or-der.
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.
           i
  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 strong 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 iu 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
usefull   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.
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   ' j
very small disturbance of it, even  from  acidity, will set the heart to
beating very violently.                                               i
  If hysterical  symptoms  are present, the  compound galbanum pill,
and valerian (97), and other nervines will be called for.                 I
  In attacks of great  difficulty in breathing, immerse all the extremi-   j
ties in  warm water, and throw a blanket around the  patient to  pro-   j
mote sweating, — at the same time admitting fresh air to satisfy the   j
desire  for breath.   Give  a draught,  composed  of ether,  laudanum,   j
ammonia, etc. (135).  This may be repeated two or three  times, at   I
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   j
latter.                  •                                            j

  Physical Signs. — Both sounds are  louder than in any other disease   ii
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-   j
nant symptoms, is specially to be  regarded in the treatment            i
251
__________    i 
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.— 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 hSart-
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.

    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 bones of  the head.
 I    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-
 j  scribed in other heart diseases  with similar symptoms.


              Shrinking of  the Heart.—Atrophy.

     The heart, like  any other muscle,  is liable to  defective nutrition,
 I  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
i   the heart, and the roots of the large blood-vessels.
I     When the  pericardium becomes acutely inflamed, it  throws out,
!   both  lymph, and serum  or  waier.  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, hike 
2<A
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
airow 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, feyer, 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. 
206                     HEART DISEASES.
----i.______-___________________________________________________
  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 anow 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  !
c/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
filincr.  .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.
   Geueral  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 were 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.

   Wiiich 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-y. Mnpr nearer the surface, has  a higher pitch than any other. 
258
HEART DISEASES.
It is  on about the same key with a whjspered 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, axe 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, — thrus 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.
2*9
  are excellent.   Should this no* 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  He art-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 Jips 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 causes produce  breathlessnes.s
and  faintness.   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 a lack 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 js 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.
Fio. 94.
   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,
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
 
DISEASES OF THE ABDOMINAL CAVITY.
2(>3
Fig. 95.

  right side, is the right hypochandrium, in which is the right lobe of the
                           fiver; 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 ox 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, a front view of                    FlQ ^
  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,  16, the
 right and left lobes  of
 the  liver;  17, the gall
 bladder  ;  IS,  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 OE 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, and  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 oi  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 &. 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
  I   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 an(i  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-
 J   iarity with chronic diseases, for several years, has  convinced  me that
 j|  it is generally curable.

 j|    Symptoms.— A sense  of fulness and weight in the right side, with
 i   some  enlargement, and shooting pains felt in the same region, partic-
    ularly when it is pressed, with pains in one  or  both  shoulders, and    j
    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    I
 m   cough; shortness of breath;  tongue whitish, and brown or yellow    I
 ,   towards the root; a bitter and bad taste in the morning.   The urine    I
 l!   deposits a sediment on standing.  There is generally a low and  des-    i
    ponding state of  mind, with irritability and peevishness of temper.       j
 ;;     The skin is often covered  with  yellow spots,  and with a  branny    I
 |j   substance.  The  various symptoms of dyspepsia are  often  present    j
 i(   The nervous  system is generally much  disturbed, and there is a dis-
 j   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-    i
    fices, and the compound pills of podophyllin, or the compound pills    I
    of leptandnn, or (36).                                         r       I
j     I have  abandoned the use of mercury in this disease, as in most    j
;    others ; but if any prefer to use it, the blue pill (52) will be found the    !
    most useful form.
     The compound  tar  plaster  placed over the liver, in bad cases, is    l
   often very serviceable.                       '                         j 
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.                                                    J
   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 in 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   i
      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-
 i   less and pale.

 j                        Jaundice.—Icterus.

 I     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.                       !
 j     Beside these leading symptoms, there  are impaired appetite, a loath-
 1   ing of food, the sense of a load at the pit of the stomach, sourness of    i
    stomach, sometimes sickness and vomiting, a bitter taste in the mouth,    |
    disinclination to move about, sleepiness, a dull pain in the  right side,    i
    which  is increased by pressure.                                        j
      The entire  body of a person who  has died of jaundice, including    j
 j   bones,  muscles, and membranes, are found to be full of bile, and col-
 I   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.    !
IJ   This little tube or vessel receives the bile from a smaller tube, called
! j  the hepatic duct, and  from another  which goes to  the  gall-bladder,
[j  called the cystic duct.                                                 j
I1    These  little tubes sometimes get obstructed or plugged up by    j
j    sticky, thickened, or hardened  bile, or by.gall-stones,  formed in the    I
11   liver, and the bile finding  no outlet through its natural channels, is    ;
    taken up by the absorbents, distributed over the system, and produces    ''
    the yellowness we witness.  When these  ducts  and the gall-bladder    ■
    are filled  and stretched by this thickened and hardened bile, they be-    I
 J  come tender and sore.   Hence  the sore  feeling in the side when  pres-
   sure  is made.                                                        I>
 |    There  is another explanation of the  way in which the yellowness   r
   of jaundice is produced, and it  matters not whether if, or the one just
 ■  given,  be  adopted.   It is this:  The bile is formed by the blood, and    !
 i  not by the liver.   The office of the liver is to draw or strain off the    I
   bile from the blood.   And when this organ is  inflamed, or gets slug-    j
   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.         j
|     Treatment. — If there be much inactivity of the liver, the treatment    j
   may  begin with an emetic (1) (2) (4).                                   j 
2°8           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, and 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 parts 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-
 ing through the ducts, if of considerable size, they produce
intense pain, particularly if they are jagged upon  their
 surface.                                               tfRflL
  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
twenty 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, ia 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.

  Nervous 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.
j    all sorts of annoyances and difficulties, such as shipwrecks, falls down
j    precipices, and nightmare.
j      The man who has all these symptoms, or any considerable  portion
i    of them, has dyspepsia, and is about as miserable as if all the sorrows
j    of life were electrical currents, and were running through him contin-
|    ually.

i      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-  !
j    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  j
    prevalent.   It is hard for the  sensitive to escape.                      jj
      Urinary JDeposits. — Before speaking of the treatment  of dyspepsia,  ii
    it will be  proper  to  take  notice of certain deposits in  the urine, to  il
    which persons suffering from  this complaint are liable, and the dis-  jj
    covery of which, will, in many cases, indicate the treatment.           ii
      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   j
    themselves, look with dread upon the  future, and generally have the   j
    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.
Fio. 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 crystafine 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 CAVITY.
Fig. 103.
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 elemente 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. 104.
Fig. 105.
Fig. 106.
  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         ^ m
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, thi3 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-work. — 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
j   pleasing enticements.  Exercise must  be had, every day, and be con-
I   nected, if possible, with  an object, so that it may be performed cheer:
I   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-
i   fluences sent from  the  brain to the  stomach should be of the most
U   agreeable  kind.   Some  people  think it vulgar to laugh.   Let such
u   stand with long faces in life's shadows, if they choose.   As a general
jj   rule, the best men and women laugh the most  Good, round, hearty,
I   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,
j   associations, and things, in  their own neighborhood, do not fill the
   compass of their wants; their many-sided faculties need to be drawn
Ij   on by the  large variety to  be found only in travel.  Their  large  and
II   impressible natures  want to  be filled full in  order to drive out disease,
jj   and it takes a world, or  a  considerable part of it to fill them.  The
11   dyspepsia of such natures  is not comprehended by the multitude, and
j!   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
I   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
gTeat 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 TnE 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
 ihis 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.  If
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 lies 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, ai>d is pinched and ghastly; and a cold sweat
breaks out 
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    I
 jelly dissolved in water,  and preparations  (298) and (299).  Indian    I
 meal gruel, toast-water, barley gruel, and the like, are the only allow-
 able diet.                                                            I
                                                                     !
                                                                     i
        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 bowels.                       i
                                                                     '|
   Symptoms. — These are sometimes very obscure, and the advances    j
 of the disease stealthy.   At first, there  may be only a little soreness    j
 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 tenskm or tightness increases,    j
 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-    j
 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.                         j
   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    'j
boiled cracked wheat.                                                 ;
   Daily bathing is specially necessary, particularly the alkaline sponge    ||
bath, with vigorous friction over the bowels.  The warm bath  once    II
cr twice a week, will  be  useful.   In some cases, the wet towil 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 (9b)
(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  pros-
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
altered.
  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,
  poultices, 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   j
  day.                                                               I
     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, unirritaring kind,—beginning   j
  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.        j
     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.                            j

           Wind  Colic—Flatulent Colic.—Interalgia.          \

     This is a severe and distressing  pain in the bowels, — sometimes  a   j
  stoppage, and a swelling about the pit of the stomach and  the navel,   j
  What children call belly ache is a mild form of it  The wind passing   j 
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*
 I  ing certain kinds of fruit.

Ij     Treatment.— When the complaint is caused by an indigestible sub-
i!  stance taken into the stomach, the offending matter should be thrown
II  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 in fu-
ll  sion of senna, elixir  salutis, elixir pro., or sweet tincture of rhubarb.
j!  If there is no sickness of the stomach, a little essence of peppermint
jl  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.

j     Explanation. — This is the  meaning  of it.   It is neither more  nor
|   less, in many cases, than the air within  the muscles and membranes
j   swelling up and distending them in consequence of their being in a
]   weakened condition.   There are two ways in which the flesh may be
j   caused to bloat.  It may be caused by placing a cupping glass over
I   it, and taking off' the external air.   When  this is done, the air within
i   seeks to fill the vacuum  above, and lifts up the  flesh.  So, likewise, if
j   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   j
   the belly a peculiarly hard feel, like the  head of a drum, and when it   i
   is pressed upon with the fingers, no indentation remains.

     Treatment—If the air  be in the intestinal tube, a stimulating in-   j
   jeetion 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   j
   bowels of the  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.           28o
             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 an(l down the
 arms; also down to the bladder, causing the urine to be  passed with
 pain arid 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, one ounce dissolved in   I
,   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   j
   or twice a day, in the same amomit of this latter salt, dissolved in a   ii
   gallon of water.                                                    |i
      Means of Prevention. — The numerous persons who work in lead,
   should comb their hair with a fine comb, wash their  hands and face,   | i
j   and rinse their mouth several times a day, and also wash the whole   j
i   person with soap once or twice a week, and with clear water, or sal-   |i
   eratus and water, once a day.  Their working clothes should be of a   I
!   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-   '
j  . 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.                  i

i      Few disorders are more common than costiveness.   By this term   j
j   I mean a sluggish state of the bowels, which  causes them to retain
1   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
i   are passed by hard straining, and sometimes with considerable pain.
I      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 .  aviness  about  the lower
   part of the belly, and a sense of confinement over the whole body.
I      Causes. — Sedentary habits, particularly when  connected with close
i   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
j   is this continual contraction of the muscular fibres of the intestines
   from above downward, which pushes the contents steadily along; and   |
   whatever  weakens  the force  of this vernicular play  of the intestinal   ;
   walls, brings on constipation.                                        \
                                                                      i
      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
 i   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
 j   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
jj  veins  of  the gut become  enlarged or varicose, or the  blood gets infil-
|j  trated  into the cells beneath the mucous membrane,  and collects so
   as to form bloody tumors.
 I     These tumors, which are seldom absent are the leading features of
 |  the piles.   They sometimes appear externally, around the anus ; this
 j  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 b'.y..t  piles when it is not.
 i
 i    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 
DISEASES OF THE ABDOMINAL CAVITY.
         piles, the  little tumors  will  bleed  at every motion of the bowels.
    i     There are  frequently disagreeable sensations in the head, general  las-
     j    situde, an  irritable state of mind, and a sense of fulness and anxiety  j
    ij    in the stomach.   The pains  experienced  range all the way from the
    |l    slightest twinges  up to the most terrible sufferings, which appear  fike
    jj    tearing the body asunder.

    !i      Causes. — Everything that  irritates the lower bowel, and causes a  j
     I    determination of blood to the part.   All drastic physic has this effect,
    il    —particularly aloes, which acts especially upon the  rectum.   Habit-  |
    11    ual  costiveness, straining at stools, riding much on horseback, sitting  j
    ji    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
    Il    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-
     j    tive  purging will do great mischief.   Yet costiveness must in some
     |    way be corrected.  For this purpose, no  remedy that  I have ever
    |i    tried has done better  in this complaint than an electuary composed
     I    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-   I
    ii    cles  recommended in the chronic inflammation of that organ.
           For the  local treatment, nothing is better than two ounces of lard
    jl    and  one dram of  the flowers of sulphur  mixed, and rubbed between  .
         two  plates of lead until they are  well blackened.  This  ointment is
     I    not  only soothing, but curative, both in the bleeding and blind piles.
         An ointment of almost equal excellence may be  made from one hand-
     j    ful each of witch  hazel bark, white oak bark,  and sweet-appletree
     I    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
    |;    COOIS.
    !;      If there  is much inflammation and distress, an emolient and sooth-
    I     ing  poultice should be applied, composed of slippery elm  bark and
    l\    stramonium or poke leaves.  Steaming the parts is sometimes useful,
    i!    by sitting over a hot decoction of  hops, stramonium, and poke.         j1
           Piles may often be cured by the use of the domestic syringe. Daily   ij
         injections of cool or cold water will do much to strengthen the bowel,  ji
    |;    and  restore the dilated veins to their natural condition.                 j
           The food should be of a laxative  nature, corn bread, rye pudding,
    j;    bread of unbolted wheat flour, mealy potatoes, ripe fruit, pudding
    jj    and  milk, buckwheat cakes, broths, and a little  tender meat once  a
         day. 
DISEASES OF THE ABDOMINAL CAVITY.
           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
 pale, dry, and, after a time, sallow.

   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  Diarrhcea.

   The acute form of diarrhcea, 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
 griping,  restlessness, thirst, poor appetite, debility, loss  of  flesh, dry,
 rough, and somewhat sallow skin, and tongue dry and dark-colored.
 The food often passes through the bowels pretty much in the  condi-
 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 
2-0           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
   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 MortTus.

   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 subset
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  diarrhcea 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, addihg 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 Cholera.

  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 diarrhcea; 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.  Tins, 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 watery 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 off 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, butr 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  'aid 
DISEASES OF THE ABDOMINAL CAVITY.
293
 upon them, will have a good effect   The starch injections should, in
 such case, have half a teaspoonful of laudanum mixed 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  podophyllm,
 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.
                                                               h
   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 Asearis, or pin-worm,  called also maw  or thread worm, is a
 small, white, 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 asearis lumbricoides, is a round  worm, about an
 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
 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.
j   robs the body of nourishment, and produces great loss of flesh, and
   an enormous appetite. _                                            j
      Symptoms. — In the grown  person  the  symptoms of worms  are   I
   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.                                        i
      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 ;
I  . 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-
I   tt>ot and senna, each half an ounce ; bitartrate of potassa, one dram;
j   pulverized jalap, half a dram ; cardamom seeds, half a drarn ; 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 expelled.
      .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
   foj 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   j
f   connected with, proper exercise,  pure  air, frequent bathing, and all
I   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.
i                                                                      \
      Acute  Inflammation of the Kidneys.—Nephritis.

    ^Before speaking of this disease, I wish to give the reader a general
|   idea of a kidney, 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 ; t, 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,           29D
  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.
FiQ. 108.
   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 diarrhcea.  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.  *
Fia. 109.
 
JHSEASES OF THE ABDOMINAL CAVITY.
j      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
j    poultice upon the small of the back, and follow  it  up with hot fomen-
i    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
j    teaspoonful doses of the compound  tincture  of Virginia snake-root,
|    given every half hour.
j      If costiveness exist, the bowels must be  opened by epsom salts,
|    cream of tartar, or salts of tartar ; or by copious injections of warm •
i    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
i    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.
                                                                      i

            Chronic Inflammation  of the  Kidneys.           i

      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  I
    quantities.  It is alkaline, — sometimes white and milky,__and has  j
    in it deposits of phosphate of  lime, and triple phosphates.             i

      Treatment. — Infusions of  pipsissewa,  uva ursi, trailing  arbutus,  j
    wild carrot queen of the meadow,.buchu leaves, or foxglove  are use-  !
    ful diuretics, and may be taken with advantage.                       j
      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. 
   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.

   Tins 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; by external injuries; by  gonor-
 rhoea ;  and by cold applied to the ieet, 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 well
 The bowels must be  opened with epsom  salts.  Injections of warm
 water, with a few drops of tincture of arnica leaves, will act finely as
 a local bath, —the water being retained as long as possible.
   The  tincture of veratrum viride will  be required in five to ten-drop
 doses, or  the compound tincture, of Virginia snake-root, to induce
 perspiration.  Dover's  powders may sometimes be  used for the same
 purpose.
  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
I  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
j  tenacious mucous, just as the expectoration  has large quantities of
|  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
arms.   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  faint-
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  diarrhcea, 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        Flo no
 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 cf
 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
 construents 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 diarrhcea, 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.   .                             y_^v  /(_v .  x,
   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 diarrhcea of the kidneys.   The 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 sacharinc  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.
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  the  Kidneys, etc.—Hematuria.

  Bv 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 C*AVITY.           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       fig. 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
 j  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,
; jBtestless, 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
j   treatment must necessarily  be  a little uncertain.    We cannot  go
I   amiss, however, in placing the  patient immediately in a warm  bath
j   for fifteen or twenty minutes.  Then apply wet  cups over the kidneys,
   and follow these either by mustard poultices, or by hot fomentations.
      L"t the bowels be opened by the compound  powder of jalap, or by
I   elaterium (31).  Epsom salts or cream of tartar might in some  cases
;   be substituted for  the above.  A stimulating injection is also desira-
   ble (246).

     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 THE 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.
                                                                    i
  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   I
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 cat he-   I
ter  must be used  daily until the  muscular  fibres  recover their lost   j 
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 thr0Ug^thfo_bvIa^Qe.r-  0^
 the same  time let  the patient take  strychnia (85) (86) (83)  (Jo).
 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, buehu, 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 came
 the excess of fluids to pass off through the skin, and lessen the action
 of the kidneys.

 hpinVTlf inStanCeSChildrun  U"nate  in bed throuSh carelessness, -
 being half conscious of what  is occurring, but not caring enough to
 rouse  themselves.  In such cases, they are often cured by somf  d °
 cided  correction,-the  impending act of passing water  connectL
 itself in  their minds  with the correction, anS recalling^ hem"ntlf
 to ful  consciousness. Of course this mode of relief should be resorted
 to with great judgment  and caution                         resorcea

necYortheWadZ1^ Pr°Ceed\from ^ility 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 ^me 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.           3Q7
   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 Trine. — 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 urinometcr (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
j   space above the large bulb is marked off into degrees corres-
   ponding to  different  densities.   When this instrument is im-
i   mcrsed in  urine,  and has come to rest, the number on the
I   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
i   densities:
Kg. Solids.; Water, jj^jg , Solid, Water.			S. solids ( Water.	Specific Gravity.	Solids.! Water.
1001 i 8.33 997.671 1002 4.66 995.34| 1003 6.99 993.01, 1004 | 9.32 990.68 1005 11.65 988.35 1006 113.98 986.02 1007 (16.31 983.69 1008 [18.64 981.36 1009 ,20.97 979.03 1010 (23.30 976.70|	1011 1012 1013 1014 1015 1016 1017 1018 1019 1020	25.63 974.37 27.96 972.04 30.29 969.71 32 62 967.38 34.95 965.05 37.23 962.72: 39.61 960 39 41.94 958.06 44.27 955.73 46.60 953.40	1021 ,48.93 951.07 1022 ' 51.26'948.74 1023 53.59,946.41 1024 55.92 944.18 1025 58.25'941.75 1026 60.50 ,'939.42 1027 €2.91 [937.09 1028 65.24:934.76' 1029 67.571932.43 1030 69.90 930.10	1031 1032 1033 1034 1035 1036 1037 1038 1039 1040	72.23 927.77 74.56 925.44 76.89 923.11 79.22 920.78 81.55 918.45 83.88 916.12 86.21 913.79 88.54 911.46 93.87 i909.13 93 20'906.80
  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 linin^
 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.
*""»■ "4-                            Fiq. 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
                           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
                           Jargely, 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
 those  who suffer from gout,  rheumatism, dyspepsia, fevers,  debility
 of the genital organs, straining  of the loins, etc., which produce loss
 of flesh.

   Treatment—The remedies for this uric acid gravel are the  alkalies,
 bicarbonate of potash, bicarbonate of soda and  magnesia.  The first
 named is generally the best.  It  may be used in the form of the neu-
 tralizing extract, — especially if  there be costiveness.  If the bowels
 do not need physic, let the potash be taken in the shape of lye made
 from hard-wood ashes (300).  Fluid magnesia is an  excellent remedy;
 so is liquor potassa, taken in twenty or thirty-drop doses.  The urine
 must be watched, and  these remedies discontinued when it becomes
 alkaline.
   At the same time the stomach should be supported  by some bitter
 tonic, as the infusion of quassia, gentian, columbo, Peruvian bark, etc
   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
 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-
erate in amount.   The quality is of less consequence than the quantity.
   Exercise is of great consequeaice, 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
j  i  sponge bath, with friction.  This will throw  upon the skin much of
i    the labor done by the kidneys.
!
i                        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
i    in urine which is either alkaline when passed, or becomes so very soon
i    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  p
l    different lights, you may see in it  the several colors  of the rainbow,  jj
    Skim off this pellicle,  place it upon  paper, and let it dry; and  you  jj
:    may then  see the little  shining crystals.  This urine quickly  grows  j'
;    putrid and offensive.   Sometimes it smells  strongly of ammonia.  |j
j    The more phosphates it contains, the  sooner it becomes alkaline.       jj
       These deposits are generally the  triple phosphates.  Healthy urine
j    contains the phosphate  of magnesia in a state of solution.   Under
    some circumstances,,the urea of the  urine  is  decomposed in the kid-  ji
I    neys, and ammonia is disengaged.   This combines with the phosphate   >
j    of magnesia, and forms the triple salt of the phosphate of ammonia
l    and magnesia, which is not soluble.

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

      Causes.— These  deposits are  produced  by great  debility of the  ji
!    constitution, by injuries of the  spine, dyspepsia, defective assiinula-  j;
j    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-  :
j    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  (?5)
    may be taken.  Morphia combined with  iron (80), 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.           31
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 all the elasticity it has.  To bring this about, journeys
and amusements  are useful.   The society of  lively, laughing, witty
friends will do a great  deal to give  the  spirits a rebound, and the
whole health an upward movement.   Such persons are a blessing to
the world ; and he who reckons a few of them  among his friends will
live the longer for it.
   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.
   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.)
Fiq. 117.                   Fia. U8.                 Fio. 119.
   The urine has a specific gravity of 1.015 to 1.025, and is generally
of a dark  amber color, and clear, and bright; it  is generally acid,
though  occasionally alkaline or neutral.  Urea is generally found  in
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.
   When the urate of ammonia is combined with the oxalate of lime,
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 meiatal 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, and 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 ii.
 
DISEASES OF THE ABDOMINAL CAVITY.
313
that the hydrochloric acid combines with the ammonia forming muri-
ate of ammonia in solution, and liberating the uric acid crystals.
FiQ. 121.
Fig. 122.
Fio.123.
  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
 sec#i.  (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 caters contains it iu 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
diseased action.  They contain twenty-six per cent of sulphur.
  Urine which  contains cystine is of a pale  yellow color, and has a
low  specific  gravity.  It frequently has' an oily appearance, and  its
smell is peculiar, resembling that of sweet brier.   Sometimes its odor
is fetid, like  putrid  cabbage.  On being kept for a short time, it has
its surface covered with a pellicle which looks oily,  and consists of a
mixture of crystals  of cystine, and the  phosphate  of ammonia and
magnesia.
  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 seidment.   It undergoes no change  by
wanning  the urine, and this distinguishes it from white urate of am-
monia.  It is not soluble in diluted hydrochloric or strong acetic acid,
which distinguishes  it again from the earthy phosphates.
  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.)
Fig. 124.                   Fig. 125.                Fig. 126.
  It is to be remembered that occasionally the chloride of sodium or
common salt  crystalizes in octahedral forms  (Fig. 125), which, in
some positions, may look  very much like cystine.   The  ready  solu-
bility of the chloride in water, and the absence of all color when they
are examined by polarized light, will prevent mistaking these cry stain
for cystine.  If urine containing common  salt be quickly evaporated
on a slip of glass, and be then examined, instead of the octahedrons,
we find crosslets and daggers.  (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.  Podophyllin  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.
Fig. 129.
  Mixed Calculus. — These calculi are frequently composed of two or
more different kinds of matter arranged in irregular layers.  Fig. 128
is a mixed calculus, — the dark layers being oxalate of limer the light
ones, uric acid.
  In  testing such, fragments of each ingredient should be separately
examined.
  Irate of Ammonia Calculus. — We  occasionally meet  with a cal-
culus composed of the urate of ammonia.   These calculi, when found,
are generally small in 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.) 
316
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
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.

        F10-130.                  Fig. 131.                  Fig. 132.
   FMsihle 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 form
 (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
 hip 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
 die 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 or 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
j   griping it is apt to  occasion alone.
j     Cream of tartar, taken in large doses, every day, will sometimes do
   well.  Epsom salts produces watery stools, and is a good rcmedv.
     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
j   organ.   Exercise does much to keep up an active  circulation, and to
j   lessen dropsical effusions.
j     The strictest  temperance, both  in eating  and  drinking, must be
j   observed.   A  light and nourishing diet, with water, tea, and  the
j  . diuretics named above  for drinks; beyond these the patient  must
|   not go.
I     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.
j
     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.
  TAplanation.— 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
full, fluids on the outside pass in, and  mingle with the contents.
This as  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 fife, 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, 
 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
 sevenlh 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^
 oft* 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
■*■ *8Ec;—'■"-. ' 
322              VENEREAL OR SEXUAL DISEASES.
cut 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 vag'uia 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, 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  into 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, first, the skiii-
and mucous membranes ; second, the hard substance surrounding tlt^
bones,  called periosteum,  the  tendons,  and the  bones  themselves.
Those affections which appear upon tjie 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 Dicers. — 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, sorne-
jvhat 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.                          . 
 
n  t>.


 
VENEREAL OR SEXUAL DISEASES.              323
  Scaly Eruptions. — There is still another affection, which is in the
form of scales, and one scale 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
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, 
32 1              VENEREAL OR SEXUAL DISEASES.
the artist  has well  represented this form of constitutional disease in   j
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,   j
— not even the skeleton, — can  escape  this devouring  complaint
The bones of the nose and face are generally the first to be attacked.   I
These perish slowly, — falling  away, piece by  piece, — the nose, in   j
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   j
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   j
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  Communicable f — 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  was generally received.  It is now  j
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-  ii
nicated from one person  to another.                                 j!
   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   j
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  |j
children, and children's  children.  The  divine law which links  the  >;
sins  of the  fathers  with  the  sufferings of  even the  third  and  fourth  j,
generation, is nowhere more  painfully illustrated than in the scourg-
ing descent, through many generations, of this terrible disease.  It  i
may be passed down  to posterity  by either of  the parents; but if  j,
both be diseased, its transmission will be  the  more certain.   If  the   (
mother be infected, she  will infect the  child  while carrying it.   If  jj
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  ij
womb, to  infect the mother.   I recollect but  one  author  of note  j 
VENEREAL OR SEXUAL DISEASES.              22L
 (Ramsbotham) who  has mentioned this mode of infection.  I have
 myself seen two cases of it.
   This constitutional disease, whether  it exist in the mother, or be
 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
 pressed more  earnestly upon the physician.  In a certain  sense  the
 disease  is  curable.   Its outward  manifestation  may be wholly re- ■
 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
 those diseases which  pass under the name of scrofula, are the produce
 of the syphilitic poison, — are,  in fact, not  scrofulous, but syphilitic."
 Astruc thought the same, and  suggested, what is doubtless  tfue, that
 the  transmission of syphilis must occur through  several generations
 before it becomes scrofula.  Bjerchn, Camper, Stoll, Portal, Hufeland,
 and Alibert, have all advocated the  same opinion.
   This is doubtless right, though there  are many authorities on the
 olher 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 L, 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 marriage 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  FerronieTe, 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
I  suggestion was made, " shall I give this disease to my wife, when we    i
i  are both sound?"  " Go visit an infected girl," said the monk, "and to    j
  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,    J
   Francis  I., the gay and chivalric monarch, perished of the most foul
   and loathsome of all diseases.                                         ij
     Debauchery did  not die with him.   It was cherished  by his succes-   jj
j   sor, Charles IX., and  his mother, Catherine de Medicis, and his grand-   jj
j   son, Henry III.  The reigns of  Henry IV., Louis XIH., Louis XIV.,
I   the Regency, and of  Louis XV., were stained by the same licentious-   jj
1   ness and disregard of public decency, until the whirlwind of the revo-
j   Jution came to purify the moral atmosphere.                           ii
'     The reader will  now, I think, be in no mood to wonder  that  the
i   kings  and queens of Europe, and  the whole royal  progeny, whether
j   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
j   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.
j   They  should  especially thank God that  they have sprung from  the
i   loins of  a race more  noble and  kingly in the eyes of Heaven than all
j   the royal lines of all  Europe.
I
     Treatment of Syphilis. — In the "treatment of this  disease, the first
j  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
j   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   h
   before the absorption takes  place.                                      l\
     The caustics used are nitrate of silver (stick nitrate), nitric acid,
   chloride of zinc, potassa with lime, caustic potassa, and the painless    |
   caustic.                                                               j
     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.    I
   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   |i
   hands.  A little vinegar and water must be immediately used to neu-   ij
   tralize the caustic when it has accomplished what we  desire.   After   j!
   the sore is cauterized,  a piece of lint, dipped in a solution of watery   ii
   extract of opium, one dram to four ounces, should be laid on it; and   i|
J  the organ invcloped  in another piece of lint  soaked in  tepid water,   Ij
j  and covered  in oiled silk.  The patient should remain at rest as much   jl
j  as possible, — keeping  the  penis  elevated,  and repeating the  opium    j
  dressing to the wound,  and the water dressing to the whole  organ,
  night  and morning.  In  addition, the patient should take two pills   I
  (19)'to be followed, night and morning, for three or four days* with 
VENEREAL OR SEXUAL DISEASES.
    a tablespoonful of (20).  In some cases, a piece of lint, wet with the  j
    tincture of muriate of iron, diluted and kept upon the chancre, will  j
j    cause it to heal kindly, and with safety to the patient.                 j
|      If this treatment be adopted early and properly, the patient is cured,
|    and nothing further is needed.   But time is generally lost.  The poi-
i    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-
i    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 all into action like
    mercury.  For this reason, no  other single drug has enjoyed  a repu-
I    tation for curing pox so wide as this.
      But it must be used with judgment  No  remedy is more  safe, if
i    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-   j
    plied to the external sore or chancre.   Ricord says that no secondary   |
    symptoms have been known to occur after this treatment.  The Lou-  i!
    don Lancet sanctions  this treatment as  being  capable of doing  all  |j
    that  Ricord claims.   Should its success prove equally great  in this   i
    country, it will take rank among the greatest gifts to  the profession.  ' i
    I sincerely hope that  in  a future edition of  this book, a full  trial of  j!
,    the remedy on this side of the Atlantic will permit me to record such  i
    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
S2H 
PI 6.
J N. luffora > 
1 
VENEREAL OR SEXUAL DISEASES.
829
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 Rubo, 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) ; but 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 of 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.

   Cuse  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 II.— 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 was  almost  identical with that in  Case I, except
 that tonics, — particularly some  of the preparations of iron, — wen;
 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 III. — 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,
 snowed 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 sarsapariUa, 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  VI,
 Fig. 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  cajise 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 catse 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, i—The first symptom of the disease is uneasiness in the
 end of the penis, accompanied, generally, with a little  redness, and
 difficulty m passing water.   The color of the first discharge may be
 white or straw-colored.  There is tenderness where the parts are red.
 bcalding 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
 vyater; 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 loug  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.                       j
      Gleet — Another very troublesome  result of  gonorrhoea is gleet,—  ij
    a thin, colorless  discharge, which persists, in a  chronic form, after all  ;j
    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.                                    j
      Orchitis.— Another  very  severe  result of clap is swelling  of the  j
    testicles,  called orchitis.   It begins frequently  with chills  and fever,
    with a feeling of weight in the scrotum, and  pains in the loins.   The
j    swelling rapidly increases, and  reaches its height in from three  to five
j    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.                                    j!
j      In the female, gonorrheal inflammation affects the external geni-
    tals called the vulva, the water-pipe, the  vagina, and the neck  of the
j    womb.                                                              j
      There is a difference of opinion as to whether  gonorrhoea ever pro-  !j
!    duces  secondary  or  constitutional symptoms.   Ricord,  the  great  '
    French authority on this  subject, affirms, and with him a great num-  il
j    ber of followers, including most of the profession in this  country,  !j
j    that constitutional symptoms never follow clap; that they never re-  M
    suit from  anything but a syphilitic ulcer.  Vidal, a French authority,  j
    safer, in my judgment, than Ricord, though not as renowned, says, on  I
    the contrary, that  secondary  and tertiary complaints do follow viwi-  j
    lent gonorrhoea.   Wilson, the  highest English authority, and many  jl
i    others, agree with  him.   Unprejudiced observers feel well convinced  ij
    that this latter opinion is right.   I have myself seen  not  less than
Ij    half a  dozen cases  of  secondary and tertiary syphilis, which were . j
jj    preceded  by  gonorrhoea,  and  nothing more.   Case I. was of this  j
1    kind.                                                                j
j      Treatment — In the first stage of the disease, there are two meth-
(j    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
i    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  j
    crackers  and  water, or something equally simple.  All meats  and  I
    stimulating drinks are to be excluded.                                 I
      The other  mode of treatment, which is  perhaps the more commonly  j
    adopted, is more general in its  nature.  It embraces the use of warm  J
    baths, warm sweating drinks, and rest.  If the patient is full of blood,  j
    and strong, from five to fifteen leeches are applied  to the space be-  I
    twcen Me scrotum and fundament.  These  things, with a low diet,  I 
VENEREAL OR SEXUAL DISEASES.
will  frequently reduce the disease  in  a few days.  If the discharge   Jj
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   j
prescription, to make the copaiba  acceptable to the stomach.   This
preparation can be taken by most persons, and generally  jn-oduces   !
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   j
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,    j
are to be united.
  Vidal says he never resorts to injections first, but employs the  anti-    j
inflammatory course first.   If  that Tail, 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.    j
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    j
recipe (272) will have an excellent effect.  But gleet is an unhealthy    j
action, sustained by habit, and may often be cured by simply exciting    j
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)    j
may be tried.   Chloride of zinc  (210) does well in  some  obstinate    j
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    j
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, "r 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 made of gold
beater's skin, and is drawn over the penis like a glove over the finger,
and thus protects it from contact with poisonous matter.
  Of still  greater importance are prompt  measures of  prevention
after the act.  Lotions should be  immediately applied to every part
of the organ, and in  the case of females, should be used as injections.
These lotions should be acids or alkalies.   A mixture of vinegar and
water has  been recommended as an  excellent wash.   Record recom-
mends  aromatic wine; Malapert, corrosive  sublimate (212), in the
form of solution.  Probably the best  preventive is composed mainly
of alcohol and soap  (213), as recommended by Langlebert
  An exposed  person, using any one of  these solutions, particularly
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 sense of the American people does not admit its necessity.  In
Europe, the  authorities watch over  prostitution.   They even go so
far as to regulate it   They appoint  practitioners, whose duty it is to
act as  a sort of medical  police, and particularly to  visit houses of
prostitution  once or  twice  a week, and examine  all  the  inmates.
When a girl is found  diseased, she is immediately 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
girls learn the vile practice of the larger ones at school, and generally
continue it up to maturity, without the least suspicion that  they are
inflicting upon themselves either a moral or a physical injury.
  This  comes of the false modesty and bastard morality which with-
holds from the young all knowledge of the proper functions of their
sexual organs, 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
question, and I tell my wife it is her  duty to do the same with the
girls."   This is wise.  Yet, how few  parents ever speak to their boys
or girls  on the subject, or  give them the least reason  to suppose there
is any better rule for their conduct than their own desires!

  Symptoms.— These  are very numerous.   The principal are, head-
ache, wakefulness, restless nights,  indolence, indisposition to study,
melancholy, despondency, forgetfulness, weakness in  the back and
private  organs, a lack of confidence in one's  own abilities, cowardice,
inability to look  another full in the face, and, among females, hysterias,
whites,  and a desire  for seclusion from society and solitude. 
   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 inforrrfation 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 publie 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 Fginale 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
signs 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 rrtenses.  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 iu 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 o'f early
dissolution ; that  it is fortifying itself against future disease.
  Girls who come thus tardily to maturity, are much more "regular"
in'alter 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 unstiinit-
iating 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  chartge,:  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
 gcstion 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.

                              Fio. 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 ^>out 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  Aeck 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, either 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 ia*restigations 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 incis-
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 
M,
r J 
 
^ar
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 oi
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 whicii 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-
mindod 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
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 Specuhun. — 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.

                              Fie. 125
  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 neck 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
by the inflammation, it will be hardened, as well as enlarged; and in
consequence of its increased weight, 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
month 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 recognizes.  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. 
<1(Q
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 local 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 is just as  unreasonable and useless to treat these
inflammations and ulcerations through  the  stomach, as it is an  in-
flamed or ulcerated throat.   Tliey 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 latter.
   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 ulceration.  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 VII., Fig. 4.
   There was no doubt as  to the treatment required.   I applied the 
3^0                    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
{hese 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 VII., 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  are numerous.   One of  the-
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 havQ 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 VIII., Figs.
 1 and 2.)  The whole, it will be seen, presents  an  amount of  disease
 which it  is pajnful 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 df 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 Avhich  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 he 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   j
quieting neighboring  parts, and warding  off external disturbances.   i
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   j
just  at the left of the  upper part of the womb, and at times a severe   j
pain in the same region, which often extended down into the groin   j
and thigh.                                                          j
  The left ovarium was so much enlarged that it  could be distinctly   !
felt through the walls of the bowels.                                  ij
  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.

   Leucorrhcea  is from two Greek words, Xeu^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
prized by a right-minded  physician.   It procures health, the highest 
354
FEMALE DISEASES.
 earthly boon, for suffering woman, and  gratitude, the most prized of
 aU^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.  lhe character of the discharge generally settles this  point.   If it
 be thin and watery, or  thick and cream-like,'it is from 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.   Having determined this  point, his remedTes have
 an intelligent bearing upon the case.   This being so, I have no reme-
 dies to set down  for whites, simply as  such.  I shall proceed, there-
 fore, to speak  of several other complaints which bear more or less
 upon this.


          Absence of  the  Menses.—Amenorrhosa.

   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.
35)
 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  the 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 in 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; and, 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 will 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 f»ot  bath  (242); also (16)
as a cathartic.                                                v   ' 
  When suppression exists, it is not always proper to try in  this
direct way to bring on the turns.   There may be noblood to spare ■
wu th^i.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 right
&'
            Profuse Menstruation.—Menorrhagia.

    Menstruation  may continue too long, or occur too often, or be too
 profuse 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
 °l the_womD '■> 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.  WThen 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 do come 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           FjQ m
 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  the1  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 ulcerati6n, 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 en 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, a'nd acid drinks, are useful.
 But one of the best remedies i« 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, fier 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, usii g in place of it, tannin in one case, and alum in the other.


           Painful Menstruation.—Dysmenorrhea.

   Dv£.vir.NORRHCEA is from three  Greek  words 81/9, p>r)v, and pew, which
 mean, literally, a difficult  monthly flow.   These words do not precisely
, descrU e the complaint; for it  consists not so much in a difficult, as in
 U pCAHjUt flow.

   Symptoms.— This affection is always marked by more or less pain 
*
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   I
of their peace, even during the intervals of  respite.                    I
  The Causes of this complaint are very numerous.  There is, doubt-   j
less, such  a thing as pain in the womb from rheumatism, and espec-   j
ially from  neuralgia, though these are much rarer forms of the com-   j
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 leads 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   j
foot or leg has to be laid up in a chair, because  it aches  when  put   j
d»wn.   The reason is, that when hanging down, it is more full  of
blood, and the sensitive nerves are painfully compressed.  When the   j
finger is" hot with  inflammation, we assuage the pain by holding it up   j
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.                                        i
   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 4
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   i 
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, untjjjj 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, I am happy to
 !  say, a cure is  attainable.   Yet how many women suffer for years,
 I  until  health has fled, and life has become a burden, — receiving from
 I  their  medical  attendant the assurance that palliation only is  pos-
 i  sible I
      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- •
 i . 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.

 j-  '  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
j  blood, as a kind of skinny substance, in shreds and patches.
     It was immediately evident that.this was a case of painful inen-
 |  struation (dysmenorrhcea)  of the congestive kind   The womb  was
 j  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
 I  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
1  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 
360
FEMALE DISEASES.
the mouth of the womb some of the  ointment (170), and by giving
two^easpoonful doses, in a little cold water, of the liquor of acetate
of aTnmonia, 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, was
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 wiiich  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 become 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-
creases  its watery portion.  As a result, the skin becomes  pale, and 
FEMALE DISEASES.
361
sometimes of a yellowish hue;  the  bowels become torpid  and con-
fined ;  the nervous system sensitive and weak; the digestion u> 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 ^nrls 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 ^\o)/3o?, 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 an 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 
                        FEMALE DISEASES.

 age of fourteen ;  but it was quite defective in quantity,  and was
 impwfectly 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 withouuWippe-
 tite, and her tongue was coated white.   She had  dizziness, jmlpita-
 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 scutelarine
 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  tcaspoonfuls 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 Bbston.  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
362 
FEMALE DISEASES.                    363
    there be a predisposition to apoplexy  or congestion of any organ, it
    it more likely to become active, now that the accustomed waste-gate
    is closed.   A distinguished writer has said  that about half the deaths
    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  wiiich  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  dis'appear  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  will 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 sTiould be
;    spare, and strictly vegetable : — to which should be added much daily
j    exercise.                    *  -
      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
I    duty of the  physician to investigate the case very thoroughly, and to
j    give the patient  the  advantage of the most prompt and decided
    treatment.   That treatment is spoken of in the proper place.
 
364
FEMALE DISEASES.
                    Hysterics.—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 upon 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 aT 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 ont 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 
PI. 8.
Ficf.l.

 
 
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 whdesome 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 tumors 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.  Jt 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 still 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.  1 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 VIII., 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 VIII., 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
    a*bout if placed in warm water.

i      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
 j   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
l    the  womb, will cause their expulsion ;  but it will not do to give these
,    remedies indiscreetly, lest the cause be one of Teal pregnancy instead
    of hydatids.

!                Inflammation of Womb.—Metritis.

      This  disease very often  follows delivery, and is connected with
 I   child-bed fever.

 j     Various Causes also produce it in the unimpregnated state.   The
    inflammations of #he 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.   Iu
    some temperaments, marriage may produce this disease;  in others,
    singleness.   It may also be brought on by painful menstruation, by   '
    facing medicines, by  constipation, by tight corsets, by solitary vices,
    ana by excited sexual feelings.

      Symptoms.— When the membrane  lining the womb is involved  in
j    the  inflammation, the  symptoms  are dull, constant pain in the region
|j    of the womb and in the  loins.   The passage of water or feces causes
J!    pain.  There is a sense of weight which causes the patient to bear
|j    down and strain, as in labor.  The belly swells, and is painful  and
j    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.
  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.

         Palling 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 id
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. 13T.
  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.      -a            a
  There  are still other more serious troubles, wh[ch are so vej^rare
as not to require me to dwell upon  them, such as  the iny£rsron of
the womb, or turning it  wrong side out, lik^ the-mnger 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, 
ro
FEMALE DISEASES.
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           i..,.m
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 of 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
vie«by the  use  o^a speculum.  This may
be dabe every othejday.
 o£a
thjjd
 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 of ten, barrenness is completely curable.

   Reproduction. — Throughout nature, life is  perpetuated  by  repro-
 duction.  The vegetable and the animal die; but before death conies,
 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
  fro» the  male.   Thus, two  palm trees, growing about forty miles
  from each  other, the  one without stamens (the  male organs), tjje 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 imirlbr-
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.
G73
animated nature, the  female  furnishes the mature germ or egg only
at certain periods.  The healthy human female, — as  I  have  already
               Flo 139                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
Fig. 14a
 into union with the ripened egg,
   This union (for, that men and women may
 have a chance to know as much about them-
 selves  as they  do  about fishes and  plants,  I
 propose to make the whole subject pJain) 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,
i  >' 
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
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  monthly 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
this 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 mn.y  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 frivohties, 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 upon  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 chil-
 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-
 it'ing, or a decided languor, in the morning; swelled and sometimes
 painful breasts; the areolae, 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 pregnancy, 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,  malte
 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 1 lungs." 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 
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.
  An Objection. — It may be objected by some, that a  large majority   i
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.            J
  To this it may be answered, that it is a great advantage to under-   j
stand the best way, so as to have the privilege of  at least aiming at   |
it  Much is accomplished, iu 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-   j
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   i
the expenses which  the prevailing fashions  and customs  of  society   j
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   j
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   j
it will be sure  to produce abortion."                                    ;
  It seems as  if the world would never  learn that God loves children,   jl
although  since Abraham's day he  has said so much  about  them in   ji
his  word, — although  His  Son, sent into the world  on purpose to   ij
show the disposition of the Father, took them up in his  arms, and   j
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   j
means to keep her bowels in order. She will thus greatly diminish
the distressing nausea, and  may entirely prevent the  accession of   j
piles.  To accomplish this object, the saline aperients (7)  (5), or, oc-   J
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
378 
FEMALE DISEASES.
379
 good  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.

   \ausea. — If, as sometimes happens,  there should be persistent
 nausea after  the first  three months, it will need to be combatted
 by mild tonics and stimulants, as  chamomile tea, or clove  tea (58)
 (111), 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 Xipplcs. — 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 sore 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 stalling 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.   Health?
 and v.gorous 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

s^ns     ch[\d-The best remedies are warm —-
(i)M91).             anodynes,  etc. (121) (122), or antispasmodics 
380
FEMALE DISEASES.
  Headaches.—These may be relieved by  antispasmodics, etc (90)
 (94), or anodynes (121).                                      V  '

  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 diuretics (130).

  Itching of the Genitals may be much relieved by borax, morphine,
 etc. (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,
which 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
11    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
11    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
jl    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
i     increase, it  may be proper in some cases to resort to the tampon or
jj    ping-  «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,
 i    or tannin, or, still better, Monsel's persalt of iron,  one  part to  six
     parts of water, — fifl 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.
!j      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.

|j       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
j     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 
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    I
  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 stronglr  and    I
  more continuous, with  intervals of  ten or  fifteen minutes' ease  be-
I  tween.   Vomiting in the early stages of labor often occurs, and may
  be regarded as favorable, — indicating the softening and opening of
I  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 iii 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. 
FEMALE DISEASES.                     3S3   i
      The Presentation.— An examination with the finger is to be made   ;
j    to learn the  presentation, — that is, to learn which part of the  child   j
i    comes first into the mouth of  the womb.      •                        j j
j      Head Presentation. — If the head present, the  labor will probably   j
'    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,
 j      Rreecli or Feet Presentation. — If the  feet or breech  present, it is   j
jl   desirable  to  have the  first part of the labor  proceed slowly, so that   .
jI   the passage may become well dilated, and prepared for a more  rapid
1    delivery  of the head.   If the breech  present,  do not pull down  the
jj   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
ij   birth  of the breech.
|       After the  feet  and  breech  have  fully cleared the  external orifice,
l    the delivery may be judiciously hastened for the  purpose df prevent-
i    ing the death of the child from pressure on the umbilical cord, before
j    its head is brought to the air,  and the act of breathing thus permitted.
11   For after the pulsations  of  the cord cease,  the child  must either   j
!    breathe or die.
ji      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
j   upper extremities  and  head by all prudent means.   Violence is never
I   in order in midwifery;  but considerable  force, skilfully directed, may
j   sometimes be safely used.  After the shoulders are delivered, the pas-
|   sage  of the head  may be facilitated  by carefully pulling down  the
11   arms.  Then, as soon as possible, introduce the finger into the mouth
j    of the child.   This will  serve the double purpose, perhaps,  of per-
ji   mitring a little air to make its way into  the child's lungs, and of fur-
j;   nishing a hold by which its head may be  gently drawn along into the
j j   world.
ji     If there is  much delay at  this juncture, perhaps in some cases the
jj   child's life may be preserved  by inserting into its mouth one end of a
i,    male  catheter, — thus furnishing an  open  tube  for the  passage of  air,
,i    until  more vigorous pains shall introduce  it into the full liberty of  the
jj    atmosphere.   While the head is yet undelivered, great care should be
i,    used  to keep the  child's  body warm by  covering it with flannel, and
jj    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 child's 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. 
*
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   j
partial separation'of the placenta, or  after-birth, from  its attachment   j
to the internal cavity; and it has recently been observed that the flow   j
proceeds more rapidly  from the detached portion of the  after-birth   i
than from the corresponding exposed surface  of the womb.   A knowl-
edge of this fact has an important practical  bearing;  for if, in severe   i
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   I
genitals, and the internal  administration of astringent* and anodynes
(152).                                          .                    |
  After Delivery, our object  is to promote contraction of the womb   I
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   i
secured, the plug should not be used, lest  internal bleeding into the   I
enlarged and expanded womb should be profuse, and fatally exhaust   !
the patient.

  After the Child  is Born, our 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-   j
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 very
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
flood ings.

   The Dressings for the Child's  Navel should  be so  fixed  that  the
navel-string or cord will not be left in contact writh 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 clown 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.
 F?CeiiVj  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 swee'tened 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
old 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.—Phlegm"asia 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.

   Fr.w complaints  more justly  excite the dread of the  practitioner
than this.   It cuts down woman at a time when she can least of  all 
^S8                    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,  diarrhcea 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) f349).
   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.                    3SJ
  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
     fio.142.     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
 Bv  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 pverTdis- 
391
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. — Leucorrhcea. — Fluor Albus.

  Though leucorrhcea  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
 either  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 bor* 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 Skin. — 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 finallv,
after  it is  some  months old, 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  mo*lur 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   Nourislied
 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, and 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 which 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 weathei
 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 iu the morning.   This habit will be worth much
 to them through life.  After the meconeum  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

   Evcreise. — 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 set 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 stomach, 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 cut off 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 ras*h 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, should 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
 —^------------------t
 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.   W'hen 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,1  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 alwavs  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  diarrhcea
should have  their  skin kept very clean. The pores should be kept
we I 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
(lie outer  skin.   In this disease, the skin of children  is apt to become 
^98         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 diarrhcea, 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 diarrhcea, 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 water 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,   ft 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 ca\\ 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 diarrhcea 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.—Apthce.

   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 df 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). 
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
diarrhcea 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.
400 
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 sleep, 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 diarrhcea, 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 
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 than 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 diarrhcea  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 diarrhcea is the result of
inflammation.   WThen 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 i confectionery, sweetmeats, and fresh vegetables.   (Jive
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  diarrhcea, — 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.
Wfhen 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- 
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  som'e 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 diarrhcea,  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
smell.   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, diarrhcea,
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 
             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 glailds, 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-
gram 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
 who e  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
 lhis latter opinion is the more general one now.

   Treatment — Keep the patient, as much as possible, in a state jof
 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 cloth.


                              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 a 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 number, — 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. 
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 historv
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 diarrhcea 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 and  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 diarrhcea 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.
411
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
T T^ .    ' tlieJreLturns 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 thf 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.
   W'hen 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.                                        J
Jl 
   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. 
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 CENERAL 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 mofe 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 more  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 actual!^ 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
 s.ze 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.                                      J
   After a time, though very slowly, they come to a head, and break
 — discharging a watery fluid, or a mixture like whey and curd.  Thev
 are seldom very sore.   When they heal, they are apt to leave a puck-
 ered condition of the skin, and ugly  scars.                    P
   The  scrofulous  humor may sometimes affect-the. eyes, when the
 ids will become  red and thick, and discharge mucus ana water •_

spec^T      ^^^ tUrnlng °Ut' ™*  PreSentinS a  sho<*ing
  The scrofulous condition is generally supposed to  be indicated bv
tZ   hnttbCate.skln'thlck>> %ht hair, and a delicate  constitu-
tion;  but these signs are  not worthy of much confidence
  lhe 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 own 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
 eyrup 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 ounce  of water.   When  they are inflamed, apply
 poultices of ground slippery elm and powdered bay berry, 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 washed daily with cool water and spirit, or water
 and saleratus; and rubbed  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 <r>pen air.
 If the residence be in a damp and unhealthy  air, it should be ^hanged
 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
 fhe 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 OP 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, will 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.
These 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
•ozes 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.

/orwirfnowiT!16 b°Wels  are to be  keP*  re^lar b? Sentle  Physic
[4,0) (~1) (1~) (10).
  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-
grain 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 to
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 aluin
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,

  Acnte Inflammation. — When the redness, the pain, the heat and
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 in 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 ioi 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. 
SURGICAL DISEASES.
   Inflammation is Secondary or Sympathetic when it is the result of
 some other disorder, which goes before, and produces it
   It has been explained 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-   i
 tant part, the sympathetic action is so great as to  disturb the whole   I
 constitution; and this  general disturbance is sympathetic or symptom-   \
 otic 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
 them when 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,
 orms a  clc$ in the basin more slowly  than usual, btit  the  clot is
 narder; and a layer of fibrine is left upon the  surface of  a yellowish
 ■juff 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 wood  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.
I
  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.

  IV.  By Mortification.— 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 
4£S
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 I
 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-
is
   A  popular orator is  speaking  to  a multitude  in a hall which
 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.  Tliis should be removed by saline
 purgatives, such as rochejle,  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
 6ome 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.   And 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 matte* is really present; and 
430
SURGICAL DISEASES.
great care should be  u§ed 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
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 aTe 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-

te- 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 system, 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 or littie 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. 
Fio. 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. — Feruncu lus.

   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 papilke
 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 .r, that it may be thrown off.   In  two or three more days, it
conies away, leaving a cup-like  cavity, which  gradually fills up, and
the boil is over.                                     J       ''
  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 cau
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 boil 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 potass©,
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 the flesh and tallow of a
dead cow.                                .        ...     ,1
  Malignant pustule begins with 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, m
fatal cases,  come great restlessness, faintings, 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.                                      r
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 he 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 bodv 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 gf%at 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 frozeii 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^aw, 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 dbes 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 writh  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, and 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 bast 
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 en  the amount and
quality of  the discharge, the  situation of the  injur; . 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 they do 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 fre'quent
 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 mueous 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 on 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 Venomous 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 end3
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 sort (Fig.
148), mast 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
poles, 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 used, 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
or thick  shinglesj four fingers wide, and in length corresponding with
that of the broken limb;  or wheat straw laid side by side; and quilted
into a piece of cloth to prevent them  moving about.   A very useful
splint may be made from the fresh bark of trees.
   The pads are to be placed  under the  splints, to  prevent injuries  to
the skin ; and the bandages to be bound over the whole.
   For some hours  after  a limb is broken, the parts continue to swell;
and if bound up immediately with  the  pads, splints, etc., much  need-
less pain will be occasioned.   It is best, therefore, not to put these on
under  two  or  three days,  but merely  to lay the limb in a natural
position, and perhaps  lightly bind one  splint to it.  Broken ribs and
collar bones are exceptions, and should  be bound up immediately.
   A broken  arm lies  easiest half bent, upon a pillow; the  thigh  or
leg, upon the outside, with  the knee bent.
   When the apparatus is  once adjusted, the less it is  meddled with
the better.
   In fractures of the shoulder or arm, a sling is a contrivance of great
importance.   This,  if well made and adjusted, keeps the broken bone
in its place, and at  the same time, allows the patient  to take  some
exercise by walking about.

                              Fig. 149.
  Beside the  above contrivances, there is the double inclined plain
(Fig. 149) for giving the leg the advantage of a bent position.  There

                              Fig. 150.
 
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 forcepsj
 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
 vmder 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
prooe up the nostril, and pressing out the bones to their natural place,
at the same time using the fingers on the  outside to prevent trick
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  of the Lower  Jaw.

     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
j   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.

     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 armpit, across the back, over  the
opposite shoulder, under the other arm-pit, and again across the back,
in the form of  the  figure  oo.  .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 £e put iu 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,
Fig. 154.
 
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 the 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 Hear 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 all 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.

    Tins 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
 ( hrsi, from the arm-pits to the  pit of the stomach.   This will confine 
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 stilt] 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.   Th-\
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, oreorae 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
keep him entirely at rest.   Generally a catheter should be kept  in the
bladder,  that the  water may pass off easily;  and  the  whole hips
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.
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)
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
gentle physic, that the broken bone may not be pushed from its place
by the pressure against it of hard stools.

              Fracture of the Thigh-Bone.

  The points where this bone are broken are at its upper portion or
neck, and near its middle.  The break at this latter place may be
straight across, or*>blique, — partially lengthwise.  When oblique, the
point of  the bone may stick into  one of the large muscles, and be
made fast by it.

  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.  The
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   Bu
the dressing may now and then be taken off and pu  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 Neck 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  bolie  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 tb,e 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 ot
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
purts.

                    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- 
*■'"               .     SURGICAL DISEASES.
 tore.  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 do 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
 aro 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.                    ±o<
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.

   Ill 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.
                                             *   m        9

                 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.
   Ihe ball and socket joints have  a greater diversity of motion, and

ZthZ^Z!       dlSl°Cati°n'  ^  m likewi*™ easily put

^^^o'nt^iT^ thC W * th—  * ^ee into the place

  The  Secondary Dislocation is one in  which the  muscles pull the 
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 be
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 projects, 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 requiring  chewing should
be taken for a short time.
0 
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 (scapula?),
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.
          •                                «
                             Fiq. 158.
 
SURGICAL DISEASES.
     To effect the reduction in  the  first form of displacement, put the
   patjent 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  the 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
   cakes 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 forwarjds upon  the  wrist,  caus-
                                            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,
 bo 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
 bas 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. *Thi, 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 bone upon 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. ICO.)

  The Dislocation  Downward  is  known by  the  lengthening of the
limb, the projection of the knee, the turning of the foot and knee out-
ivard, 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.                                *W. 163.
  The Dislocation Upward and Forward is known  by the shortening
of the  limb,  and the turning of the foot and knee outward.   (Fig.

  For replacing the bone, put. the patient upon a table, 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
^ehed  around the^ injure,J|J {-..£. * *- J. the.

SjurpuTy ripe to ra^sis^nt  The  surgeon  now  staudrng
6  li? iirr,ide directs  gradual extension to be made, while he,
bv hUhZ  or by atand pSsing around the injured thigh  and over-
sown  shoplifts tl* head of the bone, and guides ft ,„to its
socket
   Treatment. — Keep the patient in bed for two weeks or more, with
lus tee" tTeu together by a strip of modi* and a broad belt around-
his hips.

       Dislocations  of the  Knee-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, outward, 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
* 
SURGICAL DISEASES.
or six weeks, and when he begins to walk, oupport the ankle with a
roller bandage, or a laced gaiter.

             Fig. 164.                             Fig. 166.
                    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 ypots
(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, ammonias and alcohol, equal parts, and some-
times bandages.

                            Sprains.

  A sprain is a forcible wrenching and twisting ot  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.
46o
 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   il
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, like ivory,  or dark-colored and  spongy, or a mixture oT the

                            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 tToints.

  Some of these diseases begin in the cartilages, some in the synovial
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,  which  have passed
under  the common  name  of white-swelling.  The  diseases are not
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 
                      f urgicae disi:as::s.                   467

^omtTwhich ls"^ver7at 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 jits  Also a generous diet and whatever is calculated to build
up the health.

                           Bunions.

   This is an inflammation, enlargement, and hardening ontheiMidc
 of the ball of the great toe.  If ia 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,  lhen
 enclose  it in a separate part of the shoe, which is contrived by fixing
                                     ~ ~:^^v /-.r firm crwlo_l<m+bpr in
                                    a piece of firm sole-leather in
               Fl°'166'                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 tnmor 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 joint 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 forth,  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 non-
malignant. 
SURGICAL DISEASES.
469
                            Cancer.

  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            fiq. j^.
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,  wThich 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.
Fio. 170.
  The difference between these cells and those of common pus glob-k
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 wTas 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 cf 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
tupus, 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
lirst; 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  whieh  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 fiver 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.

                          Polypus.

   The polypi constitute a class  of tumors growing from mucous
membranes.  They are of two kinds, — the soft, jelly-like  polypus,
and the fleshy ox 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.

                              Fio. 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, etnd 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.

  Bronchocele 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, the 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 
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 from a  solid  'j
enlargement of the testicle by its not being so heavy, solid, or painful,  i
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, and by the enlarge-  |
ment not being increased by coughing as it is in rupture.              j

   Treatment — In children, strong scattering washes (353) are some-  \\
times successful.   But most commonly, a number of punctures are  i!
-made with a large needle, to cause  the fluid to escape into the cell  jl
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   j
 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   i
 and two  parts of water.  If the first operation does not effect a com-   j
piete cure,  it may be repeated.                                        j


            Blood in  the Scrotum.—Hematocele.             ij

   This is a collection of blood in the scrotum from some injury.

   Treatment. — If the  quantity of blood effused be small, cold appli-   i
cations may cause it to be absorbed.  If it be large, make a puncture,
and apply a poultice for the blood to ooze into.                        j


        Acute  Inflammation  of Veins.—Phlebitis.

   The veins are subject  to attacks of acute inflammation, which  ji
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.
476
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 leo-s,
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 hmb, 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  aie
particularly liable to this  complaint  It often attacks women in the
family way.

  Treatment — Where  only a  few  veins are affected, it  may  be
sulhe.ent, 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 tie whole hmb 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  mors 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. — Ilupture  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.                                      j
   Scrotal Hernia is that in which the bowel descends into the bag or
 scrotum.
   Femoral  nernia 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    j
 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, nor 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

   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^ antimony in one pint o^
 tepid water, make a suitable injection.               *        P

 mixt0urel35l/heTfttbm0r' &PP!y  P°Unded ice  in a ha& or a  ^ezing
 morphia.()"        *"* *  aCUt*' give Iarge doj*s of °Pi«<n o?
  If all  these remedies fail, there is then no hope but in relieving the
stricture  by a surgical operation.                       relieving me

  General Directions. - Rupture is an exceedingly common affection. 
478
SURGICAL DISEASES.
Perhaps  every third or fourth person suffers from it more or less.
remales, from motives of delicacy, are apt to conceal  the misfortune,
and not seek advice.   This exposes  them to danger.  Queen Caro-
line, wife of George IL, 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 oft', night or day, except to cleanse 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
might 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 ana  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           Fio. 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 oi> 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 He 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.
                i

                 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 fiat 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.,
Wh'en 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.
                   m
   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, brauny 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.

   Bystrichiasis. — 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 five to
 ten-drop doses of fluid extract or tincture of veratrum viride, every
 hour, this terrible ©omplaint 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.                                           J

            Purulent  Ophthalmia of Children.

   This always begins within a short time after birth, — generally
 on the third day.                                              J

   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,
 t?  ^u  S,tUr" uout;  andi* discharges  a thick purulent  matter!
 1 he 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
 birth       g°norrhoeal a"d  leucorrhceal secretions of the  vagina at


  Treatment—Wash out the eye frequently, and  gentlv with a
weak astringent wash (207)  (203^, or p'ut  between tne  £ oifce a
day  a arge drop, with  a camel's-hair pencil, of prescription (208)
™ri? Hu?t  fT ♦"  drhmng' app1^ to the lids> ^h a amel'i-h2
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 diluted 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 sil.ver, 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 witchhazel 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, sarsapariUa, stilfingia, and quinine.
  The eye is to be strengthened by cold water applied to the lids, the
forehead, and the temples.   The eyes may be balhed 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 and 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.  Iu 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-
 S?"1- , T°  reheve Pa»b ^  any, give Dover* 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 atrop.a, 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                          "oweis  to


          Weakness of Sight.—Muse* Volitantes.







J^^:™^^ °:jsmi>natural  °r  ~
bath, and ouWoo, c.erl^Z Z^rTei^t^ °* ^ 
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 crystafine 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
fhall 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.

  Lonjr, 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.

                             Fio. 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.

 turn  StrablSmUS'the eyes are  not  ParalleI in thei' position and moT

   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 th,
 distorted vision, or possibly the injury  to itself which would follow
 the attempt to make eyes of unequal  power work  evenly together
 The opposing muscles  lose their counterbalancing force, and the in-
ternal rectus, gaining the preponderance, draws thSeye inward,-fox
 he squint is  more often convergent than divergent; that is, the eye-
turns in more often than out.   Both eyes sometimes squint 
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 iu
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  Ihe 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
siream 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.—Otorrhosa.

  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
wiih 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 car.
If there be great pain and headache,^ut 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 ai once to the
leeches, purgatives, poultices, and fomentations. 
4Q0
*w                    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
 nts 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  ivith 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 exercise, 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 pajn, and  finally
  ulceration.   Nature, attempting to repair the mis-      no. 176.
  chief, sends out granulations, which, being perpet-
  ually irritated, shoot up  into  unhealthy growths,
  called proud flesh.  Thenceforward, the sufferings
  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
 upon this page,  we place here, in Fig. 176, a good
 representation of this  tormenting disorder, as a
 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

 t^l%da7Ut tPtPrytbelmnand W6ak ^' ch4ingP toe  police
 v)1 %   7\     !   a5 the lnflammation is subdued by this, press a
 little fine  hut gently under the edge of the nail.  At each subsequent
 dressing cut  off  as much of the nail as  is raised  out  of the  tencle
 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 wool.  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
nose  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 bindirjg 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.
   U 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
  rI/uthfub,ueding beL bdow  the  middIe of the  uPPer ™, 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
 i   be no success, lose not a moment, but, instantly,

 j      Xext, to Imitate Breathing, replace  the patient on his face, raising
 ;;   and supporting the  chest well on a folded coat or other  article of
 ij   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
 11   in a minute, occasionally varying the side.  These motions will cause
 j]   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
 j   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
 j   back of the chest, discontinuing it immediately before turning the
 I   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
 j   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 Ijack.   Beside the above, pour into the
    nostrijs a  teaspoonful of aromatic, spirit of ammonia, and thrust a
 I   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.
 i

               Apparent Death from Lightning.

jj     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,
i    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
 j   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
 Hat 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 ran. 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 dai h cold water upon it, to
 prevent the burn 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 aet 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,   lo 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 vitriol) 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-riiustard, 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 
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 of 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 i« 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 water, 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. 
SURGICAL DISEASES.
499
                 Poisoning by  Aconite.

  Give an emetic of ground-mustard or sulphate of zinc, or use the
stomach pumTinstan^y, 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"warin  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.   It 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 effect 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  intmediate 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 wno 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 all 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 
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 of 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.
                                                         4
  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
tame effect
  T:iit.ir.— 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
ca^cs, 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 bv a  frac-
ture, or, more commonly, by the rotting  away of a part of the tooth.
llns 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
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    i
   lave early and careful attention.
     The health and durability  of the permanent teeth depend materi-   j|
   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    j
   the rudiments of the second set already exist when the first are cut,    j
!   it is not  unreasonable to suppose they may inherit disease from their
1   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 Diseased Teeth upon the  Health.

     The bad effects of a diseased and unclean mouth upon the general
,   health,  ore 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    j
   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
and 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, jn a well-stopped glass  bottle.  When
used, it must be mixed in the proportion of one ounce, or two large   j
spoonfuls, to the pint  of  water.   It is excellent for cleansing car-   j
buncles, gangrenous sores, bad ulcers, ulcerated sore throat, and fetid   j
discharges  of every kind.  A weak  solution should  be frequently ap-   ;
plied.                                                               j

  Uses of Clilorides 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
 diflerent  rooms, in shallow dishes, — the small bed-rooms being par-
 ticularly remembered.
    Iu 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 draiits, 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.                                                  J
   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.
   1 he 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 coo ed by one mixture, before being mixed for another.
   lo five drams of pulverized  hydrochlorate of ammonia,  and five
crams of  pulverized nitrate of  potash  (nitre), add two  ounces  of
\va.er, in a tin  stone-ware, or glass vessel, and you may freeze water,
sea-water niilk,  vinegar  or oil of turpentine.   It  will clause the ther^
n  )ineter to sink from 50° above zero,  to 10° above; that  is, forty
degrees.                                             '        ' '"'"v 
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 CO0
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 b3° 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
 iust 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
steady 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 tiie  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 air 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.
    Ihe reader will  see that the  apparatus is so arranged that the ad-
 mission of air into the chest is entirely  impossible.

 mPn?larthStf 1lma?ing ^ LdmwinS 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
 wze, for the purpose of operating in ascites, or dropsy of the belly. 
HOMEOPATHIC  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 will be many  of them)  may consult
these pages.   Every system which wins to  its  support  numerous,
sincere, and capable 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 how 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.

  1  Aconitum napellus,     5. Apis melifica,         9. Belladonna,
  2  Alumina             6- Arnica montana,      10. Bromine,
  3'.  Ammonium carb.,       7. Arsenicum album,     11. Bryonia alba.
  4.  Antimonium cruel.,      8. Aurum metalhcum,     12. Calcarea carb., 
HOMEOPATHIC REMEDIES.
rm
13. Cannabis sativa,
14. Cantharis,
15. Carbo vegetabilis,
16. Causticum,
17. Chamomilla,
IS. China officinalis,  '
19. Cina,
20. Cocculus,
21. CofTea cruda,
22. Colchicum,
23. Colocynthis,
24. Conium maculatum,
25. Crocus sativus,
26. Cuprum metallicum,
27. Digitalis purpuera,
28. Droscra rotundifolia,
29. Dulcamara,
30. Eupatorium,
31. Euphrasia off.,
32. Ferruin metallicum,
33. Graphites,
34. Ilclleborus,
79. Arnica,
80. Calendula,
81. Cantharis,
35. Heper sulph. calc,
36. Hyoscyamus niger,
37. Hamamelis,
38. Ignatia amara,
39. Iodine, •
40. Ipecacuanha,
41. Kali carbonicum,
42. Kali bicromicum,
43. Lachesis,
44. Lycopodium,
45. Mercurius subl. corr.,
46. Mercurius vivus,
47. Mezereum,
48. Moschus,
49. Natrum muriaticum,
50. Nitric acid,
51. Nux vomica,
52. Opium,
53. Petroleum,
54. Phosphorus,
55. Phosphoric acid,
56. Platina,
57. Pulsatilla,
58. Rheum,
59. Rhus toxicodendron,
60. Ruta graveolens,
61. Sabina,
62. Sambucus nigra,
63. Sanguinaria,
64. Secale cornutum,
65. Senega,
66. Sepia succus,
67. Silieia,
68. Spigelia anthelmin.,
69. Spongia marina tosta,
70. Stannum,
71. Staphysagria,
72. Stramonium,
73. Sulphur,
74. Sulphuric acid,
75. Tartarus emeticus,
76. Uva ursi,
77. Veratrum album,
78. Zincum metallicum.
TINCTURES FOR  EXTERNAL  USE.
82. Causticum,
83. Hypericum,
84. Ruta graveolens,
85. Stapnysagria,
86. Urtica urens.
 Medicines  the  Best Adapted to the Different  Temperaments,
                               Habits, etc.

   1. For the Sanguine Temperament.— Aeon., Am., Bell., Bry, Calc,
 Hep., Merc, Cham., Nux v., Phos., etc.
   2. Bilious Temperament — Bry., Nux v., Ars., Sulph., Merc, Cob-
 culus, etc.

   3. Nervous  Temperament — Sepia, Coff.,  Platina,  Ignatia,  Puis.,
 Nux v., Cham., etc.

   4. Lymphatic Temperament — Ant, Arn., Nit  Acid, Calc,  Puis.
*SuIph.,  Con., Clematis.

   5. Melancholic Temperament — Aurum, Ars., Nux v., Verat  Ipec
 Chin., etc.                                                      '  K  *'

   G.  For Plethoric Habit—Aeon., Bell., Calc, Puis., Merc, Sep., etc.
   7.  Debilitated Ilabit—Ars., Chin., Bry., Lachesis, Arn.
   8.  Lean Ilabit— SiL, Lach., Graph.

   9. Melancholy Disposition.-Ars., Verat, Aurum, Puis., Aeon., Bry.
   10. Mild  Disposjgon—Puis., Sep., Calc, Ignag.
ites
11. Sensitive Disposition. - Calc, Ignat, Plat, Bell.,  Bry.,  Graph- 
   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; and 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, hymceopathic to the
case.                                          *     r 
512
HOMOEOPATHIC REMEDIES.
  Aconitum NArELLUS, 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. Carb., by Lye, Sil., 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., Ars., 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.,               M
  Rhus Tox., by Ars., Bry., Calc,  Con.,                 u
  Sepia Sue, by Carbo v., and Sulph.,                  "
  Silicea, by Hep., Lach., Lye, and Sep.,              **
  Spongi a, by'Hep. Sulph.,                           "
  Sulphur, by Aeon., Bell., Calc, and Puis.,      *      "
  Tart. Emetic, Ipec, Puis., and  Sep.,                 "
  Veratrum  Album, Ars., 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. — Am., 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,
 aud Vaccinin.

   Gout — Aconite, Arnica, Arsenicum, Belladonna, Bryonia, China,
 Causticum, Colocynthis, Ferrum, Mercurius,  Nux  vom.,  Pulsatilla,
 Rhus fox.

   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, Dulcamara, Hepar sulph., Ignatia, Lachesis, Mer-
 curius viv., Nux vom., Nitric acid, Sulphur.

  Putrid Sore Throat - Aconite, Arsenicum,  Belladonna,  Conhun,
 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 
5*4                HOMCEOPATIIIC REMEDIES.
   Liflammation 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.

   Bilipus 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.
   WJien 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, Verat.
   When by excessive study, Arn, Calc,  Lachesis, Nux vom. Puis,
 and  Sulphur.
   WJien by debilitating losses, as in  diarrhcea, 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, Chin,
 Puis, Sulph.
   When in persons of  sanguine temperament, Bry, Nux vom. Bell,
 Phos.      4
   WJien in persons of  bilious temperament, Cham, Cocculus, China,
Sulph.
   When in those of melancholic temperament, Aurum, Ars, Nux vom.
Puis, Sep.
   Wlien in nervous temperaments, Coffea, Ignatia,  Sulph, etc.
  Heartburn. — Waterbrash.— Nux  vom,  Cham, Pulsatilla, China,
Carbo. veg, and Belladonna.
  Cardialgia.—Gastralgia. — Belladonna,  Bryonia, Calcarea, Carba 
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. — ^.conite, 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.

   Diarrhcea. — 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, Canthandes,  Chamomilla,  Colocynthis, Lvcopodium, Nux
 vomica, and Rhus.                              *  r

  Worms.-Aconite,  Belladonna,* Carb. veg, Chamomilla, China,
 Cina, Calcarea carb  Ipec, Lachesis, Mercurius viv,  Nux  vomica
 Pulsatilla, Sulphur, Silicea.                                     '

  Itching of the Anns.-If caused by worms, Aconite, Nux vomica,
 Sulphur, and S.hcea;  if caused by blind piles, or bleeding, or liquor
etc, Nux vomica, China, Sulphur, or Ipecacuanha. 
5i6                HOMCEOPATUIC REMEDIES.
   I lies. — Aconite, Antimonium crud. Arnica,  Belladonna,  Carbo.
 veg,  Chamomilla, Colocynthis, China, Hamamelis, Ignatia, Mercu-
 l-ius viv, Nux vomica, Pulsatilla, and Sulphur.

   Protrusion of the Intestine. — Calcarea,  Ignatia,  Mercurius, Nsx
 vomica, Lycopodium, Sepia and Sulphur.

   Acute Inflammation of the  Liver—Aconite, Bryonia, Belladonna,
 L-hamomilla, China, Mercurius viv, Nux vomica and Lachesis.

   Chroiiic  Inflammation of the Liver. - Aurum,  Alumina, Calcarea
 carb, China, Lycopodium, Nux vomica, Silicea and Sulphur.

   jaundice.—Aconite,  Belladonna,  Chamomilla,  China,  Digitalis,
 -ueicurms viv,  Nux vomica, Pulsatilla and sulphur.

   Inflammation of the Spleen---Aconite, Arnica, Arsenicum, Baryta
 c*rb, Bryonia,  China, Calcarea carb, Carbo. veg, Ferrum, Lycopo-
 o-ium, 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 SarsapariUa.

   Retention of LTrine.— 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, Lycopodium, 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, NuxVom,
 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.
 acid urn, Stramonium and Rhus tox.

   Whitlow. — Mercurius,  Hepar sulph, Rhus tox, Lachesis,  Silicea,
 and Sulphur.

   Itching of the  Skin — Prurigo. — Sulphur, Conium, Ignatia, Mer-
 curus, Pulsatilla, Rhus tox, Hepar sulph, and Nux vomica.

   Ring Worm. —Sepia, Natrum  muriaticum, Nux vomica, Calcarea
 carb, Rhus tox, and Sulphur.

   King Worm of the Scalp. — Arsenicum, Hepar sulph, Ducamara
 Bryonia, Rhus tox, and Staphysagria.

   I leers. — Arsenicum, Carbo. veg, Lachesis,  Lycopodium,  Mercu-
 rius viv, Sihcea,  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, ( austicum, Euphrasia, Hepar sulph, Lycopodium, Mer-
 curius viv. Nitric acid, Nux vomica, Phosphorus, Pulsatilla, Rhus tox,
 Sambucus, Silicea and Sulphur.

 r.roW-Tl'Ilfl"JIKa-—Acon^,  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,  j
Pulsatilla, Rhus tox. Sulphur, Silicea, Stannum.

  Laryngitis.— Camphor,  Aconite, Hepar sulph, Spongia, Lachesis,
Antimonium crud, Arsenicum,  Belladonna, Cantharis, lodium, Mer-  j
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 tox, 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.
   Xeuralgia 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 ofalhe 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.

 NuEfvrL7oPtmrdsSz^yoscyamus'l8natia-Lachesis-

J£*fiS£itoZr Belladonna: China- Col^nth- ^°po-


mul; n'StSXal^r3'  P",satiUa'Stramonium' H"" 
IIOMCEOrATIIIC 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.

  Cotalgia.— 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
   Gonorrhoeal  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,
 C hina, Nux vomica, Pulsatilla, Rhus tox, and Sulphur.

  Ozcrna.— Pulsatilla,  Sulphur, Calcarea, Lycopodium and Natrum
munaticum.

  Polypus  of the \ose. - Calcarea, Sanguinaria, Sepia and Staphy-
sagna.                                           r          r J

  Baldness.— When the hair falls from debility, China and Ferrum.
   VV hen 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.           j

  Goitre. — Iodine and Spongia, in recent cases; and Calcarea, Carbo.   \
veg, and Sepia, in those of long standing.                           I
  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.                 52'3
   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,
 b>epia and  \ eratrum.

  Suppression of the Menses—Aconite, Pulsatilla, Belladonna, Bry-
onia, China, Graphites, Kali carbonicum, Sepia, Sulphur, and Vera- 
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,
 Coirea, Nux vomica, Opium, Pulsatilla and Secale.
  Childbirth Cramps  and Convulsions, — Belladonna,  Chamomilla,
 Cocculus, Hyoscyamus, Ignatia, Ipicacuanha, and Stramonium.
  Flooding after Delivery. — Belladonna,  Chamomilla, China, Cim
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 f 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, Mer-
 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.                52?
  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
 tallowing 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 ?s,
 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 le^s 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          FlQ 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 he only an apoplectic
 %tupor, 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 is 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.  I^ut 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
 
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 #. 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, almost 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 sheeti
also acts as a most soothing poultice.

                       The  Wet  Dress.

   A modification  of the \fet 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
may 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 
 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, etc.
 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 
532
PROCESSES OF THE HYDROPATHIC TREATMENT.
Fio. 179.
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 thoroughly 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
cold,  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.      53U
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 bodv.

                     The  Douche Bath.

   Tins  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,  and 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  I
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 percha,  j
leather, etc, it is easy, whenever there is a small fall or head of water,  j
to arrange what  is called a hose-bath.  It is in principle a  douche,  j
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 method of using it is, for the patient to stand in an empty  ; 
PROCESSES OF THE HYDROPATHIC TREATMENT.      5C5
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  action 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-    j
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.                                                I
   In the latter of these indications, the bath is generally used but fdl
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    i
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 than 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, filled 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 onces
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,    j
  unless  they can have  some other form of bath.  A daily towel ablu-    ij
  tion, thoroughly performed, is an excellent prevention against colds,
  helps the appetite  and digestion, and is a good means of preventing    jj
  constipation.                                           ,         ,    |j
    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. 
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, acd 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  water, 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, viz., 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
tvarm.   In a  great variety of  ailments,  such as toothache, rush of 
"f     .                                              --------:
    540      PROCESSES OF THE HYDROPATHIC TREATMENT.
blood to the head, headache, earache, inflammatioil 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.

  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-
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
various diseases of the parts.   There should not be much force  used  j
in this way.   Immersing  them also in water is often useful.  The  ;
water should not, in general, be very cold, tepid or warm being often
the best.

                   Mouth, 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 unorthodox, come under the same category of error.  A
few simple explanations on 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 ernploy
him.                                                               I
   But whatever  wTords we use to designate the different baths,  there
is one objection, which is,  that all such terms are necessarily arbitrary   I
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 ju£t quitted  the sultry valleys   j
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
warm 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 wdrm,
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 placeat 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 »nce 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 unwarmed  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 froifi 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 warm 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 de"bility, 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    I
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
can 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.                           j

   As regards temperature, sea-bathing comes under the general head    I
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 n
skin.  On account of this property, it is found that an exposure 
PROCESSES OF THE HYDROPATHIC TREATMENT       540
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.

                           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 can 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 a^t  in
this way ?"
   A great variety of injection-instruments have been invented.  Some
                                 69 
C 16       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   I
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 :

   i. 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 HYDROPxVTHIC TREATMENT.      5-17
  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.

 ?i?dy'«- l d° n0t claim' however> that the wh°le 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  aTe  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.                                                           '
                                                                   i
  Quality of Water. — For all remedial as well as hygienic purposes  j
water  should be as  pure and soft as can be obtained.  With proper  j
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  j
into  disrepute.  For several  years  of the latter part of Priessnitz's  I
career  he was very averse to  using  the process.  It was a remark of  j
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   j
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.
   3Vo 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,
I    should  be permitted.   Whispering, indeed, is  apt to  excite delirium,
j    and to augment it when it is already present.

      Beds anil Bedding. — The French beds, without curtains, are those
    best  adapted for  the sick-room.   When four-posted  bedsteads, sur-
    rounded  by curtains, wTere more in use than at the present time, the
    mischief arising  from  excluding the free air, by drawing the curtains
I    close around the  bed, was  frequent and serious.  In every case of
i    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
 I   from which the patient is moved should, on his removal, be immedi-
 |   ately turned down and fully exposed to the air; a precaution which
 j   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 furniture 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
i    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,
I    be consolatory to those whose duty it is to attend such cases, to know
    that  infection, communicated through  the air, rarely extends above a
I    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-
1    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-   i
!    tilatiou  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, or 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.        550
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.
  Iu  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  the
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. 
556         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 siqk-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 place
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- 
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 the wants
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  i
detailed to the physician, whose presence may be requisite •before his  j
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-  I
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-
ness, 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  tq  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.
^ 
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  in 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 lividily, 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 bait 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 are never free from danger when they are
accompanied with stupor or coma.   They are also dangerous when
inflammatory fever is present.  They 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 than 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 diarrhcea
exists, is equally to be  dreaded.

   Retention of the Urine, as well as its involuntary discharge, is at.
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, appear 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  marty 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 to 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 cither 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.        50,5
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 wreight 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,  indeed, 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.
  Iu  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 cr 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 ^he food is of  the utmost  importance.  The taste is often  so  per-
verted as to desire that which would 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. 
066         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 o£ 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 axe 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 cold 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
wiiich 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 deversificd
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 usm**
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 whealen bread,  all the  varieties of
fariuaceons 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
boiJing water:  but this is  not  the  fact;  and were they very nutritive, 
!_>^H
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 farinacea?,
 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 iu 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.                                             I

  Tea, in  the form  in which it is  usually taken, is too stimulant and   i
astringent to be a good  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,   j
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, axe 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 will 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
Bountiful* 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 
 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.                                               J r
   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 tfie 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 farinaceae, 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-
though 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 diarrhcea, 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. 
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.        57;
 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 takers
 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, tfcp 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 mUid 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. 
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  must 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 require, 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  (Pneumonia). — 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 SICK-ROOM.        575

 as ihe  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 stimulant, 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 himself 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   n 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 stilt customary with
 noii-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_ °f 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 of 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 diarrhcea 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, and1 light broths, are proper.  In 
DOMESTIC MANAGEMENT OF THE SICK-ROOM.        577
chronic diarrhcea, 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 kitehen 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 hjs 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 little 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.

                       Barley 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.

                          Another.

  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, 
530
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 for
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.

   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, one  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, diarrhcea, etc. 
COOKERY FOR THE SICK-ROOM.              58]
                            Sago Gruel.

     Sago, two tablespoonfuls;  water, one pint   Boil gently until it
J  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.  .

      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*2
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 str iin,
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 teaspobnfuls 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 curect  The
 different parts of a plant are to be gathered when their peculiar juices
 arc 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.
581
J
  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, and 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 Drnm.
Fig. 186.
Fig. 187.
§ Ounce.
3 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
oft 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.                                               r
   The characters  marked on weights and graduated measures,  are
explained as follows:
|j one ounce.
f§j one fluid ounce.
|ss half an ounce.
3j one dram.
f3j  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:
60 drops make one fluidnlram.
 8 drams make one fluid-ounce.
16 ounces make one pint.
 lb  The pound is equal to 12 ounces.  I  3  The dram is equal to 3 scruples.
 |    "   ounce      "•     8 drams.   |  9    "  scruple   "   20 grains.

   By apothecary's measure:

           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.
  da stand for ana, and mean of each.
  lb stands for libra vel libree, and means a pound or pounds.
  | stands for uncia vel unciae, and means an ounce or ounces.
  3 stands for drachma vel drachmee, and means a dram or drams.
  9 stands for scrupulus vel scrupuli,  and means a scruple or scruples.
  O stands for octarius vel octarii, and means a pint or pints.
  f§ stands for fiuidunda vel fluiduncice, and means a fluid  ounce or fluid
ounces.
  f 3 stands for filuidrachma vel fluidrachmce, 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.
  Collyr. 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.           58(
   Garg. 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.
  Pit. stands for pilula velpllulce, and means a pill or pills.
  Pulv. stands for pulves velpulveres, and means a powder or powders.
   Q. S. stands for quantum sufficit, and means a sufficient  quantity.
  S. stands for signa, and means write.
  Ss. stands for semis, and means a half.

  Domestic, or Approximate Measures. — 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   "     «       \  or £ drachm.
          "      "   "   4 to 7    «     «       £  or 1 scruple.
                 "   of   4        "     «       \ or 15 grains.
          "      "   "   3        "             \ or 10 grains.
                      "    2        «     «        \ 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
MEDICTNES 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
proper amount of either alcohol or diluted  alcohol,  letting it stand
from seven to fourteen days,—shaking each day,—and, finally, filter-
ing through paper.   A large proportion of tinctures are made by tak-
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,
— this tincture,  four ounces to the pint of alcohol," meaning thereby,
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 ljttle  double, 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
boil.   The vessel should usually be covered.
   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
with  it and applied to  the skin, excites heat  and redness, and, very
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, tainannd,
 and is very abundant in the red elderberry.   It is refrigerant, and anti-
 septic, and is chiefly employed as a substitute for lemonade.  JNme
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 TnEIR PREPARATIONS.
5iil*
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 ttie 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 diarrhcea.   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  Socctra.   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 involution as a gar-
gle in sore throat, and falling down of the uvula, and as an  injection
in leucorrhcea.   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 rhe'uma-
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.   \t is alterative, tonic,  astringent, and expecto-
   rant.   Used in  scrofula and syphilis.

I     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-
1   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  J-
   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-
j   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 iu 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 
MEDICINES AND THEIR PREPARATIONS.
    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  Ammonue  Aromaticvs).—
    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   J
l    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   j
    ammonia,  used warm, make  in  some cases a valuable fomentation,   i
    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).
     Assafcetida. — 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   j
    Europe and this country. It is moderately stimulant and diaphoretic. 
MEDICINES AND THEIR PREPARATIONS.           595
The warm infusion causes perspiration, and is used to relieve painful
menstruation.
  B.ilin of Gilead (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.

  Balmony (Che lone 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 assafcetida, forms  a valuable injection for worms.   An
ointment made from  the fresh leaves, is valuable for piles, inflamed
breasts, tumors, and painful ulcers.

  B;ilsam 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.
  B:il.S;im Tolu.— This is the  juice  of  the tree Myrospernuni 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.

  Burberry (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  leucorrhcea.
  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. 
MEDICrNES AND THEIR PREPARATIONS
  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,  dosej one to two drams;  and the
active principle myricin, dose, two to ten grains.

                                             Fig. 189.
BEAR-BERRY.                         BAYBERRY.
   Beef's Galls (Fel Bovinum). — Tlris 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 jn
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
wiih 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 while
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 wilh 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 kidneys;  also  in excessive menstruation, cough, asthma,
and difficult  breathing.  Boiled  in  milk, it is used, in the western
country, in diarrhcea 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  leucorrhcea 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 Androseemifolium). — 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 cau»e
                    vomiting without much nausea.
                       Preparations. — Fluid extractdo.se, 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
white 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 diarrhcea, more  especially  the diarrhcea of the latter  stages of
consumption, — over which it  has more control than any other known
remedy.   To show its best effects iu this form of diarrhcea, 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 iu  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 Didcamara). — This  is common  in Europe
and North America.  It is a woody vine, the roo^s 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 drain 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 Abler (Prinos  Verticillatus).— This  shrub is common in the
United States; its bark and berries are used.  It has been found use-
ful  in jaundice, diarrhcea, 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 drams 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-
rhcea, dysentery,  cholera-infantum, relaxed condition of the bowels of
children, and the passive discharge of  blood from the stomach, bowels,
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, leucorrhcea, 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.                            Fio. 192.
            BLACK COHOSH.                        BLOODROOT.

  Bi.ick 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
	€d **
.. f II m 1 li	
 
MEDICINES AND THEIR PREPARATIONS.           5£9
   dance, epilepsy, nervous excitability, asthma, delirium tremens, and
j   many spasmodic affections.   It has an especial affinity for the uterus.
      It reduces the arterial action very materially, and hence  is useful
!j  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;
j   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.

J      Black Willow (Salix Nigra). — This tree is found in the  Northern   i
j   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  iu the treatment spermatorrhea.

      Blooilroot (Sanguinaria Canadensis).— A perennial plant, growing
   in light, rich soils, in  most  parts of the United States.   The root is
i   the  part,  used. It is  emetic, narcotic, expectorant, alterative, escha-
j   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.                                     w                      j
      Four-grain  pills, made of sanguinarin, twelve grains, caulophyllin,
   twelve grains,  solid extract of cimicifuga, twelve grains, are said to be
   efficacious in amenorrhcea, dysmenorrhcea, and other female  disorders.
Fio. 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. 
bOO           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, amenorrhcea,
 dysmenorrhcea, chorea, leucorrhcea, 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.

   Bine Pill (Hydrargyri Pilulai). — 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  wanted.  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, iu 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;  infu-
sion, dose, one to three ounces.   Eupatorin, dose, one to three grains. 
MEDICINES AND THEIR PREPARATIONS.           601
  Two scruples of eupatorin, one scruple of xanthoxyHn, 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.
BONE8BT.                            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, two 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.

  Buckhoni 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, diarrhcea, 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 jolly.
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.
  Prejxi rat ions. — 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 (Ifycopus  Virginicus). — This grows  in shady and wet
places throughout a greater part of the  United States.   The wlfole
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.      t   ■
  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.                                                           i
  Butternut (Juglans Cinerea). —  This is a  forelt tree,  growing  in   j
various  parts of the continent, known also by the names of oilnut,   I
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   j
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-   j;
inw the whole into sixteen  pills.  From  two to five may be taken  for   j
a dose.                                                               ii
  Calcined  Deer's Horn (Cornu Cervina  Us turn).— The  horns of the   ji
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  Qiloridum Mite);— This is prepared" from
mercurv, sulphuric acid, and common salt.  It is alterative, a 11:1s
 
MEDICINES AND THEIR PREPARATIONS.           603
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,
guaiacuin, and other sudorifics.  In the beginning of fevers and other
complaints, it is often combined with  purgatives, as  gamboge, scam-
niony, 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 a-tide 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, that 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 camphora.   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 B.ilsain.— 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 day, 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
diarrhcea.   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
 
GO-l
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
diarrhcea 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 water, ten 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.
  Castor 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 may  be  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
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 ; foi a 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, brownj and
brittle pieces,  and is soluble in alcohol.  It is a powerful astringent,
and is used in chronic diarrhcea, 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, either 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.
Iu  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 water,  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 diarrhcea, accompanied with
acidity.   The most  convenient form of administering ch. 'k is  that of 
606    •       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   !
11   till they are thoroughly mixed.  Dose, a tablespoonful  frequently re-   j
j|   peated.                                                '             |       ■
Fig. 198.                               Fig. 199.
CAYENNE PEPPEB.                          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
jj  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
I   five  grains  of  the solid  extract of rhubarb,  and ten grains of assa-
   fcetida, and taken, one pill at a time, two or three  times  a day, with
!   advantage.          *

|      Charcoal  (Carbo Ligni). — Prepared charcoal is antiseptic and ab-
j   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 other articles, it is useful in painful  affections, as nervous 
MEDICINES AND THEIR PREPARATIONS.           607
I    headache, rheumatism, neuralgia, etc.  The dose when  taken inter-
    nally, is from ten to sixty drops, in flax-seed tea.
jl      ,,.
i      l tiuinmon.— This is the bark of trees growing in  Ceylon, Malabar,
i    and Sumatra.  It is a very grateful aromatic, being warm and cordial
I    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.
I    It is peculiarly adapted to diarrhcea; and in treating this  complaint   f
|    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
I    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-
i|   raon.   Cassia buds  have some resemblance to cloves, and are  com-
 i   pared to small nails with round  heads.   They.may be used for the
 |   same purposes as the cinnamon bark.
 I
       Cleavers (Galium Aparine). —  An annual plant, common  to this
 j   country and Europe,  having an  acid, astringent taste.  The whole
 I   herb is used in infusion, as a cooling diuretic, in scalding  of the urine,
ji   inflammation of the kidneys and bladder, in gravel, suppression of the
 j   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.
      (loves (Caryophyllus Aromaticus). — The flowers of  this  tree, a
    native of tropical climates,  collected  before they are fully developed,
jj   form cloves.  They are highly stimulant and aromatic, and are  used
 i   to give tone to  the digestive organs, particularly when  flatulency
I    exists, and to relieve nausea and vomiting.  They are more generally
jj   employed  to improve  the taste and modify the "action of other medi-
j.   ciius.  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
j    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
I    used with advantage in hooping-cough and neuralgia.   It is mUch
j   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 Morrhuce). — 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 wmich there is  impaired digestion,  assimilation, and nutrition.    j
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.                     !
                                                                      i
  Collodion.— This is gun-cotton dissolved  in ether.   It is applied
with  a camel's-hair brush, to cuts,  burns, wounds, leech-bites,  etc.,   ij
over which it forms a thin pellicle or skin, protecting the injured  part   j
from  the atmosphere.  It should be kept in well stopped bottles, to   ,!
prevent its evaporating and becoming unfit for use.                     i

  Colocynth  (Cucumis  Colocynthis). — A native  of northern  Africa.    j
The part used in  medicine is  the fruit, deprived of its rind.  It is a   j;
powerful drastic, hydragogue cathartic;  causing  by its harsh action,    j
griping, vomiting, and sometimes bloody discharges; from the severity   ii
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 wateT, is useful in a weakened state of the bowels,    !
showing itself in  & diarrhcea.  Dose, two  drams every hour.  Fluid    J
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,    j
one dram; fluid extract  of ginger, half  a  dram; water, one pint,—    j
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, dysentery,
   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,
 l  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
 I  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,
I   except  blue pill.   It  is much used as  a remedy  in  syphilis, particu-
I   larly  in the secondary  stage, in which, in  many cases, it does  much
I   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 sarsapariUa, preparations of yellow  dock, etc.  In order  to  avoid    .
   its irritating effects, it is often united with opium, or extract of conium.    i
   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 
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 drains; infusion, dose, one
 to two  ounces.  A  valuable astringent  wash                      •
 for sore  mouth, etc., and as  an injection in leucorrhcea, 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 diarrhcea and  cholera-morbus, when
there is much pain and rumbling of the  bowels.

  CraAlley (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.
   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
IJ  drops of pure creosote, introduced into a hollow tooth on a little cot-
ij  ton, is generally a speedy remedy for toothache, but great care  must
j   be  taken that it does not come in contact with the tongue or cheek.
j      Croton Oil (Oleum Tiglii).— This is obtained from the seeds  of the
    Croton Tiglinm, a plant growing in the East  Indies.  It is a powerful
J   cathartic, producing watery stools,  and is  used in torpidity of the
   bowels, dropsy, apoplexy, mania, inflammation  of the brain, hydro-
   cephalus, coma, and wherever a powerful revulsive action is needed
   to call the blood away from the brain.  A drop placed on the tongue
I   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
   some other affections.   If the skin is very sensitive, let it be combined
   with an equal quantity of sweet oil.
     Cubebs (Cubebm). — A climbing  perennial plant, growing in the
   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
 i  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 leucorrhcea; 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, diarrhcea, and dysentery.  A powder 
612
MEDICTNES AND THEIR PREPARATIONS.
is made from it, containing its active principle, and called  leptandrin,
which  has a fine effect in diarrhcea, 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 ; podophyllin, 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 local 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, parriculariy 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. 20a                            Fig. 204.
  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 brd¥n, fevers, etc.
   Gentian ((xentiana 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 iu 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. 
616           MEDICINES AND THEIR PREPARATIONS.
|      Preparations.—Fluid extract, dose, half a dram to a dram ; tincture,
i    four ounces to one  pint of diluted alcohol, dose, two to four drams;
il    infusion, dose, one to two ounces ; syrup, dose, one to two drams.
!
      Ginseng  (Panax  Quinquifolium).— A  perennial  plant, growing  in
    the Middle and  Southern States.   It is a mild tonic and stimulant,
I    and has some reputation for improving  impaired  appetite, and for
I    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
'!    four fluid ounces.

i      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-
    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
il    ointments.
      Gold. — The  chief sort of gold used in medicine, is the chloride or
ij    muriate of gold and soda.   It  is diuretic and  alterative.  It is used
ij    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
i,    the medicinal p*rt   It is a  tonic, having
[•    especial  action  upon diseased mucous tis-
j    sues, and  is particularly beneficial  during
j    recovery from  exhausting  diseases.  It is
    used  in  dyspepsia, chronic affections of the
!    nervous  coats  of the  stomach, erysipelas,
I    and  remittent, ■ intermittent,  and   typhoid
I    fevers.  United with geranium, it has a fine
|;    effect in chronic diarrhcea and dysentery.
1!      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),
1    dose, one to five grains;  tincture, dose, three
    ounces to one pint of diluted  alcohol, dose,
i    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;
    fluid extract of witch-hazel, half an ounce;.pulverized alum, one dram;
j    honey, three  drams;  water, one pint   As a stimulant for a sluggish
 
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; podophyllin, 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
sarsapariUa, 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.

  Iliemastasis. — 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
to prevent the outward passage of the arterial blood.   In this way,
the blood passing out continually in the arteries, and not returning
by the veins, the vessels of the  limbs become filled to their utmost
capacity, and a great quantity, for the time being, is withdrawn from
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
in  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.                                                             {
                                                                    I
  Hair-cap Moss (Polytrichum Juniperum).— An evergreen plant grow-
ing on poor sandy soils in the Northern States.  A strong infusion of   i
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 diarrhcea, 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 diarrhcea, 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.                                           hardback.

  Helonias  (Helonias Dioica). — This  Kerb 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
mm, 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, aletridin, senecin, and
asclepidin ; and in flatulent colic, spasmodic pains of the stomach
and bowels, it may be combined with dioscorein.
   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 (Hamulus 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 
620           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, corn-
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; Jupulin, 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.
G21
  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  diarrhcea.  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  TriphyHum). — 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
MEDICfNES AND THEIR PREPARATIONS.
 milk.  The fresh root is acrid, expectorant, and diaphoretic, and has
 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 lodidum). — 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-
 riUa, 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 anasmia, 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 Quince 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 Hydratum). — 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 iron 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 leucorrhcea.  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 Putvis). — This  is what is often called iron
by hydrogen, or Quevenne's iron.  It is an impalpaple  powder, and of
an iron-gray color.  If black, it  is worthless.   It is used  in  ansemia,
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 era-
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 pleaswre of using  it, with peculiar satisfaction.  Dose,
from one to two teaspoonfuls, three times a day.
  Solution Protoxide  Iron,  with Rhubarb  and Colombo. — 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 with 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.

 I     Sulphate of Iron (Ferri Sulphas). — This is in the  form of transpa-
 j  rent crystals, of a pale, bluish-green color, and  efflorescent in  the air.
 j  It has  a styptic taste, and is  soluble in about twice its weight of
 I  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, leucorrhcea, 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 Potassa Tartras). — This is in
 i  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
j   a remedy for syphilis, both externally  and internally.  The dose  is
   ten  to thirty grains in solution.
      Tincture of Muriate of Iron  (Tinctura Ferri  Chtbridi). — This has
ij  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
j;  employed for purposes for which iron is used.  It is useful in scrofula,
   gleet, and leucorrhcea ; also in hemorrhages from the womb, kidne'ys,
   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 cooling, in which
form it is chiefly used as a nutritive diet for the sick.

  Jalap (Ipomoea Jalapa).— This is a Mexican  plant.  Its root is an
active  cathartic, producing liquid stools, more or less griping.  United
wiih 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, Plero-
carpus Marsupium.   There are several varieties of it.  It is a power-
ful  and valuable astringent, and is much used in diarrhcea, 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, leucorrhcea 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 leucorrhcea 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 Jhis 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, half 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; 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,
tt is employed in form of  solution,  and  applie'd to inflamed surfaces
A-ith  cloths.   Four grains  of  sugar of lead, and four of pulverized
jpium 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;  senecin, the  active principle, dose, 
628           MEDICINES AND THEIH 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 in 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 pill*,  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
diarrhcea 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.
           LADIES' SLIPPEB.                        LOBELIA.

  Logwood (Hoematoxylon 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 iii diarrhcea, 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, dorv, five to  thirty grains; infusion, half an ounce  to a  pint
of water, dose, four drams every three or four hours, in diarrhcea.
  Magnesia (Magnesia Us la). — 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 Magnesia  (Magnesia Sulphas). — 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 Tern,(AspidiumFilix 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 power to destroy and expel the tapeworm.
  Preparations. — Solid extract, dose, nine to fifteen grains.  The fol-
low! ng 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,  diarrhcea, 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; podophyllin, 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
Europcea, 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 considerably 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 diarrhcea, 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.
Fia. 211.                           Fig. 212.
MAMDBAKE.                       MAESHMALLOW.
  Marshmallow (Althcea  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 teelh, — 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  etlter 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 (Piper Angustifolium). — The leaves of this plant are styptic,
j    and somewhat stimulant and tonic.  The leaves  brought in contact
j    with a bleeding  wound, have considerable power to arrest the flow of
j    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
j    ounce;  infusion, half an ounce to a pint of water, dose, one to two
I    ounces.
I
j      Meadow Saffron (Colchicum Autumnale). — This is a native of the
|    temperate  parts of Europe, where it grows wild  in moist meadows.
[I   The roots and  seeds are used.   Colchicum is justly regarded as a
    valuable remedy in gout and rheumatism, in which it is much and
j|  ' chiefly used.  It is thought,  also, to act upon the nervous system,
    allaying pain, and producing other sedative effects.  When not car-
|i   ried off by the  bowels, it produces sweating, and is occasionally
11   diuretic and expectorant.  Dose of the dried root, from two to eight
i|   grains.
|      Preparations. — Fluid extract of root, dose, three to twelve drops;
    fluid extract of seeds, dose, five to fifteen  drops; tincture, four ounces
ii   to twelve  ounces diluted  alcohol, dose,  ten drops to  half  a dram;
11   syrup, two ounces to fourteen ounces simple syrup, dose, one third of
■ I   a dram to  a dram; wine, three ounces  of root to a pint of sherry
:i   wine, dose, thirty to forty drops.
ij
      Monk's Hood  (Aconite).— This is anodyne, sedative, and diapho-
 '   retic.   The leaves and root are generally used separately.  It is  use-
i;   ful  in inflammatory diseases, neuralgia, epilepsy,  paralysis, gout, and   jl
    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
jj   root, and two ounces  of the  tincture of  black  cohosh, and  taken in
 j   doses of one teaspoonful every four hours, has  great power  in reliev-
 j   ing the various  forms of neuralgia, and also chronic rheumatic pains,
    particularly among old people.
      For nervous headache, irritability, restlessness, and wakefulness, the   |
 i   following combination of aconite is useful:                           |
      Solid extract of aconite, half a dram ; solid extract of stramonium,   jj
    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,   i
 i   according to symptoms.

      Motherwort (Leonurus  Cardiaca). — This perennial  plant is  sup-   ■
    posed to be a native  of Tartary,  and  introduced into this  country.   j
    It is considerably used in domestic practice, for nervous complaints,   j
    and  many  chronic disorders attended with  restlessness, disturbed   \
    sleep, pains of the nerves, and affections of the  liver.  A warm infu-   j
    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 SAFFBON.
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 July, 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 in domestic practice, and is useful in colds, coughs,
bronchitis, etc.; and 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
the 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
ekin, instead of the mustard poultice, and with similar results. 
634           MEDICINES AND THEIR PREPARATIONS.
i      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,
i    and expectorant.   It is employed in chronic bronchitis, consumption,
i    chlorosis, absence of the  menses, etc.  It is generally combined with
j    iron  and other tonics, and in amenorrhcea, 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
j    grains, to  be given in pill, or  in powder  suspended in water.  The
!    tincture of myrrh is a useful  external application.                      ;
i                                                                         ;
      IVaptha. — This belongs to  the  class of native  inflammable sub-   j
i    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                                                    ;
 I                                                                        |
      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   j
    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 willi
    five drams of lard, makes a  good  ointment for psoriasis, dry tetter,
    and leprosy.

i      Nitrate of Silver (Argenti  Nitras).— Nitrate  of silver is-a solution
J    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, St.Vitus's dance,   i
    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-   j
    larly as an internal remedy, more than three months, as it  is apt, after   j
    long use, to change the skin to  an indelible slate blue.                  H
      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   I
    nearly a specific; certainly, it is altogether  the  best remedy we have.   j
    It fails in some few cases;  but when skilfully used it never does harm.   i
    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   j 
               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
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 (Spirilus 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
is a teaspoonful, given in water every two or three hours.
  Nutmeg (Myristica Moschata). — The  nutmeg is  from a tree grow-
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-
 ,• •   i     ,    °                                     Fig. 215.
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
paralysis, and is more beneficial in general than
in partial palsy.
  Preparations. — Fluid extract, dose, two to      ^ vomica.
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.

  Oil of Cajeput (Oleum  Cajuputi). — This oil is obtained from the
 
MEDICINES AND THEIR PREPARATIONS.
   leaves of the East Indian tree  cajuputi.   It is diaphoretic and anti-
   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
   five drops, on sugar.
     Oil of Turpentine (Oleum  Terebinthina). — This is generally called
   spirits of turpentine, and is  obtained  by distilling turpentine.  As a
I   medicine, it is stimulant, cathartic, diuretic, anthelmintic, and astrin-
   gent.  In large doses, iff causes strangury, and other unpleasant symp-
   toms.   The dose  is from  five to thirty drops, repeated every two or
   three hours.   Fifteen drops, taken every fifteen minutes or half hour,
   powerfully restrains bleeding from the lungs, and is, perhaps, the best
   remedy we have for this frightful accident.
     It is  also 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.
     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.

j     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
I   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 watet, 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 two grains; in some spasmodic  affections, it is   !
given in very large doses.                                             I

  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 properties   !
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 murb.
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   J
their nauseating properties.  It is a mild tonic, carminative, and stom-   j
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- 
608           MEDICINES AND THEIR PREPARATIONS.
pression  of urine, and diarrhcea.   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. il7.
        pennyeoyAl.                          pebuvian babe.

  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 diarrhcea, 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 mou!h 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
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
extract of snake-root, two  drams of fluid extract  of orange  peel, one
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 follow-
ing is a good nervine and tonic for persons of nervous temperaments:
fluid extract of cinchona,  one ounce;  fluid extract of  valerian, one
ounce;  essence of cardamom, two drams;  dose, one dram every three
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- 
6-10           MEDICINES AND THEIR PREPARATIONS.
   ache of a periodic character, and for nervous  irritability, wakefulness,
i   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 shoald therefore  be kept covered with water. ♦
Fig. 218.                           Fig. 219.
PINE BOOT.                       PIP8I89EWA.
  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   j
for expelling worms.                                                  j
  Preparations. — Fluid extract, dose, half a dram  to a  dram  and a   i
half;  compound fluid extract, dose, half a dram to two drams; fluid 
MEDICINES AND THEIR PREPARATIONS.           641
if  extract of pink root and senna, dose, half a dram to a dram ; infusion,
|i  half an ounce to a pint of water, dose, two to six ounces.                I
j|    Pipsissewa  (Chimaphila  Umbellata). — This  is a  small evergreen
ii  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    j
;|  tonic, diuretic, and astringent, and has proved itself useful in dropsy,
jj  general debility, rheumatism, chronic disorders of the  kidneys, bladder,
   urethra, etc.                                                           i
!;     Preparations.  — Fluid extract, dose, one  dram; solid extract, dose,
j!  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    i
 !  is highly spoken of for syphilis and scrofula; 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-    j
   dant in  the  Southern States.  The root, which  is the part used, is    '
 I  carminative, tonic, and diuretic; used in pleurisy, bronchitis, inflamma-
   tion of the lungs, acute rheumatism, and dysentery.  The warm infu-
 i  sion  promotes  diaphoresis, without raising the  temperature of  ihe    I
 !  body.   United with the warm infusion of  wild  yam  root, it is  excel-
   lent for flatulency and wind colic.
 i     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    j
   grains.   Asclepidin and dioscorein, united in equal parts, make a valua-    |
|;  ble preparation  for flatulent and bilious colic; dose, two to four grains.    j
Fig. 220.                             Fig. 221.
PLECBI8Y BOOT.                     POISON HEMLOCK.
  Poison  Hemlock (Conium Maculatum).— This biennial  plant  is a   j;
native of  Europe  and Asia, and is naturalized in this country.   The   !;
leaves and the seeds are used in medicine,  Conium is  narcotic, ano   ij
dyne,  antispasmodic,  and deobstruent;  used in neuralgia, asthma,   '!
syphilis, chronic rheumatism, and various other affections.              :'
                             M                                      :; 
642           MEDICINES AND THEIR PREPARATIONS.
  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
found  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;
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 stilfingia, 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 then, 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   j
   extreme deliquescence when exposed to the air, it is kept in closely-
   stopped bottles.   It is diuretic, deobstruent, and mildly cathartic.  It   j
   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
i   three drams.                                                          j

      Bicarbonate of Potassa (Potassa  Bicarbonas). — This is a solution
   of carbonate of potassa, saturated with  carbonic  acid.  This acid is
ij   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,
i   causing free, watery stools.   This  property, as well  as  its power  of
I   acting upon the kidneys, causes it to be much used in dropsical com-
j   plaints.  Dissolved in boiling water, allowed to cool, and then sweet-
I   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   l
   is purified pear lash, 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   j
   chlorine  through carbonate of potassa.   It is refrigerant and diuretic,   I
   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-   j
   corrhcea and gleet 
644           MEDICINES AND THEIR PREPARATION?
  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 Citratis). — 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-
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
varies from a dram to an ounce, according to the effect 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 (Polassii 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 warer, 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 grainf, 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 axe 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
 diarrhcea; 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
 
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  !i
 given in half-teaspoon ful doses, every half  hour, or hour, unftl they  ;j
 operated.   The bark is sialagogue, and, in small doses, powdered, is   '
 said  to  relieve^ the dry and parched condition of the throat, in many  11
 diseases.                                                           ij

   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   I
 the urine, strangury, etc.  But this infusion is more particularly valu-   !
 able  for its power of  expelling the tape-worm.  It may be drank   i
 freely.   The oil of pumpkin seeds, obtained by  expression, has simi-  \l
 lax properties, and  may be taken in  doses  of  six to twelve drops,
 several times a day.                                                 n

   Quassia (Picrcena Excelsa) — This is the wood of a tall tree grow-  jj
 ing in  Surinam  and some of  the  West  India Islands.  It is'an in-  jl
 tensely  bitter tonic,  febrifuge,  and  anthelmintic, possessing  in  the  ji
 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  jj
 stomach which succeeds  acute disease, and indeed all complaints  i|
 where simple bitter is required.  Its generic title perpetuates the name  ij
 of the negro Quassi, of Surinam, who first discovered its medicinal  j
 virtues, about the  middle of the last century, and  who.became famous  j
 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.

   Queert 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-  j
 tions.   The decoction is the form  in which it is  most used;  the dose
 heing two to four  ounces, 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 stilliugia, two
   ounces;  fluid extract of bloodroot, two ounces; fluid extract of cherry
I   bark, two ounces;  balsam of tolu, one ounce and a half; syrup, two
!!   and a half pints.  Dose, one to two drams.
ji     Red duckweed (Anagallis Arvensis). — An annual  plant, common
i!   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
j   are improved by its use, in the form of poultice.
i|     Red Root (Ceanolhus 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, diarrhcea, hooping-cough, and chronic
j   bronchitis, in doses of a tablespoonful, three  times a day.  It makes,
   likewise, a very good injection in leucorrhcea and  gleet, and gargle
   for ulcerations  of the mouth and throat
     Red Clover (Trifolium Pratense). — The blossoms of this very com-
j   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,
Ij   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
   similar purposes.
     Red Saunders (Pterocarpus Santalinus). — This  is a large tree grow-
1   ing  in Ceylon, the wood of which imparts a red color to  alcohol,
   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
i   arises from heating it upon some hot surface is sometimes inhaled
;!   with great advantage in chronic  bronchitis, and  other chronic affec-
jj   tions of  the air tubes.
     Rhatany (Krameria Triandra). — This is a native of Peru, growing
j   in dry, sandy places.   It is a powerful  astringent, and a gentle  tonic.
j   It is given with advantage  in excessive menstruation,  vomiting of
   blood, chronic diarrhcea, leucorrhcea, and inability to retain the urine;
j   likewise, as a local application in falling of the bowel.  It is valuable
   also for  nose-bleed, and bleeding gums.  Dose of the powder, for in-
   ternal use, from ten to thirty grains. 
""^           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
 ol diluted alcohol, dose, three to six drams; infusion, two ounces to
 a pint of  water, dose, half an ounce to an ounce.

    Rhubarb (J^heum  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
 m mild cases of diarrhcea 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  large
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 amenorrhcea, 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 honey and alum.  Dose of
the infusion, from one to three fluid ounces.
  SarsapariUa (Smilax Officinalis). — Grows in  swamps  and rhedges
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 the*se affec-
tions.
  Preparations. — Fluid extract, dose, one dram ; fluid  extract of sar-
sapariUa and  dandelion, dose, one dram;  solid  extract, dose,  five to
twenty grains; infusion, dose, two to four ounces.

  Sassafras (Lauras 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, whicli 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 eff'ects 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.
Fig. 224.
alcohol, dose,  half a dram to a dram and a half; infusion, half an
ounce to a pint of water, dose, half an ounce to an ounce.   The fol-
lowing mixture is useful in amenorrhcea: 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 Acutifoliap. — 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.           6ol
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). — This 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.
Fig. 225.                            Fig. 22C.
SKUNK CABBAGE.                      8LIPPEBY ELM.
  Skunk Cabbage (Symplocarpus Fadidus).— 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 (Ulmus 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 sarsapariUa  and wild sarsapariUa.   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.    m
   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, jnodor-
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.           65'<S
  Chloride 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,   J
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,   j
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   j
of transparent crystals, and is  very soluble in water.  In doses of   j
sixty grains, this  is said to  have been used with success in frothy   j
vomitings;  it is also well spoken of as a remedy in acute rheutna-   !|
tism, and as a wash in thrush, and some diseases of the skin.

  Tartrate  of Potassa and Soda (Soda et Potassa Tartras). — This   ij
is one of the mildest, and most cooling purgatives among the salts.  It   |j
is known as rochelle salt, and generally agrees well with irritable and
delicate stomachs.  Dose, from two drams to an ounce, in a tumbler-   j
ful  of water.   The gentle  physic  called seidlitz powders is composed   j
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   11
itself; one  solution  is then poured into the other, and the whole is   j
drank during the effervescence.                                       j

  Solomon's Seal (Convalaria Multiflora). — 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   j
mucous  tissues, and has therefore found its use in  chronic dysentery,
and  piles, and in  chronic inflammation of  the  stomach and  bowels.   j
Dose of the decoction, or infusion, from one  to four fluid ounces, three   i
or four times a day.  Large doses purge and vomit.  The decoction,   i
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 Folder's solution.   j
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   I
dose is from  three to ten  drops,  three times a day, given  in water;   n
generally, it is better not to go beyond five drops.  Sometimes it dis-
turbs the stomach, and binds the bowels, producing headache, dizzi- 
C'>*           MEDICINES AND THEIR PREPARATIONS.
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  France, 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, iu 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,  leucorrhcea, 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
of tincture, mixed with various solutions, to produce irritation  and
redness of the skin.

  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
six-grain doses, in pill form, and it is said with good effect,' 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  JEtheris Nitrici). — The general
reader will  know this article  better under the  name of sweet spirits
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.          650
 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 Crass (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 bitter 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: 
606           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 Ignatii).— 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 gonorrhcea  and  gleet.   The dose is from ten to twenty
grains.  Storax is a constituent in the compound tincture of benzoin.
Fig. 227.                             Fig. 228.
*           STAB *GBA8S.                          STBAMONItTM.
  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^rops; solid
extract, dose, half a grain to a grain ; tincture, two ounWs 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 org ins 
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,
j   mixed with syrup, molasses, or milk.   When sublimed, this article is
j   called flowers of sulphur, which is the form in which it is chiefly used
|j  in medicine.
      Sumach (RJius 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 diarrhcea, dysentery, gonorrhcea, whites, hectic fever, and scrofula.
   The berries make a valuable gargle in quinsy, and ulcerations of the
 j  mouth  and throat, and also a useful wash for ringworm, tetter, and
   ulcers.   The excrescences  which grow upon  the leaves, have  nearly
 i  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 Ser'icea).— 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 willow, and rose willow.   The bark is tonic,
   stimulant, and astringent, and has been used for similar purposes with
 I  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
 l  the infusion, from two to four fluid ounces.
jl     Swamp  Milkweed (Aselepias  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
j   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.(tarns ;  syrup, four ounces fluid extract to twelve ounces
   simple syrup*ose, 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 diarrhcea, 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 
Co8
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; infpsion, two
ounces 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 Brights 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^t dan-
gerous when much used, even externally.

  Trailing Arbutus (Epigaa Repens). — This grows idHtady woods,
and rocky soils, its flowers  appearing in  early spring, aria 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 is 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 djjmted alcohol, dose, two to  four drams; infusion, half  an
 ounce to a^^it 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, three 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
iias a good effect as a  gargle in putrid sore throat, etc., and as a cool-
ing wash  in headache  during fevers.
Fig. 22».
Fig. 230.
VIRGINIA SNAKE-ROOT.
Fig. 231.
  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 M
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
HOr.EHOUND.
  Water Horehound. — This article has been described
under  Bugle  Weed, but  the  cut was forgotten.   See Bugle  Weed
(Lvcopus 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.

  Wrax. — 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, leucorrhcea, 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 (Nympheea 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, diarrhcea, 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-
corrhcea.  Dose of the infusion, from two to four fluid ounces.

  Wild ClMfcry (Primus 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 
G62           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 colt's-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 IHDIGO.                       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
		UMLjmBI
	m	W^i^imM
PS	rV	
HI	m	
 
MEDICTNES 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 four 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 diarrhcea 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.

  Winfergreen (Gaullheria Procumbens). — This evergreen grows in
mountainous, barren regions, throughout  our country.   The leaves are
an agreeable stimulant, aromatic, and astringent.  Used for chronic
diarrhcea, 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 diarrhee'a, dysentery, and excessive mucous discharges.   It 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.                        WOBMWOOD.

  Wolfsbane (Aconitum Napellus). — This has already been described.
under its other common  name, which  is Monkshood,;  but as the cut
we  had  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 (Clienopodium Anthelminticum). — This perennial is called   ,
Jerusalem oak, and is found in waste places all over the United State*.   \
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.                 I
  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   I
digestive organs, and is also  useful in amenorrhcea.  It  is excellent
applied as a tincture, or in the form of fomentation, to bruises, sprains,   i
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
rever, bleeding from the lungs, excessive menstruation, win$ colic, and
chronic dysentery.  Dose of the infusion, a wineglassful, three or four
times a day.
  Yeast (Cerevisia Fermenlum).—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   yeluw 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 that its general use
involves far less danger.                                               j
  Preparations. — Fluid extract, dose, two to twenty drops ; tincture,   j
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   j
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   j
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-   I
retic.  It is valued  in the treatment of scrofula, syphilis, skin diseases,
gout, rheumatism, dyspepsia, general debility, and  chronic inflarama-   I;
tion of  the stomach and bowels.  Dose of the decoction, from two to
four fluid ounces, three times a day  of the solid extract, from two to
four grains.                                                          I

  Zinc.— Several preparations of this metal are used in medicine, as   ij
follows:                                                             j i

  Acetate of Zinc. — This is used as  an external remedy only, gener-   i|
ally as  an  astringent wash for inflammations of the  eye, and  as  an   ij
injection in gonorrhcea, but only after the acute stage of these diseases   |!
has past.  The strength of these solutions generally should be one or   j,
two grains to a fluid ounce of soft water.                              j
  Chloride of Zinc  (Zinci Chloridum).— This is a powerful escharotic,   |;
and is employed as an external application  to cancers and obstinate   i!
ulcers.   A weak solution  of it is occasionally employed in old chronic   jj
gleet, also in whites,  and purulent discharge from the  neck of the   i!
womb.

  Iodide of Zinc (Zinci  lodidum).— This  is  in the  form  of  white   :i
needles, and is tonic  and astringent.  It is  not much used, except   j
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,   j
or a piece of sponge tied to the end of  a stick.                         j j

  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 
MEDICINES AND THEIR PREPARATIONS.
article of equal efficacy.   It is sprinkled externally upon excoriated
surfaces, and is used in ointments.  Dose from two to eight grains, in
the form of pill.

  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 intermittents, 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 gonorrhcea.

  Valerianate of Zinc  (Zinci  Valerianas). — 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
 1-ad, 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.

   Componiid-Resiii 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 Deshler's 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, each 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
canlharidin, 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. 
6C8
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 diarrhcea 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 one ounce to a pint of water, and the dose of the decoc-
tion, from one 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
course, are similar  to the oils  from which they are prepared.   They
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, of
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
obtained  by the use of water are called aqueous, or watery  extracts;
those by means  of alcohol, alcoholic extracts; and those by both alco-
hol and water, hydro-alcoholic extracts.
   Extracts are  generally prepared on a large scale, by persons who
make a business of it.   Like other articles, many  of these prepara-
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
house of  Tilden &  Co., at  New  Lebanon, New  York, as worthy of
public confidence.   Most of their solid extracts, with the proper doses,
are mentioned in previous pages, under the several articles from which
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
injured  by heat in their preparation, and not  requiring to be taken in
large doses.   Great skill is required  in their preparation, and they
should  always be obtained from  those who  have the reputation of
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
either in  the application of cloths dipped  in  hot  water, or some hot
medicated decoction, and applied to the affected  part, or, of bitter or
anodyne herbs steeped in  vinegar or water, and  then, while hot, en-
closed in a muslin bag, and laid upon the diseased place.   In either
case, whether the  cloths wet in a decoction of the herbs,  or the herbs
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 hotlrs, and strain.   An excellent
form for using  gentian.  Dose, one fluid ounce, three or four times a
day.
  Compoimd 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.
  Compoimd Infusion of Senna. — Take  of senna and  manna, each,
one  ounce; jalap, cream of  tartar, and caraway seeds, bruised, each, 
MEDICINES AND THEIR PREPARATIONS.           67 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. 
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, iu 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 pfnt 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 anodyns
application to  sprains,  bruises, and painful tumors, etc.

                     Medicated  Waters.

  Those preparations consisting of water impregnated with soma
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
  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.

  Camphor Water.— Take two drams of camphor, forty minims of
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
tJban 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 leucorrhcea and other female complaints.  Dose, from
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.
  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.
                          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 (Wliite 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, diarrhcea, 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.                            j

     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   J
   ounce of lard ; mix them.                                            i
     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;   h
   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
1   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
I   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  on.e 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, molasses, 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 ounce of resin, half an ounce
   of yellow wax, and four ounces of  lead  plaster; melt them all to-
   gether, over a gentle fire.
 I    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 C|J, with  half
   an ounce of camphor dissolved in them, and 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. 
6-0           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.


                   Po-ultices.— 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 to 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
  O.it 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 on§ 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-
cluded 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 amenorrhcea, 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 diarrhcea, dysentery, etc.  Dose, from fifteen to thirty
grains.                           4
  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 for diarrhcea,  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 diarrhcea.  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. 
MF.DICLNES 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 diarrhcea, 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 diarrhcea,  cholera morbus, dysentery, summer com-
 plaint of children, sour stomach,  heartburn, etc.

   Worm Powder. — Take one ounce each  of powdered white Indian
 hemp root (asclepias 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 
6S4           MEDICINES AND THEIii 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  sugar 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 water.  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
  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
     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-
  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
  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 whole   |
    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-   j
    sumption, on the authority of Dr. Churchill.   It  is elegantly manu-
    factured  by  Dr.  James R. Nichols &  Co., of  this city.  Dose, a tea-   j
    spoonful, three times a day before meals.
      Syrup of Ipecacuanha. — Take one ounce of ipecacuanha, in coarse   ij
    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   j
    ounces, filter again, and add water to make the liquor measure a pint;   j
    then add the sugar, and proceed as directed for syrup.
      This is chiefly used in complaints of children.   Dose, as an emetic,   j
    for  an adult, two fluid ounces;  for a.child a  year or two  old, one or
    two  fluid drams.  As an expectorant, for an  adult, two fluid drams;
 I   for a child, five to twenty minims.                                    j
      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
 i   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
ii   heated.
 j     This  is a warm  cordial laxative, admirably fitted  for the bowel
    complaints of infants.  Dose, a fluid dram, repeated  every two  hours
    till it operates.

j     Syrup of Seneka.-r-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. 
P^G           MEDICINES AND THEIR PREPARATIONS.
     It is  a useful expectorant fof coughs  and bronchial affections of
 ;  infants 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 Wild-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
 i  with various  other articles in prescribing  for dyspepsia, consumption,
 !  etc.
 i
     Compound  Syrup of Partridge Berry. — Take half a pound of par-
   tridge-berry, and two ounces each of helonias, blue cohosh, and high
 j  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,
   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
   drains 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
   twenty fluid  ounces, three pounds of sugar, and  fifteen drops of oil
   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
   water.   Mix  the solutions, and wash the precipitated phosphate of
   iron till the washings are tasteless.
     Dissolve the phosphate of lime in four fluid ounces of boiling water,
   with sufficient muriatic  acid to make  a  clear solution, precipitate it
   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
   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
  Compound Syrup of Rhubarb and Potassa (Neutralizing Cordial).—
Take half a pound each of powdered rhubarb and bicarbonate  po-
tassa, and four ounces each of cinnamon and golden  seal; macerate
for four days in one gallon of best fourth proof  brandy.   Express the
tincture with strong pressure, and add to it two fluid drams of oil of
peppermint, previously dissolved in  a little alcohol.  Break up  the
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
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 Sarsajparilla. — Take a  pound each of sarsa-
pariUa, 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 sarsapariUa, 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.
  This is a valuable alterative syrmj-and is used for syphilis, scrofula,
diseases of  the  skin,  etc.  It  is "imten improved by adding  half an
ounce of the iodide of potassium to  each pint of the syrup.   Dose, a
tablespoonful.
  Compound Aromatic Syrup of  Senna. — Take four ounces of senna,
one  ounce and  a half of jalap  root, half an ounce of  rhubarb, one
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-
solve in it  one  pound of refined sugar, and add one dram of oil of
lemons.
  An excellent cordial physic.
  Compoimd Syrup of Stilling'ia.— Take a pound each  of  queen's
root and turkey corn ; half a pound each of pipsissewa  leaves and
elder flowers;  and four ounces each of prickly ash berries  and carda-
mom seeds.  Grind all the articles, mix, and place them in a jar, and
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 the1 directions for compound syrup of stilfingia, 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.

   Foil 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 tinctures
 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  Ounces  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.          68^
i  Four Ounces to  a  Pint of Alcohol:
     Nux Vomica, Ginger,  Guaiacum, Black Cohosh
  Four Ounces to  a  Pint of Diluted Alcohol:
     Yellow Jessamine, Prickly-ash Berries, Ergot, Matico.
     The following tinctures embrace those which vary from the above .
  proportions among the simple tinctures, and also the compound tinc-
  tures :
     Tincture of Orang'e Peel. — Take three and a half ounces of dried
'  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-
   enne, and two pints of diluted alcohol.   Macerate fourteen days, and
   filter through paper.
     Tincture  of Catechu. — Take an ounce and  a half of catechu, an
   ounce of bruised .cinnamon, and  one pint  of diluted alcohol.  Let
;   them stand together two week.s, frequently shaking; then express and
|   filter.
i     Dose, from thirty drops to a tablespoonful.

     Tincture of Cinnamon. — Take an  ounce and a half of powdered
I   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.

i     Elixir Vitriol. — Take half a pint  of  alcohol;  drop into it seven
t   fluid drams of sulphuric acid, and let the mixture stand  three days in
1   a close  vessel; then add  two drams  of powdered ginger, and three
!   drams of powdered cinnamon.   Macerate seven days, and filter.
     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.
I     Dose, as a nauseant or expectorant, from thirty to sixty drops.

     Tincture of Opium (Laudanum). — Take two and a half ounces of
                                    o7 
690
MEDICINES AND THEIR PREPARATIONS.
 opium, and two pints of diluted alcohol.   Macerate  fourteen days,
 express, and filter through  paper.   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  stales 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 proprieiatis, 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.
i     Compound Tincture of Black Cohosh. — Take one fluid ounce of
;   tincture of black cohosh, half a fluid ounce of tincture of bloodroot,
j   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
j   ergot, two fluid drams of oil of savin, and twelve fluid ounces of
i   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   j
   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,   j
   in leucorrhcea, gleet, etc.
     Ammouiated Tincture of Guaiac. — Take four ounces of powdered
i   guaiac,  and a pint and  a half of aromatic spirits of ammonia.   Mac-
   crate 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
1   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   jj
   brash, soreness of the chest, etc.  Dose, a teaspoonful in a wineglass-
|   ful of water.
     Compound Tincture of Ilijrh  Cranberry. — Take one ounce of high   i
j   cranberry  bark, powdered, half an ounce each  of powdered  lobelia
   seed  and bruised skunk cabbage  seed, two  drams each of bruised 
692
MEDICINES AND THEIR PREPARATIONS.
stramonium seed, powdered bloodroot, and capsicum, and  two pints
of alcohol.  Macerate two weeks, express, and filter.
  This is an Eclectic remedy, and is useful in nervous and spasmodic
complaints, particularly  hysterics, etc.  Dose, from twenty drops to a
teaspoonful.
  Compoimd  Tincture of Lavender. — Take three  fluid drams of oil
of lavender, one dram  and a half of oil of anise, one ounce of pow-
dered cloves, three drams of mace, one ounce of raisins, two ounces
of red saunders, and one gallon of Jamaica rum.   Mix, and macerate
fourteen  days ;  then  express and filter,
  This is often  use*d for flatulence, hysterics, and faintness.  Dose,
from one to three teaspoonfuls, in water.

  Compound  Tincture of Lobelia (Dr. J. King's Expectorant  Tincture).
— 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
express and filter.
  A valuable emetic for infants and children, in croup, hooping-cough,
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
of diluted alcohol.   Mix, macerate fourteen days, and filter.
  A prompt antispasmodic in cramps, spasms, lock-jaw, etc.  Dose,
half a dram to a dram.
  Compound Tincture of Myrrh  (Hot Drops). — Take four  ounces of
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
stomach, flatulence, etc.

  Camphorated  Tincture of Opium. — Take one dram each of pow-
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
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-
dren to allay  cough,  and to relieve pains, diarrhcea, 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, rapped, and twenty fluid ounces of diluted alcohol.
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  (Sweet  Tincture of Rhubarb).—
Take two ounces and a half of bruised rhubarb, six drams of bruised
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
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.

  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
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
twenty-four  hours;  then place  the whole  in  a  vapor displacement
apparatus, and force through  the mixture, the  vapor of another pint
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 drains of thoroughly dissolved alcoholic extract of mandrake.
   This  is  tonic, diuretic,  and aperient   Useful in dyspepsia, etc.
Dose, a tablespoonful three times a  day.

  Ammoui'.ited 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
necessary. 
094           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.
   Brandreth'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.
   Prey'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 da v.   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 call 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 obstrubts  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
eAtends 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.  I may 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 throat
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,  one  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 pui^ 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; 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, moral 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 ; bareing 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 the  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
                 The 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.
701
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
everywhere, acting like salt and leaven in human society, are the work
of their hands,  but society, and government itself, have been handed
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.

   Loneliness of the Aged. — The old are left, in  some sense, alone in
the world.   The age in which they had their active  being  has  gone
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.

j!  that they often yield to melancholy reflections. The young have their
j   companions, and their sports. The companions of the old have mostly
|   gone;  and for sports they have no agility.  Cut  off from the present,
I   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
 i  old, it  would be to us a source both of profit and pleasure.  To a
 j  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.

 i    Helpless Dependence of the Aged. — No one thing should tend more
 j  to excite our pity, compassion, and kindly feelings for old people, than
 j  their helplessness and dependence.  It is one  of  the  best indications
   of humanity to  deal  gently with the weak.  The  old are in  their
 i  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 so 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
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 Old  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
to attain length of days than those who have descended from  short-
lived ancestors;  yet the  influence of correct habits  may add quite as
many years to their lives.

  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
themselves to change.   Xhe 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.
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
!   the necessity of forming good habits in early life!
     Even the  hours  of  taking  meals should  not be changed in the
I   decline of life.   Removing to  new climates, and forming new social    \\
•   relations by  those advanced in  years, is  not  favorable to length of    l;
   days.  Old trees do not often take root and live long when transferred    ||
   to a new soil.                                                       \

j     Diet. — The food of old people should of course be  easy of digcs-
j   tion.  It is often the case that  they bear made dishes such as  " hash,"
   so called, better than plain boiled or roasted meat.   This can only be    'j
   explained on the ground that  the meat is chopped fine, and  is more    ij
   thoroughly cooked.

     Mode of Cooking Meats. — This leads  me to speak  of the  best
   methods of cooking meats so that they may be tender.
     The flesh of all warm-blooded  animals  is identical in  composition
!   with that  of human beings.  That the flesh of animals used  as food,    i
!   therefore, may form flesh in the human body in the easiest  manner,    ^j
   none of its essential constituents or parts should  be  taken  from it
j   during the process of cooking.    If any  one of its  constituents is    i
   extracted, it  will no longer be like human flesh; and  that lost part    {
   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
I   used, and the length of time employed in the process.                   !
     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
   water and  helps form the soup.   Hence the proper way is to put the
t   meat into cold water when it  is  put over the fire, and  let  it.come to    j
j   the  boiling  point very gradually; during which time  the juicy part    ii
11   has a chance to  dissolve out, and, uniting with the water, make rich    ;
   soup.                                                               i
     But when  the meat  is.to be boiled simply, and eat as  boiled meat,    ,|
|   we should aim to retain  the juice within it, that we may retain the    ij
!   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    !
J   putting the meat suddenly into boiling water almost instantly hardens    ;i
   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    '!
   the  meat  from running out into the water and being lost   Keep the
   meat iu the  briskly-boiling water a few minutes, then  pour in a little
j   cold water to reduce the temperature slightly, and keep  it in this some-
I   what reduced temperature until it is done through.
j     Broiling and  roasting  are  pretty generally  understood,  and. are
I   done well enough where persons are disposed to take pains.   Frying    ij
i   is an abomination ; and should be banished from all civilized house-    j
I   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
I  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 sutler 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
i                       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  an
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 tne 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.                707
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-
en back 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 hot 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.  Th'*
 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.
   I/irgcr 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.                709
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 few
complaints, however, which are peculiar to the old, of which I must
briefly  speak.
             Bronchial  Flux. — 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
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 cause must be searched out; and then, while 
710                OLD AGE, AND ITS DISEASES.
the general remedies for asthma must  be employed,  the  particular  |
thing 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  ;j
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 columbo, 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  I
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 pf dis-
eases occurring  so very often in old  age, and in so many cases  mak-  j
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  j
to be thought of in the case of old people.  Other remedies must  be  j
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.                                        j
                                                                   i
                                                                   r
               Pulmonic  Cherry Cordial.                  j
                                                                   i.
   Wild-cherry bark, ground,  10 pounds;  ipecac root, 20 ounces;  '
blood root, 24 ounces;  squill  root, bruised, 12 ounces; pulverized  j
liquorice root, 5 ounces; cochineal, bruised, 2 ounces; anise seed, 32  j
ounces; fennel seed, 8 ounces ;  orange peel,  16 ounces; acetate  of  j 
OLD AGE, AND ITS DISEASES.                711
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' °ive 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-
affeled  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.
Boih 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.                          71^3
 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.

  " Wc 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 vdlume, known as " Tlie 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 vftgue, 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 aud 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-rubber  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 orle 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 CULTURE.
   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.      j
      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   i
   all have  good  digestion without a gymnasium.  But in a world  of   j
j   vexation and  disappointment,  we  are driven to  the  necessity  of   j
j   muscle culture, and other hygienic  expedients, to give  the nervous
i   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   j
   such as will bring  into varied combinations and play all our muscles   i
i   and nerves.  Those exercises which  require  great accuracy, skill, and   j
|   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
j   lifters.
      Another point I take the liberty to urge.  Without accuracy in the
J   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 writh 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,   I
   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-
;   fide nee 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   j
   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 ;  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 hoursT
   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, I 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 ftiore 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.
 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.  1?
 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.
   .Last 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
 by the process  ?  Would not the brain, which had only slow exercise
 in  his isolated life,  become bold,  brilliant, and dashing,  by  bold,
 brilliant, and dashing efforts.
   A farm bqy has slow, heavy muscles.  He has been accustomed to
 heavy exercises.  He is transferred to  the circus, and  performs, after
 a  few years training, a  hundred  beautiful, splendid  feats.  He at
 length reaches the matchless  Zampillaerstation of  Wm. Hanlon.
 Does  any one  think that his body has  lost power in  this brilliant
 education ?
   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
movements 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

    No. 1.  The position is shown  in Fig. 1.  Thumbs outward.  B.ils
 exactly horizontal.  Turn the thumb ends of the bells to the hips, and
 then back 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 limes.   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.
five times.
Left, the  same.   Alternately and  simultaneously, each
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 11.                                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.  The
chest is pushed 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 five 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.
  No. 15.  Stand  upright, hands by the side.  Raise the right hand,
as shown in Fig  15, five  times.  Left, the same.  Alternately and
simultaneouslv, five times.
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
Fig. 19.                      Fig. 20.
of the dotted line in Fig. 16.   Repeat five times.  Left hand the   |
same.  Alternately and simultaneously, five times.                    i
  No. 18.   Stand upright, arms hanging.  Raise  the right arm to   j 
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
info 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.
<J4) 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
|   together, body  erect, chest forward, shoulders back, arms  hanging,
    dumb-bells horizontal and parallel  to  each other.   Step diagonally
Figure 26.
Figure 27.
          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  on the next beat thrust
                           them as far upward as possible, rising on
the toes ; then back to the chest.  Repeat twenty times.
Figure 30.
Figure 31.
No. 31.   Standing erect, dumb-bells on the shoulders  (not on the 
PHYSICAL CULTURE.
chest), thrust the right 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
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
  y^"^.  S"\ /"\  / ' \ /*"\   room, the ropes fastened on the
 /    \f   \f    n    A    )   s^e °^ *ne room ^n*° staples, and
 y  J y yy  /vyVy   on the* other running through pul-
               Fi  rel              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.
(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
right hand.  The one who catches must receive it, while the left hand
grasps the arm in the same way.  ■
  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 game,  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,           Figure is.
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
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
                   Figure 1.                    Figure 2.

these rings, with another man of equal strength, the fullest opportu-
nity to  exert his utmost strength ; while the frailest child, engaged
with one of equal strength, would never be injured.
  There is not a muscle in the entire body which may not be brought
into direct play through the medium of the rings.  And if one partic-
ular muscle, or  set of muscles is especially deficient or weak, the ex-
ercises may be concentrated upon that  muscle or set of muscles.
  Wherever these rings are  introduced,  they will obtain the highest
favor and  awaken the most earnest enthusiasm.
  The ring is generally turned from cherry wood, and when finished
measures six inches in diameter, while  the body is one inch thick.  It
should be  highly polished, especially on the inner part.  Fig. 1. gives
a good idea of the ring.
  No. 1.  Standing in the position represented  in Fig. 2, the end of
the right toe against the right toe of your partner, the toes meeting on
 
PHYSICAL CULTURE.
739
a straight line 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 ri'<mt
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.
K«nre 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 rin»s
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. 12.   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 hcmd 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
Figured                             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.                          Fi^e ^
  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 4ast, with the feet changed.
                  K^re 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 time to
the music.
  No. 36.  Turn face to face, and now back to back, and again face 
PHYSICAL CULTURE.                    745
to face, arid 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-
                Figure 21.                            Figure 22.
      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.
I      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 whicfi  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
       Figure 25.         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.
It.
 
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.
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
experiments, I believe this series gives the  best variety, and is suffi-
ciently extended.   Besides, this series is admirably calculated to de-
velop those particular muscles which are almost universally deficient
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
upon the arms, and of course upon the degree of freedom with which
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
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  shoulder 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.   Same  as the  last, except every second time the  wand  is 
PHYSICAL CULTURE
749
brought down to  the  chin, being careful  that every
wand is carried  upward, it is carried as high as pos-
sible, and with much force.
  No. 6.   Hands oyer* 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.                        Figures.
  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 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 cud,
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 oack 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 tar  as
you can reach.   Bring it back to the other foot   Stil using the right
foot, step sideways to the left as far as you can  reach, passing it  by
the  eft leo- behind (Fig  16), now back to the other foot again.  Pass
ii; to.theleft agatojn front of  the left leg (Fig. 17), and bring it back
to the other foot  Continue this round 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,"
Figure 22.
Figure 23.
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
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
  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
sideways 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<riit foot, bring the wand down so as to strike  your 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

I     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-
i   ing it as the  right foot goes forward.
\     No. 62.  Cross  the hands on the two  wands placed side by side,
i   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.
1     No. 63.  Walking one in front of the other, and extending the arm*
;   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   j
|   possible.  When the left foot comes forward, let the left hand come
I   forward too,  and thus alternate.                                      j
     No. 64.  Same  as the  last, except that the  right hand  comes for-   j
i   ward with the left foot, and vice versa.                                I
     No. 65.  The same,  simultaneously  with the  right foot and with   j
 j  the left foot.                                                         j
     Be careful in the performance of the last four, that  you keep  the   J
 I  arms  exactly horizontal from first to last.
     No. 66.  Walking one hi front of the other, with the wands hang-   j
ji  ing in  the hands on  either  side, carry one up as  high  as you can
ji  reach, as  in  Fig. 25, and then  as  the  other foot  goes  forward, carry   j
   up  the other  while the first is brought down.
      No. 67.  Same  as last, except the right  arms goes up  as  the  left   j
   foot goes forward, and vice  versa.
;     No. 68.  Simultaneously up, with the right foot forward, ten times,   j
   and the same with the left foot.
     It  is perhaps unnecessary to repeat that every  motion with  the   j
   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.
 1                      Gymnastic Crown.
 1
      Bearing burthens on the head results in an erect spine and an elas-
!j  tic gait   Observing  persons who  have visited  Switzerland, Italy, or
jj  the  Gulf  States, have  observed  a thousand  verifications  of  this
jj  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
j   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 wajking ; 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
inyigoration 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-
 
I
                         PHYSICAL  CULTURE.                   759
   tional education.   They clearly saw in  a physical redemption, the   j
I   foundation of a  political redemption.  The great German heart turns   j
   to-day toward these great  gymnastic reformers  as the  salvation t f
   their noble nationality.
     It may be justly claimed that among all the great and good patriots
1   who have devoted themselves to this momentous task, the great Schre-
   ber of Leipsic was the most eminent.   He was a voluminous author,   I
   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
 i  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.
des.cs in our  schools would  make us 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
school into hopeless invalidism, not in rare instances, but  as a rule.  As
the phrase goes, their  "education was finished," but they too were
finished.   Their spines were unable  to support their learned heads.
   Anxious fathers and mothers  besought school  managers to give
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
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-
in^ 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
scfence  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. Gannett'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, f scruple.  Mix.  To be'
taken in a wine-glassful of sweetened water.

                     Purges.   Cathartics.

  5.  Precipitated Sidphur, 15 grains; magnesia,  1 scruple.  Mix.  To be
taken 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 of
the very best remedies for piles. 
764                  PRESCRIPTIONS. —RECIPES.
   7. Roche le  Salts,  2 drams; bi-carbonate of soda, 2 scruple? ; 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 coara: powder, 2 scruples; hot water, 4 ozs.  Mix and boil for three minutes,
and strain.  This may be sweetened, and taken every morning for habitual cos-
tivene.-^, or repeated once in three hours, if an immediate effect is desire^.
   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-
tire iy 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  waicr, \ 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,
\ 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 oz.-.;  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-
 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; podophyllin,  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, -j^ 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;  podophyllin, 1  scruple;  apocynin,  1 scruple;
 ext. nux vomica, 6 grs.; castile  soap, 1 dram.   Make  30 pills.  One pill every
 night.

   37.   Siceet Tinct. of Rhubarb, 4 ozs.; bicarbonate of  soda, 2 drams.  Mix.
 From  a teaspoonful to a tablespoonful, as occasion may require.

   38.   Pidverizod 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 giv.; 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 Charcocd,  l£ drams ; pulverized rhubarb, 2 scruples ; pul-
 verized ipecac,  G  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. 
766                  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 teaspoonfuls 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 Pitt,  10  grs.;  pulv. gum  arabic,  5 grs.; magnesia, 1  dram;
white sugar, 5 grs.; comp. infusion of gentian,  1^ ozs.;  water, 1^ 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, £ 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,  \\ 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,
in fusion 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.; peppermint 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.
Mix.  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-lids become  inflamed, discontinue  for a few days, and then
begin again.
   59.   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.   Qu'nine, 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 tliree 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  of water
after each meal.
  74.   Precipitated  Carbonate of Iron, 30 drams ; 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,  1 dram;  hydrochloric acid, £  dram ;  comp. 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 piils.  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.  Abo 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, 24 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. Pill of Galbanum,  1 dram ; comp. pill of valerian, 1 dram. Mix.
Divide into 40 pills.   One or two pills three times a day.
   98.  Sulphate  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 sugai, 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 meab


                    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 
PRESCRIPTIONS — RECIPES
       105.  Infusion of Se7iega, 4 ozs.; syrup of ipecac, 1 dram ; syrup of squills,
     3 drams ; tartar emetic, 1 £ 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  day.   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.
 i
 j      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 ©zs.;
     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.   I
     Mix.  One  teaspoonful every hour, till narcotic effects are observed.             j;

       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.; tinctr cayenne, ItJ-  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, 6 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 oz-^.
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, l£ 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. 
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 Mercury, 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 SarsapariUa, 1 pint;  iodide of potassium,
 \ oz.  Mix.   Take a teaspoonful after each meal.
   139.  Compound Infusion of SarsapariUa, 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  SarsapariUa, 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, ^  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 sarsapariUa, 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
 RyruP> 2 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  16 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, A dram; pulverized ipecac, 3 grains.   Mix.  Make
 12 powders.  Give one, two or three times a day.

   159.  Pulverized  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 myrrhae, 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
 cinnamon, 6 drs.; tinct. cardamom, 2 drs.   Mix.   Dose. — A teaspoonful.  A
 valuable remedy in diarrhoea.


                         Counter-irritants.

   163.   Tincture of  Spanish Flics, 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.

   105.  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
 sticking 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.   Vinfgir 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, 1 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.   Prussic  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.   Sulphur et 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.   Napthalinc, 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-Mower  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, l,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.   Sidphuric 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, 1J  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.
  203.   Rose  Water, 4J ozs.; nitrate of silver, 2 grains.  Mix.

  209.   Sulphate of Zinc, 8  grains ; tannin,  1 scruple ; water, 5 ozs.  Mix.

  210.   Chloride of Zinc, 6 grains ; soft water, 2 ozs.   Mix.         f

  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.                         jl

  215.   Copperas, 1 oz.; soft water,  1 pint.   Mix.                            .|
  216.  Alcohol, 1 \ ozs.;  rose water,  4 ozs.  Mix.                              I
  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 be applied externally only.
  219.  Nitrate of Silver, 1 ^ drams ; soft water,  1 oz.  Mix.                    !
  220.   Wlvite Vitriol, 1 dram ; rose  water, 3 ozs.  Mix.   Apply outwardly.
  221.   Hydrocyanic Acid,  4 drams;  sugar of lead, 15 grains; alcohol,  1
drams ; water, 7 ozs.   Mix.  Apply externally.
  222.   Corrosive Sublimate, 5 grains ; almond mixture, £ pint.  Mix.  Apply
externally.
  223.   Rose Water, 4 ozs.; pulverized borax, £ 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, h pint
Mix.  For external use.                                                      j
  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.                                                            j
  227.  Sugar of Lead,  3  grains;  soft water, 1 oz.  Mix.  As a  wash in    j
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,    I
 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 applied, with a
 camel's hair pencil,  to the  gangrenous ulcers of the mouth  after runnmg 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.

   2 10.  Tincture  of Arnica, J oz.; cold water, 4  oz«.  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, ^ 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.
   241.  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
 an hour, and strain.  Put a teaspoonful in a child's mouth once an hour, in ma-
 lignant scarlet fever.

                               Injections.

   246.  Castor  Od, 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, \ 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, 1 pint.  Mix.

   250.  Epsom  Salts,  1 oz.;  senna  leaves, -J- 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.; castor 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,  1^ drams ; white vitriol, 1£ 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  Salf, 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 of Spanish flies, 2 drams ;  oil of rosemary,
10 drops ;  oil of lavender,  10 drops.  Mix.  Apply cautiously.   If soreness
of the scalp is produced, omit for a short time.
  258.   Castor  Oil,  2h pounds; strongest  alcohol,  2\ pints; pulv. Spanish
flies, £ oz.; oil of burgamot, 2 J 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.   Slaved 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.   Sidphur,  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 drum.   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  sug:u-, 2 drams;
oil of partridge-berry, 5 drops.  Mix.  Take a table-spoonful throe 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,  \ oz.;  honey, 4 ozs.  Mix.
  276.  Hydrochloric Acid, 1 dram ; honey, 1 oz.   Mix.  For touching large
curdy patches in sore mouth of children.  x
  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. Blood-root, |  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, J 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. af 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 the whole to  a
coarse p< wder, 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 ; diacalon plaster, 312
parts Mnx, rosin, turpentine,  each, 16 parts; ammonia, bdellium, each, 5 parts;
olibanam and myrrh, each, 5 parts; saffron, 3  parts; spirits of  lavender, 2 parts.
Mix, and spread. 
780
PRESCRIPTIONS. — RECIPES.
   289.  Populin, 20  grs.; sanguinarin,  10 grs.;  pulv. white  su,";ar, 30  grs.
 Rub  well together, and  divide into 16 powders.   Take one foui- 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, 1^ ozs.;  wine of colchicum-root, \ oz.;  sulphate
 of  morphia, 1 gr.;  magnesia,  1  scruple.  Dose. — One  tea>poonful  three or
 four times a day.  Excellent for rheumatism.
   302.  Cream of  Tartar, 1^  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. Pidv. Alum, ^ dram; white precipitate,*1  grain.  Rub these  well  to-
 gether, and  place the  powder, in a bottle;  then  add H  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 timet  a day in
 gonorrhoea.
   305.   Tannin, 3 grains ; ext. belladonna, f grain ;  ext. conium, 2 V 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 applied 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 using 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 £ 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
liver.
  314.   Rose Leaves, 1 scruple ; boiling  water, 8 ozs.; diluted nitric acid, 21
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.   Pu7vcrized Rhubarb, 12 grains ; carbonate of magnesia, 1!^ 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, J ounce ;  tincture of ginger, J 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 potassse, 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
i  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, 2£ 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, h 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
   caake an ointment. 
PRESCRIPTIONS—RECIPES.                   783
  337.   Iodide of Lead, 1 scruple; glycerine, 1 dram;  spermaceti ointment, 2
ozs.  Make an ointment.
  338.   Rhubarb Pulv., \ oz.; spearmint herb, pulv. \ oz.;  pulv. cascarilla, \
oz.;  pulv. bicarbonate  of potassa, £ oz.; pulv. wild cherry bark, £ 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.
  34 4.   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 l\ 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 Poicder, 15  grains; leptandrin, 5 grains.  Mix.  Divide  into
ten powders.  One every three hours, for a child. 
784                  PRESCRIPTIONS.—RECIPES.
     355?.  Dover's Powder, 15 grains , calomel, 5 grains.   Mix.  Divide into ton
   powders.  Give one every three hours to a child in croup.
     353.  Hydrochlorate of ammonia, £ oz.; diluted acetic acid,  }, oz.; alcohol, \
i   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,
j   equal parts, and water enough to dissolve them.   Mix.   An excellent freezing
   mixture.
• 
PRONOUNCING  DICTIONARY.... GLOSSARY.
  Ab-do'men.  The belly.
  A-ce-tab'o-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 suck up  substances from within,
ok 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-
ually reestablish health, without sensibly in-
creasing  the  circulation, or augmenting  the
perspiration, urine, or other excretions.
  Ai/veo-lar.  Relating to the sockets  of
the teeth.
  Ai/vine (AVvin).  Relating  to the intes-
tines, as  alvine discharges, — discharges from
the bowels.
  A-mor'phous.  Having no regular form.
  Am-xi-ot'ic Liq/uid.  The fluid surround-
ing the fetus in the womb.
  AN'-ies-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/cu-l^e.  Animals so small that
they can only be seen with a microscope.
  An-ce'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 ptomach and bowels.
  Ant-ai/ka-lies.  Agents which neutralize
alkalies.
  An-ta-phko-dis'i-acs.  Agents which les-
sen or blunt the sexual propensities.
  An-tiiel-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-bpas-moi/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.
  A it-top's y. 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.
  Buu's^e  Mu-co'sa.   Small sacs, situated
under tendons, about the joints, containing a
sticky fluid.
  Cai/cit-lus.  A solid,  unorganized body
formed  in the kidneys, or bladder, and called
a stone.  The plural is calculi.
  Cap'it.-la-ry.  Small; resembling a hair.
  Capsule.  A membraneous bag, enclos-
ing a part.
  Car'ti-i.age. Gristle attached to the ends
of the bones.
  Car-mix'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
bowels.                   ,  .  „,   .  „,,
  Cer'vix.  The neck.   Cervix U'ter-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-thar'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'qca-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.
  Cox'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
stomaeh.
  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-
ing.
  De-liq'ui-um.  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.
   IIis-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-nus'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 Di8-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 svstcm, so  as to make the  discharge of
mucus 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'ciiar.  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.
  Feu'ri-fu-ges.  Medicines which  assuage
or remove fevers.
  Fla'tcs.   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.
  Fur-fu-ra'ceous.  Branny, or scaly.
  Gaxg'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.
   Grav'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.
   H,e-mop'ty-sis.  Raising  blood from the
 lungs.
   He-mi-cra'ni-a.  Pain on one side of the
 head.
   H^m'or-rhage. A flow of blood.
   HjEM-or-rha'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.
   Hyp-not'ics.  Medicines which cause sleep.
    Ich'or (Ik'or).  A thin, watery, and acrid
  discharge.
    In-ter-cos'tal.  Between the ribs.
    Lar'ynx. The top  of the wind-pipe;  the
  cavity which contains the 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.
  Maoer-a'tion.  The act of softening or
soaking a thing by letting it stand in water.
  Mac'l-l.b.  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'tiox.  The act of exciting th«
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'sus.  That part of the  foot be-
tween the aukle 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'ro-lent.   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-oVo-gist).  One  who
explains and classifies diseases.
  Nu'cle-us. A central spot.
  Nu-cle-o'lus.   A spot within a nucleus.
  Or-thop-nos'a. Great difficulty of breathing.
  Os U'ter-i.  The mouth of the womb.
  08-si-fi-ca'tion.  The formation of bone.
  O'vum. 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-cen-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-ent.  Bringing forth, or giving
birth.
  Par-tu'ri-ents.  Medicines which promote
child-bed labor, by causing contractions of the
womb.
  Par-ttt-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 tcsticlps.
  Per-i-os'te-um.  A thin, hard membrane,
covering the bones.
  Per-i-08-ti'ti8.   Inflammation of the peri-
osteum.
  Per-i-to-ke'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.
  Pha-lan'ges. The bones of the fingers and
toes.
  Phar'ynx.  The upper part of the throat.
  Phleg-mo'nocs In-flam-ma'tion.  Inflam-
mation  marked  by redness,  heat, and pain,
and a tendency to form matter.
  Prog-no'sis.  The art of foretelling the
termination of diseases.                    i
  Pty'a-lism.  Salivation.
  Pri'a-pism.  A continued  erection of the
penis  from exciting, morbid causes.
  Re-frig'er-ants.   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'cientb.  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 wiiich  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'tum.  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 (Sliif).   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'mocs.  Scaly; having scales.
  Sor'des.  The dark matter  deposited upon
the lips and teeth, in low fevers.
  Ster'ncm.  The breast-bone.
  Ster'tor.  Noisy  breathing,  as  in apo-
plexy. Snoring.
  Ster'tor-ous. Snoring and noisy, as ap-c
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.
  Strtt'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-co-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.
  Tox'ics.  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 tho 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 courso
soft, knotty, purplish tumors.
  Ver'ti-go.  Dizziness; giddiness.
  Ve-si-caJtion.  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. 
		I N D E		X.		
		rxoi		txat		PAOB
Abdominal Cavity, Diseases			Alnmen,	692	Asarum Canadense,	662
of,		262	Amaurosis,	486	Asclepias Incarnata,	657
Abies Canadensis,		617	Amenorrhcea,	354	" Syriaca,	609
'' Excelsa,		602	American Hellebore,	592	" Tuberosa,	641
" l'icea,		602	" Ipecacuanha,	593	Ascites,	317
Abortion,		380	Ivy,	593	Asiatic Cholera,	290
Abscesses,		429	" Valerian,	665	Aspidum Filix Mas,	630
Absence of Menses,		354	Ammonia, Aromatic Spirit of, 594		Assafoetida,	594
Absorbent Vessels,		38	" Carbonate of,	693	" Comp, Tinct. of,	690
Acacia Catechu,		604	" Muriate of. " Poisoning by,	693	Asthma,	243
Accidents on Water,		496		496	Atmosphere, Pressure of,	108
11 by Poisoning, Acetate of Copper, poisonin		496	" Solution of Acetate		Atropa Belladonna,	612
			of,	594	Atrophy,	253
		" 497	" Water of,	593	Attendants, Unhired,	559
" " Lead, poisoning by, 498			Ampelopsis Quinquefolia,	593	Aurantii Cortex,	637
« u 4. ointment,		675	Amusements,	114	Auricles,	36
Acetum,		660	" Games for,	114	Ausculation,	210
Achillea Millefolium,		664	" Lighter,	115		
Acid. Acetic.		590	" Want of,	116	Balm,	694
	' Citric,	590	Amygdalus Communis,	591	" ofGilead,	695
	' Diluted Hydrochloric,	591	" Pereica,	638	Balmony, Balsam Copaiva, " Tolu. Balsam odendron Myrrha,	695
	' " Hydrocyanic,	591	Anagallis Arvensis,	647		695
	' " Nitric,	690	Anasarca,	318		595
	' " Sulphuric,	591	Anatomy,	14		634
	' Nitro Muriatic,	591	" of Bones,	18	Bandages, Wet,	549
	' Tannic,	691	Anchylosis,	466	Baptisia Tinctoria,	662
	' Tartaric,	591	Aneurisms,	472	Barberry, Barbers' Itch,	695
Aconite,		632	Aneurismal Tumors of Heart,	252		149
" Poisoning by,		499	Angina Pectoris,	260	Barley,	77
" Tinct. of,		688	Anise,	694	" Coffee,	679
Aconitum Napellus,		663	Ankle, Dislocation of,	463	Barosma Crenata,	601
Acorus Calamus,		658	Anthemis Nobilis,	606	Barrenness,	371
Adipous Sarcoma,		471	Anthrax,	434	Basilicon Ointment,	667
Affections of Chest,		574	Antidotes of Poisons,	496	Bath, Cataract,	634
» " Head,		674	Antimony, Poisoning by,	497	" Cold Foot,	639
" " Stomach and			Antipathies,	560	" Douche.	633
Bowels,		676	Aorta,	37	" Eye and Ear,	640
Affusion, The,		538	Apocynin,	597	" Half,	635
Age, Influence of,		121	ApocynumAndrosasmifolium	,597	" Head,	636
Ague Root,		655	Apoplexy,	160	" Hose,	634
" Fever and,'		413	Apparent Death from Various		" Leg,	.536
Air Cells or Vesicles,		35	Causes,	494	" Mouth or Oral,	641
" " Enlargement of,		234	Apple Water,	681	" Nose,	540
" in Chest,		236	Apthse,	899	" Plunge,	536
" Swellings,		283	Aqua Calcis,	628	" Shower,	534
" and Ventilation,		108	Arachnitis,	153	" Sitz,	537
Albumen,		15	Arachnoid,	45	" Towel and Sponge,	538
A'buminuria,		299	" Inflammation of	153	" Wading Foot,	640
Alcohol,		691	Aralia Hispida,	613	" Warm Foot,	640
Alder, Tag,		658	" Racemosa,	652	" Wash-Tub, " Wave or Sluice,	637
Aletris Farinosa,		655	" Spinosa,	645		535
Aliments, Fluid,		668	Arbutus, Trailing,	658	" Cold,	542
Allium Cepa,		636	Argenti Nitras,	634	" " Effects of,	643
" Sativum,		616	Aristolochia Serpentaria,	660	" Hot,	642
Almonds,		691	Arnica,	594	«' " Effects of,	544
'■ Svrup of,		684	" Montana,	594	" Tepid,	542
Almond Mixture,		674	Aromatic Powder,	682	" " Effects of,	643
Alnus Rubra,		668	" Spirit of Ammonia	, 594	" Vapor,	642
Aloes,		592	Arrow Root,	694	" Warm,	542
" Comp Tinct. of,		690	" " Gruel,	681	« " Effects of,	644
" and Canella, Compound			Arsenic,	497	Baths of the Ancients,	103
Powder of,		632	Arsenical Solution,	653	" Cold,	105
Alpinia Cardamomum,		604	Artemisia Absinthium,	664	" Division of,	541
Althaea Officinalis,		631	Arteries,	36	" Names of.	104
Alum,		592 —t---	" Pulmonary,	37	" Neglect of,	104
 
790
INDEX.
Baths, Reaction after,
  "   Shower,
Sponge,
Vur
        upor.
      Warm,
Bathiug and Cleanliness,
   "    Sea,
Bayberry,
    "     Ointment,
Bean, St Iguatius's,
Beans,
Bearberry,
Beds and" Bedding,
Beef Tea,
  ''  Essence of,
Beets,
Beeves' Galls,
Bulladonua Atropa,
     "      Ointment,
     "      Plaster,
     "      Poisoning by,
Benzoic Acid,
Benzoin,
   '•    Comp. Tinct. of,
Beiberis Vulgaris,
Bethroot,
Bile iu Stomach,
Biliary Calculi,
Bilious Colic,
  "    Remittent Fever,
Bismuth,
    "   Nitrate of,
    "   Subnitrate of.
    "   Trisnitrate ot,
    "   White Oxide of,
Bitter Root,
Bittersweet,
Black Alder.
  "  Cohosh,
  PAOI
    107
    106
    105
    106
    106
    101
    544
    596
    676
    656
 70-78
    5;<5
96—553
    582
Brain, Abscess of,
  "   Dropsy of,
  "   Enlargement of,
  "   Exercise of,
  "   Fever,
  "   Health of,
  "   Induration of,
      Inflammation of,
                     155
                     158
                     156
                      68
                     153
                      67
                     165
                     153
and Nerves, diseases of, 152
                      59
                      59
                     157
                     154
                     155
                     578
                     674
                     680
                     452
                     888
          Old People's,
      "   Overworking,
      "   Shrinking of,
      "   Softening of,
      "   Tumors of,
582' Bran, decoction of,
 791 Brandy Mixture,
596' Bread and Water Poultice,
612 Breast Bone, Fracture of,
676   "   Broken,
6791   "   Inflammation ofj
499 Breathing, Objects of,
5961    "      Philosophy of,
596, Bright's Disease of Kidneys,
690 Broken Bones,
595 Bronchial Tubes,
6971     "     Consumption,
 64 Bronchitis, Acute,
2681     "     Chronic,
284! Bronchocele,
411 i Bruises,
597 Bubo,
697 Buchu,
597   "   Tinct. of,
697 Buckhorn Brake,
697 Buckthorn,
597 Buckwheat,
697 Bugleweed,
598; Bunions,
6981 Burdock,
            Comp. Tinct. of, 691i Burgundy Pitch,
  "   Root,                 609 i Burns,
  "   Willow,               699: Butternut,
Blackberry,                 598!
Bladder,                    34 Cabbage,
      Acute Inflammation of, 297]    "    Skunk,
      Chronic
Bleeding from Kidneys,
    "     "  Nose,
    "     "   Wounds,
Blenorrhagia,
Blistering Plaster,
Blood in Scrotum,
Bloodroot,
Bloody Flux,
Blue Cohosh,
298 Calamine Cerate,
302;    "     Prepared,
4911 Calamine Praeparata,
493 Calcined Deer's Horn,
331 Calculus,
667 jCalfs Feet Jelly,
474 Calico Bush,
5991 Calomel,
292 Calx,
599   "  Chlorinata,
    Camphor,
        "    Liniment,
             Water,
     108
     108
     299
     446
     35
     21.
     231
     233
     473
     464
321-329
     601
     689
     601
     601
     79
     602
     467
     602
     602
     435
     602
651
666
666
666
602
315
683
633
602
Camphorated Soap Liniment, 672
            Comp. Tinct. of, 691
  "  Disease,                408
  "  Flag,                   600
  "  Pill,                   600
Body, Structure of the,        14
   "   Chemical Properties of,  14  Canada Balsam,
   "   Physical    "     "   16    '•    Fleabane,
   "   Vital       "    "   18    "    Snake Root,
Boi'ed Flour,                582  Cancer,
Boils.                       433    "    of Mouth,
Bones, Anatomy of,           18  Cancrum Oris,
   "   Diseases of,           465: Canella,
   "   Death of,             4651   "    Alba,
   "   of Head,               20  Canker Lettuce,
   "   "Trunk,              21  Cantharis Versicatoria,
   "   " Upper Extremities,   221 Cantharides, Tinct. of,
   "   " Lower   "         241 Capillaries,
   "   Time required for unit-     Capsicum Annuum,
        ing,                447     "     Plaster, Comp.,
   "   Unnatural Growth of,  465  Caput Obstipum,
   ''   Ulceration of,          4651 Caraway,
   "   Uses of,                26'Carbo Ligni,
Boneset,            x       600 ] Carbuncle,
Borax,                      6521 Cardialgia,
Bowel, Falling of,            405  Cardamom,
Bowels, Affections of,        6771     "     Comp. Tinct. of,
   '*   Acute Inflammation of, 281' Carditis,
   "   Chronic  "        "  282  Care of Children,
      Looseiiess of,     289—403'_"  " Teeth,
                          TAOK
Carom Carui,                60S
Cartilage, Arytenoid,          41
    "     Crycoid,           41
    "     Thyroid,           41
Caryophillus Aromaticus,     607
Cascarilla,                  604
Caseine,                     lti
Cases Treated,               203
Cassia Acutifolia,            6.00
   "  Buds,                 007
Castor,                     604
   "   Oil,                  604
Castoreum,                  604
Catalepsy,                  168
Cataplasms,                 6.w0
Cataract Bath,               634
Catarrh,                    189
Catarrhal Opthalmia,         4F4
Catechu,                    604
   "    Tinct. of,            689
   "    Comp. Tinct. of,     690
   "    Comp. Powder of,   682
Catnip,                     604
Caulophyllum Thalictroidcs,  5'.<9
Caulophyllin,                «n0
Cayenne Pepper,             605
    "     "     Tinct. of,    6*9
Ceanothus Americanus,      C47
Celandyne,                  CO")
Cerates.                     666
Cerebellum,                  44
Cerebrum,                   44
Cerevisias  Fermentum,       664
Cessation of Menses,          362
Cetaceum,                   654
Cetraria Islandica,           621
Chafing,                    492
Chalk,                      605
   "  Mixture.              674
                            691
Comp. Powder of.
Comp. Powder ot,
with
628
603,
671
6731
Brachial Plexus,
Brain,
47 Caries,
44 Carrots,
689
603
603
662
469
400
400
603
603
648,
6541
689
 37
605
679
480
C03
606
434
276
604
690,
255
3911
401
465-491
      79
        Opium,             682
Chamomile,                 606
Charcoal,                   606
Chelidonium Majus,          606
Chelone  Glabra,             595
Chemical Food,              686
    "    Injuries,           435
Chenopodium Anthelminti-
  cum,                      664
Cherry, Wild,               661
Chest, Affections of,          674
  "  Air in,               236
  "  Diseases of,           209
  "  Water in,             237
Chicken Water,             583
Chickweed, Red,             647
Chilblains,                  468
Child-Bed Fever,            387
Children,Care and Diseases of, 391
    "    Nursing Sick,       394
    "    Weaning of,        392
Chimaphila  Umbellate,       641
Chloroform,                606
Chloroforraum,              606
Chlorosis,                   360
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
Cimicifugin,                699
Cinchona,                   639
Cinchonia,                  639
Cinnamon,                  607
          Tinct.  of,          6*9
     "    Comp. Tinct. of,   690
Circulation, Organs of,       36
Cirsucele,                   478
Citric Acid.  Syrup of,        684 
	INDEX.		791		
PAOB			PAGE		PAOB
Citrus Limonum,	627	Corn, Indian,	78 Dislocations of HiD Joint.		461
I <'lap,	331	Cornea,	49	" " Knee Pan or	
Cleaning the Teeth,	503	" Inflammation of,	485	Patella,	403
Cleanliness, 100	,665	Corneitis,	485	" " Knee Joint,	403
Cleavers,	607	Corns,	145	" '■ Lower Jaw,	458
C"erg\ men's Sore Throat,	191	Cornu Cervinae Ustum,	602	" " Shoulder	
Climate,	71	Cornus Florida,	613	Joint,	459
Clothes Catching Fire,	496	" Servicea,	657	" " Wrist.	460
Clothing,	98	Corrosive Sublimate,	009 Disturbed Sleep.		182
" Color of,	100	" " Poisoning by, 497 Dizziness,			181
" Cotton,	99	Corydalis Formosa,	659'Dock. Yellow,		664
" Hair as,	99	Costiveness,	286 Dogwood,		612
" Linen,	98	Cotton,	610	" Poisoning by,	499
*' Porous,	100	Coup de Soliel,	102	" Swamp,	657
" Silk,	99	Cow Pox,	136	Domestic Managementof the	
" Tight, 110 " Woollen,	, 111	Coxalgia,	466	Sick-Room,	551
	99	Cramp Bark,	619	Doses,	5H8
Clover, Red,	647	Cramps.	171	Douche Bath,	5.33
Cloves,	607	Cranesbill,	610	" Pail,	r34
C'ovus,	145	Cranial Nerves,	45	Dover's Powder,	682
Clysters,	671	Crawley,	610	Dragon Root,	621
Coccus Cacti,	607	Cream of Tartar,	643	Dress, Wet,	C30
Cocculus Palmatus,	608	Creosote,	611	Drink, Pleasant,	579
Cocliiueal,	607	" Ointment,	676	Dropsy of Belly,	317
Cochlearia Armoracia,	620	Creosotum,	611	" " Cells,	318
Cod Liver Oil,	607	Crocus Sativis,	648	" General,	318
Coffee,	84	Croton, Eluteria.	604	Dry Pimples,	144
" Barley,	679	" Oil,	611	Drunkard's Delirium,	155
" Crust,	679	" " Liniment,	672	Dura Mater, " " Inflammation of,	45
" Milk,	585	" Tiglium,	611		152
Colchicum Autnmnale,	632	Croup,	401	Dwarf Elder,	613
" Comp. Tiuct. of,	691	Crow Corn,	655	Dysentery,	292
Cold, Effects of.	436	Crural Phlebitis,	387	" Chronic,	21'3
" Foot Bath,	639	Crust Coffee,	579	Dysmenorrhoea,	357
Colds,	205 Crusted Tetter,		142	Dyspepsia,	271
Colic,	405 Cubeb*,		611	" Causes of,	272
" Bilious,	284 Cubebs,		611	" Treatment of,	274
" Painter's,	285 Cucumber, Wild,		662	" Urinary Deposits In, 272	
" Wind,	282 Cucumis Colocynthis,		608	Dyspeptics,	81
Colica Pictonum,	285 Culver's Root,		611		
Colitis,	292 Cupri Subacetas,		609	Ear, Affections of,	488
Colocynth,	603 Cupri Sulphas,		609	" Drum of, " External,	61
Colodion,	608 Cuprum,		609		51
Colombo,	608 Cyanosis,		408	" Foreign Substances in,	492
Colon,	32 Cypripedin,		665	" Wax in,	490
Coltsfoot,	608 Cypripedium Pubescens,		626,665	Earache,	490
Colt's Foot,	662 Cystine Deposits in Urine		, 314	Eclectics,	7
Comfrey,	608 Cystirrhoea,		298	Ecstasy,	167
" Comp. Wine of, Common Siik Weed,	673 Cystitis,		297	Ecthyma,	142
	609,			Eczema,	139
Complonia Asplenifolia,	657 Dancing,		92	Effervescing Draught, Egyptian Ophthalmia, Elbow, Fractures of,	644
Comp. Fractures, 446—456 Dandelion,			612		482
" Infusion of Catechu,	670 Datura Stramonium,		656		450
" " " Gentian,	670 Deadly Nightshade,		612	" Joint, Dislocation of, 460	
" " " Geranium	670 Deafness,		490	Elder,	613
" " " Parsley,	670 Death of Bones,		465	" Dwarf,	613
" " " Senna,	670 Decoction of Bran,		578	Elecampane,	613
Comp. Infusion of Trailing Arbutus,	I Decoctions,		668	Electro Magnetism,	613
	671 Deformities of Spine,		478	Electuaries, Electuary, Lenitive,	668
Compresses, Confections,	549 Dehsler's Cerate,		667		668
	668 Delivery,		381	Elixir Salutis,	693
" Aromatic,	668 Delirium Tremens,		155	" Vitriol,	689
" of Catechu, Comp ,	668 Dementia,		175	Elm, Slippery,	652
" of Senna,	668 Dens Leon is.		612	Emphysema,	234
Congestive Fever,	412 Derbyshire Neck,		473	Encephalitis.	153
Conium Maculatum,	641 Diabetes,		301'	Enccphaloid Tumor,	470
11 Poisoning by,	499 Diarrhcea,		289-403	Encysted, "	471
Conserves**	668 " Chronic,		289	Endocarditis,	255
Coiistipation,	286 Dictionary,		717	Enlarged Veins,	475
Constitution,	120 Diet,		228,564	Enon> mus Atropurpureus,	661
" Idiosyncrasy of,	121 " in Disease and Convales-			Enteritis,	2S1
Constitutional Differences,	217 ceuce,		664	Eneuresis,	305
Consumption,	209 Difficult Teeth. Cutting,		401	Epigaea Repens,	653
" A General Disease	220 Digestion,		61	Epiglottis,	41
" Bronchial,	217 " Table,		69	" Inflammation of,	207
" Causes of, 215—218 Digestive Organs,			31	Epilepsy,	167
" Tubercular,	212 Digitalis Purpurea, 441 Dioscorea Villosa,		614	Epileptic Fits,	167
Contused Wounds,			662	Epistaxis,	491
Contusions,	464 Diospyros Virgiuiana,		639	Ergot,	655
Convolvulus Scammonia,	650 Diseases, General,		570	Erigeron Canadense,	603
Cookery for Sick Room,	57^ " of Children,		391	Eruptions, Scaly,	143
Copiatera Officinalis,	695 Dislocations,		457	Er^ipclas,	136
Copper, Subacetate of,	609 " of Ankle Joinl		463	Erythema,	138
	609 " " Bones of Head, 461			Erytbeniatic Stomatitis,	398
" Sul]ihate of.	609, " " Collar Bone		4.r.9	Essences,	669
Coralloilii-a Odoutorhiza,	610 i " " lvbow Joint, 4CJ			Ls>*.ei cc of Beef,	582
 
792
INDEX.
Eupatorin,
Eupatorium Perfoliatum,
    "      Purpureum,
Euphorbia Ipecac,
Eupurpurin,                 646
Eustachian Tube,              51
Excoriation,                 492
Exercise,                     88
    "   Active and Passive, 89—93
    "   Excessive,             89
    "   In-door,               93
       Mental Cooperation in, 94
601  Flaxseed,
600  Flies, Spanish,
6461 Flour, Boiled,
5931 Fluid Aliments,
    90
89—95
    91
    40
   465
   669
   669
      Out-door,  "       93—229
    "  Pleasurable,        89—94
    "  Regular,
    "  for Students,
    "  When to take,
    "  for Young Women,
Exhalants,
Exostosis,
Extracts,
    "     Fluid,
Extracts of Rhubarb and To-
  tassa,
Eyebrows,
Eyelashes, Disorder of,
Eyelids,
    "    Inflammation of,
Eve, Coats of,
  " and Ear Bath,
  " Foreign Bodies  in,
  " Glibe of,
  " Humors of,
Faba Sancti Ignatii,
Fainting,
Falling of Bowel,
   "   " Womb,
   "   over of Womb,
False Grape,
  "  Joints,
  "  Measles,
  "   SarsapariUa,
  "   Unicorn,
Fat,
Fatty Tumor,
Favus,
Fel Bovinum,
Felon,
Female Diseases,
Feri»;
Fer-i Ammonio Citras,
  11  Citras,
  "   lodidum,

  "   Oxidum Hydratum
  "      "    Nigrum,
  "   Thosphas,
  "   et  Potassa: Tartras,
  "   Protoxidum,
  "   Pulvis,
  "   et  Quinae Citras,
  "   Subcarbonas,
  "   Sulphas,
  "   Svrupus Iodidi,
  "   Tinctura Chlondi,
Ferrum,
Ferunculus,
Fever,
  *'   and Ague,
  "   Bilious Remittent,
  "   Congestive,
  "   Intermittent,
  "   Lung.
         Extracts,
      "   Nutritive,
    Fluor Albus,
    Folded Wet Sheet,
    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 atd Manhood
 49 Foot Bath, Cold.
    !  »     "   Warm,
656'  "   Fractures of,
181 Fore Arm, Fractures of,
405 Foreign Bodies in Eye,
368 Fowler's Solution.
868 Foxglove,
693 Fracturei>.
447	«•	Compound,
138	u	of Bones of Foot,
fi,''2	«	" " " Nose,
618	k	" Breast Bone,
16	ii	" Collar Bone or
471		Clavicle,
151	'■	11 Elbow
h'M]	it	" Fore Arm,
467	tt	" Hand and Fin-
»U		gers.
6--.7	it	" Haunch Bonea
fi.;(		or Pelvis,
6.3	tt	14 Knee Pan,
623	it	" Leg,
623	t<	" Lower Jawi
623	tt	•' Ribs,
623	tt	•' Shoulder Blade
624	tt	» Skull,
625	it	" Thigh Bone,
624	•'	' " UpperArmBor
624	ti	" Wrist,
623 Freezing Mixtures,
624 French Decimal Weights,
625'    "   Milk Porridge,
625 Frost Bite,
625 Frost weed,
622 Fumigation of infected places  604  Hair. Disorders of,
    614  Gclseminin.
    604  lielseminum Scmperviren.
    682  Ceugivitis.
    668  General Diseases,
    669    "    System. Diseases of.
    586  Gentian.
363,390    "    Comp. Tinct. of,
    631  Gentiana Lutea.
     40  Geranium Maculatum,
        Gill-over-the-grouud,
    399! Ginger.
    669    "    Wild.
     61    "    Syrup of,
     74  Ginseng.
     80  Glands.
     81    "    Lachrymal,
     76    "    Oil.
          "    Parotid,
     67    "    Submaxillary,
     70    "    Sweat,
     74  Glauber's Salts,
     68  Gleet.
     76  Glossary,
     66  Glottis, Spasm of.
        Glycerin.
     65  Glycerrhiza Glabra.
     68  Goitre,
     73  Gold,
     66  Golden Seal,
     76    "     "  Comp. Fowder of,
     76    "     "    "   Tinct. of.
     73    »     "    "   Wine of.
    539  Golden Tincture,
    640  Gonorrhoea,
    455  Gossypium Herbaceum,
    450  Gout,
    480  Granulation,
    653  Grass,  Star,
    614  Gravel,
    442',   "    Root,
    4551   "    Urio Acid,
    4551 Green Sickness,
    447  Griffith's Myrrh Mixture,
    452  Ground Ivy,
          "    Rice Milk,
    448' Grubs  or Worms.
    450 Gruel. Arrow Root,
    450   "    Rice,

    451   "    Water,
        Guaiac, Ammoniated Tinct.
    452   of.
    454 Guaiacum,
    455 Ciullet, Foreign Bodies in,
    448 Gum Arabic,
    4511  "  Hemlock,
    449;  "  Sweet,
    447 Gums. Inflammation of,
    452 Gunshot Wounds.
    s.449 Gymnastics,
    4511
     605 Hacmastasis,
     689 Hsematocele.
     682 Ha;matoxylon Campechia-
     4361  num,
     614' Hematuria,
                      433 Fungus Hematoides
                      4091
                      413 Galbanum Plaster, Comp.,
                      411 Galium Aparine,
                      412 .Gall Bladder,
                      413|  "  Stones,
                      540 Galls.
Pernicious Intermittent.412   "  Comp, Ointment of,
Refreshing Drinks in.   679 , Gamboge.
  "   Typhoid,
  "     "     Lung,
Feverfew,
Fibrine,
Figwort,
Filling Teeth.
Fingers, Fractures of.
Fire, Clothes Catching,
Fits,
Flag, Sweet,
410 ; (iangrene of Mouth,
242 Garget,
613 Garlic,
 15    •'  Syrnp of,
614' Gastric Fever of Infancy
502    "   Juice,
451 Gastritis.
496 Castrodyma,
408 Gaultbcnarrocumbens.
658 Gelatine,
470 Hair Cap Moss.
   | Half Bath.
679 Hammamelis Virginica.
607 Hand. Di.-location of Bcnes
 331        of,
203'    "  Fractures of,
615 Hardback.
676 llardleai Colder Rod,
615 Haunch Bones. Fractures of,
400 Hazel, Witch,
642 Headaches,
615 Head. Affections of.
G^.  ••   Balh,
406:  "   Water in.
 62 Hearing, Organs of,
269 Heart,
277    "   Diseases
653    "   Altered Sound* of,
 16'   "   Aneurismal Tumors
605
664
400
570
4i)9
615
091
01;',
610
617
615
662
6-4
616
 40
 50
 43
 81
 31
 43
(X3
833
721
402
616
628
473
616
616
682
691
673
091
331
610
417
442
665
306
646
308
3:10
674
617
 682
 118
 681
 580
 681
 680

 691
 617
 403
 617
 617
 658
 400
 442
  91

 617
 474

 629
 3'>2
 150
 618
 635
 &J3

 401
 451
 618
 61S
 452
 6-3
 183
 54
 63=5
 137
   61
   36
 246
 248
f.252 
INDEX.                                     ?93
                          PAOB |
Heart, Atrophy of,           253
  "    Bone and Cartilage in, 253
  "    Dilatation of Ventricles
        of,                 250
  "    Displacements of,      261
  "    Enlargement of Ventri-
        cles of,             2481
  "    Fatty Degenerations of, 252
  "    Hypertrophy and Dila-   |
        tation of,           251
  "    Impulse of,            247
  "    Induration of,         252
  "    Inflammation of,      255
  "    Inflammation of Lin-
        ing of,              255
  "    Neuralgia of,          260
  "    Percussion of,         248
  "    Polypus of,            261
  "    Shrinking of,         253
  "    Softening of,          252
  "    Sounds of,            247
  "    Valves of,            256
Heartburn,                  276
Heart-case, Acute Inflamma-
            tion of,         253
   "     Chronic Inflamma-
            tion of,         254
   "     Water in,         259
Hedeoma Pulegiodes,         638
Helianthemum Canadense,   614
Helianthus Annuus,          657
Hellebore, White,            661
Helonias,                    618
   "    Dioica,            618
Hemicrania,                 172
Hemiphlegia,                162
Hemlock, Comp. Tinct. of,    691
   "    Gum,              617
Hemorrhoids,                287
Henbane,                    618
Hepar.                     645
Hepatica Americana,         628
Hernia,               .      476
Herpes,                     139
Hiccough.                   180
High Cranberry,             619
              Comp.Tinct.of, 691
                            466
                            461
                            313
                              7
                            508
                            403
                            619
                            481
                            619
                            660
                            620
                            620
                            634
                            692
                            620
                            139
                            619
Ho?;
ophosphites,Comp. Syrup
Hip Joint, Disease of,
  "    "  Dislocation of,
Hippuric Acid in Urine,
Homoeopathy,
Homoeopathic Remedies,
Hooping Cough,
Hops,
Hordeolum,
Uorchound,
     "     Water,
Horsemint,
Horseradish,
Hose Bath,
Hot Drops,
Houseleek,
Humid Tetter,
Hamulus Lupulus,
Huxham's Tincture,         692
Hydatids Uterine,            366
Hydrangea,                 620
    "      Aborescens,      620
Hydrargyri Chloridum Mite,  602
     "     Pillulae,         600
Hvdrastin, Comp. Powder of,
Hydrastis Canadensis,
Hydriodate Potassa,
Hydrocele,
Hvdropathv,
Hydropathic Treatment,
Hydropericardium,
Hvdrophobia,
Hydrocephalus, Acute,
     "         Chronic,
Hydrothorax,
Hvgiene,
Hyoscyamus Niger,
     "     Poisoning by:
II vpertrophy of Lungs,
Hypochondria,
616
622
473
  6
528
259
165
157
158
237
 52
618
499
235
179
ITygsop,                     6211
Hyssopus Officinalis,         621
Hysteria,                   364
Hysterics,                   364

Ice Plant,                   621
Iceland Moss,               621
Ichthyocolla,                626
Icterus,                     267
Idiocy,                     176
Ignatia Amara,              656
Ileum,                      32
Impetigo,                   142
Incised Wounds,             438
Incubus,                    182
Indian Corn,                78
   "   Hemp,               621
   "     "   Tinct of;       689
   "   Turnip,               621
Indigestion,                 271
Indigo, Wild,               662
Infancy of Being,            52
Infants, Gastric Fever of,     4Q6
  "   Milk for,              580
  "   Summer Complaints of, 404
Inflammation,               425
Inflammatory Blush,         138
Influenza,                   205
Infusion of Malt,             579
Infusions,               690,670
Inhalants,                   221
    "    Objects of,         223
Inhalation, Atmospheric,     227
Inhaler, Medicated Vapor,    223
Inhaling Powder,            682
Injections,               645,671
    "    Chemical,         435
    "    Mechanical,        437
Insanity,                    173
    "    Causes of,           177
    "    On one Subject,     175
Instrument, Tonsil,           202
Interalgia,                 • 282
Intermarriages,              57
Intermittent Fever,          413
Intestines;                   32
Introduction,                 6
Inula Helenium,             613
Iodide Potassium,            622
Iodine,                     622
Iodinum,                   622
Ipecacuanha,                622
    "     Comp. Powder of,  683
    "     Svrup of,         685
    "     Wine of,          673
Ipomoea Jalapa,              626
Iridin,                      600
Iris,                        49
 "  Inflammation of,         485
 "  Versicola,               600
Irish Moss, Jelly of,          681
Iritis,                       485
Iron,                       622
  "  Ammonio-Citrate of,    623
  "  Black Oxide of,         623
  "  Citrate of,              623
  "    "    '• and Quinia,   623
  "    "    "  "  Strychnia, 623
  "  Comp.  Mixture of,       674
  "  Hydrated Oxide of,      623
  "  Iodide  of.              623
  «  Lactate of,              623
. "  Per Salt of,             624
  "  Phosphate of,           624
  "  Powder of,              624
  "  Precipitated  Carbonate
       of, •  .               624
  "  Protoxide of,           624
  '•  Solutions of Protoxide
       of.                   624
  '•  Sulphate of,             625
  "  Syrup of Iodide of,      625
  "  Syrup of Iodide of, and
       Manganese,           625
Iron, Tartrate of, and Potass
  "  Tincture of Muria'e of,
  "  Valerianate of,
Ischuria Renalis,
Isinglass,
    "   Jelly,
Itch,
  "  Barbers',
  "  Jackson's,
Itching,
   "   of External Parts,
Ivy, American,
  "  Big,
  "  Ground,
  "  Poisoning by,

Jackson's Itch,
Jalap,
  "   Comp Powder of,
Jamestown Weed,
Janipha Manihot,
Jaundice,
Jaw, Fractures of Lower,
  "  Dislocation of "
Jejunum,
Jelly, Calf's Feet,
  "   Irish Moss,
  "   Isinglass,
  "   Tapioca,
Jerusalem Oak,
Jessamine, Yellow,
Joints,
   "  Diseases of,
   "  False,
Juglandin,
Juglans Cinerea,
Juniper,
Juniperis Communis,
Juniperus Sabina,
Kalmia Angustifolia,        633
   "    Latifolia,           633
Kidneys,                    34
   "    Acute Inflammation
          of,               294
   "    Chronic Inflamma-
          tion of,          296
   "    Bleeding from,      302
        Bright's Disease of,  299
                           419
                           626
                           683
                           408
                           463
                           454
                           617
 PAOB
i. 625
  625
  626
  303
  62fi
  599
  139
  149
  1:9
  146
  370
  593
  633
  617
  499

  149
  626
  683
  656
  659
  267
  448
  458
   32
  583
  631
  681
  581
  664
  664
   25
  666
  447
626
626
649
King's Evil,
Kino,
  "  Comp. Powder of.
Knee Joint, Dislocatian of,
  "  Pan,      "       "
  "   "    Fractures of,
Krameria Triandra,
Labor,                     381
Labyrinth,                  51
Lacerated Wounds,         441
Lachrymal Canals,           50
    "      Glands.           50
    "      Sac. Inflammation
            of,             482
Lacteals,                    32
Lactuca Sativa,             627
Ladies' Slipper,          626, 665
Lappa Minor,               602
Laryngeal Shower Syringe,  195
Larygismus Stridulus,       402
Laryngitis, Follicular,  .     192
Larynx,                     40
   "   Inflammation of,    192
Laudanum,                689
    "      Poisoning by,    499
Laurel, Narrow Leaf;       633
   "    Sheep,              633
Laurus Sassafras,            649
Lavender, Comp. Tinct. of,  692
Lead,                      627
  "  Acetate of,            627
  "  Ointment, Comp.,     678
  "  Palsy,                164
  "  Pipes,                 87
  "  PI aster,               680
  "    "    Comp,         679
100 
794                                     INDEX.
	PAOB
Leaders, Conservative,	11
Leg Bath,	536
" Fractures of,	455
Lemon,	627
" Svrup,	685
" Water,	679
Lemonade,	680
Lenitive Electuary,	668
Leouurus Cardiaca,	632
Leopard's Bane,	594
Lepra,	143
Leprosy,	143
Leptandra Virginica,	611
Ix.'ftuce,	627
l^ucorrhoea,	353
Liberality,	10
Lichen,	144
Life,	62
" Root,	627
Lily, White Pond,	661
Lime,	628
" Chloride of,	628
" Water,	628
Liniments,	671
Liniment of Ammonia, Comp	671
" Camphor,	6711
" Camphorated Soap,	6721
" Comp. Camphor,	671
" Croton Oil,	672
" ofOpium,	672
Linum Usitatissimum,	614
Liquidamber Styraciflua,	658
Liquor Ammonias,	5931
" " Aoetatis,	594
Liquorice,	628
Liriodendron Tulipifera,	659
Liver,	33
" Acute Inflammation of	264
" Chronic " "	265
" of Sulphur,	645
Liverwort,	628
Lobelia,	628
" Inflata,	628
" Tinct. of,	689
" Comp. Tinct. of.	692
" and Capsicum, Comp	
Tinct of,	'692
" Vinegar of,	693
Lobelin,	629
Local Palsy,	163
Locked Jaw,	166
Logwood,	C29
Looseness of Bowels, 289	,403
Lumbar Plexus,	47
Lung Fever,	240
Lungs.	35
'• Hypertrophy of,	235
" Swelling of,	235
Lupulin,	620
l.'ipuSj	144
Luxations,	457
Lycopus Virginicus, Lye, Poisoning by,	602
	498
Lymphatics,	38
Lypemauia,	174
Maculae,	146
Magnesia,	629
" Carbonate of,	630
" Sulphate of,	630
" . Usta,	629
Magnesiae Carbonas,	630
" Sulphas,	630
Male Fern,	630
Malignant Pustule,	434
Malt, Infusion of,	579
Mammary Abscess,	383
Mandrake,	630
Mania,	175
" a Potu,	155
Manna,	630
Marauta Arundinacia,	694
Marshmallow,	631
Marsh Rosemary,	631
Murubium Vulgare,	619
Mastich,	631
Masturbation,
Materia Medica,
Matico,
Mattery Pimples,
Meadow Cabbage,
    "   Saffron,
Measles,
    "   False,
Measures,
    "    Domestic,
Meats,
Meatus Auditorus,
   "   Inflammation of,
Mechanical Injuries,
Medicated Waters,
    "     Wines,
Medicine, Progress of,
    "    Chest, Articles for,
Medicines,
Medulla Oblongata,
Melancholy,
Melanosis,
Melissa Officinalis,
Menispermum Canadense,
Menorrhagia,
Menses, Absence of,
   "    Cessation of,
Menstruation,
      "      Painful,
      "      Proluse,
Mentha Piperita,
   "    Virides,
Mesenteric Disease,
Metritis,
Mettauer's Aperient,
Micotianum Tabacum,
Midwifery,
Milk,
  "  Coffee,
  "  for Infants,
  "  Leg^
  "  Porridge,
  "  Sickness,
  "  and Soda Water,
Milkweed, Swamp,
Mind, Derangement of,
Mindererus,  Spirit of,
Miscarriage,
Miscellaneous.
Mitchella Repens,
Mitral Valves, Diseases of,
Mixtures,
Modus Operandi of Water,
Momordica Elaterium,
Monarda Punctata,
Monkshood,
Monk's Hood,
Monomania,
Monotropa Uniflora,
Monsel's Styptic,
Morphia,
    "   Acetate of
    "   Muriate of,
    "    Sulphate of,
    "   Valerianate of,
Morphine,
    "    Poisoning by,
Mortification,
Mother's Cordial,
    "   Marks,
Motherwort,
Mountain Laurel,
Mouth or Oral Bath,
   "   Inflammation of,
   "   Follicular Inflamma-
        tion of,
   "   Gangrene of,
Mucus,
Mullein,
Mumps
Muriate of Soda,
Muriatic Acid, Poisoning by,
Mnscae Volitantes,
Muscles,
   "    Action of,
   "    Number of»
 3'J0
 6*6
 032
 142
 651
 632
 131
 138
 687
 689
  77
  51
 489
 437
 672
 673
6-9
 687
 686
  45
 174
 470
 694
 665
 356
 354
 362
 840
 357
                          PAD I
Muscles. Shape of,           27
Mustard,                    633
    "   Volatile Oil of,      633
Myrica Cerifera,             590
Myricin,                    690
Myristica Moschata,          635
Myrospernum Toluiferum,    695
Myrrh,                      634
   "   Comp. Tinct. of,      692

Naptha,                     634
Napthaline,                 031
Nasal Catarrh,              189
  "   Duct                 50
  "   Shower Syringe,       196
Necrosis,                    465
Nepeta Cataria.              604
   *'    Glechoma,           617
Nephritis,                   294
Nerve Root,                 665
Nerves, Cranial,             45
   "   Diseases of Brain and, 152
   "   Optict               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,          260
Neutral Mixture,            644
Neutralizing Cordial,        687
      "      Extract,        674
      "      Powder,        6S3
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,       654
Nose Bath,                  640
  "  Bleeding from,          491
  "  Poreign Substances in,   492
  "  Fractures of,            447
Nurse,                      657
  "   Activity of,            659
  "   Age of,               667
  "   Education of,          559
  "   Habits of,             559
  "   Health of,             558
  "   Strength of,           657
  "   Temper, etc., of,       658
Nursing Sore Mouth,         388
Nutmeg,                    635
Nutrition Table,             67
Nutritive Fluid,             585
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
   "  Morrhua:,            607
   "   Olivae,               631
   "   Ricim,               604
   "   Terebinthinae,         636
   "   Tiglii,               611
Olive Oil,                    636
Omentum,                   34
Onanism,                    33*3
One Idea Men,               6
Onion,                      686
Ophthalmia Catarrhal,       484
     "      Egyptian,       482
     "      Purulent,        482 
INDEX.
795
Ophthalmia of Children,
     "      Scrofulous,
     41      Tarsi,
Opium,
PAOB
 483
 484
 481
 636
Camphorated Tinct. of, 692
       Liniment,           '672
       Poisoning by,         499
  "    Tinct. Of,             689
Opodeldoc,                  672
Orange Peel,                637
   "    "  Tinct. of,        689
Orbits,                       60
Orchitis,                    833
Origanum,                  637
    "     Vulgare,          637
Ornus Europea,              630
Osmunda  Regalis,           601
Otalgia,                     490
Otitis,                       490
Otorrhoea,                  489
Ovaries, Inflammation of,    360
Ovaritis.                    350
Oxalic Acid, Poisoning by,   498
   "   Deposits in Urine,     311
Oxide of Zinc Ointment,      676

Pack, Half,                  530
  "   Wet Sheet,            628
Pail Douche,                534
Painter's Colic,              285
Palpitation,                 259
Palsy,                      162
  "   Lead,                164
  "   Local,                163
  "    Shaking,              164
Panada,                    580
Panax Quinquefolium,       616
Pancreas,                    33
Papaver Somniferum,       636
Papulous  Scall,              142
Populus Candicans,          695
Paracentesic Instrument,    606
Paralysis,                  162
Paraphlegia,                163
Paregoric Elixir,            692
Parrilla, Yellow,            665
Paronychia,                467
Parotitis,                    207
Parsley,                    637
Parsnips,                 •   79
Partridge Berry,            637
    "       "   Comp. Syrup
                 of,        686
Patches, Colored,           146
Patella, Dislocation of,      463
    "   Fracture of,        454
Patients,  How to Examine,  122
Peach,                     C38
Pear Leaf Wintergreen,      648
Peailash, Purified,           643
Peas,
Pediluvium,                640
Pelvis, Fractures of,         452
Pemphigus,                141
Pennyroyal,               638
Pepper, Water,              661
Peppermint,                688
Pericarditis,                263
Peritoneum, Acute Inflamma-
              tion of,       279
       "      Chronic Inflam-
              mation of,    280
Peritonitis,                 279
Pernicious  Intermittent Fe-
   ver,                      412
Persimmon,                 639
Perspiration,                102
Perspiratory Tubes,          102
Peruvian Bark,              639
    "       " Tinct. of,     692
Petrolium,                  640
IVtroselinum Sativum,      637
Pharmacv,                   666
Pharyngeal Shower Syringe, 196
Pharvngitis,                 191
     »     Follicular,       191
Pharynx,
    "    Inflammation of,
Phlebitis,
    "    Chronic,
Phlegmasia Dolens,
Phosphates, Comp. Syrup of,
Phosphatic Deposits in Urine, 310
Phosphorus,             224,640
PAOE
  31
 191
 474
 475
 387
Phrenitis,                   153
Phthisis,                    209
Physical Development,        91
Physician, True,              12
Physiological LawV,           52
Physiologists,                  8
Phytolacca Decandra,        642
Phytolaccin,                 642
Pia Mater,                    45
 "    "  Inflammation of,    153
Picraena Excelsa,            646
Pigeon-berry,                642
Pile Ointment,               677
Piles,                       287
Pills,                       678
Pimpinella Anisum,          694
Pimples, Dry,                144
    "    Mattery,            142
    "    Watery,            138
Pink Root,                  640
Pinna,                       51
Piper Angustifoliam,        632
Pipsissewa,     *            641
Pistacia Lentiscus,           631
Pityriasis,                   143
Pix Liquida,                 658
Plantago Major,             641
Plantain,                   641
Plasters,                    678
Pleurisy,                    238
    "    Root,              ' 641
Pleuritis,                    238
Plumbi Acetas,              627
Plumbum,                  627
Plunge Bath,                536
Pneumonia,                 240
           Typhoid,         242
Pneumothorax,             236
Podophyllum Fellatum,      630
Poison Oak,                 642
   "    Hemlock,            640
   "       "     Ointment,   676
Poisoned Wounds,          442
Poisoning Accidents,        496
Poisons, Antidotes of,        496
    "   Vegetable,          498
Poke,                      642
  "   Ointment,             676
Polygala Senega,            650
Polygonum Punctatem,      661
Polypus,                    471
         of Heart,           261
    "    of Womb,          365
Polytrichum Juniperum,     618
Pompholix,                 141
Poplar,                    659
Porridge, Milk,             681
    "     French Milk,      582
Porrigo,                    150
Potassa,                    642
   "    Acetate of,          613
   "    Bicarbonate of,      643
   "    Bitartrate of,        643
   "    Carbonate of,        643
   "    Chlorate of,         643
   "    Citrate of,           644
   "      "     " Solution of, 644
   "    Solution of,         644
   "        "    " Arsenite of,653
        and Soda, Tartrate of, 653
Potass*, Citratis, Liquor,     644
   "   Liquor,              644
   "   Nitras,              635
   "   Sulphas,             644
   "   Tartras,              644
Potassii Bromidum,          644
   "   Cyaneuretum,        645
   "   lodidum,            622
   "   Sulphuretum,        645
Potassium,                  644
    "     Bromide of,        614
    "     Cyanuret of.       645
    "     Sulphuret of,      645
Potatoes,                     79
Poultices,                   6*0
Powders,                    681
Pox,                        320
Prejudices,                  560
Preparations,                666
     "     of Medicine,     586
Prepared Calamine,          666
    "    Chalk,              605
Prickly Ash,                645
       Elder,               645
Prince's P ne.               641
Prinos Ve. ticillatus,         598
Prognostics,                661
Prolapsus Ani,              405
    "     Uteri,             368
Pronouncing Dictionary,     721
Prunus Virginiana,          661
Prurigo,                    141
   "   of Vulva,            370
Pruritis,                    140
Prussic Acid, Poisoning by,  4'.''J
Psoriasis or Salt Rheum,     143
Ptelia Trifoliata,             C'.l
Ptercorpus Marsupium,      626
    "      Santalinus,       647
Ptisan, Suet,                583
Ptosis,                      482
Puerperal Fever,             S+l
Pumpkin Seed,              646
Punctured Wounds,         4 U
Purple Disease,              423
Purpura Hemorrhagica,      423
Purtussis,     •             403
Purulent Ophthalmia,        482
            "   of Children, 483
Pyrethium Parthenium,      613
Pyrola Rotundifolium,       648
    "   Round Leaved,       648
Pyrosis,                     277
Quassia,
Queen of the Meadow,
Queen's Root,
Quercus Alba,
   "    Infectoria,
Quinia, Sulphate of,
   "    Valerianate of,
" Sulphate of,	014
" Tartrate of,	644
Potassae, Acetas,	643
" Arsenitis, Liquor,	653
>« Bicarbonas,	643
" Bitartras,	643
" Carbonas,	643
" Citras,	644
Rabies,
Ramollissement,
Rectum,
Red Chickweed,
 "  Clover,
 "  Iodide of Mercury Oint-
      ment,
 "  Pepper,
 "  Oxide of Lead Plaster,
 "  Ozier,
 "  Root,
 "  Rose,
 "  Saunders,
 "  Willow,
Refreshing Drinks in Fevers,
Reproduction of Lost Parts,
Resin Plaster, Comp.,
Respiratory Organs,
Rest and Sleep,
Restorative Wine Bitters,
Restoratives,
Retention of Urine,
Retina,
Rhamnus Catharticus,
646
646
641
661
615
633
639

105
151
 32
647
647

670
605
6S0
657
617
047
617
057
579
412
679
 35
 95
673
5>1
3  4
 4»
601 
■					
					_^
796	INDEX				
	PAOB		rAOB	PAOB	
Rhatany,	656	Scrofula,	419	Small Spikenard, Smart Weed,	662
Rheum Palmatum,	648	Scrofulous Ophthalmia,	484		661
Rheumatism, Acute,	416	Scrophularia Nodosa,	614	Smilax Officinalis,	649
" Chronic,	417	Scrotum, Blood in,	474	Snake Root,	650
Rhubarb,	648	" Water in,	473	Suakeroot, Virginia,	660
" Aromatic Syrup of, " Comp. Tinct. of,	684	Scullcap,	650	Soap,	662
	693	Scurvy, Scutellaria Laterifolia,	421	Soda, Bicarbonate of,	662
" " Powder of,	633		650	'■ Borate,	652
" and Potassa, Comp'		Sea Bathing,	644	" Sulphate of,	653
Powder of,	683	Seasickness,	278	" Sulphite of,	663
" and Potassa, Comp		Secale Cornntum,	655	Sodae, Bicarbonas,	662
Syrup of, " Sweet Tinct. of,	687	Secretion, Organs of, Seidlitz Powders,	40	" Boras,	6.72
	693		653	" et Potassae Tartras,	a:ji
" Syrup of, ,	684	•Self Pollution,	336	" Sulphas,	653
" Tinct. of,	690, Semilunar Valves, Disease of		256	" Sulphis,	663
Rhus Glabrum,	657 Sempervirum Tectorum,		620	Sodii Chloridum,	653
" Toxicodendron,	642	Seneca Oil,	610	Sodium,	662
Ribs, Fracture of,	451	Senecin,	627	" Chloride of,	653
Rice,	78	Senecio Aureus,	627	Solanum Dulcamara,	597
" Gruel,	580	Seneka,	650	Solidago Rigida,	618
Ricinus Communis,	604	'• Syrup of,	686	Solomon's Seal,	653
Rickets,	407	Senna,	650	Soluble Tartar,	644
Ringworm, Rochelle Salts,	151	" and Jalap, Tinct. of,	693	Sore Nipples*,	889
	653	Sensations,	54	Soup, Vegetable, Spanish J lies, " "• Liniment,	5^2
Rosa Gallica,	647	" Agreeable,	55		654
Rose Rash,	138	', Unpleasant,	56		672
" Red,	647	Sexual Diseases,	320	" " Poisoning by,	499
'• Water Ointment,	677	" " Prevention of, 335		Spasm of Glottis,	402
" Willow,	657	Shaking Pal8j4M| Sheep Laurel, ^P	164	Spearmint,	654
Rosemary,	648		633	Speculum,	345
Roseola,	138	Shingles, Shoulder Blade, Fractures of,	139	Spermaceti,	654
Rosemarinus Officinalis,	648		449	" Ointment,	677
Rotting of Teeth,	500	" Joint, Dislocation of,459		Spice Plaster, Comp.,	679
Round Leaved Pyrola,	648	Shower Bath,	634	Spider's Web,	664
Rubbing Wet Sheet,	631	Shrubby Trefoil,	651	Spigelia Marilandica, Spikenard, Small,	640
Rubeola,	131	Sick, Care of,	65		662
Jtubus Villosus,	598	u Children. Nursing, " Room, Choice of,	S91	Spinal Cord,	46
Rudbeckia Laciniata,	658		551	" " Diseases of,	159
Rue,	648	" " Cleanliness in,	555	" " Inflammation ol	159
Rules for Using Water,	548	" " Cookery for, " " Darkening of, " " Domestic Manage	678	Spinal Nerves,	46
Rumex Crispus, Running and Leaping,	664		556	Spine, Deformities of, ,	478
	90			Spirit of Nitric Ether.	654
Rupia,	141	ment of,	551	Spiritus jEtheris Nitrici, 635, 654	
Rupture,	476	" " No Cooking in,	552	" Ammonia; Aromaticus, 694	
Ruptures of Tendons,	465	" " Prejudices and		Spiroea Tomentosa,	618
Ruta Gravel us,	648	Antipathies in " " Sofa or Easy Cha	560	Spleen,	54
live,	78		ir	"■ Acute Inflammation of, 266	
" Spurred,	655	in,	552	" Chronic " "	266
		" " Temperature of,'	555	Splenitis,	266
Sacral Plexns,	47	" " Unhired Attend-		Sponge,	655
Saffron,	648	ants in,	659	Spongia,	655
Sage,	649	Sight, Organs of,	48	Sprains, Spurred Rye,	464
tl Tea,	678	" Long and Short, " Weakness of,	486		655
Sago Gruel, Saint Ignatins'8 Bean,	581		485	Squill,	655
	656	Silex Alba,	663	" Syrup of, " Vinegar of,	685
Sal Ammoniac,	593	Simple Ointment,	677		693
Salep Powders, Comp.,	580	" Syrup,	684	Sqninting,	487
Saline Mixture, 644, 675		Smapis Alba,	633	Squirting Cucumber, v	«62
Salix Nigra,	699	Singultus,	180	St. Anthony's Fire,	136
Salt,	653	Sippets,	678	St. Ignatius's Bean, St. vitus's Dance,	666
" of Tartar,	643	Sitz Bath,	537		169
Saltpetre,	635	Skin,	42	Stagger Weed, •	659
" Poisoning by,	498	" Color of, Disordered,	146	Star Grass.	665
Salvia Officinalis,	649	" Diseases,	130	Statici Caioliniana,	631
Sambucus Canadensis,	613	" Nerves of, Disordered,	146	Sterility,	371
Sanguinaria Canadensis,	599	" Offices of,	102	" Causes of,	374
Sanguinarin,	599	Skull, Fractures of,	447	Stiff Joint,	468-
Sapo,	652 Skunk Cabbage,		651. Stilliugia Sylvaticus,		646
SarsapariUa,	649! Sleep,		95> " Comp Syrup of,		687
Comp. Syrup of, 687		" Amount of,	97 Stomach,		32
" False,	662	" Disturbed,	182 " Affections of,		676
" Wild,	652	" Natural Position for,	971 " Bile in,		64
Sassafras,	649	" Preparation for,	97 " Acute Iuflammatior		
Savin,	649	Sleeping Apartment,	551	of,	269
Scabies,	139	" Rooms,	95	" Chronic Infiamma	
Scalds.	435	" " Bedding in,	96	tion of,	270
Scaly Eruptions,	143	" « Beds in.	96	" Movement of,	63
Scammony,	650	«' « Fire in,	95	" Pipe,	31
Scarification,	442	" " Night Dress in, 97		" Spasm or Cramp in, Stone in Bladder,	277
Scarlatina,	132	" '• Open Fireplace			315
Scarlet Fever,	132	in,	96	Storax,	666
Sciatica,	173	" " Open Windows .		Strabismus,	487
Scilla Maritima,	655	in.	90	Stramonium,	656
Sclerotic Coat,	481 " " Smail,		109	" Ointment,	677
Scoke,	642 ■ Siippery Elm, 421 Small Pox,		652	" Poisoning by,	499
Scorbutus,			134	Strychnine, Poisoning by,	499
				"*—	
 
INDEX
797
Stryehnoe Nux Vomica,      635
Stye,                       481
Styrax Officinale,            656 Tic Douloureux,
Sudorific Tinct.,        »    693 Tight Dressing,
Suet Ptisan,                 583jTinctures,
Sugar of Lead, Poisoning by, 498! Tissues,
  *•   of Milk,              226 [Tobacco,
Sulphur,                    6561 Toe Nail, Ingrowing,
Throat Diseases, Instruments    i Variocele,
  for Treatment of,           195 Variola,
    172 Varioloid,
101, llljVarix,
690, 688 Vegetable Poisons,
        Ointment, Comp.,    678
Sulphuric Acid, Poisoning by, 498
Sumach,                    657
Summer Complaint of Infants, 404
Sunflower,
Sunstroke,
Super Carbonate of Soda,
  "   Tartrate of Potassa,
Suppression of Urine,
Suppuration,
Supra Renal Capsules, Disease
  of,
Surgical Diseases,
Swamp Dogwood,
   "    Milkweed,
Sweat Glands, Disordered,
Sweet Fern,
   "   Flag,
   "   Gum,
   "   Oil,
   "   Spirits of Nitre,
Swelling of Lungs,
Sycosis,
Sympathetic Nervous System,
Symphytum Officinale,
Syniplocarpus Foetidus,
Symptoms, Table of,
Syncope,
Synovial Degenerations,
Svphilis,                    320
Syringe, Laryngeal Shower,  195
   "   Nasal       "      196
   "   Phryngeal   "      196
Syrups,                     683

Tag Alder.                  658
Tamarac, Comp. Tinct.,pf,    693
Tanasetum Vulgara,         658
Tansy,                      658
Tapioca,                     659
   "   Jelly,               581
Tar,                         658
 "  Ointment,               677
 "  Plaster, Comp.,          680
Taraxacum,                 612
Tea and Coffee,               84
 "  Beef,                   682
 "  Sage,                   678
Teeth,                       29
  "   Care of,               500
  "   Cleaning of,           603
  "   Composition of,         30
  "   Cutting, Difficult,      401
  "   Diseased,              503
  «   Filling,               602
  "   First,                 603
  "   Names of,              30
  "   Number of,             29
  "   Origin of,              29
  "   Rotting of,            600
  '•   Use o£i                 30
Tela Araneae,               654
Temperaments,              118
      "      Abdominal,     119
      "      Cephalic,       118
      "      Medication and, 119
      "      Muscular,       119
      "      Thoracic,       119
Temperature,               655
Tendons, Ruptures of,        465
Tetanus,                    166
Tetter,                      139
  "   Crusted,              142
  "   Humid,               139
Thigh Bone, Fractures of,    462
Thimbleweed,               668
Thornapple,                 656
rin oat Diseases,             188
        Tolu, Syrup of,
         "   Tinct. of.
        Tonsil Instrument,
        Tonsils, Acute Inflammation
                of,
          "   Chronic  Inflamma-
                tion of,
        Toothache,
           "     Tree,
        Towel and Sponge Bath,
        Tracheitis,
        Trailing Arbutus,
        France,
        Travelling,
           "      Seasons for,
     46' Trees, Cultivation of,
    657 j Trefoil, Shrubby,
    658  Trifolium. Pratense,
    658  Trillium Pendulum,
    636; Trumpet Weed,
635, 654  Tulip Tree,
    235 i Tumeric,
    149  Tumors,
          "   Encyst
          "   Fatty,
        Turkey Corn,
        Turner's Cerate,
        Turnips,
 16
668
491
202

201

202
501
645
Soup,
steoT
4661 Turpentine Liniment,
Tussilago Farfara,
Tylosis,
Tympanitis,
Tympanum
    658
    168
112,230
    113
    110
    651
    647
    597
    646
    659
    659
    468
    471
    671
    459
    667
     79
    672
                 145
                 283
                  61
Inflammation of,  490
                          PAOE
                           473
                           134
                           135
                           475
                           498
                           682
Veins,                       37
     Acute Inflammation of, 474
     Enlarged or Varicose,   475
Venereal Diseases,           320
Ventilation,         57,108, 553
                           110
                            36
                           250
                           248
                           592
                           661
                           592
                           659
                           433
           in Sick-Rooin,
Ventricles,
         Dilatation of,
         Enlargement of,
Veratrin,
Veratrum Album,
    "     Viride,
Vervain,
Verbascum Thapsus,
Verbena Hastata,
Verdigris, Poisoning by,
Vermes,
Verruca,
Vertigo,
Vessels, Absorbent,
Viburnum Opulus,
Vinegar,
Vinegars,
Virginia Snakeroot,
   ^»      "    rim
497
293
146
181
 3S
€19
660
Typhoid Fever,             410
   "    Lung Fever,        242
   "    Pneumonia,        242

Ulceration and Ulcers,      431
    "    of Bones,        465
Unhired Attendants,        569
Unicorn Root,              655
Union by First Intention,    439
Unnatural Growth of Bones, 465
Upland Cranberry,         595
Upper Arm Bone, Fractures
  of,                       449
Urate of Ammonia in Urine, 312
Ureters,                     34
Urethra.                    35
Uric Acid Gravel,          308
Urinary Deposits,           306
   "    System,             84
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,
Uteri  Prolapsus,
Uterine Hydatids,
Uva Ursi,
Uvula, Elongation of,

Vaccina,
Vagina, Inflammation ofj
Valerian,
    "    Comp. Tinct. of,
Valeriana Officinalis,
Valves, Mitral,
   "    Semilunar,
   "   Tricuspid,
Varicella,
                               660
                   Comp. Tinct.
                     of,       693
       "       "   Tinct. of;    690
    Vision, Imperfect,           486
    Vocal Cords,                 41
      "   Organs,                40
    Vomiting,                  277

    Wafer Ash,                 651
    Wahoo,                    «61
    Walking,                    90
    Warts,                     145
    Wash Down,                539
     *•   Tub,                  537
    Water,                      85
      "   Accidents on,         496
      "   Apple,               581
      "   Barley,               578
      "   Brash,               277
      "   Camphor,            673
      "   Chemical Nature of,    86
      "   in Chest,             237
      "   Chicken,             683
      "   Cochituate,           87
      "   Division of,           86
      "   Gruel,               680
      "   in Heart Case,        259
      "   Horehound,          660
      "   Impure,               88
      "   Impurities in,          86
      "   Lemon,              679
      "   Milk and Soda,       584
      "   Modus Operandi of,    646
      "   Pepper,              631
      "   Properties of,          87
      "   Rain,                 87
      "   Rice,                678
      "   Rules for Using,      648
      "   Salt,                  88
      "   in Scrotum,          473
      "   Schuylkill and Croton, 87
137 Waters, Medicated,          672
3681 Watery Pimples,            138
366 Wave or Sluice Bath,        635
695 Wax,                      661
200 Weaning,                  392
    Wens,                     471
136 Weights,                   688
369|    "     French Decimal,    689
659, Wet Bandages,              549
6931  "  Dress,                  630
6591  "  Sheet, Folded,          631
 36'  "    4i   Pack,            628
 36 i  "    "  Rubbing,         631
 36 Wheat.                     77
136,    '•    Flour, Unbolted,      71 
798                                     INDEX.
	PAOB
Whev, Alum,	683
" Mustard,	583
" Orange,	5S4
" Rennet,	583
" Sweet,	584
" Tartar,	583
" Vinegar, " with Tamarinds,	583
	584
" Wine,	584
White Hellebore,	661
" " Ointment,	677
" Indian Hemp,	657
" Liquid Physic, " Oak,	675 661
" Pond Lily,	601
" Poplar,	659
" Swelling,	466
Whites,                353,390
Whitlow,                   467
Wild Cherry,               661
  "     u   Bark, Syrup of, 686
  "   Cucumber,           662
  "   Ginger,              662
  "   Indigo,              662
  "      "   Ointment,      677
  ""   SarsapariUa,          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.,     672
     of Golden Seal, Comp., 673
                           673
                           673
                           651
                           603
                           663
                           663
                           343
                           368
                           368
     of Ipecacuanha,
Wines, Medicated,
Wingseed,
Winter Green,
Witch Hazel,
Wolfsbane,
Womb and Appendages,
  "  Falling of,
  "    "    over of,
  "  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
    "    IusflfcL.          438
         Po^^B,          442
         rolVd,        441
    "    Rules for  Examin-
          ing and Dressing, 440
Wrist, Dislocation of,
  "   Fractures of,
Wry Neck,
400
4r,l
4S0
Xanthoxylum Fraxineum,    645

Yam, Wild,                662
Yarrow,                    664
Yeast,                      614
Yellow Dock,               604
   "    "  Comp. Syrup of, 6«8
   "   Fever,               415
   "   Jessamine,           t'<'>4
   "   Ladies' Slipper,      n,;5
   "   Parilla,             605

Zinc,                      665
  "  Acetate of,             6<i5
  "  Chloride of,            665
  "  Iodide of,             665
  "  Oxide of,              665
  "  Precipitated  Carbonate
      of,                   606
  "  Sulphate of,            660
  "  Valerianate of,         666
Zinci Carbonas Praecipitas,    666
  "  Chloridum,            665
  "  lodidum,              605
  "  Oxidum,               605
  "  Sulphas,               606
  "  Valerianas,            660
Zingiber Officinale,          615
ADDITIONAL   INDEX.
Acne, Spotted,
Ague Cake,
Alteratives,
Anidrosis,
Anteversion of Womb,
Anaemia,
Apoplexy and Paralysis,
Asphyxia,
Asthma,
Astringents,            439,

Belly Ache,
Big-ivy,
Black Vomit,
Breathing Murmurs,
Bronchial Flux,
    "      "  treatment of,
Buff/ Coat,

Calvities,
Canker,
Care of the Skin,
Carminative Physic,
Carminatives,
Catarrh of Bladder,
Carthartics,
Caustic Potassa,
Chalk-stones,
Cnancre, Sloughing,
         Gangrenous,
    "    Eating,
    "    Indurated,
Changes occurring in
  Advanced Life,
Charbon,
Chicken-pox,
CliilJren's Sore Mouth,
Cliromidrosis,
Coaptation,
Convulsions,
Comedones,
Compression,
Coryza,
Cough Preparations,
Counter-extension,
    "    irritation,
    "    irritants,
1481 Cupping and Leeching,
428
772 Depositories of Family
1471   History.
368, Diaphoretics and Sedatives,
2591 Diet, Milk,
710   "  Cream,
494   "  Eggs,
709   "  Fish,
772   '•  Fruits,
   |   "  Vegetable,
282 Diet for the Old,
633 Diphtheria,        696,697,698
415 Diseases of the Old,
212 Diuretics,
709 Dropsy of Brain,
709 Dumb-bell Exercises,
426
   1Egophony,
150! Electricity,
6951 Endosmosis,
706 Engorgements, State of,
766 'Emetics,
770 Epsom Salts,
2981 Exercise,
763 j Exercises with Wands,
642 Expectorants,
4181 Exosmosis,
321, Extension,
3211
321 j Falling Sickness,
321 Female Weakness,
   I Fistula,
703 Fluctuation,
434 Freckles,
1351
3991 Gangrene,
117. Gargles,
444 Gymnastic Crown,
572
148 Helpless dependence of the
439 , Aged,                     702
131 Iloemidrosis,                147
769 Hepatization, Stage of,       241
444 Hectic Fever,               427
428 History of Gymnastics in the
778   United States,             761
700
771
564
566
666
567
667
567
704
771
158
714

239
707
319
241
696
639
706
747
706
319
444

167
353
430
429
147

430
775
757
Hives,	135
Honey Diseases	142
" Scab,	142
Horn-pox,	136
Hypo,	1.9
Idrosis, >	147
Leucorrhcea,	300
Leeching,	428
Ligature. Liniments,	438
	V74
Loneliness of the Aged,	702
Lotions,	Tib
Medical Treatment of the Old	,708
Metastasis,	416
Milk,	705
Milk Crust,	142
Milk Weed,	609
Mode of Cooking Meats,	704
Moles, Mortality in Cold Weather,	14'<
	706
Myopia,	486
Narcotics and Anodynes,	770
Night Nurse,	6o2
No fear of Death,	703
Nympho-mania,	87U
Oil-Nut,	602
Ointments, .'-	710
Papillae,	145
Paracentesis Thoracis	240
Pectoriloquy,	*J-W
Pin-worm,	SH'3
Plastic Lymph,	4.0
Plain Puddings and Ties,	'.<•!>
Presbyopia,	4M
Prescriptions,	ioJ
Presvervatiou of Old People's	
Health,	« 3
Provisional Callus,	440
Puerile Respiration,	212
Pulmonic Cherry Cordial,	uo
Pussy Willow,	Uj'J
 
INDEX.                               799
Radius,	PAOI 461
Ragwort,	627
Recipes,	763
Red Gum,	144
Red Softening,	241
Refrigerants, Regular Habits.	771
	703
Retroversion ot Womb,	638
Ripe Fruits,	705
Salt Rheum,	143
Scall,	142
School-desks and Seats,
Sinus,
Sleep.                   706
Sleeplessness,             707
Slough,                  428
Southern Prickly Ash,      645
Spider Mark,              146
Stimulants,'               771
Stricture,                 332
Styptics,                 439
Sudamina,                410
Suitable MedidinesfortheOld,708
PAOI 1
 759 Sun Heat,
 430 Susceptibility to Cold,
    Sutures,
    Sweat-drops,
                      PAOK
                       139
                       705
                       439
                       '410

The Fathers of our Race, etc. ,701
The New Gymnastics,      714
The Pangymnastikon,      758

Urinary Organs, Diseases of, 710

Wine, etc.,               705
        THE   WARREN  MEDICAL  OFFICE,
                              FOB THE TREATMENT OJ"
THROAT, LUNG, HEART,  FEMALE, SKIN, SURGICAL,
                                   AMD OTHER
                    CHRONIC    DISEASES.
  During the last fourteen years, the anthprjphis book has devoted himself to the study
 and management  of the above-named disealQEnd has treated several thousand cases from
 the different States of this Union, and from theBritish Provinces.'  I have no desire to make a
 display of it, but it should be stated that I was the first to use the present Amciican System
 of Inhalation of medicinal substances for the cure of disorders of the chest, and published iu
 the newspapers of Boston the first articles on the subject for popular reading.
  Besides diseases of the Throat and Chest, my practice has extended to Female Complaints,
 Disorders of the Liver, Stomach, Kidneys, Skin, Genital  Organs, and indeed to all  Chronic
 Complaints of long standing, which have defied the usual remedies.
  Among the instruments which I have had occasion to invent, the following are well known
 and extensively used, and may always be had of me at the prices annexed:
     Warren's Shower Syringes, three in one case, Silver,   ...   $10
     Warren's Improved Tonsil Instrument, ........   10
     Warren's Powder Inhaler,           ........'     1
     Warren's Medicated-Vapor Inhaler, .........    1
  The following elegant Instrument, recently prepared by me,  and described on pages 50t3 and
 507 of this book, is, I think, well worthy the attention of physicians and surgeons:
     Warren's JParacentesic Instrument,........$50
  If an extensive business for several years has worn my vital powers, and brought the silver
 marks of age, I am compensated by the reflection that it has likewise added to my experience
 and knowledge, and rendered me, if not more worthy of the respect, at least better entitled to
 the confidence of those who seek my professional aid.
  In my labors, growing heavy for me, I am now assisted by my nephew, Dr. Dewey K.
 Warren —a man of genial and inspiring disposition, honorable in his deportment, and pro-
 fessionally worthy of all confidence.   Encouraged by the past, we  hope, by  prompt and
 careful attention to the numerous calls we are receiving, to make this office still more worthy
of the extensive patronage it is receiving.
  Those who cannot come to Boston, but wish to take my advice, etc., may do so by forward-
ing a description of their case, carefully prepared by themselves or by their physician, as they
may choose;  or, they may send to me,  nnd  I will furnish them a list of printed questions,
which they may answer by letter.
  All sick persons, while from home, and in Boston under my  care, are most tenderly watched
over; and nothing is left undone which it is believed will tend to make their stay pleasant,
and their recovery rapid.
                                                      IKJL  WARKEJ, M. 1>.
  No. 3 A vox Plac«, Bostok, August, 1S6S. 
RECOMMENDATIONS
WARREN'S    SYHIN  G-ES
                      From the Boston Medical and Surgical Journal.
  " Throat Stringes.—Dr. Ira Warren Is the Inventor of several instruments for the appll-
cation of medical remedies to the throat, which are not only quite new in pattern, but beautiful
in workmanship.  *  *  *   The probang, and other contrivances heretofore resorted to, will
be superseded by these ingenious instruments."

                       From the FranhliwKt^jiy Medical Society.
  " Resolved,—That from an examination of Dr. Ira Warren's Laryngeal, Pharyngeal, and
Nasal Shower  Syringes, we think them well adapted for the purposes for which they were in-
tended."

From Henry J. Bigehw, M. D., Prof, of Surgery in Harvard University, and one of the Surgeons
            '              of the Massachusetts General Hospital
  " Dr. Ira Warren's Syringes are excellent instruments for injecting caustic, and other fluids,
into  the fauces, trachea, and posterior nares.              HENRY J. BIGELOW,  M. D."

     From Drs. Gould, Morrill, and Clarke, Censors of the Massachusetts Medical Society.
  "I have, for some months past, made frequent use of the Shower Syringes, constructed
under the direction of Dr. Ira Warren,  and consider them  a decided improvement  upon  all
other instruments which are in use, for similar purposes.
                                                    AUGUSTUS A. GOULD,  M. D."
   " I concur most heartily with Dr. Gould in the opinion that Dr. Warren's Syringes  are a
valuable invention, easily used, not liable to get  out of order, and the only  instruments, with
which I am acquainted, by which caustic can be applied easily and effectually to the throat
and posterior nares.                                            S. MORRILL, M. D.»

   " I consider the instruments of Dr. Warren to be a decided improvement over the sponge.
                                                           ED. H. CLARKE,  M.  D."

       From Dr. Samud Knedand, Jr., Demonstrator of Anatomy in Harvard University.
   "Every one who has had frequent occasions to introduce into  the larynx the old probang
 and sponge, for the  purpose of cauterization, with its attendant difficulties and suffering, will
 hail the improvements of Dr. Ira Warren's Shower Syringes as of great value.  They render
 ttiis disagreeable operation exceedingly easy, and comparatively free from pain.
                                                    SAM'*  mSEELAND. Jr.- M, D." 
 
 
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