ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 ANNS£ Section. Number — /'2-67-s-/ i r . 3—10543 Fohm 113c. W. D.. S. O. O. (Revised June 13. 1930) { '!'e-^k \i the n '-> °* iEOME BOOKIE ^■—- •y __________—— - OF HEALTH AND MEDICINE . A POPULAR TREATISE ON THE MEANS OF AVOIDING AND CURING DISEASES, AND OF PRESERVING THE TO THE LATEST PERIOD; INCLUDING AN ACCOUNT OF THE NATURE AND PROPERTIES OF REMEDIES; THE TREATMENT OF THE DISEASES OF WOMEN AND CHILDREN, AND THE MANAGEMENT OF PREGNANCY AND PARTURITION. ft^Ao Q . it I* s BY A PHYSICIAN OF PHILADELPHIA. J. LOCKEN, 311 MARKET STREET. 1842. J B PREFACE. The present work has not been written with the view of encouraging lomestic quackery. To treat properly and successfully the various acci- nts and diseases to which the human body is liable, requires a degree skill which can only be acquired by years of study, and an entire de- jtion of the mind to the practice of the healing art. This is the province olely of the regular bred and scientific physician. To procure as speedily s possible the services of whom, upon even the slightest attack of dis- use, is always the wisest and safest course to pursue. It is jll te.^avtant, aow&ver, that the public generally should'be, as far as possible, made acquainted with the structure and functions of the human L body; the various agents by which it is preserved in a state of health and I vigour, and by the abuse of which disease is induced; and that they should M not be left in entire ignorance of the nature and effects of remedial agents, and the causes and symptoms of the various morbid affections of most common occurrence. It is believed by the general diffusion of informa- tion on these points, that quackery of every species will be most success- fully combated, the comfort and success of the regular practitioner aided and facilitated, and the improvement of the healing art greatly improved. I - To demonstrate, as far as it is known, shortly and clearly, the nature of itihe varied and multiplied forms of disordered health is indispensable, in *der to convince the public at large, of the importance and-difficulty of acclkately distinguishing diseases. To show the real nature and effects of remedies is also requisite, in order to prevent superstitious, inert, dan- gerf us and empirical practices. And, it is not less indispensable with a viexv both to preserve health and to restore it when impaired, to explain IV PREFACE. 1 the powerful influence upon the system of diet, regimen, and other ac- cessary agents. A host of prejudices, which the medical man finds it often even more difficult to combat than the disease itself, would be thus banished; the sick would be more disposed to listen to and adopt rational advice, and would be better able to distinguish sound judgment, enlarged experience and patient observation from shallow pretension, base chi- canery, and impudent empiricism. To promote these important ends is the sole object of the Home Book op Health and Medicine. 4 To pa- rents especially, and all such as have the superintendence of children, such a work must be a useful guide—more useful by showing the diffi- culties than by giving false views of the facilities of managing the health M of their young charges. Above all, it can not fail, it is believed, to be a most effectual antidote to quackery and empiricism in all their varied forms. \ -:■(•: TABLE OF CONTENTS. PART I. ANATOMY AND PHYSIOLOGY. V AlTATOMY, 3 Physiology, 4 Section I. Bones, 5 Section II. The skeleton, 8 Section III. The muscles,20 Section IV. The integuments, 21 Section V. Digestive apparatus, 24 Section VI. Absorbents and absorption, 32 Sedion VII. Circulatory apparatus, 33 Section VIII. Respiratory apparatus, 37 Section IX. Secretion, 40 Section X. The urinary apparatus, 41 Section XT. The nervous system, 42 Section XII. The external senses, 46 Section XIII. The organs of generation, 55 SWtfion XIV. Generation, 58 Section XV. Oi gans whose office is un- known, 60 Section XVI. Sleep, 61 PART II. HYGIENE, OR THE MEANS OF PRESERVING HEALTH. Health, 68 Section I. Air, 69 Section II. Clothing, 74 Stction III. Exercise, 78 (Secfc'ow IV. Appetite and food, 82 Section V- Cleanliness, 114 Section VI. Sleep, 119 Sedion VII. The passions, 123 Section VIII. Preservation of the hair, sight and feet; Care of the bowels; Use of tobacco, 124 Section IX. Training; Bleeding; Habit, 128 Section X. Management of infants and children; Weaning; Nurses and nursing, 129 Section XI. Diseases of artizans, 134 PART III. MATERIA MEDICA, OR THE REMEDIES EMPLOYED FOR THE CURE OF DISEASES. Materia Medica, 139 Medicines, 139 Quack Medicines, 140 Specifics, 141 Sedion I. Classification of Medicines, 141 Absorbents; Alteratives, 141 Anodynes; Anthelmintics; Antidotes; Anti-emetics, 142 Antiphlogistics, 143 Antiscorbutics; Antispasmodics; Aro- matics; Astringents; Bathing, 144 Blood-letting, 147 Carminatives; Cataplasms, 149 Cathartics, 150 Section I. Clysters; Collyria; Cupping, 151 Demulcents; Diaphoretics; Diet, 152 Diluents; Diuretics; Electricity; Em- brocations; Emetics, 153 Emenagogues; Emollients; Errhines; Epispastics, 154 Escharotics; Expectorants, 155 Friction ; Gargles ; Hydragogues; Leeches, 156 Lithonrftptics, 157 Mineral waters; Narcotics; Rubefa- cients; Sedatives, 158 Sialagogues; Stimulants; Suppositories; Tonics, 159 VI TABLE OF CONTEXTS. Section n. Lvditidual Remedies, 159 Acids, 159 Aconite; Acorn coffee; Adhesive plas- ter; Aloes, 163 Alum; Amber, the oil, 164 Ammonia; Ainmoniacum, 165 Angustuia bark; Antimony, 166 Arabic, gum; Arsenic, 167 Assafoetida; Asarabacca; Azederack; Azote, 168 Balsams; Bark, 169 Barytes; Basilicon; Belladonna; Benne leaves; Bismuth, 171 Bitter sweet; Blackberry root; Blister- ing plaster; Blood root; Boneset; Bo- rax; Broun mixture; Buckbean, 172 Buckthorn; Bugle weed; Burdock; Burgundy pitch; Butterfly weed; Butter nut; Cajiput oil; Calamine; Calomel, 173 Camphor, 174 Cantharides; Carbon, 175 Carrot seed; Cascarilla; Castor; Castor oil, 176 Catechu; Cayenne pepper; Chalk; Cha- lybiates, 177 Chamomile; Cherry tree bark; Chlo- rine, 178 Citrine ointment; Colchicum; Colo- cynth; Columbo, 179 Coltsfoot; Contrayerva; Copper; Cor- rosive sublimate, 180 Cow-itch; Coxe's hive syrup; Cream of tartar, 181 Croton oil; Crowfoot; Cubebs; Dalby's carminative; Dandelion; Denarcotiz- « ed opium, 182 Dewberry root; Dogwood; Dover's powders; Dyspeptic ley; Effervesc- ing draughts; Elaterium; Elder, 183 Elecampane; Elixir of vitriol; Elm; Ep- som salts; Enemas; Ergot; Ether, 184 Fern, male; Flaxseed; Foxglove, 185 Gall-nuts; Galbanum; Gamboge; Geof- frabark; Geranium maculatum; Glau- ber's salts, 186 Section II. Gold; Gregory's powders; Grif- fith's pills; Griffith's mixture; Guia- cum; Hellebore; Jkmlock, 187 Henbane; Hooper's pills; Hops; Hoar- hound; Hydriodate of potass; Ice; Iceland moss, 188 Indian tobacco; Indian turnip; Iodine; Ipecacuanha, 189 Iron; .lalap; Juniper; Kentish ointment; Kino, 190 Laudanum; Lauro-ccrasus, 191 Lead; Acetate of lead; Lenitive electu- ary; Lettuce, 192 Lime water; Liquorice; Lisbon diet drink; Logwood; Lunar caustic; Magnesia, 193 Magnolia; Manna; Marsh mallow; May apple; Mercury, 194 Mezereon; Mineral waters; Morphia; Musk, 196 Mustard; Myrrh; Neutral mixture; Ni- trate of potass, 197 Nux vomica; Oak bark; Olive oil; Opi- um, 198 Opodeldoc; Oxygen; Oxymel; Parsley; Phosphate of soda, 201 Phosphorus; Pink root; Pipsiseva; Pitch; Burgundy pitch; Plummer's pills; Poison oak, 202 Poke; Pomegranate bark; Potass; Po- tato fly; Precipitate, red; Quassia Quinine, 203 Rhatany; Rhubarb; Rochelle salts; Sar saparilla, 204 Sassafras; Savine; Scammony; Sea ter; Seidlitz powders,- Seltzer wa- ter; Senega; Senna, 205 Serpentaria; Soap; Soda; Squill; Stra- monium, 206 Strengthening plaster; Strychnine; Sul- phur; Tansy, 207 Tar; Tin; Tobacco; Turner's cerate; Turpentine, 208 Tutty; Uvae ursi; Valerian; Warming plaster; Warner's cordial; Worm- seed; Wormwood; Yeast; Zinc, 209 ; Sar-W a wa- \ fc PART IV. SURGICAL DISEASES AND ACCIDENTS. Abscess, 211 Achilles' tendon, injuries of the, 213 Alvine concretions; Aneurism, 214 Animation, suspended, 215 Anus, diseases of the, 218 Bee sting, 220 Bones, diseases of the, 221 Brain, injuries of the, 222 Bronchocele, 223 Bubo; Burns and scalds, 224 Cancer, 226 Carbuncle, 229 Chancre; Chilblains, 230 Chordee; Circocele; Club feet; Contusion." 231 Corns; Emphysema, 232 Empyema; Eye, diseases of the, 233 Eye-lids, diseases of the; Ear. diseases of the, 238 Excoriation, 239 Gangrene or mortification, 240 Gleet; Gonnorrhoea, 241 Gullet, affections of the, 242 Gravel and stone, 243 Harelip; Hernia, 246 Hydrocele, 248 « TABLE OF CONTENTS. Vll Joints, affections of the, 249 Noli me tangere; Phymosis; Polypus, 254 Sarcocele; Spine, affections of the, 255 Sprain; Ulcers, 257 Urethra, strictures of the, 258 Venereal, 259 Warts; Wasp sting; Whitlow, 261 Wounds, 262 Wry neck, 263 PART V. DISEASES, THEIR SYMPTOMS, CAUSES AND TREATMENT. r\ Intermitting fever, 265 Bilious fever, 269 Yellow fever, 273 Typhus fever, 276 Inflammation of the brain, 280 eves, 282 tonsils, 283 larynx, 284 Catarrh, 285 Influenza, 287 Pulmonary inflammation, 288 Pneumonia notba, 290 Inflammation of the stomach, 291 intestines, 292 peritoneum, 295 bladder; Womb, 298 Dropsy of the brain, 299 Convulsions in infants, 300 Apoplexy, 303 . Palsy, 305 Hysterics, 307 .Hypochondriasis, 308 * Nerve pang, 310 ' Tetanus, 311 r Hydrophobia, 312 C Epilepsy, 313 9 Chorea, 315 4 Insanity 317 i Delirium tremens, 325 Mumps, 326 Thrush; Croup, 327 Hooping cough, 332 Asthma, 335 ^iseases of the heart, 337 ^Consumption, 339 Dyspepsia, 342 Water brash; Jaundice, 349 Colic, 351 Diarrhoea, 356 Dysentery, 360 Cholera morbus, 361 Epidemic cholera, 362 Cholera of infants, 365 Iliac passion, 366 Worms, 367 Poisons, 368 Diabetes, 373 Bloody urine; Incontinency of urine, 374 Retention of urine; Suppression of urine; Strangury; Dysuria, 375 Diseases of menstruation, 376 Green sickness, 377 The whites, 378 Falling down of the womb, 379 Inversion of the womb, 380 Polypi in the womb; Cancer of the womb, 381 Rheumatism, 382 Gout, 385 Bleeding from the nose, 391 Spitting of blood, 392 Vomiting of blood, 394 Dropsy, 395 of the belly, 397 of the chest, 400 Measles, 403 Scarlet fever, 405 Small pox, 408 Cow pox, 410 Chicken pox; Erysipelas, 415 Purpura, 417 Itch, 418 Tetter; Shingles, 419 Ring worm, 420 Scalled head; Scrophula, 421 Rickets, 423 Scurvy, 424 PART VI. PREGN\NCY AND PARTURITION, WITH THK DISEASES AND ACCIDENTS OF THOSE STATES. Pregnancy, 426 Flooding,' 429 Abortion, 431 Labour, 432 Delivery, 436 After-pains, 437 Lochia, 437 Sore nipples, 438 Phlegmatia dolens, 438 Still-born infants, 439 Child-bed fever, 439 Viii TABLE OF CONTENTS. APPENDIX. THE USES AND DOSES OF MEDICINES. Emetics, 441 Laxatives and purgatives, 442 Laxative and purgative clysters, 443 Carminatives, 443 Diuretics, 443 Diaphoretics and sudorifics, 443 Expectorants, 444 Absorbent medicines, 444 Anodynes, 444 Astringents, 444 To check vomiting, 445 Tonics and bitters, 445 Worm medicines, 445 For burns and scalds, 446 Eye-waters, 446 Gargles, 446 Dressings and plasters, 446 PART I. ANATOMY AND PHYSIOLOGY; OR, AN ACCOUNT OF THE STRUCTURE AND FUNCTIONS OF THE HUMAN BODY. { •If ANATOMY. Anatomy is the art of exhibiting the structure of organized bodies, either bydis- **-ction, injection, boiling or other modes of •eparation; or the knowledge acquired y any of these means. The importance of human anatomy as the basis of all true physiology, and of the rational exercise of physic and surgery, is now universally acknowledged. The an- cients having few opportunities of examin- ing the structure of the human body, made comparatively little progress in the know- ledge of its functions; and a few facts ob- tained by casual inspection of wounded pa- tients, with some analogies gathered from the internal parts of brutes which had been killed in sacrifice or for food, constituted the sum of their anatomical knowledge. Their opinions of the functions of living animals were still more contemptible. Of the uses of the heart and arteries, the lungs, and the liver, they were totally ig- norant ; the grand discoveries of the circu- ^tion of the blood, the absorption of the chyle and lymph, the functions of the sto- mach, the liver, and the other viscera em- ployed in digestion or nutrition, are entirely due to the skilful and patient anatomists of modern times. Of the absolute, the indis- pensable necessity of the most minute know- ledge of anatomy to the operating surgeon, it is superfluous to speak. By the exact acquaintance which surgeons have now ac- quired of the relative position of the various organs, whether muscles, nerves or blood- vessels, they are enabled successfully to perform operations, which formerly would B have been regarded as utterly impractica- ble ; and to cure diseases which in ancient times were allowed to wear out the patient in torture and putrefaction. It is greatly to be regretted, that any obstacles or discouragements to the acqui- sition of anatomical knowledge should exist in any quarter. There is undoubtedly an instinctive honor at mutilating the erect form, which was so lately the residence of an intelligent and immortal spirit; and few contemplate without the deepest anguish the possibility of this being done to the person of those who had nourished their infancy and protected their childhood, or in whose countenance they were accus- tomed to discern the benevolent feelings of their heart. Yet the instincts of nature must give way to the calls of duty and necessity. They, who for the acquisition of a useful and necessary profession, devote themselves for a time to the disgusting exercise of dis- section, should meet with no obstruction from those who are to benefit by their skill and attainments. If persons in the better ranks of life are afflicted with diseases which require the knife of the surgeon, they very properly demand the assistance of the best that can be procured; but they should remember" that they can not have a skilful surgeon who has not dissected many bodies. This should not be forgotten by judges, magistrates, and other persons in power; who, by the influence of their cha- racter and attainments, should temper and remove the prejudices of the people, in- stead of inflaming them. Every year, there are numerous judicial investigations, on the result of which many lives depend. In 4 ANATOMY AND PHYSIOLOGY. trials for suspected murder, and in coroners' inquests, almost the whole affair depends on the evidence of medical men, who are called upon to state their opinion as to the cause of death; and who can never, with the slightest accuracy, describe what is the consequence of violence, poison, or disease in any part of the body, unless, by the fre- quent practice of dissection, they have been familiar with the appearance of the same part in its usual unaltered state. Some knowledge of the human body, and some information on the importance of anatomy, should be communicated in all Mechanics' Institutions; and the labouring classes should be impressed with a proper sense of the importance of good surgeons to them in particular. A rich man, when sick or dis- abled, can command many alleviations; but to those who must live by the strength of their limbs, and the dexterity of their hands, health and vigour are equivalent to a for- tune. Sensible and well-informed masters should take proper opportunities of im- pressing on their workmen the utility and necessity of human dissections. When the fall of a scaffold precipitates a number of masons to the ground—when the burst- ing of a steam engine throws down the walls of a manufactory, and mangles many of the workmen, or scatters the destructive fragments of a vessel among the passengers and crew—when the carpenter or ship- builder cuts an artery with his tools, nothing but the assistance of a skilful surgeon can give a chance of recovery, and preserve the life and limbs of the wounded, for the support of themselves and their dependent families. No plates, no models, no descrip- tions can convey the knowledge necessary to entitle a man to make the smallest pre- tensions to operate on the diseased living body. There are means of supplying the materials for a surgical education, without imparting a shock to the feelings of any, and without demoralizing the character of those who are employed; and we confi- dently trust that the liberality and good sense of the legislature, will take out of the way those obstructions to the attainment of surgical knowledge, which have been long productive, not only of inconvenience, but of profligacy and crime. By Compakatite Awatomy, is meant the knowledge of the structure of the bodies, or of the functions of other living creatures besides man. The great functions, which are common to all living and organized be- ings, can be known only by the diligent cultivation of comparative anatomy. By this we see what powers or operations of nature are necessary to the existence of animal life,—how respiration is performed, and how digestion; how some senses are perfect in some animals, and in others de- fective, but all conducive to the comfort of the animal in whom they arc found. We are thus enabled to distinguish what is es- sential to animal life, and what is extrinsic or accidental; and in many cases, we apply to the use of man, for the cure of diseases, and the improvement of his powers, the knowledge we acquire, by observations and experiments made on the lower animals. PHYSIOLOGY. If we consider this word according to its derivation, it means a discourse concerning Nature; but it is now generally employed to denote that science which explains the functions of organized beings, whether ani- mal or vegetable. Hence we have animal and vegetable physiology. The physiology of man signifies any discussion concerning the animal, vital, or natural functions of the human body. It endeavours to explain the manner of digestion, with the changes which the food undergoes in the stomach and intestines; the way in which the pre- pared chyle is conveyed to the mass of blood, and incorporated with it in the cir- culation through the lungs. It describes the modes and uses of respiration, the cir- culation of the blood, secretion, and growth, or assimilation. Physiology describes also the impressions made on the organs of the senses by external objects; it attempts to trace the effects of the mind on the corpo- real frame ; and to explain the phenomena of sleep and waking, of sympathy and ha- bit. Muscular motion, as well in its hidden causes, as in its striking effects, furnishes a fruitful topic to the physiologist. All tTie above functions pertain to man as an indivi- dual ; but those which are connected with the preservation of the species, present a train of investigation which has occupied, but not rewarded, the researches of the greatest physiologists. The history of the embryo, of gestation, of labour, and of the nourishment of the child by the milk se- creted in the breasts of the mother, nearly complete the objects of physiology. It will be readily seen, of how great im- portance the science of physiology is, to the general philosopher, as well as to the surgeon and physician. As comprising the natural history of the most important of living beings that inhabit our globe, as fur- nishing the natural theologian with the most beautiful and instructive illustrations of wisdom and design in the author of na- ture, physiology ranks high among the ob- jects of human knowledge; while the phy- sician, who is not intimately acquainted with the manner in which the body per- forms its functions in health, can not be competent to understand the phenomena of disease. ANATOMY AND PHYSIOLOGY. 5 SECTION I. BONES. The bones compose the solid frame work of the animal body, determining its shape, containing or defending various internal or- gans, and forming levers, by acting upon which, the muscles effect some of the most important motions of our bodies, particu- larly those in which the feet, hands, arms, and legs are concerned. Bones vary in their shape, size, and texture, according to their situation and uses. They are compos- ed chiefly of phosphate of lime, or earthy matter, and gelatine or animal matter. The outer surface of bones is, in general, firm and compact; while inwardly they are spon- gy and porous, with numerous blood-vessels running through them. The most general division of bones is into the long and cylin- drical, and the flat and broad. The bones of the arms, thighs and legs, belong to the first class, and those of the skull, shoulders and hips, to the latter. The large round bones, as those of the arms and legs, have a cavity in their centre, to admit of greater lightness being combin- ed with sufficient compactness and strength. In this cavity are contained the marrow and blood vessels which nourish the bone. There are in the human body altogether, two hundred and forty-eight distinct bones. At the time of birth, the bones are very imperfect, pai-ticularly those of the head; so that by being moveable in this part, and folding over each other during the time of delivery, an easier passage is procured for the infant. There are many projections from the bones, which in infancy are soft, but which in the adult state are bony; and the same tendency to the formation of bone increasing with our years, bones which were separate in the prime of life, concrete in old age. In the decay of the body, however, the bones are diminished with the other parts, so as in extreme old age to weigh a third less than in the middle pe- riods of life. To far the greater number of bones, whose ends are not joined to other bones by immoveable articulation, are annexed, by the intervention of cartilage, smaller bones, called epiphyses or appendages. In young subjects these are easily separable, but in adults the points of conjunction are not veiy perceptible. The bones are furnished with a tough membrane, called the periosteum, which is spread on their surface, and the principal use of which seems to be to convey blood- vessels fop their nourishment; these blood- vessels are very numerous and remarkable in the bones of the infant state, but become gradually less so in the progress of life. The ends' of the long bones, where they are united to each other, are larger than their middle part, and several advantages attend this structure. By this means, the surface of contact between the two bones at the joint, is increased; their conjunction consequently becomes firmer; there is more space for the connection of the muscles, which also act more powerfully, from their axis being further removed from the middle of the joint, or the centre of motion. The marrow, which fills the cavities of the bones, is a fat oily substance, contained in a fine transparent membrane, which receives numerous blood-vessels, and is supported by the filaments of the reticular substance of the bones. If the different parts of a bone are observed, it is found that where the diameter of the bone is the least, there the sides are thickest and most compact; where the diameter is greatest, which is in general towards the ends of the long bones, their structure is very cavernous through- out. The marrow pervades the whole sub- stance of the bones, but is most remarkable in the middle part of the cavities of the long bones. Its appearance and nature also differ in different bones, or in the same bone in the progress of life. Thus, the marrow is bloody in children, oily in adults, and thinner and more watery in aged peo- ple. Besides dislocations and fractures, bones are liable to inflammation, to caries or rot- tenness, to necrosis, in which the bone, dies and is replaced by a new one; to rickets, and to distortion and softening of their sub- stance. cartilages. Intimately connected with the bones are the cartilages. Cartilage or gristle, is a white elastic substance, differing in density in different situations, and like the bones, covered with a firm, transparent membrane. Cartilage is composed chiefly of gelatine. Its use is to supply the place of bone, ad- mitting a certain degree of motion, but by its elasticity regaining subsequently its natural position. This is the case in the nose, wind- pipe, anterior part of the ribs, &c. In children, cartilage supplies the place of bone, previous to the formation of the lat- ter. It is also found covering the ends of bones which play upon each other, allow- ing the joints to move more readily and without abrasion. It finally performs the office both of cartilage and ligament, pre- senting the elasticity of the former with the firmness of the latter, as in the spine and pelvis. The cartilages are liable to frac- ture and inflammation. 6 ANATOMY AND PHYSIOLOGY. LIGAMENTS. Ligaments are strong fibrous cords, or bands, which bind together the bones, strengthen and defend the joints, and strengthen the attachment of various or- gans, or keep them in their.place. They are whitish, inelastic, glistening bodies, possessing little sensibility in their healthy state, but are acutely sensible when in- flamed. ARTICULATIONS. In the human body, the bones are united or articulated to each other, either movea- bly or immoveably. They are moveably articulated in three ways: 1st, by a ball and socket, which admits of motion in all directions, as in the shoulder joint: 2dly, by a hinge, which allows motion in only two directions, as in the knee; and Sdly, by a long process of one bone received into the cavity of another, which admits of a rotary motion, as in the articulation of the first and second vertebrae of the neck. The immoveable articulation of bones is of two kinds: 1st, where numerous processes of two bones, like the teeth of saws, are mutually received into each other, as in the bones of the head; and 2dly, by the grow- ing together of bones with the intervention of cartilage, as in the union of the os sacrum with the ossa innominata. The ends of bones which move on each other are tipped with smooth cartilage; and the friction is still further diminished by a fluid, much more slippery than oil it- self, which is called synovia. The movea- ble joints are also furnished with strong membranes, called ligaments, which pass from one bone to another, affording strength, and retaining the heads of the bones in their cavities. SYNOVIA. The synovia is a fluid, which serves prin- cipally to lubricate the ligaments and car- tilages of the articulations. It is supplied by glands which are commonly situated in the joints, in such a manner, as to be gently pressed by the motion of the limbs. By this means, the greatest amount of the fluid is caused to be secreted when the most fre- quent motions are performed. When the synovia is supplied in too small a quantit}', the joint becomes stiff, is moved with diffi- culty, and emits a crackling sound; this is very common in persons advanced in years. MOVEABLE ARTICULATIONS. The most important of the moveable ar- ticulations or joints, are the following: 1. Articulation of the lower jaw.—An ob- lique process of the lower jaw runs upwards, until it reaches the bone of the temple, im- mediately in front of the ear. The upper and inner portion of this process is some- what rounded, and covered with a smooth t cartilage ; the portion of the temporal bone which forms the joint is somewhat hollow, forming a superficial cavity, which is also covered with cartilage; immediately in front of this cavity, on the temporal bone, is a small tubercle or eminence, likewise co- vered with cartilage. Between the con- dyle or articulating surface of the process of the lower jaw, and the cavity and tubercle of the temporal bone, is interposed a por- tion of cartilage, accommodated to the shape of the parts between which it is placed. The whole are kept firmly in their place by various ligaments. In consequence of this structure, the lower jaw is capable of open- ing and shutting, and of moving from side to side, as well as backwards and forwards. When the mouth is widely opened, the con- dyle of the jaw moves out of the cavity of the temporal bone, in which it ordinarily plays, upon the tubercle in front of the cavity. 2. Articulation of the head to the spine.— The head rests upon, and is articulated to the first bone of the spine, called atlas. The atlas has nearly the form of an oval ring; on its upper surface, there is on each side a smooth cup-like depression, covered with cartilage, into which are received two pro- jections of the hindmost bone of the 'skull; this connection forming a joint, which en- ables the head to move backwards and for- wards. Similar concavities exist on its lower surface, which joint it with the next bone of the spine. Within the anterior part of the atlas, there rises from the bone below, a tooth-like projection, which, together with that part of the atlas in contact with it, is smooth, and covered with cartilage; around this tooth-like projection, passes a strong ligament in the form of a loop, which, be- ing firmly attached on each side to the atlas, keeps the former in its place, and allows the latter to revolve partially around it, in which manner the rotary motion of the head is effected. 3. Articulations of the bones of the spine. —The spine consists of tv/enty-four bones; the bodies of all which, except the first, or atlas, are connected together by the inter- vention of a cartilaginous substance which unites them firmly, at the same time that it allows of some motion, in consequence of its elasticity and compressibility. This connection is strengthened by two liga- ments, which extend the whole length of the spine, from its second bone to the last. An immense number of other ligaments pass from one bone of the spine to another, so as to bind them together firmly in every possible direction. Processes arise ob- liquely from the body of each of the twenty- ANATOMY AND PHYSIOLOGY. 7 four spinal bones, wfiich are covered with cartilage, and form moveable joints with the oblique processes of the adjoining bone ta which they are attached. The articula- tions of the spine allow of the body being bent forwards, and, to a certain extent, sideways, and also of being slightly rotated, or twisted from side to side. 4. Articulation or joint of the shoulder. —This is formed by the large rounded head of the bone of the arm, covered with smooth cartilage, being received into a cavity, or depression, folined in the ante- rior expanded angle of the shoulder blade, likewise covered with cartilage, and ren- dered deeper and broader by a tendon which runs along its outer edge. The sur- faces of the two bones are kept in contact at the joint by firm ligaments. 5. Articulation or joint of the elbow. —Th e lower expanded end of the bone of the arm (the humerus) presents a rounded surface, which is covered with cartilage, and is in contact with the upper ends of the two bones of the fore arm,' similarly covered. The internal bone of the fore arm, the ulna, at its' extremity, is somewhat excavated, so as to receive the lower end of the humerus, in such a manner, as to enable the ends of the two bones to slide over each other in the extension and flexion of the arm. The upper extremity of the outer bone of the fore arm, the radius, is likewise in contact with the humerus at the elbow joint. But the articulation and motions of this bone are somewhat peculiar; immediately below its upper extremity, a slight groove, lined with cartilage, extends around the bone, over which passes a ring of cartilage, which is ttrmly attached to the side of the ulna; the lower extremity of the ulna, at the wrist, is attached, in a somewhat similar manner, to the side of the radius. In consequence of this arrangement, the motions of the hand, which latter is firmly articulated to the ra- dius, necessary to present the palm up- wards or downwards, are effected by the radius revolving above upon its own axis, while the ulna at its lower extremity re- volves partially around the radius. Thus, when the arm is held with the thumb pre- senting upwards, the two bones are nearly parallel; but when the back of the hand presents upwards, they cross each other. When the arm is fully extended, any further motion backwards is prevented, by a large hooked projection of the ulna, passing into a depression on the back part of the hu- merus, immediately above the elbow joint. The joint at the elbow is made secure by powerful Igaments, extending from bone to bone. 6. Articulations or joints of the wrist and hand.—The articulation of the wrist is very complex, three different joints existing at this part. 1'hat formed by the connection of the bones of the fore arm with those of the wrist—that between the two rows into which the bones of the wrist are arranged, and that, finally, between the bones of the wrist and of the palm of the hand. The upper surface of the bones of-the wrist, comprising the first row, form an oblong rounded head, covered with a single plate of smooth cartilage ; which is so uniform, that the individual bones appear to be united into one. This head is received into an excavation on the lower end of the radius; the form of this joint enables the wrist to be moved in nearly every direction. The lower end of the ulna is received laterally into a semilunar cavity of the radius, but is not in immediate contact with the bones of the wrist. Strong ligaments render the articulation of the wrist perfectly secure. The upper and lower row of bones which compose the wrist, form a perfect joint, ca- pable of a very slight degree of motion in all directions. The four bones which form the palm of the hand, are articulated to the bones of the wrist by real joints, but which allow of very little motion. For each finger, as well as for the thumb, we have three joints, the lower one of which is capable of motion in every direction; the others, only of flexion and extension. All these joints are secured by strong ligaments. 7. Articulation or joint of the hip.—The large rounded head of the thigh bone, co-r vered with a smooth cartilage, is received into a deep cup-like hollow, situated in the haunch t>one, forming a joint of the ball and socket kind, and admitting of free motion in every direction. A strong round ligament grows from the summit of the round head of the thigh bone, and is at- tached near the bottom of the cup-like cavity, into which the former is inserted. This, with the strong ligaments which sur- round the joint, keeps it secure. 8. Articulation or joint of the knee.—This joint admits, only of flexion and extension; it is formed by the lower rounded surface of the thigh bone, being received into an excavation on the upper surface of the large bone of the Teg, the tibia, and by the knee pan. It is surrounded by a large capsular ligament, in which a fluid is sometimes col- lected. There are two ligaments within the joint which cross each other, as they pass from the upper surface of the tibia to the lower surface of the thigh bone ; these ligaments are stretched when the leg is ex- tended, and relaxed when the leg is bent, allowing at this time a little lateral motion. Between the thigh bone and that of the leg, are two semilunar cartilages, thick on their external edges, and thin at the centre; they alter their place according to the situation of the bones, to make the shape of the ex- tremity of the one correspond to that of the other. 8 ANATOMY AND PHYSIOLOGY. The knee pan, called by anatomists patella, or rotula, is the small flat bone situated at the forepart of the joint of the knee. Its shape resembles the common figure of the heart, with its point down- ward. The anterior convex surface of the rotula, is pierced by a great number of holes, into which fibres of the strong liga- ment that is spread over it enter. Behind, its surface is smooth, covered with cartilage, and divided by a middle convex ridge into two cavities, of which the external is larg- est ; and both are exactly adapted to the pulley of the thigh bone, on which they are placed in the more ordinary postures of the leg; but when the leg is much bent, the rotula descends far down on the condyles; and when the leg is fully ex- tended, the rotula rises higher on its upper part than the pulley of the thigh bone. The substance of the rotula is cellular, with very thin external firm plates; but these cells are so small, and such a quantity of bone is employed in their formation, that scarce any bone of its bulk is stronger. Besides, it is covered all over with a thick ligament to connect its substance, and is moveable to one side or other; therefore, it is sufficiently strong to resist the ordinary actions of the large muscles that are inserted into it, or any common external force ap- plied to it: while a fixed process, such as the projection at the elbow, would not have been sufficient to bear the whole weight of our bodies, which frequently fall on it, and would have hindered the rotary motion of the leg. 9. Articulations or joints of the ancle and foot. —The two bones of the leg, at the lower ex- tremity, are firmly connected together, the end of the two forming, when joined, an ex- cavation, covered by a single plate of smooth cartilage; into this excavation is received the upper surface, similarly co- vered, of the superior bone of the instep. The principal motions of the ancle joint are flexion and extension; it admits al- so, however, of considerable motion la- terally. The joints of the instep and toes, resemble very nearly those of the wrist and fingers. SECTION II. THE SKELETON. The skeleton, by which is understood all the bones of the body connected together in their proper situations, is divided into the head, trunk, and extremities. When the bones arc put into a natural situation, scarcely any one of them will be found to have a perpendicular bearing on another; though the fabric composed by them is so contrived, that in an erect pos- ture, a perpendicular line from the common centre of gravity, falls in the middle of their common base. On this account, we can support ourselves as firmly as if the axis of all the bones had been a straight line, per- pendicular to the horizon : and we have much greater quickness, ease and strength, in several of the necessary motions, as well as other advantages in the situation and pro- tection of the viscera. It is true, indeed, that wherever the bones, on which any part of the body is sustained, decline from a straight line, the force of the muscles re- quired to counteract the gravity is greater than would be otherwise necessary; but this is more than compensated, by the ad- vantages above mentioned. THE HEAD. The bones of the head are divided into I those of the scull and face. The scull, or | that bony case which surrounds and protects / the brain, consists of eight pieces of bone. At the forepart, is placed the frontal bone ; " at the back part, the occipital bone ; at the upper and side parts, the parietal or square bones; in the fore part of the base the eth- , moid or seive-like bone ; in the middle of it 1 the sphenoid bone. These two latter bones 1 are common to the cranium and face. 1 The frontalbone is so called, from its being 1 the only bone of the forehead, though it I extends considerably farther upwards. "H * has some resemblance in shape to the clam shell. The greater part of it is convex externally, and concave internally, with a serrated circular edge. Below, this bone contributes considerably to the formation of the cavities, in which the eyes are lodged. In the part of the frontal bone which cor- responds with that part of the forehead immediately above the eyebrows, the two tables of the bone separate, by the external being protruded outwards, to form two large cavities, called frontal sinuses. These cavities communicate with the external air by means of the nose. Each of the two parietal bones is an irre- gular square, its upper and fore sides be- ing longer than that behind or below. The inferior side is a concave arch; the middle of it receiving the upper and round part of the temporal bone. The external surface of each parietal bone is convex. On their inner concave surface we observe a number of deep furrows, disposed like the branches of trees, which receive the blood-vessels of the brain. The parietal bones are the most equal and smooth, and are among the thin- ANATOMY AND PHYSIOLOGY. 9 nest bones of the cranium. These bones are joined before to the frontal; at their long inferior angles, to the sphenoid bone ; at their lower edge, to the temporal bones; behind, to the occipital bone; and above, to one another. In a child born at full time, none of the sides of this bone are completed, and the brain is in general not completely surrounded by a bony case, till six or seven years of age. The temporal bones are equal and smooth above, where they terminate in a semicir- cular edge, which is laid over the inferior part of each of the parietal bones, as the scales of fish are placed over each other. Behind this, the upper part of the temporal bone is thicker, and more unequal. To- wards the base of the scull, the temporal bone is very irregular and unequal, and be- comes contracted into an oblong, very hard substance; which being extended forwards and inwards, becomes smaller, and is called the stony part, and contains the inter- nal parts of the organ of hearing. This bone has three remarkable projections. The first, placed at the lower and posterior part of the bone, directly below the ear, is from its resemblance to a nipple called mastoid. Within, it is composed of small cells, which have a communication with the organs of hearing. About an inch far- ther forward, the second process begins to rise from the bone; and having its origin « continued obliquely downwards and for- * wards, it becomes smaller, and is at length united with a corresponding process of the 1 cheek bone. In this manner is formed a bony yoke, under which the temporal mus- cle passes. From the inferior part of the temporal bone the third process stands out ! obliquely forwards; the shape of it has been thought to resemble the ancient stylus or pen, and it is therefore called the styloid process. The chief use of these processes is to afford attachment to muscles. 'The occipital bone, so called from its si- tuation at the back part of the head, like the other bones of the cranium, is exter- nally convex, and internally concave. Its figure is an irregular square, of which the angle above is generally a little rounded; and the lower angle is extended to the in- ferior part of the cranium, in the form of a wedge, and is thence called the cuneiform process. At the base of this triangular pro- cess, on each side of the great opening, through which passes the spinal marrow, are observed two large oblong eminences, called the condyles, which serve for the articulation of the cranium with the first vertebra of the neck. The occipital bone at its upper part, where it is chiefly exposed to injury, is very thick and strong; but lower down, where it is protected by the strong and thick muscles which are inserted into it, it is often very thin. The occipital bone is connected above to the parietal bones ; la- terally to the temporal bones; and below, it is firmly connected to the sphenoid bone, by means of the cuneiform process. The ethmoid, or seive-like bone, derives its name from the numerous small aper- tures with which it is pierced. It is situated at the fore part of the basis of the scull, be- tween the orbits of the eyes, and extends downwards into the cavity of the nose. The plate of the ethmoid which forms part of the base of the scull, is pierced by a number of small holes through which the nerve of smelling passes into the nose. The rest of the bone is made up of cells, and convoluted plates of bone, all of which are covered with a continuation of the mem- brane of the nostrils, and serve to enlarge the organ of smelling, by allowing the membrane of the nose a greater extent. The sphenoid or wedge-like bone, which is so called from its situation in the middle of the bones of the cranium and face, is of a very irregular figure, and bears some resemblance to a bat, with its wings extended. It is connected with all the bones of the scull, and several of those of the face. The scull, when seen from above, and when the forehead is placed next the eye, in form very much resembles that of an egg; the frontal bone corresponding to the smaller end of it, and the occipital bone to the greater. When seen in any other point of view, however, this resemblance is not perceptible. The sides of the scull are flat, and the lower part irregular. The size of the head, in a well-formed per- son, is to the rest of the body as one to nine. The substance of the bones of the scull is in general made up of two tables or plates, with the interposition of a spongy substance. The external table is thicker, smoother, and covered with the periosteum; the internal is thinner, more uneven, more brittle, and is lined with a thick vascular membrane, called the dura mater. The bones of the head are united to each other by a number of tooth-like pro- cesses ; and these joinings are called su- tures. The coronal suture runs across the head, and connects the frontal bone to the parietal bones. The sagittal suture divides the upper part of the head into two equal parts. It connects the two parietal bones to each other, and passes from the middle of the frontal to the middle of the occipital bone. The lambdoidal "suture is interposed be- tween the back and fore parts of the cra- nium, or between the occipital and two parietal bones. The two squamous'sutures connect the temporal bones to the parie- tal. 10 ANATOMY AND PHYSIOLOGY. THE FACE. The face is divided into upper and under jaws. The upper jaw is the immoveable part of the face, which consists of six bones on each side, and a thirteenth in the middle. The thirteen bones are two nasal bones; two small bones within the orbits of the eyes, at their inner angle; two cheek bones; two jaw bones; two palate bones; two spongy bones, and the vomer. The nasal bones are placed at the upper part, and form the arch of the nose, next the fore- head ; the check bones form the promi- nence of the cheeks; the jaw bones extend upwards on each side of the nose, and form the whole lower and fore part of the upper jaw, and the greatest part of the roof of the mouth; the palate bones are situated at the back part of the palate, nostrils and orbits; the spongy bones are seen within the nostrils, at their lower part; and the vomer helps to separate these two cavities. The bones of the face, besides being con- nected to the bones of the scull, are also firmly joined to each other. The lower jaw in the adult, consists of only one bone. In form, it resembles a horse- shoe; the convex part of which is turned forwards, and forms the chin. At its back part, this bone is bent upwards, and termi- nates in two processes. The anterior of these, which rises highest, is a thin point, into which muscles are inserted. The pos- terior process, terminates in an oblong smooth head, tipped with cartilage, which is received into a pit of the temporal bone, where it forms a hinge that is capable of very extensive motion. This bone, as well as the upper jaw bones, are furnished with an outer and inner bony plate, called the alveolar processes, for retaining the teeth with firmness. In each of the jaws are placed sixteen teeth; so that the head, if we include the os hyoides, a small bone situated under the chin, consists in the adult, of sixty-three pieces. The bony structure of which the face is composed, is covered witli muscles, cellular membrane, fat and the skin. The contraction of the different muscles of the face is capable of being excited by the passions of the mind, in some degree independent of the will, and thus gives rise to the different expres- sions of countenance, in grief, joy, anger, laughter, &c. The passion of the mind which is most frequently indulged in, whether it be of a benevolent, depressing, exhilirating, or malevolent character, by exciting frequently certain contractions of the muscles of the face; the expression pro- duced by the latter becomes habitual, and hence, as we well know, the face is, to a cer- tain extent, the index of the mind. Facial angle.—If a line be drawn from the most projecting part of the forehead to the most projecting portion of the lower jaw, and across this another line be drawn in a horizontal direction, from the base of the nose along the opening of the ear, be- tween these two lines nearly all the cere- brum or brain proper, will be included, and the angle which these two lines form where they cross will be greater in proportion to the larger size of the brain. The first of these lines is called the facial line, and the angle which it forms with the second, the facial angle. Now, as upon the develop- ment of the organs which compose the cere- brum, the perfection of the intellectual pow- ers depend, of course the more extensive the latter, the more perpendicular will be the facial line, and the greater the facial an- gle. This has been found to hold true to a very great extent in the human subject, and as we descend from man through the scale of animals placed below him, we find the facial angle to become less and less, until it is finally lost. THE SPINE. The spine or back bone consists of twen- ty-four separate bones, called vertebrae. < Seven, namely: in the neck, called cervical; twelve along the back of the thorax, or chest, called dorsal,- and five in the loins, called lumbar. These twenty-four bones are joined to each other by cartilages, finn at their circumference, but in the centre, of a consistency nearly resembling a glary t fluid. The chief advantage of this struc- 4. ture is, that this soft matter in the centre of the cartilage, when confined, has all the f resistance of a solid body, without its hard- ' ness, which in this part might be attended with very bad consequences. These bones thus joined together, form a column larger below than above, smooth and round be- fore, very rough and uneven behind, and hollow within, to receive the spinal mar- row. The spine, however, though it forms a column, does not form, by any means, an upright column. The spine, viewed side- ways, if the os sacrum is considered as a continuation of it, is bent veiy much in the form of the letter/. In the neck, it projects somewhat forwards; lower down, it takes a curved direction backwards, to make room for the heart and lungs. In the loins, it ad- vances again forwards under the centre of gravity, so as to support the abdominal or- gans. It afterwards turns backwards, for the enlargement of the pelvis; and, finally, the lower extremity turns again forwards, to give support to the lower end of the intes- tines. The head is connected to the upper ver- tebra of the neck, by two smooth projections at the basis of the scull, which are called condyles, which are received into two cor- responding cavities in the upper part of the ANATOMY AND PHYSIOLOGY. 11 first vertebra. By means of this joint, we move the head backwards and forwards on the spine, or perform the action of nodding. From the upper surface of the second ver- tebra of the neck, there arises a long tooth- like process or projection, which is received into a perforation of the first vertebra. This process is rendered smooth by a covering of cartilage ; it passes quite through the vertebra above it, and is connected to this, as well as to the cranium, by strong liga- ments, which give strength to the connec- tion, and guard against the effects of a too extensive motion. The rotary motions of the head, therefore, are not performed on the first vertebra of the neck, but on the second; the first vertebra^ with the head, moving on the tooth-like process of the se- cond vertebra, as a wheel moves on its nave. In consequence of its peculiar struc- ture, the spine is capable of flexion and ex- tension, forwards and laterally. During its flexion the spine forms a curve, and not an angle; as by the latter, the spinal marrow would suffer compression. The lumbar vertebra; arc so joined together as to allow the spine, at the loins, to perform, also, a species of rotation or twisting. THE KECK. The part of the body, situated between the head and shoulders, is called the neck. It is composed behind of the spine, and in front and on its sides of various muscles, cellular membrane, fat and skin. In the neck, are the larynx and upper part of the windpipe, and the superior portion of the gullet. At its sides are the carotid arteries and jugular veins, together with important nerves, more especially the eighth pair, or pneumo-gastric, which proceeds from the brain to the lungs and stomach. Along the neck are likewise situated a large number of lymphatics, glands and nervous gan- glions. THE MOUTH. The mouth is formed above by the pala- tine plates of the upper jaw bones, the palate bones and the soft palate ; below by the lower jaw, and various muscles of the tongue ; in front and on its sides by the lips and cheeks. Within the mouth are the bony processes that ioclude the teeth, and which are covered by the gums. THE PALATE. The upper and arched part of the mouth is called the palate. The palate is divided into the hard and the soft. The hard palate is bounded . in front by the teeth, and is formed by a plate of bone, proceeding from the upper jaw and palate bone, covered C with the periosteum and the common coat of the inside of the mouth, having on its sur- face, particularly in some of the lower ani- mals, a number of hard ridges. The soft, or pendulous palate, is a soft moveable curtain, which hangs down from the margin of the palate bones, between the cavity of the mouth, and the posterior termination of the nostrils. The soft palate is composed of the common membrane of the mouth and nose, and includes a number of mucous glands, and some muscular substance. It forms two arches on each side, descending from the hard palate. The two anterior of these arches are smaller and thinner, and are in- serted laterally into the tongue; the two posterior are large, and are connected be- hind to the pharynx. In the middle and upper part, where all the half arches unite, they are lengthened into a small pointed body, which is easily seen at the back part of the mouth, and is called the uvula. On each side, in the bottom of the space which is left between the anterior and posterior arches, are placed the glandular bodies, called tonsils, or almonds of the ear. They are of an oval form, and have on their sur- face a number of holes or depressions, which are the orifices of large cells which exist throughout the substance of the gland. From their supposed resemblance to an al- mond, they have received their popular name; their use is to supply a mucous fluid, for the purpose of lubricating the throat, and facilitating the swallowing of our food. We have the power of stopping the pas- sage of air from the nose, by drawing up the soft palate, so as to cover its posterior openings. The whole cavity of the mouth is moistened by mucus, and the liquor from the salivary glands. The cavity behind the soft palate is called the pharynx. At the back part it is bounded by the vertebrae of the neck, above by the basis of the scull, before and laterally by the soft palate and much cellu- lar substance, and every way by the muscles which surround the neck. The nostrils ter- minate, at their posterior opening, in the cavity of the pharynx, as do laterally the two eustachian tubes from the internal part of the ear. Pharynx.—The pharynx is a muscidar bag, shaped like a funnel, beginning from the back part of the throat, behind the soft palate, and terminating below in the eso- phagus, or gullet. Its substance is merely muscular, covered with the same mucous membrane which lines the mouth, fauces, and esophagus. The use of the pharynx is to receive the aliment, and impel it into the esophagus. Gullet.—The gullet or esophagus is a membranous tube, beginning from the nar- row termination of the pharynx. It is placed between the vertebrae of the neck 12 ANATOMY AND PHYSIOLOGY. and the windpipe, and descending lower, is embraced by the pleura, and lies in a trian- gular space, at the back part of the cavity of the chest. Having arrived at the bottom of the chest, it passes through the left per- foration of the diaphragm, and terminates in the cardia, or left orifice of the stomach. The esophagus has four coats. First, a covering from the pleura ; secondly, a mus- cular coat of considerable power; thirdly, a cellular coat; and lastly, a tender internal coat, like that of the fauces, and which is copiously supplied with mucus. The eso- phagus conveys the food to the stomach. THE TEETH. The teeth of a person at maturity are in general thirty-two in number, sixteen in each jaw. They are of different forms, ac- cording to their uses : thus, in the front of each jaw, there are four teeth for cutting or dividing our food, called incisores; two in each jaw at the sides of the former, for tearing or laying hold of the food; and the rest on each side of these are grinders, for bruising and comminuting it. The. teeth which first appear in children are twenty in number; but as their small size would not suffice to fill up the jaw, as it increases to its proper bulk in the adult, the first set of teeth, by an admirable provision of nature, fall out, and are succeeded by teeth of a larger size, which are permanent till the period of old age. Each tooth has a crown or body; this is the part which projects from the gums; also roots, or fangs, the number and direction of which vary in the different kinds of teeth; and a neck be- tween the other two portions. The whole of the part which is out of the socket is co- vered by a thin, but exceedingly compact and firm crust, called the enamel,- so hard and solid, says the first Monro, that saws or files can with difficulty make an impression on it. Notwithstanding its great hardness, it is in time wasted by chewing; hence, the rough surfaces of some teeth are made smooth and flat, as people advance in fife. A little to the side of the extremity of each root of the tooth is a small canal^ by which blood-vessels and nerves enter to convey life and nourishment. When in old people this hole is obliterated, the nerves and ves- sels can not enter, and the teeth loosen, and drop out. The teeth are very sensible to impressions from cold and acid fluids. Be- sides being necessary for mastication, the teeth assist in the pronunciation of several letters. Formation of. the Teeth.—The formation of the teeth takes place within the gums, about the second month after conception; the jaws of the little being contain, along the surface of the jaws, and covered with the gums, a scries of little vesicles, answer- ing in their number and situation to the first or infantile set of teeth. Each of these vesicles consists of an envelope, composed of two layers of membrane, form- ing a closed sac of an oval form, attached below to a foot stalk of nerve and vessels, and above to the gum. The cavity of these sacs is filled with a colourless, transparent fluid. The pulpy matter of the nervous and vascular foot stalks, however, by elong- ating, soon fills the sacs, the fluid which pre- viously occupied them disappearing as the pulp increases in size. Towards the end of the third month, a thin coating of bone begins to form around the upper part of the pulp. This shell gradually augments in thickness, the pulp becoming at the same time, less and less. When the bony shell, which answers to the crown of the tooth, is completely formed, it becomes firmly em- braced by the edge of the external membrane around its base, and the inner membrane of the sac, at the same time, increases in vas- cularity, and secretes on the outer surface of the bone the enamel. At birth, the crowns of the front flat teeth are fully form- ed, those of the pointed teeth on either side of these are incomplete, and the grinding teeth are still more so. The roots or fangs of the teeth are the parts last formed. As the formation of these progress,, the crown of the tooth presses upon the upper part of the bag which incloses it, and up on.the gum; these parts are gradually absorbed, and the tooth penetrates through the gum. Along with the rudiments of the infantile teeth, the gums contain, at birth, the pulps for the permanent set. Teething, or Dentition.—As infants are destined for some time to live on milk, or food that requires little or no mastication, the teeth in the first months of life are co- vered by the gums; and as they advance, they push the gum before them, till, by the process of inflammation and ulceration, the gum is destroyed, and the tooth projects from the socket. This process does not be- gin in every child at the same age. In gene- ral, the first pair of teeth appear before the seventh month, and the last before the end of the second year. Those teeth which are to drop out are called the milk-teeth or shedding teeth; they are twenty in num- ber, teii in each jaw. They generally ap- pear in pairs, and those in the lower jaw are cut before the corresponding ones in the upper. The order of succession is most usually this: the two middle front teeth or incisores, then the two next to them, the anterior grinders, the eye-teeth, or canine, and lastly, the posterior grind- ers. There is an interval of one, two, or more weeks, between each successive pair. The variety is great in different individuals, with respect to the commencement and pro- gress of teething. In some, not a tooth ANATOMY AND PHYSIOLOGY. 13 appears before the fifteenth or eighteenth month ; in others, the first pair are through by the end of the third month. Sometimes those of the upper jaw come first; some- times, several pair come very rapidly, and then there is a considerable interval before the rest advance. From the great irritabi- lity and tenderness of constitution of in- fants, they are liable to many disorders in the course of teething; from a simple and salutary looseness to severe and fatal con- vulsions. THE OHEST. The cavity which lies between the neck and abdomen is called the chest or thorax. It is bounded by the ribs and the intercostal muscles, the spine, and breast-bone; and below by the diaphragm; and contains within it many very important organs. The heart, with the great blood-vessels, both arteries and veins, is contained in it; as also the lungs, the thoracic duct, the eighth pair of nerves, and the intercostal nerve. The windpipe passes into the thorax, and the gullet proceeds through it to terminate in the stomach. The chest is lined by a fine membrane called the pleura, a doubling of which invests the lungs; and hence in the healthy state, the lungs move freely in the cavity of the chest. The variety and importance of the organs contained within the. chest, render it liable to become the seat of many diseases. The varieties of asthma, cough, difficulty of breathing, con- sumption, &c. have their origin in some diseased action, structure, or secretion with- in the chest. Severe diseases also occur when the large blood-vessels are enlarged or ossified; and effusion, within the chest, whether of blood, pus, or water, produces dangerous symptoms. THE RIBS. The ribs which enclose the greater part of the cavity of the thorax, are somewhat of a semicircular form; they pass from the spine towards the sternum or breast bone. They are articulated to the vertebrae by a projection called their head, and with the transverse process of the vertebrae immedi- ately below, by a projection called tubero- sity. P'arther forward on their external surface, we observe on most of the ribs, another smaller tubercle, into which liga- ments connecting the ribs to each other, and to the transverse processes of the ver- tebrae, and portions of the muscle are in- serted. Beyond this the ribs make a con- siderable curve, sometimes called their angle. The ribs then become broad, and continue so to their anterior end, whereas near the spine they are nearly round. To the fore end of each rib a long broad and strong cartilage is fixed, and reaches thence to the sternum, or is joined to the cartilage of the next rib. The ribs are twenty-four in number, twelve being placed on each side. They are divided into the true and the false ribs; the seven uppermost on each side, which are con- nected to the sternum, being called true, and the remaining five false. With the exception of the two upper ones, all the ribs point obliquely down- wards, as they approach the sternum, and this obliquity increases as we advance low- er. A necessary consequence of this struc- ture is, that when the ribs are raised, they must be brought nearer to a right angle with the spine, and the cavity of the chest must be enlarged. The upper rib is fixed, but the second and every succeeding rib is gradually more moveable than that placed immediately above it. The' seven upper ribs, called the true ribs, are, as was just remarked, connected to the sternum ; the three upper of the false ribs are not connected to the sternum, but adhere by their cartilages to each other, and to the cartilaginous part of the lower- most true ribs. The two lowest of the false ribs are only connected to the spine by one articulation, and have at their other end no other support than the muscles and membranes with which they are surround- ed. By this structure the trunk of the body is rendered more flexible at its lower part, where most motion is required. The uses of the ribs are to form the late- ral parts of the thorax; to render the cavity of the thorax larger or smaller in breathi»g; to protect the viscera of the thorax; to give origins and insertions to a variety of mus- cles ; and to support the mammae or breasts. THE BREAST-BONE. The breast-bone or sternum, forms the anterior part of the chest; it is of a spongy consistence, and of a flat and nearly trian- gular form; in infancy it consists of several parts, in the adult state of only two, or sometimes three. The upper part is broad and thick, the lower narrow and thin. The lowest part of the sternum is cartilaginous, and from its resemblance to a short sword, is called the ensiform or sword-shaped car- tilage. The upper part of this bone is notched for the passage of the wind-pipe, and there are two depressions on its sides for the articulation of the collar-bones. There are also seven smaller depressions on each side, for the articulation of seven ribs. The uses of the breast-bone are to support the ribs, to protect the lungs and heart, and to furnish connection to the muscular organ, called the diaphragm. 14 ANATOMY AND PHYSIOLOGY. THE INTERCOSTAL MUSCLES. The intercostal muscles are situated, be- tween the ribs, and by their contraction, raise the latter, in order to dilate the cavity of the chest in the act of respiration. There are two sets of intercostal muscles, one within the other; the fibres of the two sets run obliquely, in opposite directions, from the edge of one rib to that of another, and hence decussate each other like the strokes in the letter x. THE PLEURA. The membrane which lines the cavity of the chest, and covers the organs situated in that cavity, is called the pleura. It is a de- licate, smooth, shining and moistened mem- brane of the serous kind, its free surface being covered with a serous fluid. It forms two distinct sacs, covering the lungs on each side, and from them extending over the inner surface of the chest. The part where the two bags formed by the pleura meet in the centre of the chest, constitutes the mediastinum, between the laminae of which" are situated the heart, gullet, wind- pipe, aorta, the large veins going to the heart, &c. The inflammation of the pleura causes the disease known by the name of pleurisy, and when the serous exudation from its surface is increased, dropsy of the chest is produced. MEDIASTINUM. A fold of the pleura or lining membrane of the chest, passes from the spine behind to the breast-bone in front; this is the me- diastinum, and divides the cavity of the chest into two lateral portions, which are occupied each by one of the lungs. Be- tween the folds of the mediastinum are con- tained the gullet, windpipe, large blood- vessels and nerves, and the heart. DIAPHRAGM. The muscular expansion which divides the cavity of the thorax from that of the abdomen, is called the diaphragm. It is placed very obliquely between these two cavities, its anterior connection being much higher than its posterior. Its middle part is forced up by the viscera of the abdomen, so as to form an arch. The diaphragm, at its anterior part, arises from the ensiform cartilage, and the cartilages of the sixth, seventh, and all the inferior ribs. Its fi- bres converge towards a common centre, where they terminate in a broad triangular tendon. This is attached to the internal muscles about the loins. There are several passages through the diaphragm, through which pass the aorta, the thoracic duct, the vena azygos, the two great intercostal nerves, the esophagus, the vena cava, and eighth pair of nerves. When the diaphragm contracts, its concavity is lessened, particu- larly on each side, over which the lungs are placed, its centre being firmly fixed from its connection with the mediastinum, or bag which surrounds the heart. By the descent, however, of its sides, it pushes downwards and forwards the abdominal viscera, thus lengthening, and of course en- larging, the cavity of the thorax; it is hence the principal muscle of inspiration. THE PECT0RA1 MUSCLES. The muscles situated in front of the tho- rax, upon its upper and lateral parts, are the pectoral. They arc two in number. The most exterior is the largest, arising from two of the ribs, from the breast bone and the anterior part of the collar bone; its fibres run towards the arm-pit in a folding manner, and are there connected with a tendon, by which the muscle is inserted into the upper and inner part of the bone of the arm. When in action, this muscle moves the arm forward and obliquely up- wards towards the breast bone. Beneath this muscle is a second smaller one, which arises from the third, fourth and fifth ribs, and terminates in a tendon which is inserted into a projection of the shoulder blade. When in action, it draws the latter forwards and downwards; it also, when the shoulder is fixed, assists in raising the ribs upwards. The two muscles produce the prominence of the breast in the male subject. THE MAMMJE OR BREASTS. The female breasts are termed in anato- mical language, the mammae. They are two globular organs, situated upon the an- terior parts of the female chest, and destin- ed to secrete the milk for the nourishment of the infant during the early months of its existence. Each breast is composed of a gland, divided into distinct lobes, each of which is subdivided into smaller lobes; by these the milk is separated from the blood. From the smallest subdivisions of the gland arise small ducts, which, joining together as they advance, finally open upon the nip- ple, by from fifteen to eighteen minute ori- fices. It is by these ducts that the milk is conveyed to the nipple, from thence to be drawn by the sucking of the infant's mouth. The different lobula of the breasts are held together by cellular structure, and covered by a fatty cellular membrane, varying in thickness, and by the common integument or skin; here, however, having extreme delicacy and softness. Near the centre of each breast is situated the nipple, which is composed of a spongy tissue, perforated by the milk tubes, and capable of becoming ANATOMY AND PHYSIOLOGY. 15 mere projection, and i firmer during the process of lactation. The nipple and ring, or areola, by which it is surrounded, are of a bright red colour in young girls, but as- sume a darker hue in the progress of life, and after child-bearing. The areola of the breast is rough on its surface, being covered with a number of follicles, which secrete a fluid, the principal use of which, is to de- fend the parts from the action of the sahva of the child, during lactation. The breasts are plentifully supplied with blood-vessels and nerves. They are subject to inflam- mation, terminating in large collections of matter, to scrophulous affections, and to cancer. THE ABDOMEN, OR BELLY. Abdomen is the name given by anatomists to the cavity of the belly. It contains many important organs, as those of digestion, viz., the stomach and bowels, with all'their ap- pendages, such as the mesentery and its glands, through which the chyle, elaborated from the food, must pass, before it conveys the supplies of nourishment to the body; also, the liver, the pancreas, or sweet-bread, the spleen, the kidneys, and various large Wood-vessels. It is bounded by bones and muscles, and is separated from the cavity of the chest by the diaphragm, or midriff. Its lower part, though not so conspicuously marked off by any peculiar division, has an appropriate name, the pelvis, or basin, and is generally described as a distinct cavity. In this lower part are contained, in men, ■the urinary bladder, the spermatic vessels, and the extremity of the great gut; and in women, besides the bladder and gut, the womb, and parts belonging to it. It will be easily imagined, that from the variety and number of the parts contained in the abdomen, and connected with it, that this cavity andits boundaries mustbe the seat of many diseases, and the subject of various surgical operations. Its muscular parts are, like those of other similar textures, liable to inflammation, terminating in an abscess, or to that sort of it called rheumatism. The apertures which transmit organs from the inner parts may be enlarged so as to allow the bowels to protrude, and form hernias, or what are commonly called ruptures; or the same disease may be produced from sudden efforts of external injury forcing the bowels through the various openings. The skin and the muscular coverings, are often exceedingly distended by dropsical swellings, by corpulency, by enlarged ova- ries, and by pregnancy. After this last state, thev commonly regain the greater portion of their elasticity, but sometimes great relaxation remains ever afterwards; and requires bandages and artificial sup- ports. The abdomen sometimes requires to be pierced by the surgeon, in order to evacuate dropsical, or other fluids. This operation, from a very obvious allusion, is called tapping. THE ABDOMINAL MUSCLES. The abdominal muscles are situated be- tween the skin and lining membrane of the abdomen, and form the principal part of the walls of this cavity. They consist of three broad layers of fleshy fibres on each side, and one in front. The fibres of the most internal, pass transversely from the cartilages of the inferior ribs, the bones of the spine, and the back part of the pelvis, forwards, to the perpendicular tendon called linea alba, which passes down the centre of the abdomen in front. The fibres of the next layer, proceed obliquely upwards, from the lower part of the back, to the in- ferior ribs, and upper part of the linea alba; above this muscle is a third, the fibres of which pass obliquely downwards, from the inferior ribs, to the anterior part of the pel- vis, and lower portion of the linea alba. The last muscle is the rectus, which pro- ceeds directly upwards in front from the pubis to the lower true ribs. The uses of these muscles, are to support and compress the abdominal viscera, to bend the body forwards, or obliquely, to one or other side; they likewise assist in the acts of sneezing, coughing, in the evacuation of the bow- els, ike. Abdominal Ring.—The abdominal ring is a kind of canal, proceeding on each side, just above the groin, obliquely downwards and forwards, between the parts composing the parietes of,the abdomen. Through this canal pass the blood-vessels, lympha- tics, nerves, and excretory ducts of the testicles. PERITONEUM. The smooth shining transparent serous membrane which lines the cavity of the ab- domen, and closely invests the different ab- dominal muscles, is called the peritoneum. Prolongations of the peritoneum form the mesentery and caul or omentum. It is liable to inflammation, and when the serous fluid, with which its surface is always lubricated, is secreted in excess, abdominal dropsy is produced. Mesentery.—The mesentery is that pe- culiar arrangement of the peritoneum, by which it attaches the small intestines to the back part of the abdominal cavity. The mesentery is formed by two laminae of the peritoneum, united by cellular substance. It rises by a narrow origin from the three first vertebras of the loins; it advances for- wards, and gradually becomes broader in its progress, forming a kind of semicircle. 16 ANATOMY AND PHYSIOLOGY. The edge connected with the vertebrae be- ing about six inches in length, while the circumference, attached to the intestines, is upwards of 20 feet. By this arrangement, it is thrown at its circumference into nu- merous folds, like the ruffle .of a shirt. The laminae of the mesentery at length receive between them the intestines, and thus af- ford them their peritoneal coat. That part of the mesentery which belongs to the small intestines, is more properly called the mesentery; that which belongs to the large is distinguished by the term mesoco- lon. The mesentery includes between its laminae all the blood-vessels and nerves which go to the intestines, and also the numerous lacteal vessels which take up the chyle from the intestines, and the glands with which these vessels are connected. Caul, or omentum.—The caul or omentum is the loose apron-like substance by which the intestines are covered in front. It is formed by the peritoneal or outer coat of the stomach, which passes down from the lower extremity of that organ as far as the navel, and then is folded upwards until it reaches the great arch of the colon, or great gut, to which it is attached. It is formed, therefore, of a duplicature of the peritone- um, folded upon itself. Between the two portions of peritoneum, are interposed a quantity of fine cellular substance, and of fat. In rupture, or hernia, the omentum is very apt to pass out of the abdomen, either alone or in conjunction with the intestine. The uses of the omentum are probably to afford additional warmth to the intestines, and to lubricate their exterior surface. EXTERNAL SURFACE OF THE ABDOMEN. The surface of the abdomen has been divided into a number of regions. Thus, a line drawn across the abdomen from the lower margin of the ribs, will have above it the right and left hypochondriac region,\y'mg under the ribs, which are not immediately attached to the breast bone in front; whilst the space between these, at the lower end of the breast bone, not covered by the ribs, is called the epigastrium. A second line drav/n across from the upper edge of one hip bone to the other, will have three re- gions above and three below it. Those above it, on each side, are called the right and left lumbar, and that immediately be- fore having the navel in its centre, the um- bilical. Those below the line, on each side, beneath the hip bones, are called the iliac regions; and the one immediately in front, the hypogastric region. THE PELVIS, OR BASIN. • The pelvis or basin, so called from its shape, is the cavity at the lower part of the abdomen, in which are contained the urinary bladder, the rectum or straight gut, and the internal organs of generation. It is formed behind by the sacrum, or lower part of the spinal column, on the sides by the haunch and hip bones, and in front by the share bones; it is covered externally, and closed below, by ligaments, cellular membrane and muscles. Strictly speaking, there are but three bones that compose the pelvis, the sacrum, and two innominata. THE INNOMINATA. These bones, which form [the sides and front of the pelvis, consist in the new born infant, of three pieces united by cartilage; but in after life, are firmly united into one solid bone, leaving no trace of the original division. It is upon the lower part of these bones the body is supported when in a sitting posture ; their upper part forms the projection of the hips or haunches, and into deep cup-like cavities formed in these bones are received the large round heads of the thigh bones, forming in this manner the hip joint. The innominata are firmly united behind by cartilage and ligaments to the sides of the sacrum, and in the same manner to each other in front. THE SACRUM. The sacrum is of a triangular shape, its broadest part being uppermost. It is con- cave and smooth within, concave and full of irregular projections on its posterior side. It is pierced with a number of holes for the transmission of blood-vessels and nerves, and is very rough on its sides for connection with the cartilage, by which it is joined to the other bones of the pelvis. In contact with its inner concave surface, is the rectum or lower gut. THE COCYX. The cocyx is a small pyramidal bone which is attached to the lowest point of the back bone in the human body. It has re- ceived its name from its supposed resem- blance to a cuckoo's bill. It is generally composed of two small bones, and is slightly moveable backwards and forwards. Its principal use would appear to be to give support to the lower end of the rectum. In the inferior animals, it is comprised of many pieces, and forms the bony structure of the tail. THE UPPER EXTREMITY. The Upper extremity may be divided into the shoulder, the arm and fore arm, the wrist, and the hand. ANATOMY AND PHYSIOLOGY. 17 THE SHOtJlDER. The shoulder is composed of the scapula, or shoulder blade; the clavicle or collar bone, and the round head of the humerus, or bone of the arm, covered with muscles, cellular membrane, and the skin. THE SCAPULA, OR SHOULDER BLADE. The shoulder blade is a triangular shaped bone, situated, one on each side, at the upper and back part of the chest. Its broadest part or base presents backwards towards the back bone, and its narrowest part or head forwards, towards the top of the shoulder. Along its outer surface is a raised spine, which, when it reaches to within a short distance of the head of the bone sends off a broad flat process or pro- jection, called the acromion, which covers the head of the humerus, and forms the top of the shoulder. Another smaller, hooked process is given off from the forepart of the upper surface of the shoulder blade, called the coracoid,- to this projection one end of the collar bone is attached. The head of the bone nearest the shoulder joint is spread out, forming a superficial cavity, into which the rounded head of the arm bone is articulated. The scapula is loosely attached to the ribs by muscle. Its use is to serve as a fulcrum, or point of sup- port to the arm; and by the facility with which it alters its position, it affords, in all the varied motions of the arm, to the head of the humerus, a socket to play in. THE CEAVICLE, OR COLLAR BONE. The clavicle is a long irregularly rounded bone, curved so as nearly to resemble the italic /. It is placed horizontally between the upper part of the sternum and the acro- nium process of the scapula; to each of which it is firmly attached by ligaments; at its sternal end there is a joint which al- lows of a certain extent of motion. The use of the clavicle is to keep the shoulder blade fixed at a proper distance from the forepart of the chest, and in this manner to regulate and give efficiency to many mo- tions of the arm. mentable train of symptoms that accompany the latter stages of this deplorable malady. This is the deep cavitv beneath the shoul- der joint, called by the anatomist axilla,- it is most conspicuously marked out when the arm is held in the extended position. It contains many important parts particularly the lame veins and arteries of the arm ; the nerves which supply the limb, and many lymphatic glands. Inflammation of these Hands sometimes occurs giving rise to ex- pensive abscesses, or collections of matter It is these glands, also, which are so apt to become diwased in cancer, causing the la- The upper extremity in man, from the shoulder to the wrist, is called the arm. It is composed of three bones, covered with muscles and the common integuments, and is plentifully supplied with nerves and blood vessels. From the shoulder to the elbow, the arm contains a single round bone, called the humerus. It has a large round head, partly set on one side, by which it is at- tached to a superficial cavity, situated on the anterior part of the shoulder blade. The humerus is larger and rounder at its upper part, and becomes-smaller and flatter as it approaches the elbow. This bone is liable to be dislocated at the shoulder joint, and to fracture at any part of its length. The arm, or fore arm, extending from the elbow to the wrist, has two bones, extending pa- rallel the whole length of the fore arm. The inner of these bones, called ulna, forms the elbow by a large hooked projection; the upper end of the ulna is the largest, and is connected by a hinge-like joint to the hu- merus. The radius is the innermost of the bones of the fore arm, it is nearly similar in shape to the ulna, but having its largest end at the wrist, with which it is articulated by a kind of hinge-joint; the upper end is at- tached to the side of the ulna by a ring of cartilage; there is a somewhat similar at- tachment of the lower end of the ulna to that of the radius ; in consequence of this arrangement, in the rotatory motions of the wrist, the radius revolves above upon its own axis, and the ulna below, partly around the radius. The bones of the fore arm, are liable to be dislocated at the joints of the elbow and wrist, and to fracture. DELTOID MUSCLE. The large fleshy mass, situated on the forepart of the arm and shoulder, is the del- toid muscle. It arises from the collar bone and shoulder blade, and is inserted in the middle and forepart of the arm. Its use is to raise the arm. FLEXORS OF THE ARM. The muscles which flex or bend the arm, form the mass of flesh on the forepart of the arm, from the shoulder to the elbow joint. EXTENSORS OF THE ARM. The fleshy mass on the posterior part of the arm, extending from the shoulder joint to the elbow, is composed of the extensor muscles of the arm : they are attached by a tendon to the olecranon process of the ulna. 18 ANATOMY AND PHYSIOLOGY. THE WRIST. The wrist or carpus, is the part which in- tervenes between the bones of the fore arm and those of the hand. It is composed of eight small irregular shaped bones, covered with tendons, cellular membrane, ligaments, and the skin. The eight bones of the wrist are arranged in two rows, one of which rows is articulated to the bones of the fore- arm, the other to the bones of the hand. The carpal bones are firmly attached to- gether by ligaments, but the junction of the two rows form a joint capable of moving to a certain extent backwards and forwards, and the bones of each row have a slight la- teral motion upon each other. THE HAND. This very important part of the human body—to the possession of which man is in- debted, in a very great degree, for that do- minion which he exercises over all the ob- jects by which he is surrounded—is com- posed of bones, ligaments, tendons and mus- cles, covered with the common integuments. It is divided into the metacarpus, fingers and thumb. The metacarpus is composed of four long slender bones which sustain the fingers, and form with the latter a joint. Each of the fingers is composed of three bones, attached by a moveable joint to the end of each other. The thumb, like the fingers, is composed of three bones, but the bone at its base, instead of being articulated to a metacarpal bone, is jointed to one of the bones of the carpus. The principal muscles which move the hand, with the exception of those of the thumb, and one or two of the little finger, are situated on the fore arm, and are attached to the bones of the hand by long tendons. The muscles of the thumb are situated about its root, and those of the little finger, on the outer side of the hand. The rotary motion of the hand is produced by muscles which act upon the radius, to which the hand is attached, and cause it to revolve partially at its lower ex- tremity around the ulna. Man is the only animal that possesses an organ similarly con- structed with the hand; and to this, as well as to his intellect, is he indebted to his su- premacy over every other animal. The highly sensible integument with which the hand is furnished ; the large nervous papillae with which the fingers, particularly towards their extremities, are supplied; the nails, which support the pulp of the fingers, causing them to be the more firmly applied to the body, with which they are in con- tact; and the organization of the fingers, v» Inch enables the latter to grasp in various directions, and in that manner determine with accuracy the shape and size of bodies; render the hand a most important organ of touch, communicating to the brain the most accurate ideas, so far as this sense is con- cerned. But it is not only in this manner that the hand is of importance ; but by en- abling man to seize, and hold firmly other bodies, and to execute various mechanical processes under the guidance of the mind, it gives to him an immense increase of pow- er and skill, which, deprived of the hand, he could never have possessed. This is owing to the numerous joints, the shape, and varied movements of the hand; but chiefly to the peculiar construction of the thumb, which forms a kind of opposing force to the fingers. The hand was not, therefore, inappropriately st) led by the an- cients, "man's sceptre," and "the instru- ment of instruments." THE FINGERS. The fingers are composed of three bones, each articulated, one to the end of the other, forming joints which enable them to bend inwards towards the palm of the hand; these bones are covered with ligaments, cellular membrane and skin. Along their sides run blood vessels, and on their inner surface the tendons of the muscles which move them. The lower bones of the fin- gers are attached by a moveable articulation to the bones which form the body of the hand. The motions of the fingers are ef- fected by muscles, situated on the fore arm, from which long tendons run down over the wrist and palm of the hand, to be attached to the bones of the fingers. At the wrist, they are bound down by a circular ligament; were it not for this ligament, when the fin- gers are bent, they would start up from their places like the string of a bow. One set of the tendons is inserted into the mid- dle bones of the fingers, the other into the extremities of the latter. To preserve the free action of the two sets, and at the same time, that they may be disposed in the most convenient manner, there is a loop or slit in each of the short tendons, through which the others pass. By this contrivance, the strongest muscles are made to act upon the part at which the greatest power is required. THE LOWER EXTREMITIES. The lower extremities in man, are com- posed each of the thigh, the leg, the foot and THE THIGH. The thigh is made up of the femoral bone covered with muscles and the common in- teguments, including between them the femoral artery and veins, and the nerves of the lower extremities. The large muscu- lar mass, situated on the front part of the ANATOMY AND PHYSIOLOGY'. thigh, is the principal instrument by which the leg is extended; it is assisted by three muscles, situated on the sides of the thigh. The muscles on the back part of the thigh are for bending the leg. The muscles which move the thigh itself, are situated, principally, about the sides and back part of the pelvis. Two very considerable ones, however, are within the lower part of the abdomen; they are those by which the thigh is bent forwards ; the tendons of these muscles pass out at the openings in the in- ferior part of the pelvis; some smaller muscles of the thigh also arise within the pelvis; these are principally concerned in the lateral and rotatory motions of the limb. The femoral bone.—The femoral, or thigh bone, is the longest bone in the body, and is the largest, thickest, and strongest of the cylindrical bones. The lower extremities are connected to the trunk by the head of this bone, being received into the ace- tabulum. The thigh-bones are not placed in a perpendicular direction, their upper ends being much further apart than the lower. The body of this bone is some- what of a triangular form; it is convex be- fore, and flat behind, and is marked, par- ticularly behind, by bony ridges, which serve for the connection of muscles. This bone is perforated at one or two places for the reception of blood-vessels. The thigh-bone is not straight, but is arched considerably forwards. Its head is turned inwards, and its neck is almost ho- rizontal, considered in respect to its situ- ation with the body of the bone. The head of the thigh-bone is nearly round, and is marked in the centre with a round pit, into which a ligament, that serves to keep it fixed in the socket, is in- serted. Below the niche of the femoral bone are two large rough projections, called the trochanters. The larger of these is directed outwards, and is placed at the outer side of the thigh-bone ; the other is placed behind, but points inwards ; they are called trochan- ters, or pullies from the muscles inserted into them, being the principal instruments of the rotatory motions of the thigh. The lower extremity of the thigh-bone is thick, and terminates laterally in two large projections, which are very close to each other before, but considerably removed be- hind, where there is formed a deep canal, through which a large artery passes to ar- rive at the leg. THE LF.G . Two bones enter into the formation of the leg, the tibia and fibula; these are co- vered with muscles and the common integu- ments. The muscles situated on the leg, are those concerned in the movements of the foot. - D 19 The tibia.—The tibia, which is the prin- cipal and internal bone of the leg, is of a triangular form, larger above than below. The upper end of the tibia is large, bul- bous, and spongy, and is divided into two cavities, by a rough, irregular protuberance, which is hollow at its most prominent part, as well before as behind. 'I he two cavities are for receiving the condyles of the femoral bone. At the back part of the tihia, the same canal is continued between the con- dyles, for transmitting blood-vessels and nerves, as in the bone of the thigh. At the anterior part of this bone, is a cavity for the reception of the patella, which corresponds with one between the condyles of the femo- ral bone. On the internal part of the bot- tom of the tibia, is a process which forms the inner ankle. Still lower, at the ex- tremity of the tibia, is a transverse articula- ting cavity, covered with cartilage, and di- vided by a ridge, which receives one of the bones of the foot. The body of the tibia has three angles, and as many flat surfaces. One of the flat surfaces is turned directly backwards, and one of the angles is placed directly at the fore part of the bone, and is that sharp ridge, called the shin, which is felt by the finger, being only covered by the common integuments of the body. The fibula.—The fibula, which is placed externally, and parallel to the tibia, is a tri- angular and very thin bone, nearly as long as the tibia. Its superior extremity is united to the head of the tibia by means of carti- lage. Its head docs not rise quite so high as that of the tibia, and has, therefore, no connection with the thigh-bone ; its lower extremity is slightly connected to the foot, and forms the external ankle. Its chief uses are to afford room for the connection of muscles, and to give greater firmness to the connection of the tibia with the foot. THE GASTHOCNEMII MUSCLES. These muscles form the thick fleshy part, or calf of the leg. There are two on each leg, an external and internal. They both give off a tendon, which, uniting togeth- er, form the tendon of Achilles, or the round cord-like body felt above the heel. This tendon is inserted in the bone of the heel. It is upon this latter part, therefore, that the gastrocnemii muscles act, raising the heel upwards, and pressing the fore- part of the foot downwards, thus forming the latter into a lever, to raise the whole body from the ground. THE FOOT. The foot is made up of bones, muscles, tendons, ligaments, covered with cellular membrane and skin. It is divided into the tarsus, metatarsus, and toes. The tarsus is 20 ANATOMY AND PHYSIOLOGY. composed of seven very irregular spongy bones; one of these projects downwards and backwards, to form the heel; above this is another, to which the lower end of the tibia, or largest bone of the leg is articu- lated, forming the ankle joint. The five other bones are placed in front of these, at the instep; from these latter, project for- wards the five long slender bones of the metatarsus, which form the body of the foot, anterior to the instep. To the ends of the metatarsal bones, are articulated the bones at the basis of the toes. The big toe is composed of two, and each of the other toes of three bones, jointed like those of the finger. The lower surface, or sole of the foot, is not flat, but arched, so that when it is planted on the ground, the weight of the body is supported on the heel and anterior extremities of the metatarsal bones. The whole length, nearly, of the outer metatar- sal bone is also in contact with the ground- By the peculiar manner in which the foot is constructed, the concussion which would otherwise be communicated to the body, in falls upon the feet, in walking, and in jump- ing, is, in a great measure, prevented. The arched form likewise facilitates the ordi- nary movements of the foot, and permits us to walk with greater security and ease over an uneven surface. SECTION III. THE MUSCLES. The muscles are the organs which change, regulate, and fix the positions and attitudes of the body, and which are directly or in- directly concerned in all the more con- spicuous motions of the solids and fluids. In these numerous and important opera- tions, they exhibit phenomena peculiar to themselves, and which cannot be traced to gravity or impulse, to elasticity or to che- mical attraction. They produce their ef- fect, whether it be a state of motion or rest, by contracting their fibres in consequence of stimulants,- while the stimulants, whether chemical, mechanical, or vital, seem to act through the medium of a nervous energy. They are not restricted to any length, breadth, or thickness ; to any form, magni- tude, or colour; though every one belong- ing to a pair resembles its fellow. They are not formed of any one homogeneous sub- stance, but composed of carncous and ten- dinous fibres, interspersed every where with cellular membrane, and the ramifica- tions of arteries, veins, absorbents, and nerves, all of them alive, and all of them irritable. The carneous fibres constitute flesh. They seldom or never appear single, but are collected into small fasciculi, or bun- dles, that unite to form larger ones; which larger fasciculi being united, form the col- lections which with their tendinous fibres, &c. we call muscles, and which we distin- guish by proper names. The carneous fibres are all sensible to stimulants of one kind or another; and be- ing the only parts that contract in obedience to the will, or in consequence of stimulants operating regularly, they constitute the dis- tinguishing character of muscles. As they derive their principal power from a vital source, the change produced upon them by death, is sudden and obvious. Hence the muscles, that when living, could have ruptured their tendons, luxated the bones, or broken them to pieces, can scarcely, when dead if it were not for their tendons, their cellular membrane, and the ramifica- tions of the blood and absorbent ves- sels, support their own weight. In the living state, it is obvious, however, that their strength must vary, and in a great measure depend on the nature and degree of the energy communicated. In the vo- luntary muscles, that energy, to a certain extent, is varied at pleasure. Yet the influ- ence of the will is nothing, compared to the influence of instinct, emotion, and passion, to which the will is frequently subservient. These often affect the whole of the mus- cles, and through their medium, alter the secretions. It is this connexion, between muscular action and the vital powers, that explains how our muscular strength is va- ried by the states of sickness and health ; and how our exertions are more or less vigorous and extensive, continued for a longer or a shorter period, and attended with greater or with less fatigue, in propor- tion as the mind happens to be influenced by the exhilirating or depressing passions. Of the ultimate fibres composing a mus- cle, of their connexion with contiguous fibres, of their form, their structure, and that scries of processes occasioning their contraction, much has been said, conjectur- ed, and reasoned; but nothing of impor- tance has been added to our stock of au- thentic information. THE TENDONS. Tendons are the shining, white and firm substances by which one end of a muscle is attached to a bone. Tendons are some- what different in appearance and arrange- ment, in different parts of the body. In the greatest number of instances, they are in the form of round cords, of greater or less size. They are inelastic, and in a healthy state insensible. They are formed by a prolongation and condensation of the cellu- ANATOMY AND PHYSIOLOGY. 21 lar substance, which is interposed between the minute fibres of the muscles. The ten- dons may be compared to ropes, by which the muscles are enabled to act upon a por- tion of bone, situated at a considerable dis- tance from them. THE MEMBRANES. A membrane is an expanded thin sub- stance, lining and covering the different parts of the bod)-. The membranes are of different kinds, varying in structure, ap- pearance, and functions. They are named from the fluids which lubricate their free surfaces, serous, mucous, &c. The mem- branes are extremely liable to inflammation, which alters, if it be not speedily removed, their structure, and changes the nature of the fluids which they secrete. Most of the inflammations which occur within the body are seated in membranes. Serous membrane.—The serous mem- brane forms the envelopes of the brain, lines the thorax and abdomen, and covers nearly all the organs contained in these two .. cavities. It is a thin transparent membrane, its free surface being smooth and shining, of a silvery white appearance; it is con- stantly lubricated by a thin serous fluid; in consequence of which it receives its name. In a state of health, it is insensible, or nearly so, and presents no trace of vessels carrying blood; but when inflamed, it becomes very sensible, and of a bright red colour. Under certain states of disease, the serous mem- brane pours out an increased amount of fluid from its surface, which collects in the cavities, constituting the different dropsies. Pus is also sometimes exhaled from its sur- face, when inflamed ; it becomes likewise covered with a false membrane, which, uni- ting with a similar morbid production, from an adjoining portion of serous membrane, glues the two surfaces together. In this manner, the cavity of the thorax, or ab- domen, has been completely obliterated, or organs are made to adhere together, which, in a healthy state, have no connection with each other. Mucous membrane.—The mucous mem- brane lines the nostrils, mouth, windpipe, ami bronchiae, the alimentary canal, bladder, and various other cavities. It is called mu- cous, from the circumstance of its being constantly covered on its free surface; du- ring health, with a mucous, or slimy fluid. The structure and general character of this membrane, are the same wherever it is situated. Its free surface has a velvety, or spongy appearance; every where it is co- vered with small eminences or depression, from which exudes the mucus which lu- bricates it. It is plentifully supplied with blood-vessels, nerves and lymphatics, which are so intimately combined with the mem- brane, that they seem to form the greater part of its substance. During health, the mucous membrane has more or less of a rose colour; when inflamed, it becomes en- tirely red, and secretes, according to the de- gree or stage of the inflammation, a thin watery fluid, a thick yellow mucus, or pus. Sometimes it pours out large quantities of blood, or its surface becomes covered with a false membrane. This membrane is thick- ened by inflammation, but its surfaces, which are in contact with each other, never adhere. SECTION IV. THE INTEGUMENTS. The integuments of the body consist of the cellular membrane, the fat, the skin, hair, and nails. CELLULAR MEMBRANE. This is a loose membraneous structure, forming an immense number of cells, differ- ing in size and form, interposed between the skin and muscles, and universally distributed throughout the body. It is interposed be- tween all the muscles, all the fasciculi of muscular fibres, and even the ultimate fibres, of which these fasciculi are com- posed. All the blood-vessels also, and nerves, are in their course attached to the neighbour- ing parts by means of this substance. Many of the glands too, which are composed of smaller masses, are united into one body by its intervention. It seems probable, indeed, that the membranes which invest the con- tents of the abdomen and thorax, and other membranes, in different parts of the body, are composed of the cellular substance in a more consolidated state; and it is, there- fore, very properly considered as an uni- versal connecting medium in every part of the system. Into the cells, formed by this membrane, is exhaled by the arteries, a watery vapour by which it is kept constantly moistened, and which is prevented, during health, from accumulating by the action of the ab- sorbents ; when, however, from disease it is furnished in greater quantity than the latter vessels are able to remove it, it fills and dis- tends the cells of the membrane, producing a local or general dropsical swelling. The uses of the cellular membrane are so im- portant, that, in all probability, animals could not exist without it. By uniting the fibres of the muscles into compact masses, it secures them from becoming entangled with each other, and with the minute blood- vessels, l)'mphatics, and nerves, which are 22 ANATOMY AM) PHYSIOLOGY. every where distributed among them. At the same time, however, that it connects together the muscles, and preserves them in their relative situations, it is sufficiently loose to give full play to all their motions. It serves also the purpose of a soft and compressible cushion, interposed among the muscles, and, being always moist and slippery, renders their motions easy, and prevents friction. Certain portions of the cellular substance also afford a lodgment to the fat, and thus. fill up the interstices between muscles, and add to the beauty, evenness, smoothness, and softness of the surface of the body. The cellular substance, besides serving the purposes already mentioned, by being placed between the skin and the muscles, is always considered as one of the integu- ments of the body. The different cells of this membrane communicate freely with each other, which is the reason, why in dropsies the water passes from one part of the body to another, and accumulates, particularly in the more depending parts. If the patients are in the erect or sitting postures during the day, the feet and legs swell towards evening, and by the horizontal position during the night, the swelling in the lower extremities, in a great measure, disappears, and other portions of the body increase in bulk. Hence, also, when a wound penetrating the air cells of the lungs, permits air to enter the neigh- bouring cellular substance, the air passes to every part of the body, puffing up enor- mously the whole surface, and causing the skin, when pressed upon, to produce a, crackling noise. This constitutes the disease, called emphysema. It is by the free com- munication, throughout the cellular mem- brane, that butchers blow up the veal; and beggars sometimes produce upon them- selves enormous swellings, to excite com- passion. The cellular membrane is the seat of those collections of matter called abscesses. ADIPOSE MEMBRANE. That portion of the cellular membrane which contains the fat, is termed adipose. The fat of the human body is contained in small distinct cells, formed" by a fine trans- parent membrane, the arrangement of which, as well as the quantity of fat with which they are filled, varies in different parts of the body. The adipose membrane is al- ways found in the orbits of the eyes, on the soles of the feet, and at the pulps of the fin- gers and toes, it exists abundantly about the base of the heart, around the kidneys, within the abdomen and beneath the skin. It is never met with in the eye-lids, scro- tum, lungs, or within the scull. Adeps, or fat.—Fai is an oily matter con- tained in the cellular Bubstance of animals, of a white or yellowish colour. It seems to answer several important purposes; it fa- cilitates the motion of the various parts where it is lodged ; it fills up interstices in different situations ; and as it is a bad con- ductor of heat, it appears to contribute to the preservation of the temperature of ani- mals. It is used with other animal substan- ces as an article of food; and where the di- gestive powers are strong, it proves highly nutritious. Those animals which sleep all the winter, are generally fat at the com- mencement of their long slumber, and come out of it very lean, owing to the fat having been absorbed and carried into their system, for the purpose of nutrition. Fat has a ten- dency to accumulate very much in some persons who live luxuriously, using great quantities of animal food, with porter, and other malt liquors, and who take little exer- cise. Others, without such causes, seem to get corpulent from peculiarity of constitu- tion. It sometimes proceeds to such an extent as to be a real disease, incapacitating the individual from exercise, and from per- forming the duties of life, besides rendering him liable to apoplexy, and the other dis- eases analogous to it. THE SKIN. The skin is the outer covering of the body. It varies in texture and thickness in different parts, according to their functions and uses. It is composed of the cuticle, or scarf-skin, which constantly decays and is renewed; of a second layer, called the rete mucosum, and underneath this, of the true skin. In the rete mucosum is situated the colouring matter which determines the race, as the negro, the copper-coloured, &c. The skin varies in thickness,"according to the part on which it is spread, and the uses to which that part is destined, from the thin transpa- rent covering of the lips, to the hard and horny covering of the labourer's hands, and the soles of the feet. The skin is one of the great outlets, by which the matter that is no longer wanted, is discharged from the body. CUTICLE. The external covering of the body. It is thin, semi-transparent, has neither blood- vessels nor nerves, and exhibits no sensi- bility. It is pierced by numerous oblique pores, for the passage of hairs, and proba- bly of exhalants. In various parts of the body, numerous sebaceous follicles open on its surface, which supply a greasy matter to lubricate it. In some parts it is much thicker than in others, as on the soles of the feet, and palms of the hands, particularly of me- chanics. It is the thickening of the cuticle that causes corns. The cuticle is frequently ANATOMY AND destroyed, and quickly reproduced. It se - parates m the form of scales, from the head, and in large patches from the other parts of tne body, after various diseases affecting the skin. It is the cuticle which retains the fluid furnished by the true skin when acted upon by a blister. The uses of the cuticle, are to defend the true skin from the too rude attack of external substances, and to preserve it in a proper state of moisture, by preventing too great evaporation of its fluids. The cuticle also prevents the absorption into the system of various deleterious substances, which accidentally come in contact with the surface of the body. THE CUTIS. The true skin. It is situated within the cuticle, between which and the former, is interposed a soft mucous body, termed rete mucosum. The cutis is composed of fibres, intersecting each other in various directions, and leaving between them spaces for the transmission of blood-vessels, nerves, and absorbents. It is composed chiefly of gela- tine. On the outer surface of the cutis, are a number of small eminences, formed by the extremities of vessels and nerves. These are called the papillae of the skin ; they be- come turgid or erect, when the skin exer- cises its function of touch. The skin is the great external organ of sensation ; it is liable to inflammation, and a variety of diseases, termed eruptions and cutaneous affections. THE MUCOUS BODY. The mucous body, or rete mucosum, is interposed between the cuticle and cutis. It is of a cousistence, between that of a solid and a fluid ; it varies in colour, according to the complexion. In fair people, it is nearly white; in brown people, of a dusky hue, and in the negro, black. In the latter, it has also more consistency, and can be sepa- rated from the lower surface of the cuticle, which cannot be effected in the European. Cutaneous exhalation.—A fluid is con- stantly given off by the skin in the form of vapour; when invisible, it is called perspira- tion, or insensible perspiration,- when from any cause, it becomes condensed in the form of a watery fluid upon the skin, it forms the sweat, or sensible perspiration. It contains a great deal of water, a trace of acetic acid, and holds in solution the mu- riates of potash and soda, lactic acid, lactate of soda, and a small quantity of animal mat- ter. It probably varies, however, in its composition at different times, and in differ- ent individuals. This exhalation, from the surface, is one of very great importance to the well being of the animal system ; inde- pendent of preserving the skin supple and moist, and by its increased formation p- ^ rapid evaporajjon, enabling the bodv to uu. _ ' PHYSIOLOGY. 23 tain its proper degree of heat, when exposed to very high temperatures; it, no doubt, removes, also, from the blood, certain nox- ious ingredients, and an excess of fluidity. When the cutaneous exhalation is impeded or suspended, disease of the body is very generally produced, which points out the importance of defending the skin by proper clothing, and freeing it from all impurities, by frequent ablution and frictions. SEBACEOUS GLANDS AND FOLLICLES. These are small sacs situated in the skin, and opening by minute orifices on its sur- face ; they secrete an unctuous substance, for the lubrication and defence of the ex- ternal surface of the body. The matter secreted by these follicles sometimes be- comes hard, and completely fills them, par- ticularly about the nose ; the portion at the orifice becoming blackened by filth, gives the appearance of a number of grains of gunpowder sticking in the skin. By pres- sure, the sebaceous matter may be dis- charged from the follicle, resembling a small white worm, for which it is, in fact, often mistaken by the ignorant. THE HAIR. The hair is composed of two parts, a root and a tube or stem filled with a pulpy matter. The root is of an oval form, and composed of a soft pulp, enclosed in a semi- transparent bag, open at the lower end, to receive nerves and blood-vessels, and at the upper, to give exit to the hair. The root is fixed in the inner, or true skin, by which it is nourished with blood and other fluids. Tlie roots of the hair exist in great abund- ance over the whole body, and what is re- markable, in every individual, many more roots exist than have hairs growing from them; hence, hairs often appear on the nose and ears in men, where none gene- rally exist, and on the arms and face in women. The roots of the hair are de- stroyed by diseases, or ulcers, which affect the organization of the cutis. The hairs do not rise perpendicularly from their.roots, but pass, very obliquely, through the two outer coats of the skin. This fact explains the direction and flat position of the hair on the eyebrows, and head, the reason why they are pulled out with such difficulty, and the uneasy, and even painful sensation, oc- casioned by combing the hair in a direction contrary to that in which it passes through the cuticle. Each hair is formed of ten or twelve smaller-hairs, which unite at the root, and form a hollow tube, somewhat like a very fine stalk of grass, and, also, like some "kinds of grass, jointed at inter- vals. These joints seem to overlap each 24 ANATOMY AND PHYSIOLOGY. hair. This structure is rendered very evi- dent, by passing the hair from its end to- wards the root between the fingers, when a roughness will be perceived, which is not evident when the hair is parsed in the other direction. A hair, also, rolled between the finger and thumb, will always work towards the upper end, never towards the root; proving that the overlapings are all direct- ed to the top. It is this peculiar structure of the hair which causes it so readily to en- tangle, and enables the mechanic to form it into the firm substance composing the body of hats. Like the cuticle and nails, the hollow tube of the hair is semi-transparent, and takes the colour of the matter which rises in this tube from the root. It follows very nearly the colour of the skin, being very dark in the negro, and always white in the Albino, while it takes every inter- mediate shade in Europeans. The hair corresponds, also, in colour, with the eyes; light hair seldom, or never, accompanying dark eyes. The hair, as is well known, is principally restricted to certain parts of the body; though, in the profusion with which the body is furnished with it, and its thick- ness upon the head and other parts, there is a very great difference in different indi- viduals; the bodies of some being almost entirely covered with it, while in others, it is but thinly supplied upon the head, pubes and chin. Hair never grows upon the in- side of the thighs and arms, the palms of the hands and soles of the feet, or about the waist. The uses of the hair, besides serv- ing to bind more firmly together the differ- ent layers of the skin, are : that of the head, to protect this part from cold and injuries ; that of the eyebrows and lashes, to guard ■ the eyes from the sweat, dust, and too in- tense a light; and that on other parts of the body, to protect them from friction. The hair which appears in various situa- tions may have, perhaps, other uses, of which we are still ignorant. Hair being a bad conductor of electricity, may be of ser- vice by insulating the body. The hairs are destitute of sensibility; nevertheless, the passions have such a power over them, that they have become almost instantly blanched by extreme terror, and it is well known that this effect is produced, though more slowly, by sorrow, anxiety of mind, and close study. By many it is supposed, that froinfright the hair is caused to stand on end; this effect is produced, not by any motion in the hair, but by the contraction of a mus- cle beneath and closely adhering to the scalp, and which carries the latter along with it in all its motions. Long hair has very generally been esteemed an ornament, but it has been suspected tr> V-: in-' /\>u.i, hv »-:-.-•.. ■-,:!'.- . , ,,.. , .■ |'.|- -:. to • -v; .<> ,u-. : I. !■ ■;■;,; '";■ y~; v U,J« . i , ',;,- }Tp.- fortable from its'warmth and weight. In children, especially, long thick hair upon the head had better be avoided, by frequent cutting; otherwise, the face is apt to as- sume a pale, unhealthy appearance, the scalp to be covered with eruptions and sores, and the eyes to become weak and slightly inflamed. The hair is subject to a disease, the plica polinica, in which it is firmly matted together, is extremely sensi- ble to the touch, and bleeds when cut. THE NAILS. The horny bodies with which the ends of the fingers and toes are furnished. In man, the nails are broader than in most other animals, and thinner. In the first it ena- bles them better to support the ends of the fingers, and in the second renders them best fitted as a weapon of defence, or of aggres- sion. If the nails were allowed to grow, without being cut even with the fingers, they would bend forward, and cover en- tirely the ends of the fingers. The nails appeal' to be produced in the same manner as the hair, from a kind of pulpy root. They are firmly attached to the end of the finger by the cuticle, which, after running a little way in front of the nails, folds back, and then passes between the nail and the finger. SECTION V. DIGESTTVE APPARATUS. The digestive apparatus consists of the or- gans of mastication and the salivary glands; the organs of deglutition, the alimentary canal, the biliary organs, the pancreas, the lacteals, and the thoracic duct. MASTICATION. This process is principally effected by the grinding action of the molar, or side and back teeth of each jaw, which are made to play upon the substance held be- tween them by the tongue and cheeks; by the action of various muscles which close the lower jaw, and move it backwards and forwards, and from one side to the other. While the food is submitted to this grind- ing process, it becomes moistened by the saliva. SALIVA AND SALIVARY GLANDS. The saliva is a mucou= fl-id poured into •ii j'.j:' -.'..-.c^lv *pecially dur- i-Htioiv, b, tii tory ducts of i ■•■ .nds. i> .'- c j\ '"1 principally -, :mitu>.<:..■■..;;. .:# natters, and ANATOMY AND PHYSIOLOGY. 25 varioug salts. The glands which secrete the saliva are five in number, viz: the paro- tids, one on each side, situated before the ear and behind the lower jaw ; the submax- illary, one on each side, beneath the lower jaw, and the sublingual, immediately be- neath the tongue, in front; the four first named glands have each one, the last, se- veral secreting ducts. The ducts of the parotids, open on the inside of each cheek, between the second and third grinding teeth; the ducts of the submaxillary glands open on each side the frenum of the tongue, and the ducts of the sublingual, between the insertion of the tongue and the teeth, in front of the lower jaw. DEGLUTITION. Deglutition, or that action by which the food is made to pass through the gullet into the stomach, is effected partly by mus- cular force, and partly by the weight of the food itself. Solid food, after being pro- perly masticated by the teeth, and mixed with saliva and mucus, which, by the ac- tion of the parts, are very copiously se- creted, is collected on the tongue by the motion of the latter, aided by those of the cheeks; it is then conveyed from the tip to the root of the tongue, by the pres- sure of the tongue against the roof of the mouth. The lower jaw being now fixed by the shutting of the mouth, we are prepared to act with the muscles which pass from the bone of the lower jaw to that which supports the tongue, called the os hyoides. A convulsive action of these muscles, sud- denly draws forwards the os hyoides, the root of the tongue, and the larynx; the pharynx is enlarged, the food is forced into the gullet, and in its passage it is prevented by the moving upwards and backwards of the soft, or pendulous palate, from entering the nostrils from behind, and by the press- ing down of the epiglottis, it is prevented from getting into the windpipe. The parts previously thrown into action are now relax- ed ; the food is received by the gullet, and by the successive contraction of its circular muscular fibres from above downwards, is regularly, but rapidly conveyed into the stomach. Fluids are conveyed from the mouth into the stomach, in the same man- ner as solids. So perfect and exact is the action of the gullet in propelling its con- tents, that even air can not elude its grasp, which is proved by our having the power of swallowing air, by taking a mouthful of it, and using the same efforts which we employ in swallowing our food. AilMENTAim CANAL. The alimen1»ry canal consists of .e gul- let, the stomach, and the intestines. THE GULLET. The gullet, or esophagus, is a membran- ous tube, beginning from the narrow ter- mination of the pharynx. It is placed be- tween the vertebrae of the neck and the windpipe, and descending lower, is em- braced by the pleura, and lies in a triangu- lar space at the back part of the cavity of the chest. THE STOMACH. The stomach is a membranous sac, in form, when distended, not unlike a bag- pipe. The stomach is much larger towards the left side than towards the right. It has two orifices, one towards its left side, where the esophagus or gullet enters, called the cardia, and another towards the right, called the pylorus, which opens into the intestines. The great extremity of the stomach is situated in the left side of the abdomen, and for the most part immedi- ately under the diaphragm ; the left orifice is almost opposite to, and very near the middle of the bodies of the lowest vertebrae of the back. The small extremity of the stomach does not reach fully to the right side of the abdomen; it bends obliquely backward towards the other orifice; so that the pylorus lies about two fingers' breadth from the body of the vertebrae, im- mediately under the small portion of the liver, and consequently lower down and more forward than the cardia. The sto- mach is connected to the omentum, and by means of the omentum, on the left side, to the spleen. The orifices of the stomach are placed in the recesses on each side of the spine, to which the body of the stomach is closely applied so as in a manner to be bent round it. The orifices of the stomach are therefore placed further back than its body, and also a little higher, though when the stomach is dis- tended, its body rises nearly to a level with its orifices. The body of the stomach is distinguished into two curvatures; the con- cave surface, which is applied around the spine, is called the lesser curvature, and that which is convex, and is turned for- wards and downwards, the greater. The stomach is formed of three coats. The external of these is the peritoneal; the second is muscular, and is formed of fibres, variously distributed around the stomach; some run down each side of the stomach longitudinally, other circular fibres sur- round the stomach. There is a large as- semblage of muscular fibres round the right orifice of the stomach, which con- stringes it so as to prevent the food from passir"1 into the intestines before it has un- dergone the proper change -n the stomach. The third, or inner coat of the stomach, is the villous, or mucous. This being more ex- 2(i ANATOMY AND PHYSIOLOGY. tensive than the rest, is thrown into nume- rous wrinkles or folds. It obtains the name of villous from the unevenness of its surface, as being similar to loose velvet, wool or hair when immersed in water. It is of a reddish colour, and is copiously supplied with mucus. Besides the three proper coats of the stomach, the thick, firm, cellular substance, situated between the muscular and mucous coats, has likewise been described as a coat. The stomach is very copiously furnished with nerves, blood-vessels, and absorbents. The innermost, or villous coat, cover- ed with mucus, contains numerous ab- sorbing and exhaling vessels, and a variety of glands which secrete the fluids useful in digestion. The nerves of the stomach come from the eighth pair and intercostals. The stomach is destined to receive the food; and to perform upon it the first, and a very important part of the process of digestion. The sympathy of the stomach with other organs, renders it one of the most import- ant parts of the animal economy. Hence the great majority of medicines, which are intended to act on various parts of the bo- dy, are first applied to the stomach. By "wine, ^spirits, or opium, and other sub- stances, introduced into the stomach, we can make astonishing changes in the func- tions of the brain; and not only act upon the corporeal frame, but entirely transform or suspend the intellectual operations ; and produce every shade of mental excitement, from the cheerfulness inspired by a tempe- rate draught, to the boisterous violence of intoxication ending in madness. By medi- cines taken into the stomach, we can in- crease the action of the heart and arteries; we can aid the functions of the skin, we can allay the pain of gout or stone ; nor need we now stop to inquire whether these sympa- thies be direct, or whether the action of the brain must intervene between the applica- tion of the substance to the stomach and the ultimate effect. The stomach, also, is one of the most common inlets of disease. AVhatever mor- bid impressions are made upon it, become quickly transmitted to the liver, intestines, skin, brain, and lungs, while the diseased condition of the latter are likewise partici- pated in by it. The large class of diseases, classed under the name of fevers, in all probability, owe their origin to an irritation, or inflammation of the lining membrane of the stomach. THE PILORUS. The pylorus, or that extremity of the stomach which communicates with the in- testinal canal, is surrounded by a ring of muscular fibres of great sensibility, which, by their contraction, close the outlet from the stomach, anefcrfefuse egress to such matters as are not fitted to undergo the next changes in the process of digestion. Thus, ill masticated and indigestible food, coins, stones of fruit, and the like, are not suffered at once to pass from the stomach into the intestines. The pylorus is subject to alteration of structure, ending in cancer, and giving rise to very painful and distressing symptoms. Gastric Juice.—The fluid secreted by the exhalant arteries of the stomach. Until a very late period, the gastric juice was supposed to act upon the aliment taken into the stomach, as a powerful solvent, and in this manner to effect its digestion. To prove this, attempts have been made to cause the digestion of various articles of food, by submitting them to the action of the gastric juice out of the stomach; and, in these experiments, it has been found that the food does undergo a certain degree of softening; but the product of these arti- ficial digestions, has never been proved by chemical analysis to be chyme. Nor is it probable, that a process which is so inti- mately dependent upon the health and vi- gour of the stomach, as digestion, and which causes the food to undergo an actual change in its chemical properties, can be effected by the action merely of a solvent fluid. All the office we are permitted to ascribe to the latter, is that of preparing the aliment for the action of the stomach itself; an office which it shares with the teeth and saliva. The gastric juice, when obtained after a long fast, is a clear, ropy, faintly opaque fluid, entirely destitute of acidity; but when food, or any stimulus, even the simplest kind, is applied to the inner coat of the stomach, the gastric juice then be- comes uniformly acid, and the degree of acidity is in proportion to the amount of the stimulus applied. The acidity is de- rived from the presence of free acetic, and probably hydrocloric (muriatic) acids. THE INTESTINES. By the intestines is meant the whole of the alimentary canal below the stomach. They are divided into the small and large. The small intestines are subdivided into the duodenum, the jejunum, and the ileum. The large into the coecum, the colon, and the rectum. All the intestines, except some part of the duodenum, are surrounded and supported by the mesentery. In man, the length of the intestines is about six times that of the body, but in graminivo- rous quadrupeds their length, in proportion to that of the body, is much greater. The small intestines fill the middle and fore-parts of the abdomen, while the large fill the upper and under parts, as well as the sides of that cavity. ANATOMY AND PHYSIOLOGY. 27 Small Intestines.—•The small intestines, in general, are of a cylindrical form. They are composed of four coats, the structure of which is similar, and which bear the same names as those of the stomach. The mucous coat of the small intestines is very extensive, and forms, together with the cellular substance beneath it, a vast number of red semilunar folds or wrinkles, which serve to increase remarkably the internal surface of the intestines, and of course to expose the aliment more fully to the mouths of thelacteals. The small intestines assist in the prepara- tion of the chyle, and propel their contents towards the great intestines. With respect to the small intestines in particular, several circumstances are to be noticed. The duodenum, so named from its being about twelve inches in length, differs from the others in not being- entirely surrounded by the peritoneal coat. The duodenum, beginning from the stomach, first runs towards the right side downwards, and rather backwards; then it bends to- wards the right kidney, to which it is slightly connected, and thence passes ob- liquely across the abdomen, ascending gra- dually from right to left, till it gets before the last vertebra of the back. It continues its course obliquely forwards, by a gentle turn, and then tei'mina^es in the jejunum. Through this whole course the duodenum is firmly bound down and concealed by folds of the peritoneum. About six inches from the pylorus, the common bile duct and the duct from the pancreas pour then- con- tents together into the duodenum. Of the remaining part of the small intes- tines, two-fifths are called the jejunum, or empty gut, and the remaining three-fifths the ileum,- between them no striking line of dis- tinction can be pointed out. The jejunum is placed more about the umbilical region, the ileum more in the hypogastric. The small intestines at length terminate in the large, in the hollow of the right iliac or haunch bone, below the kidney. At this place there is a valve, which exhibits the appearance of a slit or chink. This valve permits a free passage from the small intes- tines into the large, but prevents any thing from passing readily from the large into the small. Large Intestines.—The caecum, which forms the beginning of the great intestines, may be considered as a production of the colon expanded into a bag. It is about four fingers in length, and as many in breadth. It is situated in the right iliac region, and rests on the broad part of the haunch bone. At its lower part, it has a long small pro- jection, called vermiform, from its re- semblance to an earth worm. Under the name of colon, is comprehended almost the whole of the great intestines. The colon begins in the right iliac region, and Is at- tached to the kidney; thence it rises as high as the stomach and the liver. It now runs transversely before the stomach to the left side, is connected to the spleen and kidney, descends into the left iliac region, and be- ing there bent in the form of the letter S, it terminates in the rectum. The structure of the colon is similar to that of the small intestines. 'Along the whole course of the colon are a number of cells formed by circular con- tractions of the intestine, which serve to retard the progress of its contents. Along the whole course of the large in- testines we also observe small projections of a fatty substance, contained in elonga- tions of their common coat. The rectum, which is a continuation of the colon, begins at the lowest vertebra of the loins. It is bent along the internal sur- face of the sacrum and coccygis, to which it is closely applied, and terminates at the anus. THE ANUS. The anus is the lowest portion of the straight gut, commonly called the fundament. It is surrounded by circular muscular fibres, the assemblage of which is called the sphincter ani, which keep the orifice clos- ed, except when the bowels are to be eva- cuated. The parts in the neighbourhood are abundantly supplied with blood-vessels. As the anus is also surrounded with a con- siderable quantity of cellular membrane and fat, it is often the seat of inflammation, giv- ing rise to large collections of matter, which, if not skilfully treated, cause, when they break, disgusting and troublesome fis- tulas. The anus is also subject to piles and other excrescences. When the inner coat of the intestine is protruded out of the body at the anus, which it frequently is to a con- siderable extent in delicate children, the complaint is called prolapsus ani. BILIARY ORGANS. The biliary organs are the liver, and the gall bladder with its ducts. THE LIVER. The liver is an organ of a deep red co- lour, and is by far the largest gland in the body. It is situated immediately beneath the diaphragm. In man, the liver is divided into two portions, or lobes, the larger of which is placed in the right hypochondri- um, and the smaller extends across the epigastric region, towards the left. The liver is divided on the upper and anterior side into lobes by a broad ligament, on the low or and posterior, by a deep fissure. 28 ANATOMY AND PHYSIOLOGY. The upper surface of the liver is convex and smooth, corresponding to the concavity of the diaphragm. The lower surface is concave and uneven. Behind, the liver has considerable thickness, before it termi- nates in a thin sharp edge. At the back partof the liver, near the great fissure, there is a triangular eminence, called the small lobe of the liver, or the lobe of Spigclius. The ligaments of the liver, by which it is supported, are four. Of these, one sup- ports either lobe, and the broad ligament supports the middle. These ligaments are productions of the peritoneum, and are very different from what are called by the same name in other parts of the body. They pass from the diaphragm to the liver. Besides these, there is the round ligament, which is formed by the adhesion of a considerable blood-vessel of the infant before birth, passing from the liver to the navel. Besides being supported by these ligaments, the great lobe of the liver is likewise connected by immediate adhesion, without the inter- vention of the peritoneum, to the tendinous part of the diaphragm. Round this adhe- sion, we may observe the peritoneum folded back, to form the external covering of the liver. The blood-vessels of the liver, all enter on the concave side of this organ, where it is divided into its two lobes. The uses of the fiver are to secrete and prepare the bile. THE GALL-BLADDER. The gall-bladder is a membranous re- ceptacle, sufficiently large to contain two or three ounces of bile. It consists of four coats, which are very similar to those of the intestines, and are called by the same names. The use of the gall-bladder seems to be to retain the bile till its more watery parts being removed, the remainder be- comes thicker, and more acrid. The bile in the gall-bladder sometimes concretes into hard masses, called gall-stones. As long as these remain in the gall-bladder, they occa- sion little or no inconvenience; but when they are propelled into the ducts, they dis- tend and irritate them, so as, when of a large size, to be productive of very violent pain. When these concretions are stopped in the common gall duct, they prevent the passage of bile into the intestines, and give rise to jaundice. TH£ lHLIAlir DUCTS. The ducts, which serve to convey the bile formed in the liver to the duodenum, de- serve particular attention. The duct which comes from the liver, and is called the he- patic duct, is constituted of a number of smaller ducts, which rise through the whole substance of the liver. This duct is joined to another duct,4 called the cystic duct, coming from the gall-bladder, and these ducts together constitute the common bile duct. The common duct descends towards the pancreas, and passing behind the duo- denum, pierces its external coat. After having run between the coats of this intes- \ tine for some distance, it is at length, be- tween its second and third coat, united with the duct from the pancreas, and the fluids from the liver and pancreas being thus mixed, are poured together into the cavity of the duodenum. The gall-bladder in man receives all its contents by means of the, communication between the cvstic and hepatic ducts. The bile—-the fluid furnished by the liver, and known in popular language by the name of gall. The liver secretes, or forms the bile from the blood ; bile differs, however, from the ordinary secretions, in being from venous, and not from arterial blood. The blood which supplies the sto- mach and the greater part of the intestinal canal, is taken up by the proper veins of these organs; but instead of its being con- veyed back to the heart, to be from thence conveyed to the lungs, in order to be recon- verted into arterial blood, the veins of the digestive organs convey their blood into the substance of the liver, to be employed by that organ in the formation of bile. The bile thus secreted is carried by a canal into the first of the intestines, a few inches be- low the inferior orifice of the stomach. The canal is formed by the juncture of two others, one of which comes from the liver itself, and the other from the gall-bladder, in which latter, part of the bile, which is secreted by the former, is lodged for some ;! time, and becomes somewhat thicker than that which proceeds at once to the intes- *?. tines. * The bile is a fluid of a yellowish green colour, a greasy feel, an intensely bitter \ taste, and a peculiar smell. It is composed jl of water, albumen, soda, phosphate of lime, Jfl common salt, phosphate of soda, a small ^H quantity of lime, and a peculiar substance ^j called picromel. The exact uses of the bile, in the animal economy, physiologists ^ have not as yet been able to determine. Though numerous direct experiments have proved that it is not essential, as was once believed, to the conversion of the food into chyle; nevertheless, there can be little doubt, that it contributes, in some degree, towards perfect digestion. The latest phy- siologists are of opinion that it serves to animalize the vegetable, and other portions of our aliment which are destitute of azote ; that it prevents the too rapid putrefaction of the food in its passage through the intes- tines, and that it tends probably to liquefy, and render soluble the fatty part of the food. Besides which, by its stimulant properties, ANATOMY AND PHYSIOLOGY. 29 rt excites the flow of the intestinal fluids, and increases the peristaltic motion of the bowels, by which their contents are carried regularly onwards towards the anus. The bile is, no doubt, also an important excre- tion by which the blood is freed of a por- tion of its carbon, hydrogen, and other prin- ciples which are in excess, and is thus pre- pared for the final purification and change which is effected in it by the action of the lungs. The secretion of bile is increased by heat, by various articles of diet, by cer- tain passions of the mind, as anger, and by whatever exerts a stimulating effect upon the inner surface of the digestive organs, especi- ally of the stomach and upper bowels. To the influence of the bile, was formerly as- cribed a long list' of diseases, termed bilious; closer and more extended observation has, however, shown that these diseases are de- pendent upon different degrees of irritation or inflammation of the stomach, duodenum, or some portion of the intestinal canal. Prom various causes, an excessive flow of bile is occasionally produced, giving rise, by its action upon the bowels, to a vomiting and purging of a bilious fluid—this constitutes ordinary cholera morbus, and is seldom a very dangerous affection. In other cases, the secretion of bile is deficient, or the bile is prevented from flowing into the intestines; when this takes place, every portion of the body, the skin, whites of the eyes, the saliva, urine, &c, assume a yellow colour, more or less intense; the bowels are cos- tive, and the evacuations, when procured, are of a clayey appearance, and very light colour. Jaundice is to be viewed, howev- er, merely as a consequence of a diseased condition of the liver, biliary ducts, or of the stomach and upper portion of the intes- tinal canal; by the removal of the latter only can its cure be effected. THE PANCREAS. The pancreas is a glandular organ, of a pale red colour, and is called in certain ani- mals the sweet-bread. It is situated in the abdojnen, behind the stomach, in the trian- gular space surrounded by the windings of the duodenum. In form, it resembles the tongue of a dog, the narrow termination of which is placed towards the spleen, and is connected to that organ by blood-vessels. The pancreas, in the human subject, is eight or nine inches in length, but very nar- row, and its situation in the body is very nearly transverse. The liquor prepared by this gland is remarkably similar to that prepared by the glands which furnish saliva to the mouth ; so that the pancreas may be considered as the largest salivary gland in the body. The fluid it secretes is conveyed by a large duct into the duodenum, in con- nection with tile common bile duct. THE LACTEALS. The lacteals, so called from a degree of whiteness in their appearance, like that of milk, which they receive from the colour of the fluid they convey, are delicate trans- parent vessels which arise from the mu- cous coat, of the small intestines; passing in their course through small glands, they advance between the folds of the mesentery towards the second or third lumbar verte- bra, where they meet with the lymphatics of the lower extremities and pelvis, as well as of the whole of the abdominal viscera. This junction forms the beginning of the thoracic duct. The lacteals have at least two coats, which are thin and transparent, but toler- ably strong. They are furnished with valves, which are placed in pairs, and which are so numerous, that three or four of them often occur within the distance of one inch. THORACIC DUCT. The thoracic duct, so called from its course through the thorax, usually begins about the second or third lumbar vertebra. It is of different sizes in different subjects, and is sometimes distended at its lower part into a pyriform bag, called the receptacle of the chyle; but, in general, there is no en- largement so remarkable as to deserve a particular name. The thoracic duct some- times divides and again unites. It ascends as high as the sixth vertebra of the neck, where, forming an arch, it turns downwards, and enters the left subclavian vein, near the insertion of the internal jugular. The thoracic duct is furnished with few valves, and these are placed without much regularity. At the place, however, where it is inserted into the subclavian vein, there is a circular valve, which prevents the blood from getting into it. Besides the thoracic duct, which receives the lymph from the lower extremities and the left side, and the chyle from the intes- tines, there is another vessel somewhat similar, but much shorter, on the right side. This receives the lymphatics from the right arm, the right lung, artd the right side of the head, and enters the right subclavian vein at the same place where the thoracic duct enters the left. DIGESTION. By this term is indicated those changes which the food undergoes within the animal body, in order to adapt it to the purposes of nutrition. The first process to which solid food is subjected, after it is taken into the mouth, is that of mastication. In other words, the food is broken to pieces, and ground into a pulp by the teeth ; and is at 30 ANATOMY AND PHYSIOLOGY. the same time intimately combined with the saliva, which, during mastication, is poured into the mouth in large quantities by the ducts of certain glands which sepa- rate it from the blood. That mastication and mixture with the saliva, are necessary to the perfect digestion of solid food, at least, can scarcely be doubted. In those who swallow their food, not at all, or but im- perfectly chewed, either by eating too fast, or from the loss of a part of their teeth, or who waste the saliva by constant and pro- fuse spitting, digestion is known to be less perfectly performed, and attended with greater difficulty, and the food is more apt to cause irritation and disturbance of the stomach, than in others who chew their food fully before it is swallowed, and in whom nothing has occurred to prevent the natural supply of the saliva. The uses of mastica- tion are, no doubt, to break up the texture of the food, so as to enable the action of the stomach upon it to be more readily and fully effected. The saliva, besides giving the food that pulpy consistency, so necessary to its perfect digestion, has been supposed to exert upon it a solvent power, similar to that attributed to the juices of the stomach. Still later physiologists suppose that the saliva communicates to the food its first de- gree of animalization, thus approximating it in its character to the substance of the ani- mal it is intended to support. The food being duly masticated, is conveyed down the esophagus, or gullet, and through the cardia, or left orifice of the stomach, into the cavity of the latter organ. It remains here for a short time, apparently without undergoing any change ; but after a time, which varies according to the food and other circumstances, the superfluous watery portion is taken up by the absorbent vessels, situated at the large extremity of the sto- mach, and the food is caused, by the ac- tion of the muscular coat of the stomach, to pass gradually along the larger cuiva- ti\e of the organ, towards its right, or pyloric extremity. During this movement, its external surface is moistened with the fluids, secreted by the inner coat of the stomach, to wliich the term gastric juice has been applied, and a thin layer of that part of the food which is in contact with the surface of the organ becomes changed into a homogenous slightly acid paste, of a grayish colour, called chyme. Successive lay- ers which, as they are formed, are conveyed out of the stomach tlirough the pylorus, or right orifice, into the duodenum, undergo the same change, until the digestion of the food in the stomach is completed. During the conversion of the food into chyme, both orifices of the stomach arc closed. The period necessary for the conversion of food into chyme, varies according to the nature and volume of the former, its degree of mastication and admixture with saliva, the condition of the stomach and other circum- stances. The formation of chyme is ren- dered imperfect, or altogether suspended by a variety of circumstances. W hatever im- pairs the health and energies of the stomach, whether directly or indirectly, will produce this effect, as likewise a sensation of nausea, excited even by the imagination ; care, grief and anxiety; intense application of the mind, or disgust; an indolent and seden- tary mode of life; passing over the habitual period of eating; the sudden report of good or bad news; the use of opium and other narcotics ; violent exercise of the body after a meal; eating too rapidly; the presence of too small or too large a quantity of food in the stomach, or even pressure made upon the stomach after a meal. The manner in which the change of food into chyme is ef- fected, is as yet not perfectly known ; by most physiologists, it is supposed to be ow- ing to the solvent powers of the gastric juice. Even admitting, however, this fluid to possess the solvent powers ascribed to it, mere solution of the food by its agency will not explain the formation of chyme. The latter is not merely the food converted into a soft pulp; but of whatever nature may be the aliment of which it is composed, it is a homogeneous substance, differing in its chemical properties from the latter. Ac- cording to the experiments of Leuret and Lassaigne, it is proved that all alimentary substances, with the exception of liquid al- bumen, undergo in the stomach a complete transformation • and that, so far at least as it regards animal principles, this change con- sists in their being made to approach more nearly in their nature to albumen. The food received into the stomach, is, no doubt, prepared for the action of the latter by the gastric fluids with which it becomes impreg- nated; but its change into chyme can only be ascribed to the vital action upon it of the coats of that organ ; how exactly this is ef- fected, we pretend not to understand. During the chemical changes which sto- machic digestion effects in the food, various gases are disengaged, particularly carbonic acid gas. The chyme having passed into the duodenum, or first of the intestines, there meets with the bile, and pancreatic juice, and the mucus of the intestine. It now assumes a yellowish colour and bitter taste, and loses, in some degree, the sharp odour which it previously exhaled. Of the uses of the bile in digestion, we have al- ready spoken in the article bile,- these are, briefly, to retard the putrefaction of the chyme, to render soluble the fatty parts of the food mixed with it, and to aid in animali- zing those portions of it which contain a deficiency of azote ; in the latter office, it is aided, late experimenters suppose, by the pancreatic juice. As the chyme accumu- ANATOMY AND PHYSIOLOGY. 31 late9 in the duodenum, and moves 6lowly onwards through it and the other small in- testines, the softer and more fluid parts pass to its surface, and from these the numerous vessels, the mouths of which open upon the inner coat of the bowels, select the mate- rials which enter into the formation of the chyle; a white fluid resembling milk, and nearly approaching in its composition to the blood. The chyle passes onwards through the vessels already alluded to, called lac- teals, and through certain glands situated in the mesentery, by the action of which certain important though unknown changes are supposed to be produced in the chyle, and finally is emptied into the thoracic duct. The chyme does not remain so long in the intes- tines as the food does in the stomach. As new portions arrive from the stomach, that which previously entered is propelled on- wards, by the continued peristaltic action of the intestines. The part of the aliment which is fit for repairing the waste of the body being thus removed, the excrementitious part which the lacteals refuse to take up, is pushed onward by the peristaltic motion of the intestines, into the ccecum; its return be- ing prevented by the valve of the colon. Here it acquires the peculiar smell of ex- crement, and it accumulates for some time, and often to a considerable bulk, ow- ing to the delay occasioned by the cells and compartments of the large intestines ; till having entered the rectum, and by its bulk distending that portion of the gut, or irrita- ting it by its acrimony, there is an uneasy sensation, and a desire for relief. On many occasions, this uneasy feeling is not so great but it may be resisted ; and the in- testine ceasing to feel the distension, the desire of evacuation ceases, and may not re- cur for some time. The consistence of the excrement has considerable effect here ; we are less able to retain thin or fluid stools than solid ones. There is great variety in the intervals at which different persona evacuate their bowels. The most usual and healthy period is once in twenty-four hours, but some persons do it only every second day; others once a week. The regularity of the bowels also depends much on habit, and it is of great benefit to solicit nature at a certain time ; when this habit is establish- ed, the inclination will generally return at the usual hour. The process of digestion, above describ- ed, is applicable chiefly to solid food; but a great deal of our aliment is taken in the form of liquids, as milk, broths, &c. When a liquid having nutritive matter dissolved in it, is introduced into the stomach, it is either coagulated by the gastric juice, or its wa- tery part is absorbed ; and the solid matter is deposited, and changed in both cases into chyme. Milk is coagulated before being changed into chyme, and broths have their watery part absorbed, and the gelatine, fat, and other solid parts they contain, are then changed into chyme. Wine and fermented liquors undergo a similar change ; their al- cohol coagulates a portion of the juices found in the stomach, and this, with the other portions of the liquid, Is digested. Oil, though fluid, is not absorbed, but is en- tirely transformed into chyme. But it is not every stomach, nor the same stomach at all times, that can digest oil; the quantity also that it can manage is limited, and the overplus getting down into the bowels, proves laxative. HUNGER. The well known sensation which is expe- rienced when the stomach is in a healthy condition, and has remained empty for some time. This sensation does not depend on mere emptiness of the stomach ; for in va- rious diseases the stomach remains long empty without the sensation being produ- ced ; and hunger is allayed by various ways, although no food has been taken. If the usual time of eating is passed, it is not un- common for the feeling of hunger to go off; and it is quite a familiar occurrence to have the appetite spoiled by the communication of bad news. A narcotic substance applied to the stomach removes the sensation of hunger. The juice of tobacco will have this effect in those who are not accustomed to it. Ardent spirits also take away the ap- petite of those who are not used to them. Hunger does not seem to recur till the ali- ment already thrown in has been assimila- ted in the body. It does not, therefore, appear to have a particular reference to the state of the stomach, and in some diseases of the glands through which the chyle passes, the appetite is never satisfied, though there is plenty of food in the sto- mach. Excessive and voracious appetite may depend on some morbid state of the pylorus, by which the food is allowed to pass out of the stomach before it is changed into chyme. The inference drawn from the above facts by Dr. Paris, one of the la- test writers on digestion, is, that the several processes by which aliment is converted into. blood cannot be performed at the same time, without such an increased expenditure of vital energy as,weak.persons cannot, with- out inconvenience, sustain, and that proper time should be allowed for the food to go through all its changes ; that the stomach should not be set to work during the last stages of digestion, otherwise the processes will, in weak persons, be much disturbed. 32 ANATOMY AND PHYSIOLOGY. It is a well known fact, that if a person be interrupted in his meal for a quarter of an hour, he finds, on resuming it, that his ap- petite is gone, although he may have not eaten half the quantity which he required. This is explained by supposing, that during the suspension of the meal, the food had entered on its ulterior changes, and that the energies of the stomach had therefore declined. The subsidence of appetite is not produced by the quantity, but by the quality of the food; thus showing, that it is not the mere volume of the aliment alone that is necessary to pacify the cravings of the stomach. At the same time, it is equally true, that a certain bulk must be introduced into the stomach for the purposes of good digestion; and hence, even the most nutri- tive soups must have some solid or bulky vehicle or accompaniment, when they are taken into the stomach. Besides the pecu- liar sensations referred to the stomach, when a person is hungry, other symptoms at the same time occur in the constitution. There is a universal lassitude, a sensation of pres- sure at the pit of the stomach, and much air is heard passing from one part of the intes- tines to another. When a certain quantity of food has been taken in, the feeling of weariness gives place to that of renewed strength, and all the other phenomena of hunger cease. The instinctive feeling by which we are admonished of the necessity of t iking li- quids into the system, to repair the waste which the body has sustained, and to assist in the solution of the aliment. Hence, we are thirsty after excessive perspiration, and after the use of dry and salt food. The state of the stomach, and its contents, have much influence on thirst. It is also caused by nervous sympathy, as in severe pain, or great terror. Tltis sensation appears to re- side in the throat and fauces; but it is not always connected with dryness of these parts; as, in many cases, the tongue is per- fectly dry, while little thirst is felt. In such cases, drink should be frequently offered, although the patient does not ask for it. Thirst is borne with much greater diffi- culty than hunger. It is evidently much under the power of habit: they who fre- quently indulge in drink, increase their craving for fluids. Children should not be suffered to take drink every time they de- mand it, if the demand be very frequently repeated. Thirst is morbidly increased in fevers and other diseases, it is then best re- lieved by barley water, toast water, or the vegetable acids, or fruits. SECTION VI. ABSORBENTS AJTD ABSORPTION. The absorbents are small transparent ves- sels extensively diffused throughout almost every portion of the body, and furnished with numerous valves. Their uses in the animal economy are of the most important nature. From the alimentary matter in the intestines, they select, as we have already seen, a nutri- tive fluid, called chyle, and convey it towards the heart, to be converted into blood. The absorbent vessels, destined to this office, are called lacteals. The absorbent vessels like- wise take up those particles, which have become useless in any of the organs, and convey them into the mass of circulating fluids, from which they are ultimately sepa- rated, and removed out of the body. The bones themselves afford evidence of the action of these vessels, as their component particles are continually changing through- out life. Absorbent vessels are particularly numerous in the glands, and veiy probably are concerned in effecting the phenomena of secretion. The fluids which are fur- nished for lubricating the joints and mus- cles, and for moistening the several cavities of the body, are continually renovated by the absorbent vessels taking up what is al- ready effused, while the arteries are con- stantly furnishing a new supply. It is by the absorbent vessels that medicinal sub- stances, applied to the surface of the body, are taken into the system; they also intro- duce various acrid and poisonous substan- ces, as the matter of small-pox, or of cow- pox, and the poison of certain reptiles. It is these same vessels that carry off the ef- fused blood and other fluids, which give rise to the black and blue appearance of a part on which a stripe or blow has been in- flicted. The absorbent vessels which do not carry chyle, are ranked under the general name of lymphatics. Through the skin, absorption is effected with great difficulty under its ordinary state of health ; but when the outer skin, or cu- ticle is removed, there is no longer any im- pediment offered. Of the manner in which absorption is effected, we know nothing. Besides the absorbent vessels, properly speaking, it is more than probable that ab- sorption from the inner surface of the intes- tines, at least, is also a function of the minute veins. In the act of absorption, the substances taken up by the vessels some- times undergo no change, but are conveyed into the blood in the same state in which they enter the mouths of the vessels; in other.cases, they are completely transformed ANATOMY AND PHYSIOLOGY. 33 from their first conditiordlpreviously to be- ing taken up by the absorbents. Liquors can also pass into the blood, directly through the coats of the vessels. All the absorbents of the body pass through certain glandsj which are connect- ed with them. When tears from running over the eye-lid, as any |J other fatty matter would do, and it prevents «j the eye-lids from adhering to each other, in consequence of the drying of the tears dur- ing their contact when we are asleep. When these orifices become the seat of inflamma- tion, they produce the painful tumor de- J nominated, in common language, a sty. On examining the eya in a looking glass, when it is turned away, as far as possible | from the nose, there is perceived, at its inner angle, on the ball, a little red fleshy emi- nence in the form of a half moon. Its use would appear to be to arrest any minute substance that has accidentally been admit- ted within the lids, and to carry it to the corner of the eye behind its folded edge. In this it is aided by a fleshy substance, in the inner corner of each eye, and exterior to the former, called the caruncle, which is studded with a number of small hairs. Both these bodies are likewise useful in directing the tears through the proper channels into the nose. The caruncle secretes an ointment similar to that of the edges of the eye-lids. In some of the inferior animals, particularly in birds, the semi-lunar mf mbrane just de» ANATOMY AND PHYSIOLOGY. 49 scribed, is capable of being} spread at will over the whole front of the eye, performing the office of an additional eye-lid, by veil- ing the eye from the light. Motions of the eye-bati.—The varied mo- tions of the eye-ball, by which we are en- abled, without altering the position of the head, to extend so considerably the field of vision, are performed, like all other volun- tary ones of the body, by the action of mus- cles or fleshy ribbons. There are six mus- cles appropriated to each eye. Being firmly attached by one extremity to the inner sur- face of the bony orbit, and by the other to a chord or tendon, which is inserted into the eye-ball, it is evident that when these are excited by the will to contract, or be- come shortened, they must draw the eye in the direction in which their fibres are dis- posed. Four of the muscles in each eye-ball pro- ceed in nearly a straight line, from the bot- tom of the orbit, to the anterior part of the eye-ball, and are hence termed straight {recti") muscles; one being placed above, causes the eye to turn upwards; a second placed below, turns it downwards; a third on its outer side, turns it towards the tem- ple; and a fourth, on its inner side, towards the nose. When these four muscles act to- gether, they sink the eye within the socket, and keep it fixed and motionless. When they are called into action in quick succes- sion, they give to the organ a kind of rota- tory motion. Independently of the foregoing motions, the pupil of the eye is capable of being turned obliquely upwards, and inwards, and also downwards, and outwards; the eye can likewise be protruded, to a certain ex- tent, directly forwards. These motions are produced by the action of the two oblique muscles. The lower oblique muscle takes its rise from the side of the bony orbit within the internal corner of the eye, and running obliquely backwards, and to the inferior part of the socket, is inserted into the eye- ball near its middle. When this muscle contracts, it will, of course, by drawing that part of the ball to which it is attached to- wards the point of its insertion, turn the pupil upwards and inwards. The motion of the eye in the opposite direction, is per- formed by the superior oblique muscle, the singular mechanism of which merits par- ticular attention. It originates far back within the orbit, and running forwards is attached to a slender chord or tendon, which is made to pass through a pulley in the bone beneath the eyebrow, near the point where the latter forms an angle with the nose: the pulley is sometimes of bone, but more gene- rally it consists of a loop of cartilage or gris- tle. After going over the pulley, the chord runs back again, and is inserted into the up- per part of the eye-ball, about its middle. The two oblique muscles acting together, cause the eye-ball to project forwards, as in the effort to view a distant mountain, or a ship far in the offing—a most beautiful contrivance, quite unequalled in all our works of art, in simplicity of mechanism, and utility of design. Connected with the organ of sight there are two other motions, viz. the opening and closing of the eye-lids—or, more strictly speaking, the eye-lid, for, as we have al- ready remarked, it is the upper eye-lid only that moves. The eye-lid is raised by a mus- cle which originates within the socket, very nearly at the same place with the upper oblique, or pulley muscle of the eye-ball; running downwards, beneath the skin of the lid, it is attached to its cartilaginous rim or tarsus; when it contracts, it draws the latter upwards and within the orbit. The eye is closed by a muscle which arises from the edge of the temple and cheek, near the outer angle of the eye; its fibres then run in an oval direction within the substance of the two lids, and uniting to- gether at the inner angle, are there attach- ed by means of a small round tendon, which may be felt by the finger. This muscle be- ing fixed at its two extremities, its contrac- tion has the effect of changing the oval sweep of its fibres to a straight direction, and, of course, of bringing them, and with them the lids to which they are attached, in contact. The action of the muscle has also the effect of compressing the sac, which receives the tears, and, by that means, caus- ing the flow of the latter into the nose. PHENOMENA OP VISION. The rays of light proceeding from the objects within the field of vision, being col- lected by the transparent humours of the eye into a proper focus, pass onwards to the re- tina, where it covers the posterior part of the internal chamber of the eye, and on it form an exact image of the objects, with their appropriate colours; but in what man- ner the mind becomes conscious of this image is unknown. The image formed by the pencil of luminous rays which enters the eye, upon the retina, does not represent the object in its upright position, but in- verted. This can be easily demonstrated by taking the eye of a white rabbit, and after carefully divesting it of its fat and muscles, holding it with the pupil directed towards a candle or other object, when the picture of the latter will be seen inverted on the back part of the eye; or if a fresh bullock's eye be taken, and the posterior coats dexterously removed to the vitreous humour, and a piece of white paper be then placed over this part, the image of any bright object placed before the eye will be 50 ANATOMY AND PHYSIOLOGY. seen distinctly painted on the paper, in an inverted position. It has been a matter of much doubt and dispute by what means it happens that we see every object in its natural upright posi- tion, when we know it to be inverted on the organ of sensation. To this the most satisfactory answer that can be given is, that we do not sec the picture which is formed at the bottom of the eye, but the object it- self. The picture, or rather the impression made on the retina, is the means of seeing, and therefore it does not appear of material consequence on what part of the retina the impression is made. We, in fact, see the image in the direction of that ray which conveys to us the sensation, or rather in the direction of the axis of that pyramid, which a pencil of divergent rays forms in proceed- ing from any point of an object. Although, therefore, the image, which is formed, may appear inverted to a person inspecting a natural eye, as in the preceding experi- ment, still the eye itself discerns the object in its proper and natural position. It is veiy difficult to explain how it happens that a distinct image is painted upon both eyes, and yet that we only per- ceive a single object. This difficulty has been attempted to be solved by having re- • course to the power of habit; but the cor- respondence of the centres of the two eyes, on which single vision depends, would ap- pear rather to arise from some natural con- stitution of the optic nerves, than from habit. The case of the young man born blind, who was couched by Mr. Cheselden, and who saw singly with both eyes, imme- diately upon receiving his sight, may be adduced in favour of this supposition. Three young gentlemen, also, whom Dr. Reid en- deavoured to cure of squinting, saw objects singly, as soon as they were brought to di- rect the centres of both eyes to the same object, though they had never been used to do so from their infancy. In those who squint, the distance between the two pupils is considerably less than in other persons, for when the pupil of the undistorted eye is seated in the middle of the aperture, as in looking directly for- wards, the pupil of the other eye is drawn close to the nose, so that the two axes are never pointed at the same object, though the muscles so far act in concert with each other, as to move both eyes the same way at the same instant of time. This vicious habit may easily be contracted by a child, if he is laid in his cradle in such a position as to perceive the light with one eye only. The most common cause of squinting is, however, an inferiority in the sight of one of the eyes. Dr. Reid asserts, that having examined above twenty persons, who squint- ed, he found in all of them a defect in the sight of one eye. Four of them only had so much of disljhct vision in the weak eye as to be able to r*ad with it, while the other was covered; the rest saw nothing distinctly with the defective eye. When the eyes are equally good, we see with both eyes more distinctly than with \ one, by about a thirteenth part; but when the eyes are unequal in their powers, ob- jects appear less distinct with both eyes than with one. It is no wonder, therefore, , that such persons should choose to make , use of one only, and to turn the other aside. The weak eye, in this case, is generally ~M turned to the nose, because in that situation ™ the direction of its axis is as distant as pos- ^_ sible from that of the good eye; and besides jl this, the nose conceals many objects from its view. The powers of vision are limited, as well as those of every other sense and faculty of man. The sight is very limited with respect to bodies in motion; for with a certain degree of velocity, as that of a cannon ball through the air, they are not visible, unless very lu- minous. The same effect is exemplified by the experiment of whirling a lighted coal. If two objects unequally distant move with the same degree of velocity, the more i remote will appear the slower. A visible object moving with any velocity, appears to be at rest, if the space describedin a second of time is invisible to the eye. Thus, a near i object, as the index of a clock, moving slow- i ly, or a remote one, as a planet, moving swiftly, appears to be at rest. It is well j known,that when we are proceeding straight forward, as in a boat at sea, a lateral object, either at rest, or moving not so fast, appears J to the eye to move the contrary way. If, Jj however, the object is at a very great dis- tance, it will seem to go the same way, as when a person runs by moonlight, the moon appears to accompany hira. If two or more ,_. objects move with the same velocity, and a third remains at rest, it will appear in mo- \ tion, while the moving ones seem at rest, this is exemplified by? the moon and the clouds. There are six natural methods by which we judge of the distance of objects from the eye. 1st. By the angle which is made by the optic axes. For want of this direction it has been observed, that persons who are blind of one eye frequently miss their mark in pouring liquor into a glass, &c.; 2dly, and I think most generally, by the apparent mag- nitude of objects. By depending upon this method we are frequently deceived in our estimates of distance by any extraordinary large objects, as in travelling to a great city, church, or castle, we fancy them near- er than they really are. This furnishes us also with a reason why animals and other ' small objects, seen contiguous to large J mountains, appear exceedingly small; for "* ANATOMY AND PHYSIOLOGY. , 51 we imagine the mountain^p be nearer to us than it actually is. On the other hand, when we look down from a high building, the objects beneath us appear much smaller than they would at the same distance on the level ground; the reason is, plainly, because we have no distinct idea of distance in that direction, and therefor* judge by the im- pressions upon the retina; whereas, custom has corrected our judgment in the other case. The third method of determining the distance of objects, is by the force and vivid- ness of the colours, and the fifth is analogous to it, namely, by the different appearance of the minute parts. When these appear distinct, we judge the object to be near, and the contrary when they appear faint or con- fused. 6th. We are assisted in judging of the distance of any particular object, by the other objects which are interposed. On this account, distances upon uneven ground do not appear so great as upon a plain; for the valleys, rivers, and other objects that lie low, are many of them lost to the sight. This too is the reason why the banks of a river appear contiguous when the river lies low and is not seen. When the eye-ball is either more flat or more elongated than usual, the focus does not fall properly upon the retina, and sight is defective. In the first case, the light, par- ticularly that coming from near objects, reaches the retina before the rays come to a point. This commonly happens in old people. If the eye be too full and elon- gated, the rays, particularly those from re- mote objects, will meet in a point before they reach the retina, as happens in near- sighted people. It is a certain and very important fact, that long-sightedness may be acquired; for countrymen, sailors, and they who are habituated to look at remote objects, are generally long-sighted, want spectacles soonest, and use the deepest magnifiers; on the other hand, the far greater part of the short-sighted are to be found among stu- dents, and those who are conversant with small and near objects; every one becoming expert in that kind of vision which is most useful to him in his particular profession and manner of life. SMELL. Smell is the sense by which we perceive the various odours of bodies. The lining membrane of the nose is the organ of smell. THE NOSE. The nose, in popular language, is the prominence in front of the face, formed prin- cipally of cartilage, covered with the com- mon integuments, and guarding the external opening of the qpstiils. The proper organ of smell is a soft, vas- cular, porous membrane, furnished with papillae, which is spread on the internal surface of the nostrils. On this membrane are distributed a great number of nervous fibres, which proceed chiefly from the first pair of nerves, and pass from the brain through the ethmoid bone. In order to render this sense more acute, the internal cavity of the nose is variously contorted, and enlarged by a communica- tion with several adjoining cavities, so as to increase very much the surface on which the sentient membrane is distributed. The cavities with which the nostrils communi- cate are called sinuses; they are, the fron- tal, which are seated in the front bone of the scull, beneath the eye-brows; the eth- moid, which is a spongy cavity in the eth- moid bone; and the maxillary, which are chiefly formed in the upper jawbone, and lie immediately above the upper double teeth- In animals, which smell most acute- ly, these provisions for enlarging the inter- nal surface of the nostril are still more re- markable. The membrane of the nose is defended and moistened by a viscid mucus; and so necessary is this to smelling, that when it is deficient, this sense is always imperfect. The external nostrils are furnished with muscles, by which they are dilated, when, in order to distinguish scents more accu- rately, we draw in a large quantity of air. Posteriorly the nostrils open into the throat. They are separated from each other by a partition, formed partly of bone and partly of cartilage. The air, loaded with the effluvia emitted from odoriferous bodies, being inhaled into the nostrils, passes through the whole of the interior cavity of the nose. The effluvia are in some measure arrested and retained in contact with the lining membrane of the cavity, by the mucus with which the latter is covered. The olfactory nerves, which are distributed through the substance of the membrane, receive the peculiar impression produced by the odour, and convey that impression to the brain. Smelling is impaired by too dry a state of the nostrils, by various disorders, especially a common cold, by the habit of taking snuff, &c. Sneezing.—Sneezing is a sudden spasmo- dic action of the muscles used in expiration, by which the air is forcibly expelled from the lungs through the nostrils, with a loud noise. Thus it is excited by any acrid or irri- tating substance applied to the nose; it is also a common symptom of catarrhal dis- eases. HEARING. Hearing is that sense which communicates to the brain the phenomena connected with 52 ANATOMY AND PHYSIOLOGY. sound. The organ of hearing is very com- plex, and composed of the external and internal ear. THE EAR. The external ear, which, from its resem- blance to a certain sea shell, is called concha, is a cartilaginous funnel, of an irregular oval form, moveably connected to the head by ligaments, muscles, and cellular substance. The muscles with which the ear is furnish- ed, and which are much employed by quad- rupeds, are of little or no use to man. The concha, becoming narrower, termi- nates in the meatus auditorius extcrnus, or external auditory canal. Into this are con- tinued the skin and cuticle, which, as they enter it, become much thinner and more sensible, and are furnished with minute hairs, by which warning is given when any insect has found admittance, or when any injurious substance requires to be removed. This passage, and the membrana tympani, by which it is terminated, are moistened by a viscid secretion, called the wax, which by stagnation becomes hard, and, when ne- glected, sometimes accumulates to such a degree as to occasion deafness. If we were to examine all nature for a contrivance pro- per for augmenting and echoing sounds with the utmost force and the greatest ex- actness, we should find the ear best formed for these purposes; by its admirable struc- ture it receives sounds of all kinds, admits the greatest quantity in the smallest space, and echoes each back without confusion. The membrana tympani, a membrane composed of several laminae, is stretched before a roundish cavity, within the sub- stance of the temporal bone, hence called the tympanum or drum, and which is about seven or eight fines wide, and half as many in depth. This cavity is increased in the adult by a communication with cells within the protuberance of bone felt immediately behind the external ear, and which do not exist before birth. Within, the tympanum is lined by a moist and vascular membrane. The tympanum communicates with the cav.ity of the throat, by means of the mea- tus auditorius interims, or Eustachian tube. This canal, which is partly bony and partly cartilaginous, begins by a very narrow open- ing at the anterior and almost superior part of the tympanum, increasing in size as it advances towards the cavity of the throat, where it terminates by an oval opening be- hind the nostrils. Within the tympanum are lodged the little bones of the ear, which are four in number, and from their form have received the following names. 1. The malleus, or hammer. 2. The incus, or anvil. 3. The roundish or oval bone. 4. The stapes, or stirrup. The body of tie malleus is placed in the upper part of the. tympanum, and a long process, called the handle, descends be- tween the layers of the membrana tympani, where it is accurately fixed. It is articu- lated with the incus by means of two pro- jecting ridges with a furrow between them. The incus, which consists of a body and two legs, and is not unlike a tooth with a double root, exceeds the other little bones of the ear in size and strength. Its body is connected with the malleus; its shorter leg is placed at the entrance of the canal, which leads to the cells of the ear; its longer leg takes the same direction with the handle of the malleus, to which it is attached by a ligament, and being bent inwards at its ter- mination, receives the small oval bone, and by means of this is united to the stapes. The resemblance of the stapes to a stir- rup is so strong, that it can scarcely escape observation. Its head, which is formed by the union of its two legs, is hollowed for the reception of the little oval bone which connects it with the longer leg of the incus. The two legs of the stapes are bent nearly into a circle, and where they unite at the - basis, cover the oval opening into the laby- rinth. The stapes is situated in a part of the tympanum, separated from the other _ parts by a particular membrane. The stapes and malleus are each of them furnished with a little muscle. The first of these, which is the smallest distinct muscle in the body, draws the stapes obliquely up- wards, and assists in stretching the mem- brani tympani. The other muscle is more remarkable, and as it operates like the for- mer in stretching the membrana tympani, has more particularly obtained the name of tensor tympani or drum stretcher. That part of the ear which is situated be- hind the tympanum is called the labyrinth. The labyrinth is separated from the tympa- num by a bony partition, and only commu- nicates with it by means of two openings of nearly equal size, one of which is oval, and is shut by the basis of the stapes; the other is round, and closed by a continuation of the membrane which lines the cavity of die tympanum. In the labyrinth of the ear are situated the vestibule, the three semi-circular canals, and the cochlea. The vestibule or porch is a cavity of an irregular roundish form, and is placed nearly in the centre of the solid portion of the tem- poral bone, between the tympanum, the semicircular canals, and the cochlea. It opens on the side of the tympanum by means of the oval hole, and communicates, with the upper portion of the cochlea by an ob- long opening, which is under the first open- ing, from which it is'separated only by a very thin partition. The semicircular canals are three in num- ANATOMY AND PHYSIOLOGY. 53 ber. They form rather rafcre than semicir- cles, and open at both ends into the vesti- bule. Only five openings, however, are observed, since two of the canals are united at one termination. The cochlea, so called from its resem- blance to the shell of a snail, is formed by a conical nucleus and circumvolutions of thin bony plates, which perform two com- plete circles and a half before they termi- nate at the apex. The canal of the cochlea is divided by a septum into two parts; of these, one begins from the round hole, the other from the vestibule. The septum, which divides them from each other, is partly bony and partly membranous; it is deficient at the apex of the cochlea, where the two cavities communicate. The bony Bhell which separates the two canals is exceedingly thin, and fills about two-thirds of the diameter of the canal. The rest of the septum is composed of a most delicate membrane, which lines the whole internal surface of the cochlea. The portio mollis of the seventh pair of nerves furnishes a film of medullary matter to the whole inter- nal surface of the vestibule, the semicircu- lar canals, and the cochlea. Every part of the labyrinth is also supplied with an aque- ous exudation, which is supposed to receive and propagate to the nerves the vibratory motions imparted by the air. When this fluid is collected in too great quantity, or is compressed by the stapes, it is supposed to escape through two minute canals or aque- ducts. One of the aqueducts opens into the bottom of the vestibule, and the other into the cochlea, near the round opening. They both communicate with the cavity of the cranium; they are lined with a membrane, which is supposed to be a production of the dura mater. PHENOMENA OP HEARING. By the external ear the sonorous undula- tions of the air are collected, and thrown inward upon the membrana tympani, which receives and repeats these undulations; from thence they are transmitted across the cavity of the tympanum by the air contained in the latter, by the chain of bones within this cavity, and by the bone which forms its sides; and by this means reach the mem- branes which close the oval and round openings at the bottom of the tympanum, through which they are transmitted to the fluid which fills the cavity of the labyrinth; over the inner surface of this, the portio mollis of the seventh pair of nerves, or the nerve of hearing, is spread, which, receiv- ing the sensations thus imparted, transmits them to the brain. Every animal that has an ear is capable of hearing sounds, but it is only in man that the ear is capable of dis- tinguishing accurately between the different modulations of sound, and the exact rela- tion which their modulations bear to each other. But even in the human subject there is a very great difference in the acuteness of hearing, as well as in the capability of appreciating the harmony of sounds. Some individuals appear intuitively to have a taste and capacity for music; others are incapable of distinguishing between discord and har- mony of sounds. Much of this, it is true, depends upon education, but in all proba- bility much more upon the greater or less developement of a particular organ of the brain, upon which the musical talent de- pends. TASTE. Taste is the sense by which we acquire a knowledge of the sapid properties of bodies, and by which we are in general taught, with considerable certainty, whether substances are proper to be taken into the stomach or not. In general, noxious substances have a disagreeable taste, which causes their im- mediate rejection, at least in animals, in- cluding the human subject, in an unsophis- ticated state. Vicious indulgences and ex- cess may cause very pleasant sensations to be produced upon the palate by noxious substances of a very disgusting flavour, and may render the most savoury food destruc- tive to health; while a few of the drugs, which are highly poisonous, are by no means ungrateful to the taste. In fevers, and various other disorders, the taste is de- praved or lost. The organ of taste is com- posed of the tongue and palate. THE TONGUE. This important organ, the organ of taste, and, in a great measure, of speech also, is composed of muscles, by the help of which it is moveable in all directions, and may be rendered broad, narrow, or hollow, at plea- sure. Other muscles, which arising from the neighbouring parts, are inserted into the tongue, or the half-oval rim of bone at its base, cause it to be protruded, retracted, and moved to one or the other side, as cir- cumstances may require. The skin, with which the tongue is co- vered, is remarkably soft and thin, and is continually preserved moist and warm. On the surface of this skin, papillae, or eminen- ces of several sorts are observable. The first kind are few in number, and are placed at the back part of the tongue. These are surrounded with a small furrow, and their form is almost that of an inverted cone. They are not of a very delicate structure, nor are they much concerned in tasting. The second kind, which are smaller and softer than the preceding, and into which the first gradually degenerate, have some- 54 ANATOMY AND PHYSIOLOGY. what of the form of a mushroom; they are scattered on the superior surface of the tongue, till, becoming more numerous to- wards its sides, they are there distributed in diverging lines. The third kind are of a conical form, are mixed with the other kinds, and are very generally distributed over the whole superior part and sides of the tongue. They are endued with a very acute power of sensation, and are the true organs of taste. These conical papillae dif- fer greatly in their size; and some of them are extremely minute. These papillae, besides being copiously supplied with blood, are also furnished with nerves, of which the tongue receives more, in proportion to its bulk, than perhaps any other part of the body. On the upper sur- face, and towards the back part of the tongue, are two or three openings, which pour out a mucous fluid. The papillae in man are covered with a thin and semipellu- cid membrane, which answers the purpose of an epidermis. In many animals, as those which feed on grass, the tongue is covered with a very rough and thick membrane, perforated so as to admit the dissolved food to the papillae, which are placed beneath it. THE VOICE. The principal organs of the voice are the glottis and the tongue, assisted by the fau- ces, the nose, teeth, and lips. THE GLOTTIS. The opening into the upper end of the windpipe, situated directly behind the root of the tongue. It is formed by four liga- ments running parallel with each other, from the front to the back of the larynx, two above, and two a little distance below. In front, the ends of each set of ligaments are in contact, but they slig'htly diverge as they pass backwards, leaving a space be- tween them. The space between the two upper ligaments is called rima glottidis, and is covered, in the act of swallowing, by the epiglottis. Over the ligaments passes the lining membrane of the throat, and in the space which intervenes on each side, be- tween the upper and lower ligaments, it is so disposed as to form a bag or cavity; these are called the ventricles of Morgugni. The chink, between the ligaments, which forms the opening through the glottis into the windpipe, is capable of dilitation or con- traction, by the action of muscles inserted into the posterior cartilages of the larynx. THE EPIGLOTTIS. The cartilaginous lid which shuts up the entrance into the windpipe during the ac- tion of swallowing; so that, although the whole of our fftod passes over the tube which conveys air to the lungs, it is exceed- ingly rare for the smallest particle to go the wrong way, where it would be productive of great inconvenience and danger. This is so admirably contrived, that the very act of swallowing shuts the glottis. It is some- what in the shape of a small leaf, and is situated in the back part of the throat, at the root, and on a line with the centre of the tongue. It may be seen, by depressing the latter with any flat substance, and view- ing the back part of the throat in a looking- ' glass. A case mentioned in Cooper's Dic- tionary, from Barron Larrey, shows how much we are benefitted by this simple and beautiful mechanism. It is that of a French soldier, who had the epiglottis shot away at the battle of Alexandria, on the 21st of March, 1801. The ball entered at the an- gle of the jaw, crossed the throat obliquely, and came out at the opposite side of the neck. The base of the tongue was grazed, and the epiglottis shot away. The patient was not in much pain; but his voice was hoarse, feeble, and scarcely audible. When he first attempted to swallow, he was seized with a convulsive suffocating cough, at- -f^ tended with vomiting. Annoyed by thirst, which the extreme heat of the weather and the irritation of the wound excited, he in- cessantly repeated his attempts to drink; but always with the same result. Four days were passed in this deplorable condition. j| He already experienced violent complaints in his stomach; continued loss of sleep; he had a small quickened pulse, and was be- jj ginning to look thin. When Larrey saw him on the fifth day, the most urgent indi- 31 cation was to appease his hunger and thirst, which was done by introducing into the gul- *j let an elastic gum tube; by means of which some drink was given to the patient, which relieved him much; and afterwards some rich broth.. He was fed in this manner for six weeks, at the end of which time he was able, without the assistance of the tube, to swallow thick panado, and thickened rice, made into little balls. The powers of speech and deglutition intime became much more perfect, in consequence, probably, of the enlargement of the neighbouring carti- lages and of the expansion of the base of the tongue, having formed a sort of substi- tute for the epiglottis. This patient must have been starved to death, but for the use of the elastic gum tube. The voice of man, and other animals, de- pends on the form and structure of the la- rynx, or upper part of the windpipe, and on the opening into it, called the glottis. ' Articulation, which is peculiar to man, is produced by the muscles of respiration, the ' tongue, the teeth, the palate, and the lips. The glottis has been proved to possess the properties both of a wind and of a stringed ANATOMY AND PHYSIOLOGY. 55 instrument, as its openingTor chink can be enlarged or contracted; and the ligaments attached to it can be more or less stretched. But the voice can be so varied and compli- cated in its tones, that no physiologist is able sufficiently to explain it. The following specimen of inquiry on this subject is given in the printed Lectures of Mr. Abernethy: " It is questioned how the tone of the voice is produced by the muscles of the throat; for that it is produced by those muscles, is manifested by the division of the recurrent nerve that supplies them. I said, in speak- ing of that nerve, that experiments had been made on that most noisy of all animals when under torture, namely, a pig; that when that nerve was divided, no sound was produced. Then, I say, how is this done ? Does the tone depend upon the enlarge- ment or diminution of the aperture, or does it depend upon the tension of the strings? Now, for my own part, I am not competent to say; and when I cannot make up my own mind on any subject, I always form my opinion from the opinions of those who are sound-headed, and inclined to labour; and I find that Haller affirms that it entirely de- pends upon the tension of the strings, and not in the enlargement or diminution of the aperture. Y'ou know, on wind instruments, you blow an octave higher with the same aperture, only by shortening the tube; and this also takes place in the larynx, as I shall afterwards mention; but this relates to the note, and not to the tone of the voice. As to the tone, there is no tone if the muscles do not act; and the muscles seem to pro- duce tone by tightening the strings. A two-stringed instrument—how can this pro- . duce tone ? Now here, you know, you must attend to the construction of musical instru- ments in general. The strings are not the cause of the tone; the tone arises from the vibration of the wood by which those strings are surrounded. In the harpsicord, do the strings give'the sound, or the vibra- tion of the wood? Bvery one knows that it is the vibration of tfce wood. So it is also with the fiddle. It is the wood, then, that gives the vibration, and this communicates with the air, as the material which commu- nicates sound to us. It is in this way, too, that the tone of the voice is produced; and it is very curious that such results should take place from such simple mechanism; but you are already apprised of how these results do take place. Then, again, the current of tone is split and subdivided, and so are particular sounds. With regard to this splitting and subdivision of the current of sound, necessary for articulation of words and communications of feelings, I would have you study-that, to a certain extent, at any rate. It is 'a very curious thing, that from this study there has resulted an effect, which is the greatest that we can imagine to have been produced by human labour and observation, that of teaching the deaf to speak—teaching a man who never heard a sound to communicate his sentiments to an- other, and be capable of understanding, merely by the observation of the lips. Now, then, the outlines of the study are formed in the following manner: All vow- els seem to be but notes of the voice; they are all done in the larnyx. Then consonants are divided into labial, lingual, dental, and so on. The labial consonants called b, p, and m, are produced simply by the closing of the lips; and this being a motion which a child might perform without volition, the first thing a child pronounces is ba, ba, pa- pa, papa. Lingual, d, t, I, and so on, ta, ta, la, la,- g is a lingual, it is done by the back part of the mouth, and is certainly the very first sound a child utters, ga, ga, ga ,• s and z are dental, or compound, and are pronounced by a sort of hissing through the teeth." The voice is injured by various diseases. A catarrh or common cold produces in- flammation of the larynx; and the voice is altered both by the elasticity of the liga- ments being diminished, and by the quan- tity of mucus secreted, preventing their vi- brations. In fevers, and diseases of debility, the voice is affected from the weakness of the muscles subservient to it. In hysterical complaints, the voice is sometimes lost; it is occasionally recovered for a few minutes or a few hours, without any evident cause, and then lost again. In palsy, the voice is weakened, and the power of articulation lost. The passion of fear has the same ef- fect. The treatment of this unpleasant de- fect must vary with the cause producing it. Inflammation is to be subdued by the pro- per means; and palsy and other nervous affections are to be treated with repeated blisterings. When the delicate structure of the parts concerned in the formation of the voice is considered, it will- not appear surprising that various organic changes should take place, and cause an almost constant, or even a permanent loss of voice; and from the great exertions of public speakers and singers, they are often the subjects of dis- ease in those parts. SECTION XIII. THE ORGANS OF GENERATION. The organs of generation of the male are the testicles, the spermatic ducts and ves- sels, the seminal reservoirs, and the penis; of the female, they are the mons veneris, 56 ANATOMY AND PHYSIOLOGY. clitoris, nymphae, vagina, uterus, fallopian tubes, and ovaries. THE TESTICLES. Two firm ovoid glandular bodies situated in the scrotum, by which the semen of the male is secreted. They are covered with an external coat of serous membrane, and by a proper enveloping coat of great firm- ness and density, and of a white colour. On the upper and anterior extremity of each testicle, and firmly attached to it, is a body of a reddish colour, called epididymis. Internally the testicles are composed of a soft pulp, and a filamentous matter, of a yel- lowish brown colour, divided into separate portions by a delicate membrane. In con- tact with the inner surface of the testicle, at its posterior part, is a long whitish substance which gives support to the ducts as they pass to the epididymis. From the fila- mentous matter of the cells pass small straight tubes, which at the back part of the testicle form a net work. From this net work other vessels, between twelve and eighteen in number, pass through the coat of the testicle to the epididymis, in the up- per part of which they are formed into con- voluted bundles. These tubes unite, at length, into a single canal which is also con- voluted; this finally becomes straight, and proceeds from the back part of the testicle to the spermatic cord, with which it enters the abdomen, conveying the semen secreted by the filamentous matter of the testicle to .the urethra, at the posterior part of the prostate gland. THE SCROTUM. The bag containing the testicles, is called the scrotum. It is formed of skin and cel- lular membrane, with a few delicate muscu- lar fibres; these parts form two cavities which are lined internally with a serous membrane. When the secretion from this membrane is in excess, it forms the disease termed hydrocele. The cellular membrane of the scrotum becomes also occasionally distended with fluid; it constitutes dropsy of the scrotum. The bowels occasionally pass out of the abdomen through the ab- dominal ring, and descend into the cavity of the scrotum; this is what is termed scro- tal hernia. THE SPERMATIC CORD. The blood-vessels, lymphatics, nerves, and excretory ducts of the testicles, con- nected together by cellular membrane, and covered by a few muscular fibres, constitute the spermatic cord. The cord passes through the abdominal ring into the cavity of the scrotum. THE SBJTINAL RESERVOIRS. The reservoirs are two bodies of a whitish colour, and irregular form, situated between the bladder and rectum. They appear to be composed of a tube, and numerous branches convoluted, or folded together, ^| and connected by cellular membrane. From I each reservoir proceeds a short duct, which V joins with the proper duct of the testicle Jm and the common duct penetrates through a <'■ part of the prostate gland into the cavity of the urethra. These bodies are generally a believed to be reservoirs of semen. THE PROSTATE GLAND. The prostate gland is a firm solid body, shaped like a chestnut; and is situated at the lower part of the neck of the bladder. Its broadest extremity presents backwards, its smallest forwards; its uses are unknown. THE PENIS. iB The body of the penis is composed of two ■ irregular cylindrical bodies, called corpora- f^ cavernosa. They are formed of a membrane so arranged as to form innumerable cells, "M which communicate freely with each other, and are filled with blood when the penis is erected. The two cylinders are united to- ->, gether laterally, and communicate through openings in the membranous septum which _,J exists between them. The cavernous bo- dies arise from the bones of the pelvis, to which they are firmly attached. Where they join each other, there exists above and be- 9 low a groove running their whole length. ;|d The upper superficial groove is occupied by .19 a large vein; the lower groove, which is much deeper, receives the urethra, covered with a spongy body. The urethra is the membranous canal which conveys the urine ■ from the bladder. The spongy body, as its — name implies, is a soft spongy substance jS contained in a thin membrane. The termi. j nation of the penis anteriorly is covered fl with a soft spongy body, having a delicate jJ and very sensible skin< this body is called 1 the glans penis. At its base, its circumfer* m ence is larger than that of the body of the i penis; and hence, it projects over it at its I upper and lateral parts. The whole of the j penis is loosely enveloped by the common * integuments, which, when they arrive at the basis of the glans, continue some distance i beyond the end of the penis, are then folded back upon themselves, and adhere firmly J over the whole glans, acquiring here a greater delicacy of structure. The free fold : of skin thus formed covers the glans like a cap; and is called prepuce. The arteries of- the penis discharge their blood into the • cells of the cavernous bodies, and the inter- \ stices of the spongy bodj^and glans, under ANATOMY AND PHYSIOLOGY. 57 certain excitements of the fcind, thus caus- ing the elongation and erection of the organ. FEMALE ORGANS OF GENERATION. The mons veneris is a cushion, composed of cellular membrane and fat, and covered with the skin and hair. It is situated over the share bones, in front of the abdomen, and immediately above the labia. The labiae are two projections or thick lips, consisting of cellular substance and fat, covered by the skin and hair; they proceed downwards from the mons veneris, on each side of the external orifice of the vagina. The nymphx are two folds of the skin, situated immediately within the labiae,-and surround the entrance into the vagina. The vagina is the canal leading from the labiae to the neck of the womb. It is lined internally by a mucous membrane. The clitoris is a small body about an inch in length, situated in the angle, formed by the union above of the two nymphae. In structure and appearance it very nearly re- sembles the male penis, and like it becomes erected during the veneral excitement. It is liable to inflammation, cancer, and en- largement. The urethra in females is about one inch in length, it opens externally immediately below the clitoris. The womb.—The womb, or uterus, the organ in the female, in which the embryo fives and grows till the time of birth. It is shaped something like a pear, with the broad end uppermost. Its broadest part is called its fundus,- it has also a body and a neck: its mouth opens into the vagina. In the unimpregtiated state, it would hardly contain a kidney-bean, but at the full time, it expands sufficiently to contain one or more children, with their waters, mem- branes, and after-births. At the upper part of the womb, two broad membranous ex- pansions arise, and are the means of its at- tachment to the sides of the pelvis; in the doublings of these expansions are situated the ovaria, and also the tubes, through which one or more vesicles pass down into the uterus, where they open on each side of the fundus. Sometimes the embryo stops in one of these tubes, instead of get- ting into the uterus. From the womb pro- ceeds the monthly discharge. The sympathies of the womb with other parts are of the most general and extensive kind. Not even the stomach itself has more influence on the rest of the system. When the state and contents of the womb are al- tered by pregnancy, the stomach, the bow- els, and digestive functions are in very fre- quent instances exceedingly deranged. The brain and nervotip system, the function of respiration, and the state of the breasts are all very much influenced by the condition of the womb. The ovaries.—The ovaries are two gland like bodies of an oval form, and pale red colour, situated in the cavity of the pelvis. They are enveloped by the broad ligaments of the uterus, and are in contact with the fringed extremities of the fallopian tubes. On the surface of each ovary are a number of small rounded projections. The ovaries are the seat of conception. The fallopian tubes.—The fallopian tubes are conical membranous canals, which pro- ceed from the angles of the uterus, at its basis, upwards towards the ovaries. The end of each tube, nearest the uterus, com- municates with the cavity of the latter by a very small opening. The upper extremity of the tube is fringed, and communicates with the cavity of the abdomen, excepting at the moment when impregnation takes place, when the fringes which surround the opening into the tube clasp firmly the ovary with which they are in contact, and allow the ovum, or small egg which is detached from the latter, to pass into the tube, through which it is conveyed into the cavity of the uterus. The ovum is sometimes arrested in the tube, and the foetus is there developed instead of in the womb; this constitutes what is called tubal pregnancy. MENSTRUATION. The discharge of a bloody fluid which takes place about every four weeks from the womb. The regularity, permanence, and universality of this discharge from the uterus of the human female, is certainly one of the most curious facts in physiology and natural history. It occurs in the female of none of the inferior animals, and in no cli- mate of the globe is the human race exempt from it. It commences at different ages, according to the heat of the climate, being earliest in the warmer regions. In our cli- mate, and in the more temperate regions, it begins about the age of fourteen, at which time also the breasts begin to form, and the whole appearance of the person is more in- teresting and mature. The discharge con- tinues each month for a few days at a time, and the average quantity is about four or six ounces. This discharge returns with great regularity for many years, till about the age of from forty-two to forty-six. With some the period is shorter, being every three weeks. There are some women who do not menstruate at all, and such are univer- sally barren. Menstruation, therefore, seems necessary to the capability of conception. Menstruation is suspended during pregnan- cy, and for some time after delivery, while the woman is giving suck; but if the nur- sing be continued too long, the discharge returns, and the milk is less fit for the nour- 58 ANATOMY AND PHYSIOLOGY. ishment of the child, or it ceases altogether. Some women menstruate easily, without any particular change or inconvenience, but in most women there is some irritation of the whole system, or the stomach and bowels are affected; and costiveness and flatulence, or spasmodic pains occur, before and at the time of menstruation. It is pro- per to avoid the exhibition of all medicines, particularly those of any activity, during the flow of the menses; and the sex, in general, have a prejudice against taking medicine at that period; but in cases of alarm or danger, it may be necessary to depart from the ge- neral rule, and this may be done without much injury. It is proper, during men- struation, for women to avoid every thing that disagrees with the stomach, or that is indigestible; they should avoid also expo- sure to cold, violent exercise, as also strong or sudden mental emotions; as all these cir- cumstances are apt to produce bad effects, either deranging or stopping the discharge, or occasioning flooding, or much pain and spasmodic action. SECTION XIV. GENERATION. The functions of those organs by which the human species is propagated, is termed generation. Without entering into a con- sideration of the numerous theories to which this subject has given rise, and avoiding those details which are improper in a work like the present, we shall endeavour to give, in a few words, the present state of our knowledge in regard to it. By the experi- ments of modern physiologists, it seems to be proved that the embryon of the future child pre-exists in the ovary of the female; and in the moment of impregnation, is de- tached from thence. Yellowish spots or cicatrices remain at the spot from whence the ovum or egg containing the embryon has been separated, which spots are said to exist in exact proportion to the number of times that conception has taken place, and to be absent in the virgin. The ovaries are two spheroidal flattened bodies, situated in the upper and lateral parts of the pelvis. They have no immediate connection with the womb; but near them the superior open extremities of the fallopian tubes hang sur- rounded by loose fringes into the cavity of the abdomen. During the venereal orgasm, when conception occurs, these fringed ex- tremities are erected, and grasp the ovaries, from one of which, sometimes, perhaps, in the case of twins, from both, they receive an ovum, which is conveyed through these tubes into the cavity of the uterus, which has been previapsly prepared for its recep- tion, by its whore internal surface becoming lined with a spongy coat (the decidua.) In order for conception to take place, and the ovum to become detached from the ovary, it is necessary that the male semen be in- troduced into the uterus. Whether it pro- duce here an impression which, when re- peated in the ovary by sympathy, rouses the latter into action, or is conveyed through the fallopian tubes to the ovaries, is un- known. The first of these opinions appears to be the most probable, as an ovum has been found detached from the ovary, when the fallopian tubes have been tied or divi- ded. Generation then is merely the ani- mation of a pre-existing germ by the stimu- lus of the male semen. The embryon being independent of the mother, excepting so far as it is her who supplies it with the fluids necessary for its growth; there is little diffi- culty in accounting for its subsequent de- velopment, and the successive evolution of the different organs. The male semen would, however, appear to contribute something more to the foetus, than the mere stimulus necessary to call its germ into ac- tivity. The primordial embryon is undoubt- edly in the female; but when we recollect that in a large family some of the children will partake of the form, temper, and dis- eases of the father; others of the mother; and that the union of a male and female of different species, even in the vegetable kingdom, is followed by a hybrid produc- tion, partaking of the natures of both; it must be evident, that the male stamps upon the embryo, in the act of generation, an im- age of himself, either by a union with it of principles derived from him, or a modifica- tion, by the influence of his semen, of those which pre-existed, in a manner which will probably never be explained." GESTATION, On PREGNANCY Is the period during which the foetus re- mains within the womfe, from the period of conception to that of birth. In the human female, this period is nine calendar months, ■<■ or forty weeks. THE FCETUS. The young of animals while in the womb. The human foetus is contained in a bag com- posed of different membranes, which is styled the ovum. This ovum, as soon as it becomes visible, appears like a small vesicle, attached to some part of the uterus, gene- rally to its upper part; and all the organs of which it consists, seem to be confusedly blended. By degrees they appear more distinct, and in the advanced periods we observe the membranes, called the amnois, the chorion, and the decidua. The decidua ANATOMY AND PHYSIOLOGY. 59 lines the inner surface of "fce uterus, and is reflected over the ovum;, the amnios is next to the foetus, and the chorion lies between the other two membranes. In the early pe- riods of gestation, the bag or external parts of the conception are large in proportion to the foetus, but afterwards they are in a smaller ratio, the foetus increasing more ra- pidly than its contents and accompaniments; the latter seldom become more bulky after the seventh month. The foetus is for a time invisible, on account of its minuteness and transparency. A foetus of four weeks is nearly the size of a common fly; soft, muci- laginous, and, in appearance, suspended by the belly; its bowels covered by a transpa- rent membrane. At six weeks, it is of a somewhat firmer consistence, nearly the size of a small bee; the extremities then be- gin to shoot out. At three months, its shape is tolerably distinct, and it is about three inches long. At four, five, and six months, it is five, nearly seven, and nearly nine inches, respectively. In the successive months, it increases in length to ten, fif- teen, and twenty, or twenty-two inches, though varying in different women, and in different births. Indeed, all these mea- surements are rather approximations than accurate representations. Between the cho- rion and amnios in the early months, a col- lection of gelatinous matter is found; and in the latter months, this space is occasionally filled by a serous fluid, styled the false wa- ters; so that every discharge of water in pregnant women is not dangerous. If not attended with a discharge of blood, it is ap- parently harmless. The navel string, which is composed of two arteries and a vein, proceeds from the navel of the foetus, and passes into the placenta, a thick spongy substance, which is most commonly attach- ed to the fundus, or upper part of the womb. It consists of two parts, one of which contains numerous blood-vessels that can be injected exclusively from the arteries of the mother. The remaining part of the placenta is an organ of the foetus, and the vessels can be injeflted only from the um- bilical cord. Thejtwo arteries which form part of this umbilical cord, are a continua- tion of the hypogastric arteries of the foetus; and they are thought to convey to the pla- centa the blood which has circulated in the child, that some change may be produced in it, analogous to the change produced on the venous blood of the adult by respira- tion. Numerous vessels take up the puri- fied blood from the placenta, and carry it into the umbilical vein, which transmits it to the liver, in which organ one half of the whole mass circulates. _ The remainder of the blood is carried by a vessel, called the ductus venosus, to the vena cava, or large vein terminating in the right auricle of the heart, where alsy the blood, after having circulated through the liver, arrives. As the lungs are not yet expanded by air, they cannot receive the whole of the blood, and one part passes through the foramen ovale, an aperture in the partition which divides the right from the left side of the heart. The rest proceeds to the right ventricle; and of this portion, only a part enters the pulmonary artery to go to the lungs, the rest being conveyed directly to the aorta, by a duct, called the ductus arteriosus. Thus the entire mass of fluids is conveyed to the aorta, to be circulated through the whole machine. It is difficult to explain how the foetus is nourished. The blood probably undergoes some change in the mother, which fits it for furnishing materi- als for growth and nourishment when it reaches the foetus. There are some other peculiarities of the foetus which may be mentioned. The head is very large in proportion to the rest of the body; the bones of the head are soft and yielding; the sutures not yet formed, and a triangular space is left at the union of the coronal and sagittal sutures. This is what nurses call the opening of the head. The bones of the trunk, the extremities, and the articulations are very flexible. All the protuberances of the bones are distinct portions, united by cartilage, to the bone of which they are afterwards to form a part. The brain and spinal marrow, the glands, and the sanguiferous system are larger in proportion than in the adult. The cavity of the chest is less than it is after respira- tion has commenced; the lungs are smaller, more compact, and of a red colour, like the liver. The belly is disproportionately large, and the extremities particularly small. When the child is born, and respiration has begun, the peculiarities of the foetus be- gin to disappear. In consequence of the expansion of the lungs, a larger portion of blood is carried into that organ; the foramen ovale soon closes, and the ductus arteriosus is lessened, and gradually contracted into a ligament; while the whole of the blood brought by the veins is now carried through the lungs. When the supply from the um- bilical cord is cut off, the ductus venosus contracts in the same way. It seems now to be admitted, except by the very credulous and ignorant, that the imagination of the mother has no power over the infant in her womb, either to alter its structure, to mutilate its limbs, or to im- press any mark on its surface. A few re- markable coincidences have certainly hap- pened, but many falsehoods and misrepre- sentations have given currency to the stories which have been adduced, in proof of the influence of the mother's imagination on the foetus: honest inquiry and sound phi- losophy alike, put a negative on the asser- tion. But though the imagination and long- 60 ANATOMY AND PHYSIOLOGY. ings of the mother cannot affect the foe- tus, her diseases have done so. In fe- ver, it is possible the increased heat of the blood, may affect the irritable frame of the foetus; and the matter of small- pox which pervades all the fluids, may be absorbed from the maternal part of* the af- ter-birth, and conveyed to the embryo. Sometimes the foetus is lodged, and grows, not in the womb, but in some of its appendages, and even in the cavity of the abdomen. Such extra-uterine conceptions are generally fatal to the mother; but, in some instances, when the foetus dies, adhe- sions having taken place to the sides of the belly, an abscess is formed, and the child comes away in parts, the mother eventually getting well. THE PLACENTA, OR AFTER-BIRTH. The placenta, or after-birth, is the thick and spongy cake by which the child, before birth, is attached to the internal surface of the womb, and through which, by means of the umbilical cord, it receives a supply of blood from the vessels of its mother. In the human subject, the placenta is flat and circular, about a span in diameter, and an inch in thickness, becoming gradually thin- ner from the centre to the circumference. It consists of two portions closely united by cellular membrane; into that portion which is attached to the womb, the blood-vessels of the mother penetrate and ramify; into the other the vessels of the umbilical cord. In ordinary labour, the placenta is thrown off by the contracting of the womb, in what is called the third stage of labour. THE CHORION. The chorion is the outermost of the mem- branes which envelope the foetus. It is a thick, opaque, firm, spongy membrane, co- vered with flocculi, or villi, on both its sur- faces. THE AMNIOS. The soft internal, transparent membrane , by which the child is surrounded in its mother's womb. It is very^thin in the early period of pregnancy; but acquires consider- able strength in the latter months. Liquor amnii.—The watery fluid contain- ed within the amnios, and in which the child floats, suspended by the navel string. The discharge of this fluid, in consequence of the rupture of the membranes which contain it, is known by the name of the dis- charge, or breaking of the waters. THE NAVEL STRING. Navel string, or umbilical cord.—A cord composed of two arteries and one vein, held together by a c^ular structure containing a gelatinous fluid, and covered by the mem- branes which envelope the foetus, when in the uterus. It is by means of this cord that the child in the womb is nourished. The vein which conveys the maternal blood to the foetus, arises by numerous branches from the foetal portion of the placenta, runs up the cord, enters the abdomen of the child at the navel, and proceeds to the liver. The arteries of the cord bring back the venous blood to the placenta from the body of the child. The length of the cord is various, it is generally, however, at the pe- riod of birth, about twenty inches. It often forms knots by becoming twisted upon it- self, and occasionally passes around the neck of the child, causing strangulation in the lat- ter during birth. MILK. The white opaque fluid secreted by the mammae of the female for the nourishment of the young. When milk is set at rest, it separates spontaneously into three parts, cream, serum, or whey, and curd. The cream contains the oily part of the milk, and when fully separated from the other parts of the milk, forms the well known substance, but- ter. The whey is composed principally of water, holding in solution a saccharine matter, and various salts. The curd, or coagulable part, is composed chiefly of al- bumen. The milk of the human female contains a greater amount of saccharine matter, and less curd than that of the cow. The quantity of milk secreted, is not pro- portionate to the bulk of the female breasts; a small breast sometimes affording a larger supply than a large one. The secretion of milk generally commences immediately af- ter the birth of the child, and continues for one or two years. The quality, as well as the quantity of the milk, is influenced by the health of the female, and the nature and quantity of her food. It is most abundant and richer when she lives upon animal food, less so when she is confined to a spare vege- table diet. Various substances taken into the stomach of the mother, will communi- cate their active properties to the milk, and, through it, act upon the infant. A violent fit of anger, also, has been known so to al- ter the milk as to cause convulsions in the child who partakes of it. SECTION XV. ORGANS WHOSE OFFICE IS 17NKN0W1T. The thyroid gland.—A glandular body, situated on the forepart of the windpipe, it ANATOMY AND PHYSIOLOGY. 61 has no excretory duct. 9 is larger in the infant, before birth, t^ian in the adult. In mountainous regions it is often enormously enlarged, forming the goitre, or wen of those countries. The thymous gland.—A spongy body, situated in the anterior and upper part of the mediastinum, behind the superior end of the sternum. It is very large before t)irth, and is then filled with a thin whitish fluid. In adults it is hard, small, and gradu- ally decays. It has no excretory duct. The renal glands.—-Two triangular bodies, of a glandular appearance, situated, one on each side of the abdomen, immediately above the kidneys. They are attached both to the diaphragm, and to the kidneys. The one on the right side adheres to the liver; and that on the left, to the spleen and pancreas. In the foetus, they are larger than the kidneys, but become gradually smaller in after life. These bodies are hollow, and are filled with a reddish matter. THE SPLEEN. A soft substance, situated on the left side of the abdominal cavity, the functions of which are still a subject of much specula- tion. The spleen is a flat body, of a blueish colour, and an irregular oblong shape, va- rying in size in different individuals, from a few to several inches in length, and of a proportionate breadth and thickness. It is in contact with the diaphragm, and situated below the eighth rib of the left side, near its junction with the spine. It is plentifully supplied with blood-vessels and absorbents. It has no excretory ducts. It is connected with the left extremity of the stomach by three or four small blood-vessels, called vasa brevia. The spleen is subject to in- flammation, enlargement, and other dis- eases. SECTION XVI. SLEEP. TnAT state during which the organs of animal life are rendered insensible to their accustomed stimuli, and cease to act. The external senses can no longer receive im- pressions; the mind is unconscious of ex- ternal objects, while the passions, emo- tions, and intellectual faculties are in a state of complete torpor. Sleep is, therefore, the periodical suspension of nearly all those functions, which render us conscious of our own existence, and connect us with the exterior world. The organic functions still, however, rtmain active, though, per- haps, even these are less active, during sleep, than in the waking state. The or- gans of animal life become fatigued, and their energies exhausted, after they have been in action for a length of time, and their inactivity, during sleep, would appear to be necessary, in order to enable the fa- tigued organs, by rest, to recruit their ener- gies. How sleep is induced, by what pow- er the activity of the mind and body is in- terrupted during that state, and what are the causes by which it is terminated, and the organs which had been in repose are again caused to perform their appropriate func- tions, are circumstances of which we know but little, if any thing. During sleep, the circulation of the blood, respiration, diges- tion, secretion and nutrition are regularly performed, but with less activity than du- ring the waking hours. The heart beats slower, and, of course, the circulation is less rapidly performed, respiration is also re- tarded, and the whole capillary system acts with less vigour; hence, the temperature of the surface is reduced, and the individual, if not properly protected from the external air, feels sensibly its changes; and cold is more liable to induce disease than when the body is exposed to an equal, or even great- er degree of it when awake. Digestion too is less vigorously performed; and, hence, the impropriety, and even danger of eat- ing food immediately before retiring to rest. Without a due amount of sleep, health suffers; and even death would ensue, were by any means wakefulness to be pro- tracted for too long a period. Indeed, there are no circumstances, however urgent, that will prevent, for any length of time, the ap- proach of sleep. Under the severest ca- lamity, when surrounded by the loudest noises, even amid the din and dangers of battle, or when the body is suffering the most excruciating agonies, sleep has been known to steal at length upon the harassed frame, and lull its senses into sweet oblivion. Healthy sleep is generally so profound as to resemble, in all that re- gards voluntary motion and self-conscious- ness, death itself. The period which elapses between the commencement and termina- tion of sleep, is, as it were, blotted out.of ex- istence. But it is only in those who live active and temperate lives, and whose minds are free from absorbing cares and passions, and from intense thoughts, that sleep is thus perfect. In others, it is so slight as to be interrupted by the slightest noise which occurs near them; or the inac- tivity of the organs of animal life and of intellect is but imperfect, some still exer- cising to a greater or less extent their func- tions; and hence, dreams, violent strug- gling of the body and limbs, speech, or even the full activity of the voluntary mus- cles, or sleep walking, is not unfrequently 62 ANATOMY AND PHYSIOLOGY. observed. The period required for sleep, by different individuals, depends much up- on temperament and peculiarities of con- stitution, and the state of health, as well as on the mode of life and habit. While some do not sleep beyond five, six or seven hours, others again cannot do with less than eight or nine hours. Children sleep more than half their time, while adults, need much less repose, until old age advances, when once more a lengthened period for sleep is demanded. As a general average, eight hours is a good allowance. Beyond this, sleep becomes injurious. Night is the proper period for repose. When man is left to obey the impulse of nature, unimpeded by the factitious habits of civic life, as regularly as the sun sinks below the horizon, he feels that instinctive desire which urges him to court repose. As the day declines, the pulse becomes accel- erated; the skin is apt to be more dry and hot, and all the functions of the body feel a peculiar languor, which renders the indi- vidual disinclined to active exertion, and all his organs seem to court that repose and re- freshment which sleep alone can afford. Experience has, in fact, shown, that in the first hours of the night the sleep is the most profound, and communicates the'lar- gest amount of refreshment to the body. BREAMING. That state of imperfect sleep, during which a series of images, either sensible or intellectual, are presented to the mind. These images are more or less vivid, and sometimes so lively as to impress the mind with the fullest conviction of their real ex- istence. Joy, despair, pleasure and pain are excited by them, and the judgment would appear, in many cases, to possess the power of deciding upon the propriety of the actions which they suggest, while, in other instances, the voluntary motions to which these images prompt are called forth by the will. The images, however, which, in the dreaming state, pass before the men- tal eye, are generally incongruous, disjoint- ed, and absurd; but whatever forms they may assume, it may be assumed, as a well established fact, that every part is derived from sensible ideas, formerly received du- ring the waking state. So extensive, how- ever, is the power which suggests these imaginary scenes, that their objects are as various as our ideas. Our feelings, sympa- thies and passions, appear to be excited as by realities, but our reasoning is weak and imperfect. In dreams, we seem to reason, to argue, and compare; and in all these cir- cumstances, during sleep, we are highly gratified, and think that we excel. If, however, we remember our dreams, our reasoning we find to be weak—our argu- ments inconclusfce, and our compositions trifling and absurd. , Many of the images of our dreams we fancy to be new; but if we can recollect them when awake, we find that this opinion arose from our imperfect recog- nition, and we shall I will not affirm, however, as some have done, that, by them, we may make a more Accurate discovery of our temper and prevailing passions, than by observing what passes in our minds when awake. For in sleep we are very incompe- tent judges of ourselves, and of everything else; and one will dream of committing crimes with little remorse, which, if awake, one could not think of without horror. But as many of our passions are inflamed or al- layed by the temperature of the body, this, I think, may be affirmed with truth, that, by attending to what passes in sleep, we may sometimes discern what passions are predominant, and so receive good hints for the regulation of them. Intemperance of every kind, in eating or drinking, in sleep or watching, in rest or exercise, tends to make dreams disagree- able; and therefore, one end of dreaming may be to recommend temperance ana moderation. For the time we employ in sleep bears a great proportion to the whole of human life; and if there be any expe- dient for rendering that part of time agree- i able, it is surely worth while to put it in practice. Habits of virtue and soberness, J the repression of turbulent desires, and the indulgence of pious, social, and cheerful dispositions, are, for the most part, effec- fl tual in giving that lightness to the animal M spirits, and that calm temperature to the J blood, which promote pleasurable thoughts M through the day, and sweet slumber and | easy dreams through the night. I As agreeable thoughts accompany good j health; as violent passions, and even mad- J ness, are the effect of certain diseases, as J dullness and confusion of thought, may be M occasioned by a loaded stomach; and as the swallowing of much strong liquor produces m a temporary madness—as our thoughts, I say, when we are awake, are so much de- m termined by our bodily habit, it is no won- der that they should be still more liable to | such influence when we are asleep. ' SOMNAMBULISM. J The propensity which some people have 1 to walk in their sleep. This very danger- 1 ous and morbid inclination is observed in 'M different degrees. Sometimes persons | merely get out of bed, and repeat the ac- tions of the day, or go to the places they J usually frequent at other* times; sometimes Jfl they climl) to the tops of houses, or go to places which, in their waking hours, they would shudder to approach. Like dream- ing, and various mental operations, we are ignorant of the cause of sleep-walking. To cure it, we should correct whatever bo- j dily ailment we can discover, especially 1 should we attend to any symptom more 5 particularly indicating derangement of the I nervous system. Precautions should al- ways be taken to prcvfct sleep-walkers ANATOMY AND PHYSIOLOGY. 65 from hurting themselves; ^y having a per- son to watch them while asleep, and apply proper restraint when they rise to walk; or by putting a vessel of water by the bed- side, into which they will step, and be im- mediately awakened. The windows should be properly secured. -Perhaps altering the time of taking the last meal, or the time of going to bed, might contribute to break the habit. Somnambulism, says Dr. Abercrombie, ap- pears to differ from dreaming chiefly in the manner in which the bodily functions are af- fected. The mind is fixed in the same man- ner as in dreaming, upon its own impres- sions, as possessing a real and present exis- tence, in external things; but the bodily organs are more under the control of the will, so that the individual acts under the influence of his erroneous conceptions, and holds conversation in regard to them. He is also, to a certain degree, susceptible of impressions from without, through his or- gans of sense; not, however, so as to correct his erroneous impressions, but rather to be mixed up with them. A variety of re- markable phenomena arise out of these pe- culiarities, which will be illustrated by a slight outline of this singular affection. The first degree of somnambulism gene- rally shows itself by a propensity to talk during sleep; the person giving a full and connected account of what passes before him in dreams, and often revealing his own secrets, or those of his friends. Walking during sleep is the next degree, and that from 'which the affection derives its name. The phenomena connected with this form are familiar to every one. The individual gets out of bed; dresses himself; if not pre- vented, gets out of doors; walks, frequently over dangerous places in safety; sometimes escapes by a window, and gets to the ^roof of a house; after a considerable interval, re- turns and goes to bed; and all that has pas- sed, conveys to his mind merely the impres- sion of a dream. A young nobleman, men- tioned by Horstius, living in the citadel of Breslau, was observed by his brother, who occupied the same room, to rise in his sleep, wrap himself in a cloak, and escape by a window to the roof of the building. He there tore in pieces a magpie's nest, wrapped the young birds in his cloak, re- turned to his apartment, and went to bed. In the morning, he mentioned the circum- stances as having occurred in a dream, and could not be persuaded that there had been any thing more than a dream, till he was shown the magpies in his cloak. Dr. Pritchard mentions a man who rose in his sleep, dressed himself, saddled his horse, and rode to the place of a market which he was in the habit of attending once every week; and Martinet mentions a man who was accustomed to rise in his sleep, and pursue his business as a saddler. There are many instances on record of persons com- posing during the state of somnambulism; as of boys rising in their sleep, and finish- ing their tasks which they had left incom- plete. A gentleman, at one of the English Universities, had been very intent during the day in the composition of some verses which he had not been able to complete? during the following night he rose in his sleep, and finished his composition; then expressed great exultation, and returned to bed. In these common cases the affection oc- curs during ordinary sleep; but a condition very analogous is met with, coming on in the day-time, in paroxysms, during which the person is affected in the same manner as in the state of somnambulism, particular- ly with an insensibility to external impres- sions; this presents some singular phenome- na. These attacks, in some cases, come on without any warning; in others, they are preceded by noise, or a sense of confusion in the head. The individuals then become more or less abstracted, and are either un- conscious of any external impression, or very confused in their notions of external things. They are frequently able to talk in an intelligible and consistent manner, but always in reference to the impression which is present in their own minds. They, in some cases, repeat long pieces of poetry, often more correctly than they can do in their waking state, and not unfrequently things which they could not repeat in their state of health, or of which they were sup- posed to be entirely ignorant. In other cases, they hold conversation with imagina- ry beings, or relate circumstances or con- versations which occurred at remote pe- riods, and which they were supposed to have forgotten. Some have been known to sing in a style far superior to any thing they could do in their waking state; and there are some well-authenticated instances of persons in this condition expressing them- selves correctly, in languages with which they were but imperfectly acquainted. I had lately under my care, a young lady, who is liable to an affection of this kind, which comes on repeatedly during the day, and continues from ten minutes to an hour at a time. Without any warning, her body be- comes motionless, her eyes open, fixed, and entirely insensible; and she becomes totally unconscious of any external impression. She has been frequently seized while play- ing on the piano, and has continued to play over and over, a part of a tune, with perfect correctness, but without advancing beyond a certain point. On one occasion, she was seized after she had begun to play from the book a piece of music which was new to her. During the paroxysm, she continued the part which she had played, and repeated 66 ANATOMY AND PHYSIOLOGY. it five or six times with perfect correctness; but, on coming out of the attack, she could not play it without the book. During the paroxysms, the individuals are, in some instances, totally insensible to any thing that is said to them; but in others, they are capable of holding conversation with another person with a tolerable degree of consistency, though they are influenced to a certain degree by their mental visions, and are very confused in their notions of external things. In many cases, again, they are capable of going on "with the man- ual occupations in which they had been en- gaged before the attack. This occurred remarkably in a watchmaker's apprentice, mentioned by Martinet. The paroxysms in him appeared once in fourteen days, and commenced with a feeling of heat extend- ing from the pit of the stomach to the head. This was followed by confusion of thought, and this by complete insensibility; his eyes were open, but fixed and vacant, and he was totally insensible to any thing that was said to him, or to any external impression. But he continued his usual employment, and was always much astonished, on his re- covery, to find the change that had taken place in his work since the commencement of the paroxysm. This case afterwards passed into epilepsy. Some remarkable phenomena are pre- sented by this singular affection, especially in regard to exercises of memory, and the manner in which old associations are re- called into the mind; also in the distinct manner in which the individuals sometimes express themselves, on subjects with which they had formerly shown but an imperfect acquaintance. In some of the French cases of epidemic " extase," this has been mag- nified into speaking unknown languages, predicting future events, and describing oc- currences of which the persons could not have possessed any knowledge. These stories seem, in some cases, to resolve them- selves merely into embellishment of what really occurred; but in others, there can be no doubt of connivance and imposture. Some facts, however, appear to be authen- ticated, and are sufficiently remarkable. Two females, mentioned by Bertrand, ex- pressed themselves, during the paroxysm, very distinctly in Latin. They afterwards admitted that they had some acquaintance with the language, though it was imperfect. An ignorant servant girl, mentioned by Dr. Dewar, during paroxysms of this kind, showed an astonishing knowledge of geog- raphy and astronomy; and ,expressed her- self, in her own language, in a manner which, though often ludicrous, showed an understanding of the subject. The alter- nations of the seasons, for example, she ex- plained by saying, that the earth was set a-gee. It was afterwards discovered, that her notions onAese subjects had been de- rived from overnearing a tutor giving in- structions to the young people of the family. A woman who was, some time ago, in the Infirmary of Edinburgh, on account of an affection of this kind, during the paroxysms, mimicked the manner of the physicians, and repeated correctly some of their prescrip- tions in the Latin language. PHRENOLOGr. The word phrenology signifies a discourse on the brain; it is applied to designate the doctrines advanced by Gall and Spurzheim in relation to the structure and functions of the brain. According to these gentlemen, theibrain is not a single organ, but a collec- tion of organs, each one destined to per- form a particular function. The mental faculties they divide into those of the feel- ' ings, and those of the intellect. The first are subdivided into propensities and senti- * ments. The second, or intellectual facul- ties, they divide into the knowing and re- flecting.^ The propensities do not give-^J origin to ideas, they merely produce sensa- > tions of a kind peculiar to each. They are 9 common to man and other animals. They 1 are amativeness—the propensity to physical fl love; philo-progenitiveness—the instinctive u love of offspring; concentrativeness, the func- tion by which the mind maintains two or \ more powers in simultaneous action, and determines the individual to fixedness of location and purpose; adhesiveness, the in- stinctive attachment for surrounding objects, whether animate or not—it disposes to friendship and society; combaiiveness, in-,^J stinctive desire to combat; it manifests itself J by anger and rage; constructiveness, in- stinctive tendency to construct; in man, directed, by the predominance of other . faculties in different individuals, to various ■ objects; in the lower animals, to form their -• burrows, dens, or nests; acquisitiveness, 3m instinctive tendency to acquire and possess; J9 the love of property and wealth is founded ;fl on it; its predominance causes avarice; se- fl crctiveness, instinctive tendency to conceal ■ the thoughts, desires and emotions of the mind, until the understanding has decided upon their fitness and probable consequen- ces; when properly balanced by other or- gans, it produces prudence; when it pre- dominates, it causes slyness and cunning. The sentiments are mere emotions, or ten- dencies to emotion, they produce no ideas, many of them are possessed by other animals as well as man, some are peculiar to the lat- ter. The first are self-esteem—love of appro- bation—cautiousness, and benevolence, which are fully indicated by their names. Those, peculiar to man, are veneration—hope—ide- ality, or the faculty of the mind which causes in individuals a desire % something more ) ANATOMY AND PHYSIOLOGY. 67 perfect than what ordinarily presents itself, which inspires them with "enthusiasm and exaggeration, and prompts to embellish- ment and splendor of conception—wonder, the sentiment of the marvellous, or marvel- husness, proneness to belief in mysterious incidents, ghosts, sorcery and witchcraft; conscientiousness and firmness. The organs upon whose functions the sentiments and propensities just enumerated depend, are situated in the posterior and inferior por- tion of the brain; the organs of the intellec- tual faculties now to be enumerated, are seated in the anterior and upper part of the brain. They are eventuality, or the desire and ability to know facts and things; form, the faculty of judging of form; size, the faculty of judging of magnitude—weight —colouring—locality, the faculty of remem- bering and recognizing places; order— time—number—tune—language—compari- son—casualty—wit—imitation. The great- er the development of the individual or- gans, the more powerful the propensity, sentiment, or intellectual faculty, to which they are destined, becomes. The develop- ment of the organs is caused by their fre- quent exercise. The predominance of one or more of the mental organs, stamps the pe- culiar moral or intellectual character of the individual. Of course, the foregoing is a very superficial sketch of the leading pro- positions; the explanation and application of which constitute the doctrines of phre- nology; sufficient, however, has been said to give the reader a general idea of that science. TEMPERAMENTS. By the word temperament, we mean the differences that are observed between the constitutions of men, dependent upon the relative predominance of one or the other of their organic systems. The ancients re- ferred these differences of constitution to the predominance of the humours, which they imagined to perform so important a part in the human economy. As these hu- mours were four, they, of course, described four leading temperaments; 1st the sangui- neous, from the predominance of the blood; 2d the bilious, from the predominance of the bile,- 3d the pituitous, from the pre- dominance of the phlegm, and 4th, the me- lancholic, from the predominance of the black bile. These views have, of course, been rejected, in common with the fanciful physiology upon which they were based; and the moderns have adopted, as a more philosophic basis for the individual differ- ences, constituting temperaments, the pre- dominance of some one of the organic sys- tems. This has given rise to a new divi- sion, and a greater extension of the number of the temperaments. To enter into these divisions, and enumerate the temperaments of different authors, would be out of place in a work like the present. We have, therefore, adopted the division in most common use, which is into the sanguine— choleric—melancholic—phlegmatic, and ner- vous temperaments. In the first, the heart and blood-vessels predominate; in the se- cond, the liver and biliary organs; in the third, the stomach,- in the fourth, the lym- phatics,- in the fifth, the nervous system. There is, after all, however, something very fanciful in all the divisions of the temperaments; many of them are the ef- fect of education and manner of living; and others, of an over excitement of cer- tain organs, by which these are brought in- to a condition, bordering on disease. K PAET II. HYGIENE; OR, THE MEANS OF PRESERVING HEALTH. HEALTH. Health is that state of the human body in which the structure of the parts is sound, and their functions properly performed, rendering the individual fit for all the duties and enjoyments of life. When a person has received a sound constitution from nature, his health is to be preserved by a proper regulation of the various circumstances, in- ternal and external, on which animal life is dependent. These are, principally, air and exercise, clothing, food and drink, the ex- cretions and discharges, sleep and waking, and the management of the passions of the mind. The variety of temperaments or constitu- tions renders it possible for the phenomena of health to be very different in differentper- sons; hence what would preserve the health of one would occasion disease in another. Persons of a sanguine temperament, whose vessels are full, and whose fibres are firm and active, easily excited to motion, and often to irregular actions, bear evacuations well; and have their health best promoted by abstinence and low living, by avoiding excess of every kind, and particularly guard- ing against cold after active bodily exer- tions. The bilious temperament is distin- guished by equal strength and activity with the sanguine, but by a yellow hue on the skin, and red hair; with a constitution more acutely sensible, always more irritable. It requires the same precautions as the sanguine; but the evacuations best adapted, which are indeed almost indispensable to this kind of constitution, are the free and frequent use of the milder laxativ es. To pre- serve the health of the melancholic, of those whose complexion is dark, and whose pow- ers are torpid, whose mind is dull, but per- severing, they should use much exercise to assist digestion and to determine to the skin; they should occasionally aid the torpor of the bowels by purgatives of the aloetic kind; and their occupations and amusements should be varied and interesting to the mind. The phlegmatic temperament is pale in com- plexion, languid in its exertions; the ves- sels, if full, are torpid, the constitution in- active; the mind not easily excited to exer- tion. The diet in this temperament requires to be nutritive and somewhat stimulating, though it ought not to go the length of what would be called high living; a small propor- tion of wine may be allowed, but never to excess; health is merely not injured by what would excite fever in the sanguine or bilious. The bowels should be kept open, but not much purged, for the phlegmatic do not bear evacuations well, especially of blood; and they should use constant, regu- lar exercise in the open air. These observa- tions may appear to savour too much of the exploded pathology of other times, when all the phenomena of health and disease were considered to depend on the predomi- nance of certain humours, as the phlegm, the blood, the yellow and the black bile. In all these speculations the ancients were unquestionably wrong; but the different temperaments and appearances of men are sufficiently obvious to the most careless ob- server; and the terms which are employed to express these varieties may now be used without regard to their original derivation, and without occasioning any material error. HYGIENE. 69 The health of women fcas some pecu- liarities arising from the delicacy of their frame, the monthly discharge, the state of pregnancy, and of nursing. All these cir- cumstances constitute a condition very dif- ferent from the robust and vigorous strength of man in the prime of life; yet equally per- fect, relatively to the sex and and the indi- vidual. Such functions require, for their healthy performance, the attentions pecu- liar to themselves. The irritability of in- fants, and the mobility of boyhood are con- sistent with good health, though they would be unsuitable at a more advanced period of life. Health varies in people of different occu- pations. The acuteness of the senses which is necessary in some employments, would be morbid in persons otherwise engaged. There is a state of vigour and perfection of the-different faculties, with great muscular strength, which is often spoken of as a state of high health,- but, as Celsus says, a person so circumstanced, should look with a jeal- ous eye on his attainments. Such a state is incapable of remaining at its acme; the balance is so nicely poised that a very little external agency or incautious conduct readily excites some disease. This state of extreme muscular vigour is sometimes arti- ficially induced for the brutal purpose of prize-fighting, and the method of doing this is called training. The foregoing remarks on what consti- tutes health in different individuals, are principally applicable to those whose con- stitutions, though varying from one another, may all be considered as sound. But some have various diseases or predispositions to disease, either derived from parents or ac- quired in the progress of life, which render health with them only a comparative term. The scrofulous can hardly be said in strict- ness ever to be in perfect health; but their disease may be dormant; and in favourable circumstances, may permit the subject of it to enjoy an exemption from pain and incon- venience, to the end of a long life. Gouty patients may also enjoy good health during the intervals of their attacks. SECTION I. AIR. Air is that invisible, transparent, compres- sible, and elastic fluid, which every where surrounds our globe; and which generally receives the name of atmosphere. It is the medium in which we breathe, and without which we cannot exist. Atmospheric air, or that by which we are usually surrounded, is not a simple, but a compound body, con- sisting of at least four distinct substances, viz. oxygen, azote, carbonic acid, and aqueous vapour. The two former substances, however, constitute almost the whole of the atmo- spheric air near the surface of the earth; the other two arc variable in their propor- tions; the first exists only in minute quanti- ties, which it is difficult to appreciate. Vi- tal air, or oxygen, which constitutes about one-fourth of the atmosphere, is necessary to respiration and combustion, and an ani- mal immersed in it will live much longer than in the same quantity of common air. The remaining three-fourths, called azote, or mephitic air, is totally incapable of sup- porting respiration or combustion for an instant. If a candle be included in a given quan- tity of atmospheric air, it will burn only for a certain time, and then be extinguished, as the oxygen is all absorbed, and that which remains is incapable of supporting flame. If an animal be put in a given quantity of common air, it will live only a certain time, at the end of which, the air will be found di- minished about one-fourth, and the remain- der will neither support flame nor life. The oxygen which is received into the lungs of animals from the atmosphere, com- municates the red colour to the blood, and imparts heat and activity to the system. When animals die for want of vital air, their blood is always found black. There is a constant consumption of the oxygenous portion of atmospheric air, by the burning of combustible bodies; by the fermentation and putrefaction of vegetable substances; and by the calcination of metals. A diminished proportion, therefore, of the oxygen of our atmosphere, and an in- creased amount of carbonic acid and other deleterious gases, undoubtedly arises from the innumerable processes of combustion, putrefaction, and respiration of men and animals, particularly in populous cities, the atmosphere of which is almost constantly prejudicial to health. The atmospheric air is never absolutely pure and salubrious in any situation, but always mixed with hete- rogenous particles, and these different states and changes produce very perceptible ef- fects on the constitution. In the open country there are few causes to contaminate the atmosphere, and the vegetable productions continually tend to make it more pure. The winds which agitate the atmosphere, and constantly oc- casion its change of place, waft the pure country air to the inhabitants of the cities, and dissipate that from which the oxygen has been in a great measure extracted. Were it not for this wise provision of the author of nature, from the daily combustion of an immense quantity of fuel, the numer- ous substances constantly undergoing pu- trefaction, the respiration and exhalations 70 HYGIENE. of a large number of men and animals, the air in populous towns would soon become unfit for the purposes of life. The air of any place where a numerous body of people is assembled together, espe- cially if to the breath of the crowd, there be added the vapour of a great number of candles or lamps, is rendered extremely prejudicial, as these circumstances occasion a great consumption of oxygen. The practice of burning lamps with long wicks, and thereby filling the room with smoke, is very detrimental to health; and it is not a little surprising that common sense is so devoid of all philosophy, as not to de- tect and avoid a vapour so pernicious and poisonous when received into the lungs. The fact is well known, that when air has been long confined and stagnated in mines, wells, and cellars, it becomes so ex- tremely poisonous as to prove immediately fatal to those who imprudently attempt to enter such places. No person should de- scend into a well or cellar, which has been long closed, without first letting down a lighted candle; if it burns clear there is no danger, but if it cease to burn, we may be sure that no one can enter without the ut- most danger of immediate suffocation. It sometimes happens also, that when air is suffered to stagnate in rooms, hospitals, jails, ships, &c. it partakes of the same un- wholesome or pernicious quality, and is a source of disease. It is obvious, therefore, that in all confined or crowded places, the correcting of vitiated air, by means of clean- liness and frequent ventilation, is of the highest importance, and the most effectual preservative from disease. No accumula- tion therefore of filth about our houses, clothes, or in the public streets, should on any pretence be suffered to continue, espe- cially during the heat of summer. It is a very injurious custom for a number of persons to occupy or sleep in a small apartment, and if it be very close, and a fire be kept in it, the danger is increased. The vapour of charcoal, when burnt in a close apartment, produces the most dangerous effects. Our houses, which are made close and almost air-tight, should be ventilated daily, by admitting a free circulation of air to pass through opposite windows; and even our beds ought to be frequently exposed to the influence of the open air. Houses situated in low marshy situations, or near lakes or ponds of stagnant water, are constantly exposed to the influence of damp and noxious exhalations. Among the most powerful means furnish- ed by nature for correcting air which has become unfit for respiration, is the growth and vegetation of plants. The generality of plants possess the property of correcting the most corrupt air within a few hours, when they are exposed to the light of the sun; during the^ught or in the shade, how- ever, they destroy the purity of the air, which renders it a dangerous practice to allow plants to vegetate in apartments oc- cupied for sleeping. marshes. The neighbourhood of marshes is pecu- liarly unwholesome, especially towards the decline of summer and during autumn, and more particularly after sunset. The air of marshy districts is loaded with an excess of dampness, and with the various gases given out during the putrefaction of the vege- table matters contained in the waters of the marsh. Persons exposed to this air are lia- ble to various diseases, but especially ague, bilious fevers, diarrhoeas, and dysenteries. They who breathe it habitually exhibit a pallid countenance, a bloated appearance of the abdomen and limbs, and are affected J with loss of appetite and indigestion. Health ' is best preserved in marshy districts by a regular and temperate life—exercise in the , I open air during the middle of the day, and 1 by retiring as soon as the sun sets, within the M house, and closing all the doors and win- j dows. The sleeping apartment should be 1 in the upper story, and rendered perfectly j| dry by a fire, lit a few hours before going M to bed, and then extinguished. Exposure jM to the open air should if possible not take -J place in the morning before the sun has had M time to dispel the fog, which, at its rising, J covers the surface of the marsh. Persons 1 who are intemperate, or use ardent spirits I habitually, are those most liable to suffer w from the unwholesome air of marshes; such J generally perish from diseases of the liver '■ and dropsy. 3 NIGHT AIR. Many diseases are brought on by impru- dent exposure of the body to the night air; i and this, at all seasons, in every climate, t and variety of temperature. The causes of this bad property of the night air, it is not difficult to assign. The heat is almost uni- 1 versally several degrees lower than in the | daytime; the air deposits dew and other moisture; the pores of the skin are open, i from the exercise and fatigues of the day; * the evening feverishness leaves the body in some degree debilitated and susceptible of external impressions; and from all these concurrent causes, are produced the various effects of cold acting as a check to perspi- ration; such as catarrhs, sore throats, coughs, consumptions, rheumatisms, asthmas, fevers, and dysenteries. In warm climates, the night air and night dews, with their tainted impreg- ■ nations, act with much malignancy on the I unwary European, who too often, after an imprudent debauch, or in a state of fatigue HYGIENE. 71 absurdly lays himself downiin the woods or verandahs, to receive the full effects of the morbific powers, then unusually active. In civilized life, and in crowded towns, how many fall victims to their own imprudence, in exposing themselves to the cold, the damp, and the frostiness of the night air. Issuing from warm apartments with blazing fires, or from crowded churches, theatres, or ball rooms, with exhausted strength, pro- fuse perspiration, thin dresses, and much of the person uncovered, how many are attacked with a benumbing cold and uni- versal shivering, which prove the fore- runners of dangerous inflammations of the brain, of the lungs, or of the bowels, which either cut them off in a few days, or lay the foundation of consumption or other linger- ing illness. Such being the dangers of exposure to the night air, it ought to be in- culcated on all, both young and old, to guard against them, by avoiding all rash and hasty changes of place and tempera- ture, by hardening the frame by due exer- cise and walking in the open air in the day- time; and on occasions where the night air must be braved, taking care to be suf- ficiently clothed; and to avoid drawing in the cold air too strong or hastily with the mouth open. SEA AIR. The air upon the sea and in its neigh- bourhood is generally distinguished by its greater coldness, purity, and sharpness; and is therefore in many cases directed to patients, whose complaints do not affect their respiration, and who have vigour of constitution enough to derive benefit from the stimulus which such air occasions. A residence by the sea-side is beneficial to persons of a scrofulous habit and debilitated constitution, provided they take care not to expose themselves to cold and damp; and in the fine season, when there is no reason against it, they ought to bathe. In com- plaints of the chest, the use of sea bathing, and a residence near the sea, is more ques- tionable ; and by such, an inland rural situation, in a mild equable climate, is to be preferred. A sea voyage has long been famous for its good effects at the com- mencement of consumptive complaints; and these good effects may be ascribed partly to the good air at sea, partly to the affection of the stomach and skin induced by sea sickness, and to the excitement of the mind, caused by change of scene and occupations. VENTILATION. The air cannot become stagnant or un- changed for even a short period without its becoming unfit for respiration, and destruc- tive to the health of those who breathe it. The greater number of persons by whom an apartment or any given place is occu- pied, the more quickly the air becomes de- teriorated, and the greater the necessity of a free ventilation. The streets of a city should, therefore, be so laid out, as to en- sure a constant and free circulation of air; hence the unwholesomeness of a residence in narrow alleys, courts, and passages. Not less important is the continued renewal of the air of our apartments—the ventilation of which, however, should be so conducted as to prevent a current of air from blowing directly upon the persons Within them. Our bed chambers in particular, should be freely ventilated during the day; and even at night, when the windows are closed, the chimney should be left open, or, if the room is small and the weather sultry, a door, opening into another room. No considera- tion of economy should prevent the most constant attention being paid to proper ventilation, so essential is the latter to health and comfort. CELLARS. It is important that cellars should be per- fectly dry, kept strictly clean and freely ventilated. The damp and foul air so fre- quently generated in cellars, where dry- ness, cleanliness, and ventilation are not properly attended to is often the cause of disease, not only in the persons who in- habit the house to which the cellar is at- tached, but in others residing in the imme- diate neighbourhood. No house can be considered a healthy residence, in the cellar of which water is allowed to stagnate; this may easily be obviated, in most situations, by a sink dug to gravel. The air of cellars can be preserved sufficiently dry and whole- some by free ventilation, the removal of all filth and corruptible materials, and fre- quently whitewashing the walls. Cellars, especially when entirely under ground, are improper places of residence; allowing them to be occupied by the poor should be prohibited by law. HEAT. The temperature of the human body, that is of its internal organs, is about 98 degrees of Fahrenheit's thermometer. This degree of heat is maintained independent of that of the surrounding medium, by the evolution of caloric within the body itself. Under or- dinary circumstances, the human body is surrounded by an atmosphere many degrees colder than itself, and hence transmits con- stantly heat to the air; its energies are, therefore, tasked to evolve a sufficient amount of caloric to supply the loss thus occasipned. Nevertheless, when the tem- 72 HYGIENE. perature of the surrounding air greatly ex- ceeds that of the body, and the latter is continually receiving heat from the for- mer, its temperature is not raised in propor- tion. This arises in consequence of a di- minished evolution of heat within, and of the increased transpiration from the sur- face causing the loss of a large amount of the caloric it receives. Hence, at first sight it might be inferred that the animal system is capable of being little influenced by the temperature of the atmosphere. This, how- ever, is not strictly true; the changes in the temperature of the air cause in the body the sensation of heat or cold, according as they are to a higher or lower degree, and produce other important effects upon its various organs. Habitually subjected to an average temperature many degrees be- low its own, the body, when exposed to a heat of 98°, notwithstanding it can receive no increase of caloric from the air, experiences, nevertheless, a decided sensation of heat, and the skin and other organs are unduly stimulated. This arises from the heat being accumulated in the system. So, likewise, when suddenly exposed to a temperature many degrees below that to which we have been accustomed, but one, nevertheless, to which the term temperate may be applied, we experience a very considerable sensation of cold, and all the functions of the system suffer from its sedative effects—the caloric being exUacted from the body more rapidly than it is evolved within. Every circum- stance likewise, by which the vital ener- gies of the body are increased or diminish- ed, will occasion the sensation of heat or cold to be experienced to a different ex- tent, from the same degrees of atmospheric temperature. All degrees of heat beyond that of temperate, produce a stimulant ef- fect upon the skin, and through it upon the different internal organs. If the elevation of temperature occur gradually, and is con- fined to only a few degrees, its effects are often beneficial, but if it occur suddenly, or is considerable, either the stimulation of the skin or of some one or more of the in- ternal organs is carried to the extent of producing disease, and we have inflamma- tion either of the skin, brain, stomach, or bowels, of a more or less violent grade; or the over stimulated organs fall into a state of indirect debility ; in consequence of which, and the excessive perspiration which ensues, the vital powers of the system be- come exhausted, and are unable to resist the impression of any morbific cause, how- ever slight, to which it may be exposed— as cold and damp, errors in diet, fatigue or a renewed excitation, from subsequent ex- posure to heat. It is in this manner that high degrees of atmospheric temperature become a source of disease. Heat is like- wise an indirect cause of disease by its ac- tion upon varjpas putrefiable materials, causing the evolution of certain gaseous substances by which the purity of the air is destroyed. COLD. Whenever the air, or other medium in which the body is immersed, is of such a temperature as to abstract from the latter its heat, more rapidly than by the internal actions of the system it is generated, the sensation of cold will be produced; and the intensity of this sensation will always be in proportion to the rapidity with which the heat of the body is carried off, and to the feebleness of the heat-generating powers of the system. Cold, or the abstraction of heat from the system, in a degree disproportion- ate to its powers of generating it, produces a sedative influence upon nearly all the or- gans. That is, it reduces their activity and diminishes or suspends their functions. It causes a diminution in the action of the blood-vessels and exhalants of the surface; hence, under its influence, the skin becomes pale, shrunk, and dry. It diminishes the action of the heart and arteries, as is evinced by the smallness, weakness, and diminished fl frequency of the pulse. The sensibility, y first of the external parts of the body, and a subsequently of the internal organs, is like- wise diminished by the action of cold. j| Hence the numbness of the hands, fingers, i and entire surface, as well as the dimin- ished activity of the functions of the brain and nervous system generally, and the fee- i bleness of the muscular action. It is by this 'il sedative impression upon the nervous system of intense cold, that the almost irresistiblev'l inclination to deep sleep is produced in those exposed to very low degrees of tem- perature. The sudden application of cold ) occasions a hurried and irregular action of the respiratory organs, and when intense or long continued, it materially impedes, or prevents entirely the action of these organs, \ so that the respiration is^so imperfectly per- formed that the change of the venous into arterial blood no longe* takes place, and J the lips, tongue, and external surface of ' the body assumes a livid or leaden hue. The moderate and transient application of cold to persons in robust health, and of con- siderable energy of constitution, is gene- rally followed by phenomena which have misled many into the belief that cold acted upon the animal system as a stimulant, Every one in health has experienced the bracing and invigorating influence of a bright winter's day, and has felt from it a healthful glow in his frame, and a degree of increased vigour throughout every organ. These ef- fects, however, are not, strictly speaking, the immediate consequence of the low tem- ] perature to which the bodf is exposed, but HYGIENE. 73 they result from the reaction of the vital' energies, after the first temporary reduction of their activity by the cold. The excite- ment of the surface and of the internal or- §ans being reduced by the sedative in- uence of the reduced temperature, their susceptibility to the action of the ordinary stimuli is increased; hence subsequent ex- posure to a slight augmentation of tempera- ture, exercise, the friction and warmth of the clotliing, even the stimulus of the blood, as the heart renews its activity on the withdrawal of the sedative agent, will induce an augmented excitement on the internal and external surfaces. Hence the agreeable glow of the skin, the augmented vigour and increased activity of the system, the improved appetite and feeling of cheer- fulness consequent upon a transient and moderate reduction of the temperature of the body. That these phenomena are solely to be referred to the reaction of the system, after a temporaiy diminution of excitement, is sufficiently established by the fact, that unless the system be endowed with a con- siderable degree of energy and activity, no such favourable effects will follow the ac- tion of cold. Upon the weak and exhausted cold acts as a permanent debilitant; or if reaction takes place, it is only partial, being confined to some one or a few organs, in which it causes not a healthy activity but disease. There is not, indeed, a more frequent ex- citer of disease than cold, when applied to the body under certain circumstances. Were we to enumerate all the diseases to which cold gives rise, we should give a list of nearly all to which, in our variable cli- mate, the human body is subject. The numerous inflammations of various parts, as the eyes, the throat, the chest, the lungs, the bowels; the inflammation of tendinous and membranous parts, constituting rheu- matism; catarrh, called by way of eminence, a cold,- the rose, fevers of various kinds, con- sumption; these and many more, closely follow the application of cold; and whatever may be the distinction we make between predisposing and exciting causes, the plain, practical inference to be drawn, is the necessity of guarding against cold, and all those circumstances in its application on which depends its power of affecting the body with disease. The circumstances which give to cold the power of producing bad effects on the body, are: 1. Its degree and intensity: a certain degree of it will either produce gangrene or mortification of a part of the body, or death of the whole. 2. The length of time during which it is applied: a tran- sient exposure will do comparatively little harm; but long exposure is highly danger- ous, as when a person has lost his way on a winter night. 3. When cold is applied with moisture. This is by far the most per- nicious way in which cold can be applied. Hence the numerous ailments arising from damp or wet clothes, wet feet, damp rooms, bed-clothes, and the like; and the numer- ous sore throats, rheumatisms, &c. that fol- low such exposure. 4. Cold is very hurt- ful when applied in a stream or current of air; hence the impropriety of sitting or sleeping near an open window, and the danger of cross currents of air in hot rooms and crowded assemblies. 5. One of the cir- cumstances most hurtful in the applica- tion of cold, is its being a sudden change of temperature from heat to cold, without the body being properly protected by sufficient clothing. Hence the frequent colds and pleurisies that occur, when cold suddenly comes on after hot and moist weather; and hence the numerous illnesses which assail those who leave warm and crowded public places, to be exposed to the sharp air of a frosty night. Hence the fair votaries of pleasure and dissipation so often fall a sacri- fice to the destructive pursuit; and hence the sorrow for many a lovely youth, who, on leaving the dance, receives the chilling blast that proves to be the call to an early tomb. There are certain circumstances in the constitution itself, which render it very lia- ble to be affected with cold. 1. Weakness and diminished vigour of the circulation by previous disease, by evacuations, by intense care or study, by intemperance in living, by Lhuiikenness, or by fatigue. All such as are weakened by any of these debilitating causes, are more easily brought into a state of disease by cold than others. 2. When any part of the usual coverings of the body is wanting, a person is more easily affected with cold. Thus a great many complaints are brought on, when a person accustomed to wear a flannel shirt happens to leave it off even for a very short period, or when a thinner dress is used, or when the bed- clothes are thrown off without being re- placed quickly; and even from the want of a night-cap, to a person who has been ac- customed to wear one, bad consequences often follow. 3. It is bad, when one part of the body is exposed to cold while the rest is kept in its usual state, or warmer. The circumstances which enable the hu- man body to resist the morbific effects of cold, are a certain vigour of constitution, exercise, activity of mind, and the being occupied with some exciting passion. Cor- dials also, as wine, spirits, or other stimu- lants, prevent the body from suffering from the immediate effects of cold; but it is to be noted, that they who are in the habit of dram-drinking, are not those who are best able to resist the action of cold. The tem- porary stimulus of spirituous liquors is al- ways succeeded by great weakness, and 14 HYGIENE. susceptibility to external impressions; and the unhappy drunkard, from the combined effects of his debility and exposure, too fre- quently ends his days, overcome by the se- dative effects of cold. CLIMATE. Climate is considered by physicians, not with reference to geographical situation, but to the state of regions as to the warmth and steadiness of their temperature, or the dryness or moisture of their atmosphere. The interior of continents and islands is generally mountainous, and, in consequence, cold. From the bracing qualities of the pre- vailing winds, the inhabitants are robust, and disposed to inflammatory diseases: in- valids, or persons coming from warm cli- mates, should therefore prepare themselves gradually for mountainous regions, by not coming abruptly into those colder parts. Excepting the eastern parts of our con- tinent, especially during those seasons when the east wind prevails, the air near the sea is mild and moist. In most coun- tries, consumptive patients are therefore often sent to the sea coast, where the air is more temperate in winter, and the heat more tolerable in summer; or to such of the South and Western portions of our continent as present a temperate and equa- ble climate, throughout the year, and where no local sources of disease present them- selves; or they are recommended to obtain those desirable circumstances by a removal to some one of the southern countries of Europe. The advantages of a mild and equable climate, even were it in our power to point out any that is uniformly agreeable, are, however, counterbalanced by many incon- veniencies as hurtful to the sick and debili- tated, as the mere circumstance of a lower temperature. The being surrounded by strangers who cannot sympathize in their cares or feelings, the embarrassment arising from the use of a foreign language, and the ideas of comfort so different from what they when at home considered as desirable, com- bine to produce a state of irritation and a sense of unhappiness, which will often be more injurious to a patient than any thing he must necessarily suffer from the atmo- sphere of his own country. An artificial climate may be commanded by those in easy circumstances in rooms properly warmed; and thus they may be spared all the fatigue of travelling, and the pain of suddenly and forcibly altering their condition and habits. The diseases most common in cold cli- mates are, catarrh, consumption; scurvy, rheumatism, and the various inflammatory affections; in warm climates, the plague, remittent fevers, the yellow fever, dysen- tery, inflammation and other disorders of the liver and oft,the biliary secretion, are the prevailing maladies. QUARANTINE. The period during which the crews of vessels, coming from a sickly port, are de- barred from all intercourse with the people _ of the country at which she has arrived, for || fear of communicating to them disease. Quarantines were originally instituted as a preventive against the introduction of the plague into various ports along the Medi- 1 terranean and other seas; and as the period during which this disease was supposed to remain latent in the constitution, was de- clared to be forty days, the prohibition of intercourse was continued during that pe- j riod, hence the name quarantine. A closer investigation into the phenomena connected with those diseases which are endemic at certain seasons of the year in different i countries, or prevail epidemically over a large portion of the globe, and into the cir- cumstances under which they are most 1 likely to occur, has convinced nearly all enlightened physicians of the impossibility of their being communicated from one in- dividual to another, and of the inefficiency 1 of quarantines in guarding against their in- troduction among any community. Hence, « to interdict for forty days, or even for a' ■ much less period, intercourse between per- -J sons coming from a part where sickness prevails, and the inhabitants of the place at which they have arrived, is not only unne- cessary, but an improper interference with personal liberty, and an impediment to commerce, from which often serious evils result. All that would appear to be neces- sary, under any circumstances, is to clean and ventilate thoroughly the vessel and her cargo, and to have the clothing of the crew and passengers washed and well aired. The ship and all she contains, with the excep- tion perhaps, during the summer season, of t certain perishable articles of commerce, ■ when in a damaged state, may then be per- 1 mitted to proceed to the desired port, and I discharge her cargo, without the least dan- <■ ger of the introduction in this manner of 1 disease of any kind. SECTION II. CLOTHING. The design of clothing is to contribute to the health and comfort of the body, by pre- venting the changes of the atmosphere from I affecting the system, and by counteracting, on the one hand, the pernicious influence of cold and moisture; and on the other, that HYGIENE. 75 of too hot an atmosphere. Clothing pos- sesses no warmth in itself, but merely pre- vents the heat of the body from being car- ried off by the air, and other surrounding bodies, faster than it can be supplied by the process of calorification. The essential requisites for clothing are, that it be soft and pliable, so as not to obstruct the free and easy motion of the joints, or occasion inconvenience by its weight or tightness; adequate to protect the body from the ex- ternal influence of the atmosphere, and preserve it in that degree of temperature which is most agreeable, as well as best adapted to the exercise of its different healthy functions and motions; and that it does not produce any detrimental effects, occasion any unnecessary degree of per- spiration, or absorb the vapours of the atmosphere. Clothes of a light colour, have the least attraction for heat; those of a black, the greatest; the first mentioned are, therefore, most proper in hot, the last in cold weather. But besides these general properties of commodious and comfortable clothing, it should be suited in quantity and material to the climate, the season of the year, the pe- riod of life, the constitution, and the habits and mode of living. Thus, a person who is engaged in a sedentary employment, will always require warmer clothing than one who is actively engaged in manual, or other labour demanding considerable"" muscular exertion; and the latter will always require an addition of clothing the moment he has ceased from his active labours, to what is proper whilst engaged in them. Neither do children, or persons in the prime of life, and in robust health, require clothing in the day, or covering in the night, of so warm a nature as persons advanced in years; because the performance of their functions is more equal and vigorous, and of course the generation of heat in the body is quicker, and of greater extent, than is the case in old age. One of the safest rules in the regulation of dress, is to adjust it to the vicissitudes or fluctuations of the season; and this rule should be carefully attended to by the va- letudinarian, the delicate, the infirm, and the old. The winter clothing should not be left off too early in the spring, nor the sum- mer clothing worn too late in the autumn. Neither should this rule be disregarded by the young, and those in the enjoyment of perfect health; for though strong and robust persons may, with impunity, endure many changes of temperature without any change in dress, yet they should not be too slightly clothed; and all changes of their dress should be made with extreme cau- tion. Such persons, however, relying too much on the strength of their constitutions, often expose themselves imprudently; and as the violence of their diseases is in gene- ral in proportion to the vigour of their vital powers, so are they frequently rapid in their progress and fatal in their termination. The grand rule is, so to regulate the clothing that, when exposed.to the external air, the difference of temperature experienced shall not be such as to produce any dangerous im- pression, whatever may be the inclemency of the weather, when we go abroad. Hence the necessity of a thinner clothing within doors than without, and of a greater warmth of clothing after night, and during cold, damp weather, than during the day, and when the air is perfectly dry. Persons of delicate and irritable constitu- tions, whose powers of life are feeble, and whose circulation is languid and irregular, are very apt to suffer severely by a very slight diminution of the temperature of their skin. This is also the case with invalids. All such persons, therefore, ought rather to exceed than be deficient in the quantity and warmth of their clothing. But while clothing should not be too light, or too small in amount, neither should it be too heavy or too much in quan- tity. The effects are equally mischievous. By over-clothing, too much perspiration is drawn out of the body, by which the frame is greatly weakened, andcoldnessandnumb- ness of the extremities are occasioned. Dress is often injurious in consequence of its being made fashionable, in compliance with the modes and customs of the times; frequently occasioning innumerable mala- dies, either by compressing the muscles or viscera, stopping the access and retreat of the blood to and from the head, or from circulating through the veins, or prevent- ing the free expansion of the chest or the unconstrained action of the limbs. Tight clothes are invariably detrimental to the health, comfort, and symmetry of the body. By the pressure they make upon the muscles, and the impediment they offer to their free exercise, they produce in them an emaciation and debility which prevent them from supporting properly the natural and graceful position of the body, or of ef- fecting its active movements with sufficient vigour. They prevent also the free circula- tion of the blood, and cause it to accumu- late in the veins of the head, lungs, or ab- domen. When the pressure of the clothes, or any part of them, is around the neck, it is apt to produce headache, discolouration of the face, vertigo, and apoplexy, or other diseases of the brain; when upon the chest and waist, it prevents the full develop- ment of the lungs, impedes respiration, and interferes with the proper actions of the heart, in consequence of which, the health of the whole system suffers; when around the abdomen, the stomach, liver, and intestines are affected and indigestion is produced, 76 HYGIENE. or the nutrition of the whole body is ren- dered imperfect. The clothes, therefore, should be perfectly loose, leaving to every part the fullest liberty, and to all their na- tural and unconstrained motions. This is all important at every period of life, but particularly so during infancy and child- hood. Another practice equally pernicious to health, is, that of going about all the morning and first part of the day,the men muffled up in great coats, and the women with furs and flannels, while in the afternoon and evening they sit at home, or brave the external air in a much thinner dress, which but imper- fectly covers, or leaves bare parts of the body which in the previous portion of the day were closely enveloped in the warmest clothing. FLANXF.L. Flannel worn next the skin, in addition to ordinary clothing, is of very great service in preserving the health of the inhabitants of all cold and temperate climates, more especially where the vicissitudes of tempe- rature are frequent and considerable, and during the seasons of spring, autumn, and winter in our own climate. It produces a moderate warmth of the surface, promotes perspiration, readily absorbs the perspired fluids, and easily parts with them again by evaporation, on account of the porous na- ture of its texture. These important ad- vantages render the use of flannel at all seasons of inestimable service to the vale- tudinary and the aged, and all those subject to disorders of the chest, bowels, &c. Hufe- land has justly remarked, that it is the very best dress for those who have begun to de- cline in years; for all who lead a sedentary life; for individuals subject to cough or fre- quent colds, gout, diarrhoea, and the like; for all nervous patients, and convalescents from severe chronic disorders; to persons who are too susceptible of the impressions of the atmosphere; and lastly, in such cli- mates and pursuits of life where exposure to sudden changes of temperature, and to wet or moisture, is unavoidable. Flannel is also well adapted for infants and young children, especially in autumn, winter, and spring. Older children do not require it, excepting during the seasons of greatest cold, and all persons under forty in good health, should reserve it as a resource for their declining years, during which it becomes every year more and more useful and necessary. Flannel ought not to be habitually worn at night. By far the best practice is, to throw it off in bed, unless from great debility or age, sufficient warmth cannot be ensured by a moderate quantity of bed-clothes. The necessity of frequently changing the flannel in order to preserve it strictly clean, neetl scarcely be urged, as rt must be apparent to all. Such persons as find flannel too irritating to their skin, may obviate this by having it lined with thin muslin. The health of fe- males would most certainly be benefited by adopting, during the winter season at least, an under dress of flannel. We espe- cially recommend to them the use of flan- nel drawers. cotton. Cotton, as an article of clothing, espe- cially when worn in contact with the skin, is far better adapted for general use than linen. In preserving the equable warmth of the surface, and guarding it from sudden vicissitudes of temperature, it is far supe- rior to linen, but it is inferior in this respect to flannel. In warm weather, and in hot cli- mates, it is in every respect the most com- fortable and wholesome article for an inner dress. It is cooler than linen, inasmuch as it conducts more slowly the excess of ex- ternal heat to our bodies, and when a sud- den reduction of atmospherical temperature occurs, on the other hand, it abstracts more slowly the heat from the body, and thus preserves the surface of a more steady and uniform temperature. For children and young persons of robust and healthy consti- tutions, it should constitute the material of the inner garment throughout the year. linen-. Whatever may be said in favour of the comforts of linen, and the greater ease with- which it is kept clean, it is by no means a substance well adapted for the dress worn next to the skin, at any season of the year, nor by any class of persons. In the winter it is altogether insufficient to preserve the sur- face of a proper temperature, or to guard it against sudden changes. For children, and the labouring classes generally, as well as by all delicate persons, muslin should be preferred for summer wear and soft flannel for winter. The chief objections to linen are, that it is too good a conductor of calo- ric, and hence causes the body to feel the influence of very high or low degrees of atmospheric temperature; it imbibes readily the matter of perspiration, and when wet, communicates a disagreeable chilliness to the surface with which it is in contact. HEAD DRESS. Whatever covering is worn upon the head should be light, sufficiently large, and adapted in its form to the shape of the head. Too heavy or warm a covering, or one which compresses unduly the head, is productive of pain and inconvenience., la HYGIENE. 77 summer the colour of #ie hat or bonnet should be white, or at least some shade ap- proaching to white, in consequence of the tendency of all dark colours to absorb and transmit the rays of heat. The brim of the hat should also be sufficiently broad to pro- tect the face and eyes from the sun. Al- though the nature of a head dress may ap- pear to be a subject of very little importance in regard to health or comfort, yet every one has perhaps experienced more or less of the pain and inconvenience occasioned by wearing a new hat too small in the crown and unfitted to the head, and the almost immediate relief which results from ex- changing it for one of more ample dimen- sions; while we are assured by physicians that disgusting,painful, and even dangerous affections of the head are caused by the warm thick coverings constantly worn upon the head by the peasants in the different parts of the north of Europe. CAPS. The head, excepting perhaps in the first months of infancy, is sufficiently protected from cold and other external agents, by its natural covering of hair; hence every kind of artificial covering is, to say the least of it, unnecessary—even during exposure to the open air. Caps are particularly objec- tionable in children; by keeping the head too warm, and by the roughness of their texture when richly worked, producing an irritation of the parts with which they are in contact, they cause too much blood to be sent to the vessels of the head, and thus increase the danger of diseases of the brain, eruptions, and sores about the scalp, the forehead, and the ears; while the broad border of lace with which they are so often ostentatiously decked, interfering with the motions of the eyes produce often a perma- nent squint. In adults, caps should never be worn, excepting when the head has be- come prematurely bald, as the cooler the head is kept when covered with hair, the less danger there is of affections of the brain or of the ears and eyes. Wearing caps at night is likewise always an objec- tionable practice, excepting when the indi- vidual is accustomed to them during the day. cravat. The neck might be left entirely uncover- ed from the period of birth without injury, probably with advantage to health. But so long as the imperious laws of custom and fashion require the use of a covering in the male sex, it is important that of whatever it is composed, it be very light and loosely applied. When the neck is kept too warmly covered, it becomes peculiarly liable to the impression of slight degrees of cold,—the throwing off of the cravat for a few mo- ments, or exchanging it for one of lighter materials, will often give rise to a violent inflammation of the throat. When the cra- vat girts too tightly the neck, it prevents the free return of the blood from the head, causing a constant pain and sense of over- fulness. corsets. Of all the whims of fashion, no one is more absurd, or more mischievous in its effects, than that which condemns the female, un- der the pretence of improving the grace and beauty of her shape, to the torture of a tightly laced corset. Equally detrimental to comfort and to health, this portion of fe- male attire cannot be too severely censured by the physician. It is productive of not the least advantage, real or imaginary, to com- pensate for the injury it produces, nor to excuse the folly of females in persisting in its use. The immediate effect of the cor- set is, by compressing firmly the chest, to prevent its free expansion in the act of breathing, and hence to impede materially the function of respiration—a less amount of air is taken into the lungs in inspiration, and as a consequence, the blood is less perfectly changed. The impediment to respiration is increased when the corset extends so low as to compress the abdomen, by the bowels being then forced upwards against the dia- phragm; this is prevented from descending, and the dimensions of the chest are thus contracted from below. A sense of oppres- sion and weight is always experienced about the breast when the corset is drawn very tight around the body, the breathing is short, quick, and panting; and not only is the blood prevented, in a great measure, from undergoing that change in the lungs by which it is adapted for the healthy nour- ishment of the various organs, but the ac- tions of the heart are also impeded; violent palpitation of the latter is not unfrequently produced, accompanied with a sense of vertigo and occasionally fainting. When the corset is worn constantly from early youth, the growth of the ribs is prevented, and the whole capacity of the chest is per- manently contracted; and hence spitting of blood, difficulty of breathing, or even more dangerous and fatal diseases of the lungs and heart are induced. Consump- tion is a very common complaint, the pro- duction or aggravation of which may be traced to tight lacing. But it is not mere- ly to the chest that the injurious effects of the corset are confined; it likewise compresses the whole of the upper portion of the abdomen, and by the yielding nature of this portion of the body, the pressure upon the organs within is even more con- siderable than that experienced by the heart and lungs. The liver, the stomach, and the intestines in particular, experience 7S HYGIENE. this pressure to a very great extent; in con- sequence, the free and healthy secretions of the liver are prevented from taking place, the stomach and the bowels can no longer perform their functions with proper vigour and regularity; the digestion of the food is impeded, and the bowels become costive and distended with wind. In this manner, in connexion with the injury in- flicted upon the lungs, the vigour of the whole system becomes prostrated, from the use of corsets; the skin assumes a sallow hue, the countenance a haggard and wrinkled appearance, and all the functions of life are performed imperfectly. It is a fact, that nothing is better adapted to produce the premature decay of beauty, and the early appearance of old age, than the use of the corset. There are two other effects produced by this article of dress, which would be suffi- cient of themselves to induce every prudent and sensible female to abandon it. The first is thjg injury inflicted upon the breasts, by which their proper development is prevent- ed, and the nipple is almost entirely oblite- rated, so that, when called upon to fulfil the sacred office of nurse towards her off- spring, the mother finds, to her sorrow, that, from her folly, she has totally incapaci- tated herself from performing its duties, or experiencing its pleasures. The second effect is that produced by the pressure of the corset upon the pelvis and the womb, more especially when worn in early youth, or during the first stages of pregnancy. From this cause barrenness, miscarriages, or a stunted and deformed offspring may result, or the pains, the difficulties, and the dangers of child-birth, may be increased to a frightful degree. Serious as are the injuries we have thus detailed, they are far from being all to which tight lacing gives rise. The firm pressure of the corset upon the muscles of the back and of the chest preventing these from performing freely their seve- ral motions, and their vessels from re- ceiving a due supply of blood for their nourishment, cause them to become pale and diminished in bulk and in strength. Hence, when attempted to be called into action by the exercise of the arms and up- per part of the body, fatigue and exhaus- tion are quickly induced. Upon the pro- per tone or strength of the muscles of the back depends principally the upright position of the back bone, and of course of the whole trunk—when, therefore, these muscles are debilitated by the long con- tinued pressure of the corset, an ungraeeful curvature of the body to one or other side results, amounting often to very striking deformity. This is frequently increased by the voluntary twisting of the body, or of the shoulders, in order to escape from the constraint experljnccd, as well as from the uneasy sensations occasioned by the pres- J sure of the corset upon some particular point. In a very large number of instances it will be found, that in the female who has worn a corset from her youth, the shoulders are thrown more or less out of their natural position—an ungraceful elevation of one, and an undue depression of the other, is a very common occurrence. GARTERS. • The best garters are made of elastic web- J bing, and fastened round the leg with a flat jj buckle. Tight garters are injurious by im- J| peding the circulation of the blood in the leg, particularly by preventing the free re- J turn of the blood from below the part on which they are fastened towards the heart. Swelling and numbness of the leg, and per- manent enlargement of the superficial veins of that limb, are consequences of wearing tight garters. SECTION III. , EXERCISE. | The body of man is evidently formed for 1 activity and exertion. By labour or exer- ■ cise man preserves his health, augments his ' strength, and improves his mental faculties, ^| besides procuring the means of his subsist- 1 encc, and the conveniences of life. In re- j gard to health, none of the various processes '*M connected with the important functions of digestiop, circulation, and nutrition could be properly or adequately performed, un- • j| less the body were stimulated for that pur- pose by labour or exercise. The health of .<<{J all the parts, and the soundness of their structure, depend on a free supply of blood and the perpetual absorption, and perpetual fl renovation of the atoms of which they are 4 composed; and exercise, by promoting at once circulation, absorption, and secretion, -j invigorates life without hurrying it; reno- vates all the parts and organs, augments their strength and vigour, and preserves them apt and fit for every office they have i to perform. * By this means disease may often be prevented, and not unfrequently cured, even when it has taken a very strong hold of the constitution. Generally speaking, a sedentary life is the source of all those dis- eases which are termed slow or chronic, the number of which is in our day very considerable. Among these, scrophula, in- digestion, bilious and liver complaints, low- ness of spirits and nervous irritability, and . pulmonary consumption, stand foremost; j and there may be added to them jaundice, , various deformities, as twisting of the ' shoulders and curved spine, palsy, apo» HYGIENE. 79 plexy, &c. The neglect of exercise like- wise occasions either an emaciation, or when conjoined with luxurious living, a bloating and over fatness of the body. For these, exercise is one of the most effectual, as well as most agreeable remedies; it strengthens every organ, preserves the fluids in a healthy state, augments the ap- petite, facilitates the secretions, invigorates the spirits, and excites pleasing sensations throughout the whole system. The exercise which is necessary to the maintenance of the health, vigour and the perfect and full development of the hu- man frame is such as will bring into action every limb and muscle, this is termed active exercise, and is produced by the exertions of the body in walking, running, dancing, and various species of labour. Passive exercise, or that in which the motion is communicated to the body from without, can never be adopted as a substi- tute for the former, as it calls into action but imperfectly the powers dependent upon the will, and therefore leaves a large por- tion of the muscular system entirely inac- tive; at the same time, the motion itself is generally so slight, that it can contribute but little to correct the evils arising from the long continued sedentary habits and the full diet of those who most generally resort to it. Passive exercise, under certain cir- cumstances, however, is of advantage; but whenever active exercise can be pursued, it should always receive a decided prefer- ence. The chief kinds of passive exercise are, riding, swinging, and sailing. To de- rive all the advantage resulting from exer- cise, it must bcvregular; several hours daily should be devoted to it. Little benefit need be expected, when, to occasional exercise of the muscles, a long period of inaction succeeds. Exercise, to be beneficial, must also be in the open air, and should never be carried to the length of inducing undue fa- tigue. The other general rules in regard to exercise, may be laid down as follows. 1. The effect of exercise should be as general as possible, and not confined to any particular limb or part of the body. Those kinds of exercise, therefore, which give ac- tion to the greatest number of the bodily organs, as walking, running, riding, &c, are much to be preferred. 2. Little benefit is to be expected from exercise, unless it be performed in a pure air; and hence it is, that many manufactu- rers and artificers, who perform all their la- bours under cover, and are often exposed to unwholesome effluvia, from the materials they work upon, are more unhealthy than almost any other class of men. 3. The higher, the drier the situation, and the more varied the air in which exercise is performed, the more beneficial must be its effects. 4. On commencing any exercise, begin with the more gentle, and then proceed to the more laborious: and as sudden transi- tions are always wrong, follow the same rule when exercise is given up. 5. A good appetite after exercise, is a proof that it has not been carried to any im- proper excess. 6. After having taken exercise, we should not venture to expose ourselves to a current of air, or rest out of doors, in a cool or ex- posed place, or lie down on a green plot. A sudden change of temperature, by sup- pressing perspiration, may be extremely injurious. 7. It is a good rule, frequently to vary the exercise you take. 8. Lord Bacon correctly observes, it is requisite to long life, that the body should never abide long in one posture, but every half hour at least, should change it, saving only in sleep. 9. Muscular motion is most agreeable and healthful, when the stomach is neither too empty, nor too much distended. Exer- cise Is improper, therefore, immediately after a meal, or after long fasting. 10. Nothing can be more injudicious than to sit down to a substantial dinner or sup- per, immediately after a fatiguing walk, ride, or other violent exertion. When the body is heated, or in a state of perspiration, to devour quantities of solid food can never be wholesome. Every man, therefore, should rest for some time after exercise, before he sits down either to dinner or to supper. 11. In taking exercise, the dress should be free and easy, particularly on the neck and joints. 12. In violent exercises, a flannel waist- coat ought to be worn next the skin, to ob- viate the possibility of injury. 13. It is found very refreshing, after fa- tiguing exercise, to wash the feet in warm water, before going to bed. 14. Serious thinking, when we are walk- ing or taking other exercise, soon fatigues us; but if we give ourselves up to amusing thoughts, or the conversation of agreeable and intelligent friends, the exercise is res- torative. 15. It is veiy desirable to have a certain object or spot by which the exertion is to be bounded; as to call at the house of a friend, to see some delightful prospect, and the like. WALKING. There is no exercise so natural to us, or in every respect so conducive to health, as walking. It is the most perfect in which the human body can be employed; for by it every limb is put in motion, and the cir- culation of the blood is effectually carried 80 HYGIENE. on, throughout the minutest veins and arte- ries of the system, while both the body and the mind are amused and enlivened. This salutary and most excellent exercise is in the power of all persons having the use of their limbs, and can be adapted, in degree and duration, to the various circumstances and wishes of each individual. Walking is of two kinds, either on plain ground, or where there are ascents. The latter is in every respect greatly preferable, as by it the lungs are exercised, and the ascent and descent agitates the body, un- less it be in a weak state, with a useful va- riety. Walking against a high wind is very severe exercise, and not to be recom- mended. As, from various circumstances, persons residing in large towns, and engaged in se- dentary occupations, cannot take all that exercise abroad, which is necessary for their health, they ought, at least as much as possible, to accustom themselves to walk about, even in their own houses, instead of sitting constantly at a desk or table, as is usually the case. This rule is peculiarly ne- cessary to be attended to by literary men; and though such practice does not make up for the want of exercise abroad, yet it is, to a certain extent, a substitute for it. The following rules are recommended to the attention of those who make use of this excellent species of exercise. 1. The most proper walk, for health, is in a pure and dry air, and in rather an ele- vated situation, avoiding marshy and damp plains. 2. In the summer season, the walk to be taken morning and evening, but by no means during the middle of the day, unless guarded from the oppressive heat pf the sun, under the shade of woods or trees; in winter, the best period of the day is usually after breakfast, or from ten to one o'clock. 3. It is advisable, occasionally to change the direction of the walk; for the same road, constantly gone over, may excite as many disagreeable and painful sensations as the closet or the study. 4. We ought to accustom ourselves to a very steady and regular, but not to a very quick pace; in setting out, it should be rather slower than what we afterwards in- dulge in. 5. An agreeable companion contributes much to serenity of mind; but unless the manner of walking of both is similar, as well as the taste and character congenial, it is better to walk alone; as either the one or the other of the two companions must be subjected to some constraint. 6. To read during a walk is an improper action, highly detrimental to the eyes, and destroys almost all the good effects that can be derived from the exercise. Dancing, under proper limitations, is a wholesome exercise, and well adapted to young persons, especially in winter; violent and too long continued exertion in dancing is, however, injurious. Dancing should be performed in a large well ventilated apartment, and the dress worn by those who engage in it, should be such as not to bind or constrain any part of the body, es- pecially the chest, upper part of the abdo- men, and limbs. Dancing for the greater part of the night in overheated and crowd- ed apartments, has not unfrequently laid the seeds of fatal disease, by which the young and gay have been hurried in a few weeks to the grave. The injury done to the constitution by over exercise at the midnight ball is more generally augmented by improper food and drinks, and by sub- sequent exposure to the night air, when the body is unduly excited and fatigued by the exercise, and other stimulating agents, to which it has been subjected. SWIMMING. For the young, the robust, and healthy* j swimming is an excellent recreation. Itf combines all the advantages to be derived] from bathing, with active exercise of nearly every part of the body. It possesses an- other important recommendation, which should cause it to be taught to, and prac- tised by, every one; its presenting, namely, a means of safety in cases of accidental sub- mersion to the individual himself, who has acquired the art of swimming, while it may enable him to save the lives of others under similar circumstances, who are unacquaint-^ ed with it. Swimming, however, as well from the powerful and constant exertion it demands, and the coldness of the water in which the body is immersed, is improper for the debilitated, or those exhausted at the time from fatigue, profuse perspiration, or any other cause. Though adapted to a larger class of persons than the cold bath, all the remarks made when speaking of the lat- ter, are applicable to swimming, nor should those which refer to the state of the body at the time of swimming ever be neglected. See Cold Bath. GESTATION. Gestation is that species of exercise which is communicated to the body by foreign means, with but little or only par- tial exertion of the muscles. The principal modes of gestation are, riding in a carriage J or on horseback, being carried in a litter, " sailing, or swinging, either in a suspended seat or on an elastic boards Gestation does HYGIENE. 81 not afford sufficient exemse for the de- mands of the system during a state of health; it is, nevertheless, occasionally pro- per, and in certain diseases, or for persons in a state of considerable debility, it is the only species of exercise that can with pro- priety be resorted to, and under such cir- cumstances its effects are very beneficial. RIDING. Next to walking, riding on horseback is the most salutary and useful species of ex- ercise, especially for invalids. Riding may be varied according to the strength of each individual and the state of his health, by walking, pacing, trotting, or cantering. Persons labouring under ill health, whether occasioned by too long continued sedentary habits, or from defective diges- tion, as well as those predisposed to con- sumption, will experience from the exer- cise of riding the most decided advantage. In riding to preserve health, eight or ten miles a day are sufficient to answer all the purposes we would wish for; but, in riding to restore health, these little excursions will avail nothing. The mind, as well as the body, must be roused from its languor. In taking an airing, as it is called, we ride over the same ground, for the most part, every day. We see no new objects to divert us; and the very consideration of riding for health sinks our spirits so much, that we receive more harm than good from it. Upon this account, long journeys are recommend- ed to such people, in order, by the variety or novelty of the journey, to awaken or di- vert the mind. Many have, by these means, been surprised into health. Riding in a carriage has but few advan- tages; it communicates but little motion to the body, and when the blinds are closed, the persons using it are excluded from the benefit of fresh air; upon the free exposure to which the success of all kinds of exercise in a great measure depends. It should be used only by such persons as are unable to walk or to ride on horseback, and with the blinds open. It is to be lamented, that those people use this mode of exercise most who stand in. the greatest need of a more violent species. Riding in a gig or chair, if the individual himself drives, is a far better exercise than that of a carriage. The less gentle the mo- tion of the vehicle in which we ride, and the rougher the road, the greater is the amount of exercise communicated to the body. Riding, however, excepting on horse- back, if long continued, causes a feeling of soreness and stiffness in the limbs; and in the aged and debilitated, a swelling and numbness of the feet and legs. SAILING. Sailing is generally described as being the most advantageous of the passive kinds of exercise. Much, however, of what has been said in regard to it, whether as a means of promoting health or removing disease, is extremely vague and unsatisfactory. The influence of an hour's sailing upon the sys- tem, in a pleasure boat, is very different from that which would result from an East India voyage, or a cruize with an Anson or a Cook around the world. The effects will also differ, according as the individual is placed in the situation of a mere passenger on board the vessel, or is obliged to partake of the homely fare, the broken rest, and the fatiguing labours of the sailor. Rowing a boat, to those who are not daily accustomed to the task, may be ranked among the most active species of exercise. To the robust and those in perfect health, this exercise, when not earned to the ex- tent of producing very considerable fa- tigue, is one admirably calculated to impart strength to the arms, and breadth and de- velopment to the chest. When, however, it is too frequently repeated, to the neglect of other species of exercise, it is very apt to produce a partial and ungraceful expan- sion of the frame. The management of a sail-boat is a more attractive, and far more gentle exercise than rowing. As a means of preserving health, it is, in every respect, however, inferior to either walking or riding—but affording to many an agreeable and useful variety in the means of exercise, it may be occasionally resorted to with no little advantage. A trip in one of our steamboats has no claims to the title of exercise. The good effects which the infirm and convalescent derive from it, are to be attributed solely to the agreeable occupation of their minds by change of scene, and to the pure atmo- sphere they are enabled to breathe. Du- ring the summer months, short daily trips in a steamboat afford, however, an admirable means of counteracting the deleterious in- fluence of the heated air of the city upon infants and young children—it is, indeed, almost the only manner, when a removal to the country cannot be effected, in which the occurrence of the dreaded summer complaint can be prevented, or when pre- sent, its violence mitigated. FRICTION. Friction of the surface, in conjunction with regular bathing, forms a very import- ant means of preserving and improving the health of the body. It removes thoroughly from the surface every species of impurity which may accidentally adhere to it—pro- 82 HYGIENE. motes the freedom of the blood's circula- tion in the minute vessels of the skin, and insures the regular and perfect performance of the important functions of that organ. It promotes the growth and development of the muscles—invigorates the digestive or- gans, and imparts a comfortable glow and an increased energy to the whole system, by which it is rendered less liable, during cold and changeable weather, to become affected with disease. The ancients, it is said, had the art of rendering fat people lean, and those that were emaciated fleshy, partly by means of a proper course of active exercise generally, but more especially by the diligent use of frictions of the skin. Though useful to all, frictions are pecu- liarly adapted to increase the health and vigour of persons of debilitated habits, who lead a sedentary life, are subject to dyspep- sia, gout, and rheumatism, or who are par- ticularly liable to be affected by cold or slight variations of atmospheric tempera- ture. Their whole bodies, more particu- larly their limbs and the anterior part of the trunk should be rubbed for half an hour at least, morning and evening, with a flesh brush or coarse towel, until the surface .be- gins to grow red, and assumes an agreeable glow. In many cases premising the use of the warmth bath, or sponging the body with cool or tepid water, will be found to increase the good effects to be derived from the practice. Frictions are highly use- ful in the case of delicate females; and in children they promote their growth and ac- tivity, and prevent many of the diseases to which they are liable. The best time for using friction, is in the morning and evening, but especially the former, when the stomach is not distended with food. They who are subject to wake- fulness and disturbed sleep, will find, in ad- dition to a properly regulated diet and active exercise in the open air, that sponging the body with tepid water, followed by brisk frictions of the surface, will more effec- tually induce quiet repose than any other means. GYMNASTICS. A series of regular exercises, calculated to call all the muscles into action, and pro- perly graduated, according to the age, strength, health, and other circumstances of different individuals. Whether gymnas- tics be considered as a means of active ex- ercise, well adapted to the condition and wants of the inhabitants of large cities—as making a part of the physical education of students and of )'outh generally—or as a remedy in certain diseased states of the hu- man body, their importance is confessedly great, and the advantages to be derived from them, under either point of view, has -been strangely^)vcrlooked or underrated, in this country in particular. Every large city should possess its public gymnasium, open to all classes of its citizens. The lan- guor and lassitude induced in the sedentary artisan, in the clerk and in the shopkeeper", in their daily occupations, will be effectual- ly dissipated by an hour devoted to its va- rious exercises; while the mechanic, some of whose muscles are called by his labours into constant and active exertion, while others are allowed to remain totally inac- tive, will find at the gymnasium the means of restoring that harmony in the strength and development of the different parts of his body, by calling all into equal action, which his ordinary pursuits tend so power- fully to destroy. We know of nothing which would so effectually prevent the oc- currence of diseases of the stomach, or im- prove the health of mechanics generally. CALISTHENICS. A regular and methodical scries of bodily exercises, adapted to call into equal and sufficient action the various muscles of fe- males, in order to promote the general health and development of their systems, to prevent deformity and to remove that languor and inertness of various functions, produced by the confinement and sedentary habits to which the female sex is so impro- perly subjected. Of the importance and benpfirinl pffpets nf calisthenic exercises in civil life, there can not be a doubt. By the ridiculous prejudices of fashionable society, girls are debarred from participating in the active sports of childhood, and during the period of their education, as well as in after life, for the greater part of the day, they are forced to breathe a confined atmosphere, and to remain in a state of comparative in- action; the effects of this mode of life upon the health can only be counteracted by ex- ercise in the open air, and in the present state of society in this country, calisthenics present almost alone the plan of exercises adapted for general use. SECTION IV. APPETITE. Appetite is that instinctive sensation which warns man of the necessity of parta- king of food for the support of his system. The indulgence of the appetite is attended with pleasure; neglecting its calls is produc- tive of painful feelings, more or less in- tense. There are three kinds of appetite: 1st. The natural or healthy appetite, which is HYGIENE. 83 stimulated and satisfied with the most sim- ple dish, as certainly as with the most pala- table: 2d. The artificial appetite, or that excited by condiments, liqueurs, pickles, high-seasoned dishes, variety of food, wine, &c, and which remains only so long as the operation of these stimulants continues: 3d. The habitual appetite, or that by which persons enjoying no inconsiderable health, accustom themselves to take food at stated hours, but frequently without relishing it. The true and healthy appetite alone can as- certain the quantity of aliment proper for the individual. If we were seldom to tres- pass the due limits of temperance, our natu- ral appetite would be able accurately to determine how much food we may consume with satisfaction and benefit; but the usual physical education of children is now so loose and bad, and the temptations to cat of improper food, and at improper times, are rendered so powerful by the refinements of cookery and the artificial habits of society, that we rarely meet with a natural and heal- thy appetite at any period of life. If after a meal we feel ourselves refreshed, and as cheerful as before it, or more so, we may be assured that we have taken no more than a proper quantity; for, if the right measure be exceeded, torpor, heaviness, and relax- ation, are the necessary consequences; our faculty of digestion will be impaired, and a variety of complaints gradually induced. The celebrated Cornaro used to speak with delight of the cheerfulness and serenity he felt after partaking of the small portion of food which he was accustomed to enjoy. Before he determined on adopting a spare diet, he was much afflicted with lowness of spirits, heaviness, and debility, and severe bowel complaints were the torment of his life; but his careful and abstemious diet per- fectly cured him of these and other evils. There can be no doubt, that the majority of persons, in easy circumstances, eat and drink considerably more than is either ne- cessary or beneficial. It is a remarkable fact, that almost all those who have lived to a great age, have uniformly observed a very temperate diet, and in numerous instances of longevity, it has been scanty and coarse. Hunger.—That uneasy sensation which is occasioned by too long abstinence from food, when the stomach and system gene- rally are in a state of health. The effects re- sulting from excessive hunger, are noticed under the head of abstinence. As a gene- ral rule, the sensation of hunger should as seldom as possible be allowed to occur; for although the old proverb, " hunger is the best sauce for our food," is true, if the term hunger be used merely to signify keenness of appetite; yet, the moment it becomes a pain- ful sensation, the stomach and other organs suffer, and the energies of the system are, to a certain extent, prostrated. In various M diseases of the stomach, hunger is a mor- bid phenomenon which cannot be appeased by any quantity of food; and in children, a constant craving of food, and that of the richest and most substantial kind, which is often mistaken by parents for hunger, is merely the effect of improper indulgence of the appetite, both in regard to the quantity and quality of their food, and is to be re- moved by a proper regulation of the diet; by its being rendered more simple, given at sta- ted periods, and in greater moderation. abstinence. By abstinence, is meant either the re- fraining entirely from food, or for a cer- tain period, or from some particular spe- cies of food habitually. In a more limit- ed sense, however, abstinence implies extreme moderation and temperance; the sustaining life upon the smallest possible amount of food, and that of the simplest kind. Entire abstinence from food, cannot be endured for any great length of time by persons in health, without its producing the most distressing sensations; and if food be still withheld, or the individual is enabled to control the desire to partake of it, a dis- eased condition of the body is induced, ter- minating quickly in death. The effects of prolonged abstinence are general and ex- cessive emaciation, a diminished size, and colourless state of the muscles; extreme de- bility; the blood becomes deficient in quan- tity, and altered in its qualities, and the other fluids undergo a similar change. The functions of the brain often become deran- ged, and death is preceded by delirium. The length of time an individual may sur- vive under entire abstinence from food, varies according to his age, constitution, habits, and a variety of other circumstances. Many instances of long continued abstinence being endured with perfect impunity, are re- corded; but, in general, it will be found that these have occurred in persons labouring under disease, who were in a state, resem- bling somewhat that of torpid animals, or that while they abstained from solid food, they drank various fluids more or less nu- tritive. Abstinence from food, for a limited period, is often, during health, of very great importance; it is one of the most powerful means of obviating the effects of any acci- dental excess, of warding off disease, and of removing those disorders of the stomach, incident upon the introduction into it of ali- ment of an improper kind. Occasional ab- stinence from food, by omitting a meal or two, or substituting for an animal diet a bowl of gruel, or a slice of bread and tea, restores the force of the digestive organs, by diminishing their action, and giving them rest, and time to collect their healthful en- ergies; while, at the same time, when the 84 HYGI system is rapidly verging into disease, or the vessels are overloaded with blood; it re- moves from the first a stimulus which might increase its deviation from health, and upon the second, it acts as an evacuant, by allow- ing the secretions time to remove from them their excessive amount of fluids. The stu- dious, as well as they who lead sedentary lives, are especially benefited by occasion- al abstinence; as these, from the want of sufficient exercise, are generally the seve- rest sufferers from diseases of repletion, and a disordered state of the digestive organs. Diseases of the most violent character may often be prevented by the observance of an abstemious diet, during the period of their prevalence, and they have been cut short by rigid abstinence from food, from the moment the symptoms are experienced which threat- en their attack. Abstinence, says Dr. Miller, is one of the most convenient means of cu- ring disease. No confinement is necessary, no interference with the ordinary occupa- tions of life. If the apprehensions which give rise to it prove groundless, no trouble nor injury is sustained; but the system, freed from unnecessary excitement, feels a lucid interval, not often experienced by the vo- taries of luxury, and afterwards returns to a more substantial diet with redoubled satis- faction. If the disease, about to attack, be of a moderate kind, abstinence alone will often be sufficient to strangle it in the birth; if more violent, and our easy precaution should prove insufficient, some advantage, and of no trifling amount, will at least have been gained. The stomach will certainly be in a better condition for the reception of other remedies. scrfeit. By a surfeit, is meant an overloading of • the stomach, with too great a quantity, or mixture of food, or by indulging in food of a very rich or indigestible quality. The effects of this, if it be not got rid of at once by the vomiting which sometimes sponta- neously occurs, are nausea, acid, or acrid eructations, pain of the head, flatulency, disinclination to food, a sense of chilliness, alternating, with flushes of heat; pains in the stomach, bowels, and disturbed sleep. These symptoms often continue for many days', and then produce a looseness of the bowels, or even profuse and obstinate diarr- hoea. The prudent will always carefully avoid a surfeit; it being one of the most cer- tain means of destroying the tone, and in- ducing disease of the stomach. When in- temperance of this'kind has been commit- ted, a gentle emetic should be given, followed by a dose of calcined magnesia; and, for some time, the diet should be of the lightest kind, as thin gruel, or panado, toast and water, or crackers with milk. ENE. rooii. A sufficiency of food of a wholesome and nourishing quantity is demanded for the ] support of the system in health, and to en- able it to undergo that amount of labour to which each individual is subjected. Excess of food, even of the lightest and most whole- some kind, interrupts digestion, oppresses , and irritates the stomach, produces a fever- J ish heat of the surface, loads the vessels M with an excess of blood, and when sufficient exercise is not taken, renders the body un- J wieldy by the accumulation of fat beneath ' the skin, and around the abdominal and tho- racic organs. The action of the heart be- J comes sluggish; muscular exertion is per- I formed with difficulty; the mind is render- I ed dull and torpid, and the body is predis-, W posed to various acute and rapidly fatal B diseases from very slight causes. Equally injurious is a deficiency of food. The ener- gies of the body and of the mind suffer, and 'M disease is as certainly induced by inanition j as by repletion. The just medium must be I left to the instinct and reason of each indi- ,■ vidua], in whom it will vary considerably, j|H according to his age, constitution, occupa- J tion, and degree of health. It may be safe- ;Vl ly inferred, however, that a person in health fl has not transgressed the bounds of modcra- ^H tion; if, in rising from his meals, he feels j light and cheerful, with a stomach unop- H pressed, and capability of applying himself at once to study, or to labour; while on the ■ other hand, if he experience giddiness, hea- <■ viness, lassitude, uneasiness, distention of ■ the stomach, or an inclination to sleep, he J has exceeded the bounds of prudence, and fl should be on his guard in future. Parta-'» ^M king of a great variety of food at one meal is injurious; it causes more to be eaten than 'M is proper, impedes the digestive powers of I the stomach, and inflicts serious injury on • I the latter organ, and through it on the sys- ijf tem generally. WTith respect to the solid or fluid nature of our food, we may remark, J^M that a certain degree of solidity assists its digestibility, and hence, soups, jellies, gravies, and the like, are more readily digested, when bread or other solid sub- stance is added to them, than when they , are eaten alone. A sufficient bulk of food in the stomach, to give to it a gentle stimu- lus and distention, is absolutely necessary for healthy digestion, it is on this account that all such articles as contain much nutriment in a very small space are unwholesome. In regard to the concentration of aliment, very erroneous and injurious opinions generally * prevail. It is supposed, by most persons, that by extracting and insulating what they ^ conceive to be the nutritious principle or 1 principles of any given alimentary substance, 1 they are able, with greater certainty and ef- 1 feet, to nourish the body-of the sick and ■ HYGIENE. 85 delicate; thus, we continually hear of strong beef-tea, pure arrow-root jelly, and the like, being prepared with great care for such per- sons. But many of our readers will be much surprised to hear, that dogs and other car- nivorous animals, fed on the strongest beef- tea, or pure jelly alone, rapidly emaciate, and die within a short period, and that pre- cisely the same consequences would ensue from confining the strongest man to the same food. A certain bulk, therefore, of food taken into the stomach, is essential to nu- trition; and all attempts to combine too much nutriment in too small a space, mate- rially impairs the wholesomeness of our food. Aliments.—Whatever is capable of-being used as food, and of supplying the waste of the animal body, is called aliment. The great variety of nutritive substances may be classed and arranged in various ways, as ani- mal or vegetable; fish, fowl, or flesh; solid or liquid, &c.; or they may.be classed ac- cording to the particular principles, as they are called by chemists, on which the nutri- tive qualities depend. Some of these prin- ciples are fibrin, albumen, gelatine, oil and fat, gluten, fecula or starch, mucilage, su- gar, acids, &c. On this plan, Dr. Paris classes aliments in the following way: Class I. Fibrinous aliments. Comprehending the flesh and blood of various animals, especi- ally such as have arrived at puberty, veni- son, beef, mutton, hare. II. Albuminous. Eggs: coagulable animal matter. III. Ge- latinous aliments. The flesh of young ani- mals, veal, chickens, calf's feet, certain fishes. IV. Fatty and oily aliments. Ani- mal fats, oils, and butter; cocoa, &c, ducks, pork, geese, eels, &c. V. Caseous ali- ments. The different kinds of milk, cheese, &c. VI. Farinaceous aliments. Wheat, barley, oats, rice, rye, potato, sago, arrow root, &c. VII. Mucilaginous aliments. Carrots, turnips, asparagus, cabbage, &c. VIII. Sweet aliments. The different kinds of sugar, figs, dates, &c. carrots. IX. Acidulous aliments. Oranges, apples, and other acescent fruits. The numerous substances classed above, vary much both in their nutritive and diges- tible properties. When we talk of a sub- stance being nutritive, we mean that it has the power to supply more or less nourish- ment to the body, without saying whether the stomach and the other assimilating or- gans find much or little difficulty in con- ducting the process; and when we say that a substance is digestible, we mean that the stomach and its coadjutors take with ease the nutritive portion from it. Thus a sub- stance may be very nutritive, but not very digestible; and the reverse may also be true. Fat oilyaliment is very nutritive, but of difficult digestion. This is what people mean when they say such an article of diet is heavy; though oil is specifically light, and often floats on the other contents of the sto- mach. The digestibility of food, consider- ed without reference to the stomach, de- pends on a variety of circumstances, par- ticularly the state of %he food, with regard to texture and consistence; and this texture in animal food depends on the time that has elapsed since the animal was killed, on its age, sex, feeding, and mode of killing; and above all, on the operations of cookery. In a matter which varies so much in different individuals, it is not easy to lay down any general maxims with regard to the digesti- bility of different kinds of food; but it is found pretty generally to be the case, that tender mutton is the most digestible food. Beef is not quite so easily digested; but it is equally nutritious. Soups, oils, and jellies are digested with some difficulty, both on account of their tenacity and because they are not so easily acted upon by the me- chanical powers of the stomach. vegetable food. That man is capable of sustaining the health, vigour and strength of his system upon a diet purely vegetable, is established by so many facts, as to place the fact be- yond the possibility of doubt. The Hindoo lives almost exclusively upon rice and wa- ter. A great proportion of the Irish pea- santry subsist on potatoes, with the occa- sional addition of bread and milk; and the labouring classes, in many districts of Scot- land and the north of England, are nourish- ed upon little else than oat-meal and pota- toes; while in various other countries of Europe, the poor are restricted almost ex- clusively to a vegetable diet, even less nour- ishing than either of these. When the food, just referred to, is in sufficient quanti- ty, and of a good quality, more robust, ac- tive and vigorous frames, and a greater amount of general health, than are present- ed by the individuals who make use of it, can scarcely be met with in the inhabitants of any other country, or among any other classes of society, whatever may be the na- ture of their diet. Although vegetable ali- ment requires a longer time to digest in the stomach than that from the animal kingdom, and notwithstanding the latter presents a larger amount of nutritive matter in a smaller bulk than the former; yet it is indis- putable that the human system can derive from vegetable food as great a quantity of suitable nourishment as from animal, while the former produces much less excitement and heat, and is far less liable to produce over fullness of the blood-vessels, or to pre- dispose the organs to disease. As a gene- ral rule, it will be found that they who make use of a diet, consisting chiefiy of vegetable substances, properly cooked, 86 HYGIENE. more especially the farinaceous seeds and roots, have a manifest advantage in looks, strength and spirits, over those who par- take largely of animal food; they are re- markable for the firm, healthy plumpness of their muscles, and the transparency of their skins. This statement, though at va- riance with popular opinion, is amply sup- ported by experience. The diet of chil- dren, and young persons generally, should consist almost exclusively of farinaceous ali- ment and milk. In summer, and in warm climates, a greater proportion of vegetable food is required than in winter and in cold climates. They who, with a sufficiency of daily exercise in the open air, to preserve the activity of the digestive organs, never- theless spend a life of ease and comparative inaction, will find their health and comfort better promoted by a diet principally vege- table, than by one in which animal food abounds. Towards the decline of life, also, the amount of animal food should be gradu- ally diminished, and that of wholesome ve- getable aliment increased. ANIMAL FOOD. It is evident from the structure of the di- gestive organs in man, as well as from ex- perience that he is destined to live upon both animal and vegetable food, and that a proper combination of both constitutes the aliment which, generally speaking, is best adapted to his taste, and the one by which the health and vigour of his system is under most circumstances best sustained. It is nevertheless true, that whole tribes of peo- ple subsist almost entirely upon the flesh of animals, without, apparently, its producing any striking influence upon their bodily strength, or inducing disease; while, on the other hand, we know that by a diet almost exclusively vegetable, the growth and de- velopment of the body is in no manner cur- tailed, and its muscular strength and free- dom from disease, is as fully maintained as it can be by any other species of food. The nourishment communicated by both animal and vegetable food is much the same; but the animal product is the most easily separated by the digestive organs, and is afforded in the greatest amount. The blood of the individual who purtakes largely of animal food, is hence richer, more elabo- rated and stimulating, and produces a much greater excitement of the different organs of the system, than the blood of those fed principally upon a vegetable aliment. The first gives, likewise, a greater tendency to inflammatory affections than the latter. For those who are accustomed to active and la- borious employments, a greater amount of animal food will be proper than for the sedentary and inactive. Infants require less animal food than children, children than adults, and* women than men. In summer, the quantity of animal food should always be diminished, whatever may be the habits or occupations of the individual. In winter, and in the more northern climates, a more permanent and stimulating nourish- ment is required than under opposite cir- cumstances, this is best afforded by animal * food; and hence the propriety of the latter being increased to a certain extent during the cold season, and in cold climates. The different kinds of animal food differ in the degree of nourishment they afford, as well as in the case with which they are digested. _■> Thus, the flesh of full grown animals is much more digestible and nutritious than that of their young; and as it respects the larger animals, this rule is without excep- tion. Beef and mutton, for example, are more easily digested, and more wholesome than veal and lamb. The sex of animals I too influences the nature of the food; the female being more delicate than the male. I The mode of killing, too, gives a tenderness to the flesh. Hunted animals are, hence, — tenderer than those that are killed on the spot. The flesh of animals who are allowed ^H to range freely in the open air, is more M wholesome and nutritious than of such as M are stall fed. In general, the flesh which is ^ dark coloured, and which contains a large (■ proportion of fibrin, is more digestible and 1 nutritious than the white flesh of animals. -■ Thus, the white flesh of domestic fowls is not 9 so readily dissolved in the stomach as that of ■ the different kinds of game. By cooking, Tl animal food is changed in its texture, being jl generally rendered softer, and easier of di- ~M gestion; but by certain modes of cooking, JB it is entirely changed in its nature, being MM rendered indigestible, unnutritious and un- wholesome. varieties of animal food. ,| Gelatine, or animal jelly is highly nutri- j tious-; but in its separate or concentrated state, it is very difficult of digestion; hence, the impropriety of the dyspeptic, and per- sons of weak stomachs generally, being fed upon strong soups, calves' feet jelly, and similar articles of food. Gelatine of Bones.—Bones have been found, by careful analysis, to contain in every 100 parts, 60 of an earthy matter, 30 of a nutritive jelly, a portion of the residue being pure fat. By a process lately invent- ed by Mr. Darcet, of Paris, the whole of the nutritive part of bones can be extracted from the other substances contained in them, and with the addition of proper seasoning, and such vegetables as ordinarily enter into ' I the composition of good soups, a highly pa- I latable and nutritious food is afforded, 1 which, from its cheapness, is well adapted I for the use of the poor; and is now exten- m HYGIENE. 87 sively employed in several of the public charitable institutions of France. In pre- paring the jelly from bones, it is only the spongy extremities, and the soft cellular portions of them that are made use of. The hard compact bones are s'ill, therefore, re- served for the various purposes to which they are now so extensively applied. Not only does the jelly procured from bones deserve attention by its affording a palata- ble and economical soup for the supply of the poor; but from the facility with which it can be converted into dry cakes, and in that form kept without undergoing the least change, for years. The crews of ships, des- tined for long voyages, can, by this means, be constantly supplied with wholesome fresh food; all that is required, to convert the cakes of dry jelly into soup, being to dis- solve them in boiling water, and to add the proper seasoning, with biscuits, rice, pota- toes, or any other vegetable aliment that can be obtained. Biscuits are also made with the jelly, combined with flour. These biscuits have been introduced as an article of diet on board the French national ves- sels, with decided advantage to the health and comfort of their crews. Calves' feet jelly.—A jelly obtained by boiling calves' feet in water for a length of time. The decoction being properly strain- ed and clarified, is allowed to cool, in the form of a pure jelly, or previously to its cooling, sugar, wine, spices, &.c. are added to it. Plain calf's foot jelly, or that which is sweetened, is grateful to the palate, veiy nu- tritious, and not very difficult of digestion; it ishence, sometimes a usefularticle of dietfor convalescents; it may be taken cold, or dis- solved in warm water, according to circum- stances. It should, however, only be given occasionally, or in moderation; for jelly, like all other concentrated aliment, is not so readily converted into chyle, as many other articles which contain a less amount of nu- triment. Dyspeptics, especially, will find it to disagree, very generally, with their stomachs. The addition of wine and spices to the jelly, renders it an improper article of diet under most circumstances. Albumen.—The purest example of albu- men is that presented by the white of the egg; it nevertheless enters largely into the composition of many of the animal fluids and solids. As an article of food, it is at once readily assimilated in the stomach, it being taken up by the absorbent vessels, without its being required to undergo digestion, and highly nutritious. It was once supposed, that when coagulated by heat its digesti- bility was, in a great measure, destroyed; this, however, has been proved by late ex- periments not to be true; the white of a boiled egg being converted into chyme without difficulty. The injurious effects resulting from the eating of hard boiled eggs, is occasioned by the effects of the heat upon the oily matter of the yolk. Milk—Milk is confessedly one of the most valuable presents which a bountiful provi- dence has bestowed upon man. To the healthy and active, it affords far more strength and support than is generally sup- posed. In many instances, either alone, or in combination with the farinaceous seeds or roots, it has formed the sole sustenance of life—maintaining fully the health and ro- bustness of the system, without any of the disadvantages which result from an excess of animal food on the one hand, or the di- minished strength and vigour which have been supposed to be the effect of a purely vegetable diet, on the other. Incalculable would be the benefits which would result to the working and labouring classes of our country, were they to substi- tute this wholesome and nourishing food in their families, for the expensive and unnu- tritious slops, which, under the name of tea or coffee, constitutes the chief of their morning and evening meals; or, at least, were they, in order to support their system under labour, and to defend it from the ef- fects of cold, heat, or fatigue, to substitute a tumbler of milk for the pernicious dram of ardent spirits, or the too often deleteri- ous preparations presented to them in the form of beer, porter, or ale. For children, milk with bread, or a simple preparation of milk with rice, or with eggs and sugar, is perhaps the best and most wholesome food that can be de- vised: it should, at least, form the principal part of their nourishment for the first twelve or fifteen years of their life. In place of being weakly or stinted in their growth up- on such food, they will be found stronger, stouter, more healthy, and of a more rosy and pleasing complexion than children who are fed upon meat, and pampered with the delicacies of a well filled table. Milk, to be perfectly wholesome, should be drawn from sound, young animals, sup- plied with a sufficiency of their natural food, and allowed free exercise in the open air. The best mode of using it, is, un- doubtedly, in its raw state, and when it has stood about two hours after being drawn; it may be eaten with bread or mush. Milk enters, also, into various diseases, which it is not necessary here to enumerate, being well known to every skilful housewife. Largely diluted with water, milk furnish- es also a very palatable and wholesome drink during warm weather. Cream.— That portion of the milk which rises to the surface, when it has stood for some hours, and may be skimmed off and separated from it. It has many of the pro- perties of oil; when allowed to stand for some days, it becomes thicker, the flavour of cream is lost, and is succeeded by that 88 HYGIENE. of cheese. When cream is agitated by churning, it separates into butter and a fluid like skimmed milk. With some sto- machs cream disagrees, as a small quantity of oil or butter would do; with many dys- peptics, pure cream, however, agrees bet- ter than milk; when taken in modern quan- tity, as an accompaniment to tea, coffee, fruits, &c, it seldom gives inconvenience to any one. Eggs.—Eggs contain ajrJJat deal of nour- ishment in a small bulk; and when perfect- ly fresh, and soft boiled, they constitute a species of food of very easy digestion. When hard boiled, and especially when fried, they are indigestible and stimulating, and produce very considerable disturbance to weak stomachs. Cheese.—All kinds of cheese are of dif- ficult digestion; and as an article of food, are suited only to the healthy, strong and laborious. Such persons would, in fact, appear to require an aliment which, while sufficiently nourishing, is not rapidly di- gested. This has reference to cheese in its recent state, or which has been preser- ved in such a manner as to undergo but lit- tle change. With age, cheese, in general, acquires new properties, becoming more stimulating, and less nutritious. This arises from a spontaneous decomposition which takes place in it, by which a certain amount of ammonia, and of other salts are develop- ed. It is this which gives to it its peculiar sharpness, and, in some measure, its taste and smell. In this state, cheese can with safety be made use of, only in very small quantities, as a condiment along with other food. By persons of delicate stomach, it should be eaten with great caution. The idea entertained by many, that a portion of old cheese taken with the dessert aids di- gestion, is perfectly absurd. When cheese has advanced very near to a state of putre- faction, though eaten by certain epicures, and by some of the nations of the north of Europe, it is at once disgusting to the sen- ses, and injurious to the stomach. Certain changes which cheese occasionally under- goes, imparts to it poisonous properties. Roasted, or cooked cheese, is very indi- gestible, and liable to occasion painful sen- sations in the stomach, head-ache, acrid eructations, feverish heat of the skin, and disturbed sleep. A few persons have a decided aversion to cheese, so that it can neither be seen, smelt or tasted by them, without exciting nausea, or vomiting. Cheese is an article of diet not well suited to children; it is very apt, in their excita- ble systems, to give rise to unpleasant symptoms of longer or shorter duration. When eaten by adults, it should always be combined with a large portion of bread. Butter.—An unctuous substance obtained from the milk of animals, and most plentifully from that of the row. It is got by long con- tinued agitation, which operation is called churning. It is universally used as an arti- cle of diet; and when perfectly fresh and thinly spread upon bread, there are few stomachs with which it disagrees. Butter is used as a sauce to many articles of food, and is frequently added to flour to be baked into paste; and it is in both these forms in- jurious, for though it does not produce ef- fects that are immediately apparent, it lays the foundation of stomach complaints of the greatest obstinacy. Its use is also very apt i to give rise to diseases of the skin, very dif- ficult to cure. Persons labouring under t stomach complaints should not use much butter in any form. It is also very un- wholesome when heated. It is a bad part of the management of children, to pamper their palates by frequently indulging them with butter; as it is apt to give rise to a gross and unhealthy habit of body, characterized by the frequent appearance of boils and j other sores, discharges from behind the j ears, &c, or eruptions on the head, and J other parts of the skin. Its immoderate ■ use also occasions too great fulness of the 1 system. Butter, when rancid, is peculiarly I unwholesome and disagreeable. Fat affords a rich nutriment, requiring, A however, strong powers of digestion, and ] hence, adapted only to the healthy and la- borious; it is more wholesome, however, I when eaten with a proper quantity of lean, or with a considerable addition of farina- M ceous aliment in the form of potatoes, bread,' ■ rice, &c. To persons with weak stomachs, fat is too heavy and stimulating, and is apt M with them to turn rancid, and to produce ■ uneasiness and disease of the digestive or- gans. When partly burned, as in roasting, or frying, fat is decidedly unwholesome. % Children and invalids, especially, should be extremely cautious in the use of fat meats. :' beef. Beef affords a strong, easily digested, and wholesome nourishment, it should be ten- der, fat, and well mixed; and taken from a bullock of middle age. Beef is more generally acceptable to the taste, than most other species of animal food; it is good at all seasons, and we con- tinue longer to relish it without disgust than any other kind of meat. The particu- : lar flavour and delicacy of beef, depends , much on the feeding on which the animal is reared. Beef furnishes proper food for the strong, and laborious; when eaten to ex- cess, it predisposes to inflammation, and an \ over fullness of habit. Of its different parts, its fat is less easily digested than the lean; the tongue and also the tripe, being of a HVt.l more dense texture than the other parts, are more indigestible, and therefore an unfit ali- ment for weak stomachs. The best mode of preparing beef, is roasting, or boiling. Beef steaks appear to be the form, how- ever, in which its nutritious qualities are best retained. The excessive body of fat which is accu- mulated upon what is called prize beef, adds nothing to its goodness, but on the contrary, renders it less wholesome and nutritious. Beef-tea is an important restorative for persons recovering from sickness, and in many cases of actual sickness. The follow- ing is the best mode of preparing it: cut a pound of lean beef into thin slices, put it into a quart and a half of cold water, set it over a gentle fire, so that the water shall become gradually warmed. When a scum arises, skim it off. Let it simmer gently for about an hour, then strain it through a fine sieve, or napkin. After it has stood about ten minutes to settle, pour off the clear liquor. MUTTON Is a highly nutritious and wholesome meat. It appears to be the most digestible of all animal food, and is perhaps more uni- versally used than any other. The flesh of the male animal has so strong and disagree- able a taste, and is, besides, so exceedingly coarse, and difficult of digestion, that it is only adapted to persons of strong digestive powers. Ewe-mutton, if it is more than between three and four years old, is like- wise tough and coarse. Wether-mutton, or the flesh of the castrated animal, is most es- teemed, and is by far the sweetest and most digestible. Lamb being less heating, and less dense than mutton, is better suited to persons convalescent from acute diseases; but by the majority of patients labouring under indi- gestion, or any other severe affection of the stomach, it is not found so digestible or pro- per a diet as wether-mutton. It is, how- ever, to persons in health, a light and wholesome food, especially when the lamb is not killed too young. A lamb that has been allowed to suck five or six months, is fatter and more muscular, and in every re- spect better, than one which has been killed when two months old, and before it has had time to attain its proper consistency. House- lamb is a dish esteemed chiefly because it is unseasonable. Like all animals raised in an unnatural manner, its flesh is depraved and unwholesome. venison. The flesh of the deer is reckoned a great delicacy; it is savoury and easy of digestion. The animal being commonly killed in the chase, its flesh, like most species of game, is more tender than that of tame beasts slaughtered in the usual mode. VEAL. The flesh of the calf, like that of all young animals, abounds in gelatinous mat- ter; it is far less easy of digestion than the flesh of the ox, or beef. For persons in health, the most proper mode of cooking veal is by roasting or baking. Veal broth produces a laxative effect upon the bowels, and is hence a very suitable food for persons troubled with costiveness. PORK. Good pork is unquestionably a very sa- voury food, and affords strong nourishment, well suited as an occasional diet to persons who lead an active or laborious life, but it is not easily digested, nor can it be considered as wholesome as beef or mutton. The too frequent and long continued use of this meat favours obesity, and is apt to disorder the stomach and bowels, and occasions eruptions upon the skin. When salted, or dried and smoked, pork is still more indi- gestible, and less nourishing, as well as less wholesome; with some delicate people, it immediately affects the bowels in rather a violent manner. The flesh of the sucking pig is reckoned a great delicacy; but it is digested with great difficulty. It produces very considerable disorder to the digestive organs of such as are weak or sickly. Pork should be avoided by the dyspeptic, by the sedentary generally, and by all those who are liable to affection of the skin and bow- els, or who are inclined to excess of fat. Bacon.—Pork salted, dried, and some- times smoked. Bacon is in general pre- pared from the flesh of the flanks and sides of the full grown hog. It is a strong, very indigestible, and stimulating food, adapted only to persons of a robust frame, and ac- customed to laborious occupations. The best mode of cooking bacon is by boiling it with vegetables. When fried with eggs it is decidedly unwholesome. Ham.—The thigh of the hog salted, dried, and smoked. When properly cured, and when boiled, ham is a very palatable and wholesome food. It is, however, stimu- lating and difficult of digestion, and hence only suited to such persons as exercise much in the open air. Fried ham is still more indigestible than that which is boiled; it should be carefully avoided by dyspep- tics and weakly and sedentary persons generally. Sausages.—A very common article of food, prepared in this country chiefly from pork, chopped fine, with the addition of pepper, and various other spices, and some- times highly flavoured with garlic. They are sometimes eaten fresh, at others they are dried and smoked. The sausages im- ported from the north and south of Europe are prepared from the flesh of various ani- mals boiled. In whatever form they are eaten, sausages are an indigestible and un- wholesome food, fitted only for the stomach of the most robust. Sedentary persons and dyspeptics should avoid them entirely. When sausages have been long kept, par- ticularly in a damp place, they are apt to undergo certain changes, in consequence of which they become poisonous. GAME. Game, or such birds and beasts, adapted for food, as are allowed to enjoy their natu- ral habits and modes of living, and are kill- ed by fowling or hunting, are in general wholesome. When plainly cooked, they are more readily digested than the same I species of animals domesticated and killed ' in the ordinary manner. POULTRT. Poultry, in the common acceptation of the terni, includes all the domesticated birds used as food, as the common fowl, turkey, duck, and goose. In point of diges- tibility they rank nearly in the order we have enumerated them. The domestic fowl and turkey are also the lightest and most wholesome. The duck and goose are the most difficult of digestion, the most stimu- lating, and hence, the most apt to disagree with persons of weak stomachs and irritable habits. Chicken soup.—Chicken soup, when pro- perly prepared, is a light food, adapted to many invalids and to persons convalescent from fevers. For their use it should be pre- ' pared from the fleshy or lean parts of the chicken, well boiled in water, with a little salt, the scum and fat being taken off as it rises. The addition of broken crackers, or of rice or barley, may be made, according to circumstances. To many palates, the peculiar flavour given to the soup by plung- ing in it a slice of toasted bread, is extremely agreeable. Highly spiced chicken soup is liable to the same objections as all high seasoned food. FISH. Fish are less nutritious than the flesh of warm blooded animals, while to most sto- machs they are more difficult of digestion. That they afford, hoWever, sufficient nour- ishment to support the general health and vigour of the constitution, is proved by the condition of entire communities that subsist upon little else. Fish, however, especially some particular kinds, and in certain consti- ENE. tutions and states *£ the stomach, produce very considerable uneasiness, some febrile excitement, and a rash or eruption on the skin. When used habitually, there can be little doubt that they are apt to induce . diseases of the skin and disorders of the * bowels. The fat of fish is still more indiges- tible than that of other animals, and readily j turns rancid on the stomach. In certain climates, fish possess a poisonous property at particular seasons, and, when not in sea- son, all kinds of fish every where are very indigestible. The best mode of cooking fish is by boiling; stewed or fried fish are very indigestible. Salted and dried fish are a still more unwholesome food than such as is eaten fresh, and should therefore be 1 avoided by all excepting the healthful and laborious, and even by them should be taken with great moderation. Butter and the acid fruits form improper sauces for fish, causing it almost always to oppress and irritate the stomach, nor should fish and milk ever be taken at the same meal, this combination has frequently occasioned se- vere bowel complaints. Salt water fish are the best, as their flesh is more solid, more agreeable, less liable to putrescency, and less viscid. They possess these desirable qualities, when fresh; when salted, they have all the properties of salt fish, and consequently its disadvantages, fl Those fish which have scales are, in gene-;9 ral, the most easily digested, and the bestffi and of all these the fresh herring, shad, J trout, perch, trout, whiting, sole, cod, tur- bot, and flounder, are perhaps the most wholesome. Salmon, mackerel, skate, and sturgeon, with lobster and most other kindk^ of shell fish, are digested with difficulty,, and unwholesome. :fl SALTED MEAT. Salted meat is more difficult of digestion I, than that which is eaten fresh, from the in- \ creased firmness of its texture, as well as less nutritious, both from the pickle in which it is immersed washing out, as it were, a considerable amount of its nutritive % parts, and from the chemical change which 1 it always undergoes to a greater or less ex- tent. When used as food, salted meat should always be well boiled, and eaten with a large quantity of vegetable aliment CRABS AND LOBSTERS. Crabs and lobsters, in whatever manner cooked, are indigestible and decidedly un- wholesome. In certain persons they pro- duce effects which might lead a person un- aware of the fact, to believe that poison had been administered. Thus they sometimes cause a burning sensation in the throat, pain in the stomach, and eruptions on the skin. In HYGIENE. 91 other instances, violent vomiting and pur- ging have followed the eating of them. When taken in excess, they have caused stupor, insensibility, and all the other phe- nomena of apoplexy. TURTLE. The flesh of the turtle, when plainly cooked, is a wholesome, palatable, and nourishing food—when, however, it is con- verted into soup, with an excess of spices, force-meat balls, and other pernicious arti- cles, it is productive of not a little injury to the stomach, and to health generally. MUSSELS. The mussel—mytilus edulis—a shell fish often used as food, is highly indigestible and unwholesome. It is apt in certain indi- viduals to occasion violent affections of the stomach and bowels, restlessness, and agi- tation, and an insupportable itching, with eruptions on the skin: at some seasons of the year, and under particular circum- stances these effects are produced in all who eat of them. OYSTERS. Oysters, when taken raw or after being slightly cooked by roasting, are a light, nu- tritious, and easily digested food. The hard white part, or eye, as it is sometimes term- ed, should always be rejected. When thoroughly cooked, however, particularly when stewed or fried, they constitute on the other hand, one of the most indigestible and pernicious articles of food in ordinary use. Eaten to excess in this form, they give rise frequently to the most violent and dangerous symptoms. When out of season, oysters are always unwholesome. To some stomachs, oysters always prove injurious, causing the same train of symptoms as were noticed when speaking of mussels. The juice of the oyster, thickened with grated biscuit and warmed, is sometimes an excel- lent diet for persons labouring under great delicacy of stomach. Salt water oysters should always be preferred to such as breed in rivers. SOUPS. For the labouring classes generally, there is scarcely a more wholesome and economi- cal article of diet than soup. We allude now to the ordinary domestic soups, pre- pared from beef, mutton, or veal, with the addition of various vegetables. The more fashionable dishes, served at table under the name of soups, are merely refinements in cookery, adapted to render the articles of which they are composed as indigestible N and stimulating as possible. They can be received, therefore, in no other light than as provocatives to appetite, and induce- ments to partake of food beyond the powers of the stomach and the wants of the system. In the preparation of soup, the meat and vegetables should be well bojled, and what- ever seasoning is added to increase the fla- vour, care should be taken that it be not thereby rendered too stimulating. Pota- toes, rice, and barley, as well as broken crackers or stale bread, form a wholesome addition to soup. The combinations of flour and butter, which are sometimes met with in soups, under the denomination of dump- lings, are highly indigestible and improper. Soup should always .be eaten with bread; this gives it that degree of consistency which, in all our food, appears to cause it to be more readily acted upon by the stomach. Broth.—A term generally applied to the fluid in which meat has been boiled for a long lime with a slight addition of salt— this, with bread, forms often an excellent diet for persons to whom we wish to com- municate nourishment, without exciting to any extent the, digestive organs, or increas- ing the heat ofvthe system. Many suppose Hhat soups gener?1' v c calculated only for "those whose - . > digestion are weak, but this ' .\kr the reverse being generally >v' the digestive powers are w.< it will almost always be foil .!-,; ment agrees the best, parti 'ttnv •.. mal food; this the stomach -eV with ease and in a very short t as, liquid food is apt, in the */thod of preparing it: Take a descrt- v "oonful of the r^jwdcr, and add as much cold water as \\*A make it into a paste; to this add eight ounces of boiling water, stir it briskly, and boil it for a few minutes, when it will become a clear, smooth jelly. To this may be added a little milk and su- gar, with a little nutmeg to make it sit light on the stomach; or for children a little of the sugar of anise, or a few drops of the es- sence of carraway seeds, or of cinnamon. Sugar is a peculiar and well known ve- getable substance, procured chiefly from the saccharum officinarum, or sugar cane, but yielded abundantly by various other vegetables, and contained in the greater part of the fruits in their ripe state. Sugar is highly nutritive, and when eaten in mo- derate quantities, is perfectly wholesome. It is apt, however, when eaten by itself in excess, to become quickly sour, or to pro- duce sickness and nausea. Combined with other alimentary substances, it forms a use- ful and important article of food to all clas- ses—so much so, that it may now be ranked as one of the chief necessaries of life. The idea entertained by many of its injuring the teeth is unfounded. Molasses has, as an article of diet, nearly the same properties as sugar. It is merely a syrup, in which the sugar is mixed with a quantity of mucilage and other vegetable matter, and more or iess water. Sugar-plums.—We merely notice these articles in order to point out to parents the fact, that in common with most of the sugar toys sold to children, they often contain a quantity of plaistcr-of-paris, which, being insoluble, must be dangerous, if it accumu- lates in the bowels. Many of them pre also covered with preparations of arsenic, cop- per, lead, and other poisonous paints, which though in very minute quantities, neverthe- less produce more or less of an injurious effect upon the stomach. Honey very much resembles sugar in its alimentary properties; it is very nutritious, and when eaten in moderation with bread, is perfectly wholesome. Like sugar, how- ever, it readily ferments, and when the sto- mach is delicate, it is apt to occasion grip- ing and irritation of that organ and of the bowels, accompanied with considerable looseness. That obtained from the olive by exprei- sion, is the only vegetable oil used in this country as food. It is highly nutritious, but is oppressive and irritating to a weak sto- mach. When used in cooking other articles c-f food, it becomes extremely unwhole- some. In moderation, provided it be per- fectly free from rancidity, pure olive oil, combined with vegetables, may be taken without injury, by persons in health and of active habits. Wheat, the triticum hybernum, (and other species,) of botanists, has been culti- vated from time immemorial in Europe, in Asia, and in the northern parts of Africa, and the seeds employed as one of the most important and wholesome articles of food. Indeed, wheat flour is the only sub- stance known from which good loaf bread can be made. In its nutritive properties and wholesomencss, it stands before almost all other of the vegetable substances used as food. The seeds of the wheat, when ripe, are ground to a fine powder, and by HYGIENE. 93 passing this powder through cloth sieves, of various degrees of fineness, it is separated into distinct portions. The fine flour con- stitutes the greatest portion; and the bran, which consists of the outer coat of the seed, the next greatest portion. Bran.—The husks or shells of wheat, which remain in the bolting machine. It contains a portion of the mealy matter; and a decoction of it is used as a drink in febrile diseases. This decoction is made by boil- ing a pint of water with two^ounces of bran, till only three quarters of a pint remain; and then straining it. It is thought to have something of a laxative quality ^ RICE. The seeds of the oryza sativa, an excel- lent grain, much used in the East, and an- swering with them the same purposes as bread with us. When mixed with other food, it furnishes a wholesome article of diet, as it is not disposed to become sour, or to ferment in the stomach; but if it be taken in too large quantity, as it is not very stimulating, it is apt to remain long in the stomach, especially if it has been much boiled. Rice, simply boiled, is an excellent vegetable to be eaten with roasted or baked meats. Baked or boiled with milk, eggs, and sugar, it affords also a very light, whole- some, and palatable food. Rice is supposed to be in some degree astringent; and in looseness of the bowels, the water in which it has been boiled forms an excellent drink; by its mild mucilaginous properties, it aids greatly also in allaying the irritation of the bowels. OATS. The avena sativa of botanists. The meal obtained by grinding the grain of oats af- fords a wholesome and nutritious food, upon which many persons almost entirely subsist in Scotland, Ireland, and the north of England. It is generally used boiled with water, in the form of gruel, or made into thin cakes, which are baked or roasted, without their undergoing fermentation. Bread made from oatmeal fermented in the usual way, is neither palatable nor easily digested. Gruel.—By gruel is generally understood oatmeal boiled in water. It may be made thin or thick, according to the circum- stances under which it is resorted to as a diet, by the addition of a smaller or larger quantity of the meal. It is a wholesome and nutritious food for children and delicate persons, and is better adapted as an article for the supper of such, than cither tea or coffee. When desirable, it may be render- ed more nutritious by the addition of milk and sugar; and it? flavour may be heighten ed by the addition of a little grated nutmeg. Thin plain oat meal gruel, or a gruel made from Indian meal is a useful diet for conva- lescents from febrile diseases, and for those who have committed an excess in eating. RYE. The rye (secale) affords a meal, the food prepared from which, though less nutritious than wheat, is nevertheless wholesome and sufficiently nourishing. Rye bread is more difficult, however, of digestion, and being apt to turn sour on the stomach and to irri- tate the bowels, it is not so well adapted as wheat for the use of sedentary and delicate persons. The grains of rye are occasionally subject to a peculiar disease, termed ergot. When in this state, eaten in any quantities, or for any length of time, it is peculiarly unwholesome, and apt to occasion diseases of a very serious nature. Bread made of a mixture of rye and wheat is more palatable, and in other respects better than when made entirely of rye. BARLET. The hordeum distichum of botanists. A" annual plant, cultivated in almost every country of Europe. Pearl barley is pre- pared by grinding off the husks of the grain, and forming the latter into little round pellets, of a pearly whiteness. Barley forms an excellent article of nourishment when boiled in water, or made into cakes. Barley bread is not, however, a v cry plea- sant and wholesome food. Barley-water.—The water in wl< ch bar- ley is well boiled, forms one of c ;-• _ st drinks, in various febrile and other diseases. We annex two receipts for its preparation. 1. Take a couple of ounces of shelled barley, wash it clean with cold water, put it into half a pint of boiling water, and let it boil for five minutes; pour off this water, and add to it two quarts of boiling water; simmer to two pints, and then strain. 2. The above is simple barley water; to a quart of this is frequently added two oun- ces of figs, sliced; the same quantity of rai- sins, stoned; half an ounce of liquorice, sliced and bruised; and a pint of water. Boil till it is reduced to a quart, and strain. These drinks are intended to assuage thirst in fe- vers, and inflammatory disorders, for which plenty of a mild diluting liquid is one of the chief remedies demanded by honest instinct, in terms too plain to be misunderstood. MAIZE, OR INDIAN CORN. The meal made by grinding Indian corn, made into mush, or with the addition of wlv-it flour bukcd into bread, furnishes n 94 HYGIENE. most wholesome, nourishing, and palatable food, and one well adapted for the support of the activ e and laborious generally. In- dian bread, properly prepared, were it not from habit and fashion, would recommend itself to every palate by its agreeable fla- vour, and the beauty of its appearance; it is far preferable to the ordinary bread made from wheat alone. To make this bread, a mush should be made of the Indian meal in the usual way; into this, when cold, with the addition of a very small quantity of warm water, and a little salt and yeast, is to be kneaded a sufficiency of wheat flour to make it into a paste; when sufficiently rais- ed, it is to be again kneaded, and baked in the same manner as bread. BUCKWHEAT. The flour, or meal, furnished by the seeds of the buckwheat, is incapable of be- ing converted into a wholesome, palatable bread. As an article of food, it is generally used in the form of cakes, made by baking the meal, made into a thin paste with water and properly fermented. Buckwheat cakes, though extremely palatable, afford little nourishment, and arc apt to disagree with delicate stomachs, in consequence of the large amount of melted butter which is eaten with them. They should be avoided, at least, by invalids and dyspeptics. BREAD. A very important article of diet, made from the farina of various plants. This farina consists of different principles, a mu- cilaginous saccharine matter, starch, and gluten, which is a peculiar substance having many of the properties of animal matter. This latter ingredient is most abundant in wheat flour, and gives it its great superi- ority over that of barley, rye, oats, and other grain. In the making of bread, flour is made into a paste by mixing it with water, in the average proportion of two parts of water to three of flour; and the older and better the flour, the greater quantity of water will be required. If this paste be allowed to remain for some time, a fermen- tation takes place; and by the action of the ingredients on one another, important che- mical changes take place, and alcohol, car- bonic acid, and acetic acid, or vinegar are formed. This paste is what is called leaven; and if a portion of it be added to new made paste, the fermentation begins more speedily, carbonic acid is given off, but the gluten hinders its escape, and ex- panding like a membrane, forms numerous little cavities in a light and spongy mass. If there be too much leaven put into the paste, the bread has an unpleasant flavour; and if there is too little, it is compact and heavy. Barm, ou»the head that collects on the surface of fermenting beer, being ad- ded to dough, makes a bread superior to what is made with leaven; and is in this country generally employed for raising bread. After the dough has been ferment- ed, and properly raised, it is put into the oven, heated to about the temperature of 448°, and is there baked. Bread is very different from the flour of which it was made; the ingredients of the flour cannot be discovered in it; it mixes more easily with water, and is incomparably more di- gestible. That is, provided the bread has been properly fermented, and sufficiently baked. There are three different sorts of bread used in this country, the fine, the wheaten, and the household. Fine bread is made of flour only; [wheaten bread, of flour and a mixture of fine bran; and household of the whole grain, including both the coarse bran and the fine flour. The finer bread, from its greater quantity of starch, is apt to induce a degree of costiveness, which the coarse bread is enabled to coun- teract by its admixture of bran. Brown bread, or that made with a mixture of wheat and rye flour, is often usefully prescribed with a view to its laxative effect. As an- article of diet, bread is of very great im- portance, from its nutritive qualities, and its utility when joined with other food, both to correct the bad effects of too much ani- mal diet, and to divide the aliment more completely by being intimately mixed with it. The best observations seem to prove, that a certain degree of distension of the stomach is necessary to proper digestion^ and, consequently, that we could not con- veniently feed on essences and jellies, in which the nourishing parts of the food are concentrated into the smallest possible bulk; and that even very rich and nutritive soups are much easier for the stomach, when a proper proportion of bread is taken along with them. New bread is particu* larly unwholesome and indigestible, and should always be avoided, especially by pa- tients troubled with indigestion. The only apparent exception is in the case of new rolls, which healthy stomachs manage to digest pretty well, provided they be well baked, and the crust bears a consider- able proportion to the whole. Toasted bread is a very useful article of diet for ten- der stomachs, and for the diet of invalids. Bread, in some constitutions and diseases, is apt to sour on the stomach, especially in young children, in whom it often pro- duces flatulence and costiveness. Where acidity occurs, biscuit, without butter, should be substituted, or the bread should be toasted. In the foregoing remarks on bread, we have had principally in view leavened HYGIENE. 95 wheaten bread; though bread may be made of rye, barley, maize, potatoes, rice, and other substances; and although, strictly speaking, biscuits, cakes, and other un- leavened mixtures are entitled to the appel- lation of bread. Most of the articles last mentioned are sufficiently nutritive, but difficult of digestion, though they are ex- cellently adapted for the powerful sto- machs of those who are engaged in labo- rious and rustic occupations. The addition of butter to such articles before they are baked, causes them to disagree with the stomach, and to make them turn sour or rancid. A good deal has been said about bread being frequently adulterated. In large communities, some dishonest persons will probably adulterate bread, as well as other articles of food; but the evils of such practi- ces have been much exaggerated. Bean flour, or potato flour, have occasionally been mixed with wheat flour in the making of bread; and alum very frequently added to increase its whiteness. Toast.—Bread slightly toasted, but not burned, is a wholesome diet, especially for persons upon whose stomachs most articles of vegetable food, including bread in its ordinary state, are apt to turn sour. In eat- ing toast, the butter should not be spread upon it until it is cold; the heat of the toast will otherwise produce a change in the but- ter, rendering it indigestible, and very irri- tating to the stomach. Panado.—The crumb of wheaten bread softened with boiling water. It forms an excellent diet for children; for those affect- ed with febrile diseases, and for women in the first days after delivery. It should be sweetened with sugar, and for children an addition of fresh milk will very generally be proper. Biscuit.—Bread which is much, or doubly baked, as its name imparts. It is not fer- mented, and is not much disposed to be- come acid in the stomach. Biscuits are, therefore, useful in the diet of children, and of those who are liable to acidity of the sto- mach. Biscuits keep a long time without spoiling; hence, their utility as a part of sea provisions. Those made with butter, have all the inconveniences of pastry, and should not be used by such as have diseased, or weak stomachs. Ginger-bread.—A bread, or cake prepa- red of flour, molasses, and powdered gin- ger. When well baked, and eaten in mo- deration, it affords, under many circumstan- ces, a useful stimulus to the stomach. It is an excellent article for individuals going to sea; it being frequently, in cases of sea-sick- ness, retained on the stomach, when every other article is immediately rejected. Tra- vellers, also, on sitting out early in the morning, will find, that eating a small por- tion of it, will afford a grateful stimulus to the stomach, when they have been obliged to commence their jojurney without break- fasting. Children, and young healthy indi- viduals, generally, should, however, eat it seldom, and very sparingly; all spices, and other stimulants, save that of a moderate quantity of wholesome food, are to their stomachs unnecessary and injurious. PASTRY. Pastry, or dough mixed with butter, is used in a great variety of forms, and though grateful to the taste, is highly indigestible, and injurious to health. It is a fertile source of stomach complaints; it is apt also to oc- casion an overfulness of blood, convulsions, and diseases of the skin in children; and apoplexy and fever in adults. At dinner, in the shape of pies and tarts, pastry is thrown into the already loaded stomach, and the overtaxed powers of that organ are un- able to digest what is difficult to manage when they are the most vigorous. To chil- dren, pastry is peculiarly unsuitable. Its taste is pleasant, and injudicious fondness is apt to indulge them with it; but those children who use it much, are subject to runnings from the ears, disorders of the bowels, erup- tions on the skin, and inflammatory com- plaints of various kinds. Pastry should be entirely excluded from the nursery table. The same remarks are true of nearly all kinds of cakes containing butter or lard. Puddings.—This is a term applied to va- rious preparations of the farinaceous seeds, or vegetables. When composed of flour, or crumbs of bread, combined with suet and dried fruit, they are extremely indigestible, and constitute one of the most unwholesome dishes served at meals. Such puddings should be avoided entirely by sedentary and delicate persons; to the dyspeptic they are in the highest degree injurious. Pud- dings made of batter, baked or boiled, are also indigestible, and unwholesome. Bread and milk pudding, as well as rice pudding is readily digested, and may be eaten in moderation, without injury. Pudding is also the name given to a kind of sausage made of the liver, or blood of animals, with the addition of fat, and certain vegetables and spices. They are all extremely indi- gestible, and are a suitable food only for the most robust individuals, whose days are passed in laborious occupations in the open air. Pancakes and fritters.—Cakes made by frying a paste formed of wheat flour and the yolks of eggs in lard. Although in per- sons" who have active and strong powers of digestion, these cakes may produce little inconvenience, to all others, they will prove indigestible and injurious. By the seden- 96 HYGIENE. tarv and dyspeptic, they should be care- ful Iv avoided. Sago.—An alimentary substance prepared from a species of palm. Boiled with water or milk, sago furnishes an agreeable and nourishing jelly; it is easy of digestion, and excites but little the system; and is, hence, an excellent article of diet for convalescents and for children. Salep.—A nutritious substance obtained from two species of the orchis. Boiled in water, or milk, it forms a food which is light, nourishing, and easy of digestion, and like the arrow root and sago adopted for the diet of children and invalids. POTATO. The root of the solanum tuberosum. This vegetable, which was unknown in Europe as an article of diet, until about the com- mencement of the 17th century, constitutes an article of diet, which, whether we have reference to the nourishment it affords, the agreeableness of its flavour, its wholesome qualities, and the extent to which it is con- sumed in this country, as wrcll as in many parts of Europe, is certainly of the great- est importance to man. It is difficult, in- deed, to conceive how the poor and labour- ing classes could hav"e subsisted, or main- tain the health of their systems without it. To thousands of them, it, at this day, sup- plies the place of bread and of other vegeta- bles, and to an equal number it affords al- most their entire sustenance. Potatoes are the lightest and most nutritious of those vegetables which are served at table in their natural state; and next to bread, the very best accompaniment to every kind of ani- mal food. The dry mealy kinds are the best, and should always be preferred to those which are hard and waxy. The best manner of cooking the potato is by boiling, or by roasting. Finely mashed, or fried potatoes are indigestible, and oppressive to the stomach. Combined with flour, pota- toes are often made into bread, and in this manner, also, afford a cheap and wholesome food. Sweet Potato.—The root of the convolvu- lus batata. The sweet potato, besides a considerable amount of farinaceous matter, contains a portion of a saccharine substance. They are unquestionably highly nutritous, and when simply roasted, or properly boil- ed, form a very palatable and wholesome article of food. They do not appear, how- ever, to be so ready of digestion as the com- mon potato. They should, therefore, be eaten in very moderate quantities by per- sons of weak stomachs. YAM. An esculent root, obtained principally from three speofc of dioscorea, the alata, bulbifcra and sativa. They grow sponta- neously in both Indies, and the roots arc eaten as the potato is with us, which they somewhat resemble in taste; but their fla- vour is more luscious. When boiled, or roast- ed, they are nutritious, and easy of diges- tion; and are preferred by many to wheaten bread. They arc sometimes ground into flour, and made into bread and puddings. They might doubtless be raised in perfec- tion in many parts of the United States; and we are convinced, that on many accounts, they are a preferable food to the potato. CABBAGE. The several varieties of cabbage consti- tute an article of food, than which few are more generally and extensively made use of in this country. For the healthy, robust, and labouring part of the community, cab- bage forms an excellent addition to their usual meat diet; and when eaten in modera- tion, appears to agree very well with their stomach. But, after all, cabbage affords but little nutriment, is very flatulent, and Where the stomach is delicate, or irritable, it is very apt to produce uneasy sensations, cholic, or even a tolerably severe attack of cholera morbus. For the invalid, therefore, 'i or persons who lead sedentary and inactive** lives, cabbage is a very improper food. The only proper mode of cooking cabbage is by boiling it, until such time as it is perfectly tender. Boiling it in two waters deprives i it, in a great degree, of that unpleasant taste and smell, so disagreeable to many palates. Sourcrout, or cabbage, prepared in a par- ticular manner, and allowed to undergo fer- mentation to a certain extent, forms an ex- cellent and wholesome vegetable food for the crews of ships destined for long voy- ages; and for all persons so situated as to be deprived of a sufficient supply of fresh vege- tables. In regard to its effects upon indi- j viduals, whose powers of digestion are im- paired, the same remarks will apply as to cabbage in it:; recent state. Brocoli.—Brassica ilalica.—A species of cabbage which furnishes a very agreeable article of food. Though sweeter, and of a more tender texture than the other varieties I of cabbage, it is still apt to disagree with weak stomach ;, producing flatulence, and often cholicky pains. By the sedentary and dyspeptic, it should, therefore, be carefully abstained from. Cauliflower is perhaps the species of cab- bage, which is the most readily digested by persons in ordinary health. It is liable, however, to the same objections as an arti- cle of food, for the sedentary and inactive, ; as cabbage in general. Artichoke- Cinara sc>hjmu*.—A kind of HYGIENE. 97 thistle cultivated for the table. The only alimentary part of the plant is the recepta- cle of the flower. The whole of this recep- tacle, even in its recent state, possesses very little of the acrimony peculiar to other por- tions of the plant; and when well boiled, it is perfectly mild, of a tender texture, some- what sweet and mucilaginous, and, there- fore, tolerably nourishing. It is sometimes, however, rendered unwholesome by being eaten with a large quantity of melted butter. The Jerusalem artichoke, helianthus tube- rosus, a species of sun flower, having fleshy tuberculated roots, somewhat resembling small potatoes. These tubercles are some- times eaten as food; and when roasted or boiled, they acquire a mealy texture, like the potato, but with a sweet taste, resem- bling yam. As an article of diet, they may be ranked with the potato, though they are very apt to be more watery and fla- tulent than the latter, when of a good quality. Spinage.—The spinacia oleracia, of botan- ists. The tender leaves of the spinage well boiled, constitutes one of the best and most wholesome of the green vegetables in com- mon use. They act gently upon the bow- els, and are particularly useful to persons habitually costive. Asparagus.—The asparagus officinalis of botanists. The asparagus has a creep- ing root, throwing up numerous scaly erect steins, the tender ends of which, on their first appearance above the ground, are the parts used as food. These shoots are, when sufficiently boiled, readily dis- solved in the stomach, and are not disposed to create flatulence and acidity. Asparagus is wholesome only when in its early state; when old, it is remarkably acrid. Poke.—The tender shoots given off in the spring from the roots of the poke, (the Phytolacca decandria,) cooked in the same manner as the asparagus, is esteemed by many an equally delicious and wholesome vegetable. It is difficult, indeed, to distin- guish it, so far as regards its flavour, from the latter. BEET. The beta vulgaris.—The root of the plant is of a sweet taste, and a beautiful red colour. In some parts of Europe, a considerable quantity of sugar is extracted from it; and hence, it must evidently possess consider- able nutriment. When well boiled, it af- fords an excellent vegetable for the table. When eaten with vinegar, it will not, hovv- ever, be found to agree with such stomachs as possess but feeble powers of digestion. CARROT. The daucus cureta. ---The root of the car- rot, like that of the beet, contains a con- siderable amount of saccharine matter; it contains also a quantity of mucilage. It may be presumed, therefore, to be nutritive in no small degree. When young, and suf- ficiently boiled, the carrot forms an excel- lent vegetable for the table. It is liable, however, to cause flatulence in persons of a delicate stomach. When too old, the fibrous matter it then contains, diminishes greatly its digestibility. PARSNIP. The pastinaca sativa.—The root of the parsnip, when well boiled, affords a whole- some and very nourishing food, and one not difficult of digestion. Its nutritive proper- ties depend on the large amount of mucila- ginous and saccharine matter which it con- tains. The peculiar flavour of the parsnip renders it, however, offensive to some sto- machs. TURNIP. The brassica rapa.—The root of the tur- nip forms a very agreeable article of diet, to be taken along with animal food. It af- fords an excellent, mild nourishment, when there is nothing in the state of the stomach and bowels to forbid vegetable diet. Tur- nips should be well boiled, and have the water well pressed out of them. ONION. The root of the allium cepa,- it is used both as a condiment and as an article of food. Eaten raw, onions, in general, arc much too stimulating for the generality of stomachs; they produce, also, a disagreeable fetor of the breath, and perspiration; and when the stomach is weak and irritable, they cause a sense of oppression, and heat, and sometimes griping. They are most wholesome when boiled or roasted. In this state, they contain a large portion of a mu- cilaginous matter, combined with a decided sweetness, and may be considered a nutri- tious and wholesome vegetable for persons in health. Leek.—The allium porrum is eaten as a condiment in its raw state; and when boiled, as a vegetable aliment. It is a common in- gredient in soups and various sauces. When boiled, it is sufficiently nutritious and whole- some for those in health; but it is apt to prove flatulent upon delicate stomachs. Garlic.—The allium sativum.—In this country the root of the garlic is usedcliiefly as a condiment; when taken in moderation with certain kinds of food, it is not unwhole- some. It, no doubt, contains a nutritive principle; but its taste being offensive to most stomachs, causes it to be used by few as an article of food. 9S HYGIENE. LEGUMEN, OR PULSE. Beans and peas, which are included un- der the general name of legumens, or pulse, afford a species of farinaceous aliment, con- taining a good deal of nourishment; but arc very difficult of digestion, particularly in their dried state. They are apt to lie heavy on the stomach, and to occasion flatulence. Hence, as a diet, they are only proper for persons having sti-ong powers of digestion. By the sedentary and dyspeptic, they ought on no account to be used. The symptoms of uneasiness which they cause in such are often very v iolent. The green pods of cer- tain beans, previously to the full develop- ment of the seeds within, when well boiled, afford a pleasant vegetable food, by no means difficult of solution in the stomach. Vegetables eaten in their raw state, with the addition of vinegar, spices and oil, have received the general name of salads. Few of the salads, in common use, afford much nourishment, and like all raw vegetables, are, to a certain extent, indigestible; their indigestibility is likewise often increased by the manner in which they are prepared at table; while the large addition of pepper and other spices combined with them, ren- ders them not unfrequently decidedly inju- rious to the stomach by over exciting it. To the very class of persons by whom they are most freely partaken, the luxurious anil inactive, they prove always the most preju- dicial. The propriety of eating any vege- table, with the exception of some fruits, without cooking, is, as a general rule, at least doubtful. To those, however, who from any cause are restricted to a diet of salted and smoked meat, raw vegetables ren- dered more palatable by the addition of a moderate quantity of vinegar and spices, are supposed to be beneficial; but even then, when a sufficient supply of wholesome cooked vegetables can be procured, we ap- prehend that the latter will be found most conducive to health. Celery.—ipium graveolens.—The long leaf-stalks of the celery, when blanched by being covered, during their growth, in trenches from the sun, are eaten raw as a salad, with the addition of vinegar and pep- per, and sometimes olive oil. In this man- ner they are not, however, very digestible; and like all salads, will disagree with deli- cate stomachs. Cresses.—Sisym brium nasturtium.—A plant growing plentifully in brooks and stagnant waters. The leaves have a pun- gent taste, and a penetrating smell like that of mustard seed, and are eaten as a sa- lad in their raw state, with oil and spices. Used in moderation, they form an excel- lent addition to animal food for persons in health; when the digestive powers of the stomach are weak, they are, however, apt to cause more or less disturbance. Lettuce.—Lactuca sativa.—The leaves of the common garden, and other species of lettuce, eaten raw, with oil, or vinegar and spices, is one of the most common salads in ordinary use. It can neither be considered nutritive nor digestible, and as it contains a considerable amount of a narcotic princi- ple, we must consider it as the most excep- tionable salad for the, general class of per- sons living in our cities. When used, the leaves should be young, perfectly white and tender. CUCUMBER. The fruit of the cucumis sativa.—It ia eaten raw, and in its unripe state. Posses- sing very little or no nutritive properties, and extremely difficult of digestion, few vegetables of which the inhabitants of this country partake so largely, is so pernicious as the cucumber. We would advise the dyspeptic, and those whose powers of di- gestion are in any degree enfeebled, to avoid it as they would poison. The root of the raphanus salivus is eaten rawr, with salt. It contains only a veiy small amount of nutritious matter, and being verv difficult of digestion, is an improper article to be taken by persons of delicate stomachs; in such, it is apt to occasion considerable ? uneasiness, flatulence and pain. MUSHROOM. The mushroom is a very indigestible and unwholesome article of food, affording little or no nourishment. It ought never to be eaten by persons of delicate stomachs. The mushroom is frequently poisonous, and oc* casions, when taken into the stomach, the most violent vomiting and purging, and other unpleasant symptoms. Fruits are much used as an article of luxury; and from the bad effects they too frequently produce, they would seem to be by no means of a salutary nature. Looseness, vomiting, indigestion, and even inflammation of the bowels, have been seen evidently to proceed from their use in certain cases. Yet it is pretty certain that the fault has lain not with the fruit, but with the consumer. When fruit is eaten in large quantity, and in an unripe state, when it is forced into the stomach, already loaded with a plentiful dinner of soup, meat, pud- HYGIENE. 99 ding, and all the items df a luxurious table, there is nothing wonderful in the subse- quent intestine war. But when fruit is taken in moderation, of a proper quality, and at proper seasons, no bad effects are to be dreaded. Fruits are evidently useful, and they are kindly sent at the very season when the system, heated and excited by the warmth of summer, stands in need of something cooling and laxative to be taken with the food. The fruits in most common use may be classed under the heads of stone-fruits, the apple kind, berries, (without affecting bo- tanical accuracy in the use of this term,) and farinaceous fruits. The stone-fruits are those which are of most difficult digestion. Plums and cherries are particularly so. The ripe peach is both delicate in its flavour and easily digestible; the apricot is also very wholesome; but the nectarine is liable to disagree with some stomachs. The fruits of the apple kind are somewhat firm in their texture, and therefore rather indigestible, and liable to be detained in the stomach. Pears are rather more allowable, as their texture is softer. The white skin of the orange should be carefully rejected, but the inner pulp is grateful to most stomachs, whether in health or sickness. The fruits of the berry kind are the most wholesome of all. The strawberry or raspberry are par- ticularly good; the grape is cooling and lax- ative, but the husks and seeds are to be re- jected; the gooseberry is not so digestible, especially if the skin be swallowed. It is only the pulp of these fruits that is digested; the seeds always pass through the body un- digested, unless they be chewed. Other berries are generally baked in pies, but the pastry should be sparingly used. The me- lon, a farinaceous fruit, is almost sure to dis- agree with weak stomachs; especially when eaten after dinner. Many fruits, otherwise unsafe, are much improved by cooking. Baked apples are an excellent article of food, and may even be of benefit to dyspep- tic patients. Dried fruits are generally es- teemed veiy safe, but they are apt to run into fermentation in the stomachs of children and delicate persons, from the quantity of sugar which they contain. Apples.—Of this fruit there are several va- rieties. All of them, when perfectly ripe and mellow, may be considered as wholesome. Though not so liable to run into fermenta- tion as some of the other fruits; yet, being of a firm texture, they are somewhat diffi- cult of digestion, and remain long in the stomach. Hence they should be avoided by such persons as have weak digestive powers. Stewed or baked with sugar, they are rendered more soluble and wholesome, and in this form prove gently laxative. Dried apples stewed, form an excellent sauce for various species of animal food. O Cherries. There are several varieties of the cherry. Some contain much water and sugar, others a large proportion of acid; others, again, present a soft, mucilaginous pulp. The last, when fully ripe, are the most wholesome for eating. In weak sto- machs, and when eaten immoderately, cher- ries, especially the two first varieties, are apt to occasion flatulence and colic This fruit is, in general, more wholesome when cooked with sugar. In eating cherries, care should be taken to reject the stones; when these are incautiously swallowed, they are occasionally retained in the bowels, pro- ducing alarming and even fatal symptoms. Currants, perfectly ripe, are an agreeable fruit, and perfectly wholesome when eaten in moderation; they have less of a laxative effect upon the bowels than strawberries or gooseberries. The skin and seeds are in a great measure indigestible, and as these constitute a large portion of the dried cur- rants that are imported, these are very apt to cause more or less irritation of the sto- mach and bowels—this indicates the neces- sity of great caution in their use. The plumpest and sweetest should be prefer- red. Cranberry. The berries of the oxycoccus. It is a plant which grows extensively in many- parts of the U. States, in uncultivated wet or marshy ground. The fruit, or berries, when ripe, are of a bright scarlet colour, and an agreeable acid taste. They are employed in great quantities, stewed with sugar, as a sauce to various species of poultry and for tarts. In this form they possess a rich and delicious flavour, and are sufficiently whole- some when eaten in moderation. For ducks, geese, and other species of poultry abound- ing in fat, they form a very appropriate sauce. Dates. The fruit of the phoenix dadylifera, a species of palm. It is in its dried state that the date is met with in this country. This fruit abounds in sugar, and is highly nutri- tious. Like most saccharine substances, it is very liable to oppress and disorder per- sons of weak stomachs, and by them should be eaten with caution. Figs. The fruit of the ficus carica. The dried fig contains a large portion of sugar, considerable mucilage, and a small quantity of oil. When eaten in moderation, they are grateful to the stomach, and more easy of digestion than most of the dried fruits. When eaten alone, however, they are apt to occasion flatulency, and to disagree with feeble stomachs. The fig acts as a gentle laxative, and may be eaten occasionally with great advantage by persons habitually costive. Gooseberry. The fruit of the ribesgrossu- laria. When perfectly ripe, they are a delicious and wholesome fruit. In eating them, the skins should always be rejected. 100 HYGIENE. Grapes. The ripe grape, especially of the rich saccharine species, is among the most luscious and wholesome of our summer fruits. It is the pulp only, however, divest- ed of the seeds, that should be eaten. The large portion of sugar and mucilage con- tained in grapes renders them nutritive, while their slight amount of acidity facili- tates their easy digestion. Baisins, or grapes in a dried state, are equally nourishing and wholesome with the fruit in its recent state. The skins, how- ever, which can scarcely be rejected in eating them, being rendered tougher by drying, cause raisins to be more indigesti- ble than fresh grapes. They are also more apt to disagree with weak stomachs, in con- sequence of a portion of their acid being lost in the process of drying, while, at the same time, a larger amount of sugar is de- veloped. The more purple and plump the raisins, the more wholesome they are. They should always be eaten with bread, and never in large quantities; otherwise they are apt to produce flatulence and griping pains. Lemon. The fruit of the Citrus acida, and the Lime, the fruit of the Citrus limonium, which do not differ the least in their quali- ties, are never eaten as food from their ex- treme acidity. The juice of both enter as a condiment in various made dishes. The juice also, diffused in boiling water, and sweetened with sugar, constitutes a very pleasant beverage for quenching the thirst, and allaying heat during the summer sea- son. The lemonade thus made may be drank, occasionally, without injury; but it is not proper as a habitual beverage, as it is very apt to disorder the digestion, and to produce irritation and pain of the bowels. Preserved limes are indigestible, and one of the least wholesome of the ordinary sweetmeats served at table. Oranges. The fruit of the citrus aurantium. The juice of the orange is gratefully acid, and taken in slimmer, is well adapted to allay thirst, and take off that sense of dryness in the mouth and throat, experienced by per- sons who perspire much during exercise. For the same reason, it is often allowed to patients labouring under fever. The pulp, however, in which the juice is contained, is indigestible, and should not be eaten; neither should the seeds or white tough rind. The best mode of using the orange, to prevent injury to the stomach and di- gestive organs, is to squeeze out the juice, and drink it diluted with water, and with the addition, if necessary, of sugar. The yellow rind of oranges is frequently used to communicate an agreeable flavour to va- rious dishes; in moderation it is not inju- rious. Pear. The fruit of the pyrus communis. There are several species of pear, some of which, from the firmness of their texture and the acerbity of their juices, are improper for eating, unless well cooked with sugar. Others, however, when perfectly ripe, pre- sent a soft juicy pulp, of an agreeable fla- vour, and readily digested by a healthy stomach. Peach. The fruit of the amagdylus per- sica. The peach is unquestionably one of the most wholesome as well as most deli- cious of the stone fruits. When perfectly ripe and mellow, it may be eaten in modera- tion, without inconvenience. The outer skin should, however, be rejected. Neither J peaches, nor any other kind of fruit, should be eaten after a copious dinner. They will then be very apt to oppress the stomach, and to cause acidity and flatulence. Pine-apple. The fruit of the bromelia ana- nas. A delicious fruit of tropical climates. < However delicious in flavour, the pine-ap- ple, as we obtain it in this country, is very indigestible, and when eaten freely, decided- J ly injurious to the stomach and bowels. Plums should never be eaten, unless per- fectly ripe and mellow. The skin and stones should always be rejected. In their J ripe state, or cooked, plums are wholesome jj| and readily digested. But when unripe, or sour, they cause disorder of the stomach and bowels, with flatulence and griping. Prunes. Plums, when dried, are deno- J minated prunes. Eaten uncooked, they are ■ difficult of digestion and unwholesome. When stewed, they have a laxative effect, ■ and freely used in this form, are an ex- ; cellent means for obtaining a free state of the bowels in persons troubled with cos- tiveness. ^ Baspberry. The berries of the rubua 1 idxus, are a very wholesome and grateful fruit. Next to strawberries, they are per- f; haps one of our very best summer fruits of the berry kind. — • Strawberry. The fruit of the fragaria '■M vesca. In point of flavour, in the ease with which they are digested by most stomachs, ?| and their general wholesomeness, perfecdy I ripe strawberries rank first upon the list of I the summer fruits. Eaten in moderation, j at a period when the stomach is not ac- tively engaged in the digestion of other food, they are seldom found to produce the i least unpleasant effect on persons in the J enjoyment of ordinary health. Tamarinds. The fruit of the tamarindusin- j dica, preserved in sugar. Tamarinds contain too 1 arge an amount of acid, and act too pow- 1 erfully upon the bowels, to permit their be- M ing eaten as food. They form, however, a ™ very agreeable and effectual laxative; and a drink made by pouring boiling water up- on them, is well adapted for quenching thirst, especially in patients labouring un- der fever. Melons. The cantaleupe and water-melon HYGIENE. 101 are the only only ones eaten in this country. They both contain a saccharine juice, which may be presumed to afford some nutriment, but they are both very indigestible, and the pulp of the water-melon more especially, is apt to oppress and irritate delicate sto- machs. They should be eaten, therefore, with great caution; and by the dyspeptic, and those subject to affections of the bow- els, abstained from entirely. NUTS. The kernels of oily nuts contain a farina- ceous substance, combined with a large quantity of bland oil. They are all ex- tremely nutritious, but difficult of diges- tion, and irritating to the stomach, upon which they are apt to turn rancid, causing heart-burn, acid eructation, feverish heat of the skin, pain in the head, and restlessness or disturbed sleep. They are suited only to such persons as are in health and possess active digestive powers. They should ne- ver be eaten by the dyspeptic, nor by any one when the stomach is already loaded with other food. They should always be perfectly fresh, and taken with a little salt and with bread, and well chewed before they are swallowed. \\ hen taken to ex- cess, or in certain conditions of the stomach, they often occasion difficulty of breathing, and sometimes very violent and dangerous complaints of the bowels. Almonds. A well known nut, the product of the amygdalus communis. There are two varieties of almonds, the sweet and the bitter. The bitter almonds are now seldom eaten; they contain an active poison, in conse- quence of which they are liable to produce injurious effects. Sweet almonds possess little nourishment, and are difficult of diges- tion, unless thoroughly triturated. In con- sequence of the oil they contain, they are very apt to produce disagreeable symptoms when eaten by persons the digestive pow- ers of whose stomachs are impaired. By age they often become rancid, and are then highly acrid, and should on no account be eaten. Chestnuts contain a considerable amount of nutritious matter. They indeed form a considerable part of the food eaten by the peasantry in many parts of the south of Europe. The raw fruit, however, is not readily dissolved in the stomach; it is also very flatulent, and apt to occasion colicky pains and bowel complaints. When kept for some time they evolve a greater amount of saccharine matter, becoming sweeter and more digestible. When roasted, the chest- nut becomes still more light and nutritive; they are still, however, as well as when boiled, flatulent, and should be avoided by persons of delicate stomachs, and by dys- peptics generally. From the chestnut may be obtained a farinaceous matter, fit to be made into bread; this bread, however, is neither palatable nor wholesome. Cocoa-nut. The fruit of a species of palm, cocos nucifera. Within the hard woody shell of the cocoa-nut is a thick layer of a solid white substance of a sweet and agreeable taste, which no doubt contains a considerable amount of nutritive matter; it is, however, extremely difficult of digestion, and very apt to disagree with delicate stomachs. The interior of the nut is filled with a fluid, re- sembling milk, which is made use of in the West Indies as an agreeable beverage to quench thirst. CONDIMENTS. Condiments, or seasonings, are those sub- stances which, though not nutritive them- selves, are taken into the stomach along with the food, to promote its digestion, and to correct any injurious properties it may possess. Some such assistance would seem to be necessary to all animals; and the lower animals instinctively seek after bitters, salt, &c. to take with their food. Condiments are of various kinds, as salt, acids, aromatics, oils. Some of those in most frequent use are, sea-salt, vinegar, lemon juice, pepper, cinnamon, nutmegs, cloves, ginger, parsley, garlic, onions, leeks, horse-radish, mustard. A small proportion of these condiments may be used with propriety. While they give an additional relish to the food, there can be little doubt that they aid its digestion. But the misfortune is, that in the use of condi- ments mankind are prone to excess. They are used as stimulants to induce the stomach to partake of food, when already loaded to repletion, or exhausted by habits of intem- perance. Condiments also are injurious to the stomachs of those who indulge in the constant use of animal food. They fur- nish a temptation to excessive indulgence, and ultimately occasion organic disease of the stomach or liver, and permanent injury of the digestive functions. Oils and butter are also to be regarded as condiments; their use ought to be sparing. All kinds of seasoning, with the exception of salt, are improper for children, and young persons generally. Acids. Vinegar, and a number of acid fruits, and vegetables or theirjuices, are often used as condiments to our food, and from experience we should judge, that, during a healthy state of the stomach, and when used in moderation, they are, generally speak- ing, a very useful addition to an animal diet; especially such as is rich in fat or ge- latine. They appear to render it less liable to disturb the stomach, and to cause it to be more readily digested. The addition of ]02 HYGIENE. lemon juice to rich and glutinous soup, and the custom of eating apple-sauce with pork, or cranberry-sauce with ducks and geese, may be viewed, therefore, in a favourable light. Vinegar. The product of the acetous fer- mentation. For commerce it is procured either by allowing the fermentation of wines, or of cider, to progress until the liquor be- comes completely acid. Yinegar is a grateful acid, much used as a condiment with food. In small quanties it is a grateful and whole- some stimulant; it also checks the fermenta- tion of certain species of aliment in the sto- mach, and prevents raw vegetables from inducing flatulence; it seems, also, to render fatty and gelatinous substances more easy of digestion, and less liable to offend the stomach. Taken in too large quantities, it, however, produces serious injury to the stomach. Yarious fruits preserved in vine- gar are served at table as condiments, un- der the name of pickles. Prepared in gene- ral from firm, unripe fruits, they are ex- tremely indigestible, and when taken in any quantity, disturb the stomach, interfere with the digestion of the food, and often cause griping or colicky pains, and other disagreeable or even dangerous effects. Anchovy. A small-fish, of the herring kind, imported from the coasts of the Medi- terranean sea, in a pickled state. Anchovies arc either eaten as a condiment, or are form- ed into sauce for other fish. They possess little nutriment, and in consequence of the spices with which they are generally pre- pared, not only act as provocatives of the appetite, causing too much food to be eaten, but of themselves act injuriously upon the stomach. They should be ranked among those luxuries of the table from which it is better to abstain. Ginger is the root of- the amomum zingi- ber. Its properties are those of a stimulating aromatic, and in moderation, it forms a use- ful and very wholesome condiment. A weak infusion of ginger in boiling water forms an excellent drink for persons the tone of whose stomachs and bowels has been weakened by excess in eating or drinking. Persons who have adopted the commenda- ble resolution of abandoning at once the habitual use of intoxicating drinks, in which they had for many years indulged, will find in the ginger tea a useful beverage, the use of which will remove that sense of sinking at the stomach, caused by the sudden sus- pension of its accustomed stimulus. Horse-radish. The root of the cochlearia armoracea. It has a strong, pungent smell; and a penetrating acrid taste. Grated or scraped, with the addition of sugar, the horse-radish is much used at table as a con- diment for various kinds of animal food. In moderation it is wholesome; but with many persons it will be found in any quan- tity to produce irritation of the stomach and colic. Mustard. The flour made by grinding the seeds of the sinapis nigra,- it is used as a condiment. In moderation, generally speaking, it is not unwholesome; but with many persons the smallest quantity of mus- tard causes great irritation and heat of the stomach and griping. Nutmegs, the fruit of the myristica mos- chata, a native of the Molucca Islands. It is chiefly used to communicate an agreeable flavour to various articles of food; when in moderation, it constitutes a pleasant and harmless condiment. It is too much the cus- tom, however, to add nutmeg to the gruel and panado used as the diet of lying-in wo- men and convalescent patients; here it is injurious by increasing too much the stimu- lating properties of the food. Olives. Pickled olives are eaten chiefly as a condiment. They are decidedly nauseous to most palates when first eaten, but habit soon renders their taste not only pleasant, but a decided relish for them is created. Olives, however, are indigestible and irri- tating to the stomach. They who have gained from active exercise a keen healthy appetite, need them not; and they whose appetite is weak, or entirely lost, will re- ceive injury from their use. Pepper. An aromatic and stimulating pro-. duction of several plants of warm countries, constituting the most common of the stimu- lating condiments eaten with our food. When used in very moderate quantities, it is not injurious, in some instances decidedly wholesome; but when resorted to in ex- cess, or as a stimulant to spur on the jaded appetite to new efforts, it is destructive to health. Cayenne-pepper, capsicum annuum. The pods of the plant constitute one of the most heating and stimulating of the various con- diments employed in cookery. In modera- tion, it forms a very proper addition to some kinds of food, but when used in excess it produces all the injurious effects which arise from the immoderate use of condiments in general. Salt appears to be a natural and necessary stimulant to the digestive organs of all warm-blooded animals; hence they are led instinctively to immense distances in pur- suit of it. In man, it seems not only neces- sary to render his diet sufficiently sapid, but to a certain extent to be absolutely es- sential to health. When entirely deprived of it, the digestive organs become diseased, and nutrition imperfect. The excessive use of salt is, however, in the highest degree injurious. Preserves are different kinds of fruits, boiled or stewed in sugar or molasses. When eaten in moderation, with milk or bread, preserves constitute an innocent, if HYGIENE. 103 not advantageous, addition to our meals; provided always, they are prepared of fruit tolerably ripe and not too acrid. With the stomach of the dyspeptic, however, pre- serves will seldom agree. Many of the foreign preserves being prepared of vege- tables of a very tough consistence, and con- taining a large amount of woody fibre, are al- together indigestible, and invariably disturb the stomach and bowels of those who par- take of them. Preserves should never be kept in glazed earthen-ware vessels. The oxyde of lead contained in the glazing be- ing acted upon by the vegetable acids, ren- ders the fruit and its syrup to a certain ex- tent poisonous. COOKERY. Cookery is that application of heat to our various aliments, either single or combined, by which they are prepared in some mea- sure for the stomach, and rendered both more agreeable to the palate, and more sus- ceptible of undergoing the various proces- ses of digestion. By cookery, the nutritive principles are altered, both in their chemi- cal arrangements and their mechanical tex- ture. Its principal operations are boiling, roasting, frying, broiling, and baking. By boiling, the principles not properly soluble are rendered softer, more pulpy, and easier of digestion; but the meat at the same time is deprived of some of its nutritive proper- ties, by the removal of a portion of its solu- ble contents. The albumen is rendered solid, and the gelatine is converted into a glutinous substance. When meat is boiled too long or too fast, if it contains much al- bumen, as in beef, we shall obtain a hard and indigestible mass, like an over-boiled egg; or in young meats, such as veal, where there is more gelatine, the result will be a gelatinous substance, not easily digestible. Young and viscid food, therefore, as veal, chickens, &c. are more wholesome when roasted than when boiled, and are easier digested. Boiling- is very properly applied to vegetables; as it renders them more solu- ble in the stomach, and deprives them of a quantity of air, so injurious to weak sto- machs. But even in this case, the opera- tion may be carried to an injurious extent; thus potatoes are frequently boiled to the state of a dry insipid powder; instead of be- ing preserved in that state, in which the parts of which they are composed are ren- dered soft and gelatinous, so as to retain their shape, yet be very easily separated. On the other hand,> the cabbage tribe and carrots are frequently not boiled long enough, in which state they are highly in- digestible. The quality of the water used in boiling requires some attention; mutton boiled in hard water is more tender and juicy than when soft water is used, while hard water renders vegetables harder and less digestible. Boosting. By this process, the fibre is corrugated, the albumen coagulated, the fat melted, and the water evaporated. As the operation proceeds, the surface becomes first brown, and then scorched; and the tendinous parts are rendered soft and gluey. When underdone, roasted meat may be more nourishing; but, from the closeness of its tex- ture, it will not be so easily digested. The fat, also, particularly on the surface, undergoes a change, by the effects of the heat to which it is exposed, which renders it indigestible and irritating to the stomach. Animal mat- ter loses more by roasting than by boiling; by boiling, mutton loses one-fifth,' and beef one-fourth; but by roasting, they lose one- third of their weight. Frying. This process is perhaps the most objectionable of all the operations of cookery. The heat is applied through the medium of boiling oil or fat, which is ren- dered empyreumatic, and therefore ex- tremely liable to disagree with the stomach. Broiling. By this operation, the sudden browning or hardening of the surface pre- vents the evaporation of the juices of the meat, and imparts a peculiar tenderness to it. It is the form selected as the most eligi- ble, by those who seek to invigorate them- selves by training. But though feeding on it may induce a state of body fit for the purposes intended, the over-excited health so brought on, is peculiarly liable to become changed into disease by very slight causes. Baking. The peculiarity of this process depends upon the substance being heated in a confined space, which does not permit the escape of the fumes arising from it; the meat is, therefore, from the retention of its juices, rendered more savoury and tender. But baked meats are not so easily digested, on account of the greater retention of their oils, which are, moreover, in an empyreu- matic state. Such dishes, accordingly, re- quire the stimulus of various seasonings to increase the digestive powers of the sto- mach. As there is often much pastry, made with butter, used to confine the odour of the meats baked, such accompaniments render meat pies of all kinds of food the most difficult of digestion, and peculiarly unfit to form a part of the diet of children. Besides, their use by children, too early teaches them to please the palate at the ex- pense of their health. Stewing has a similar effect to boiling in depriving the meat of much of its nourish- ing juices; but as the fluid in which the meat is stewed is made use of as food in connexion with the latter, little nourish- ment is absolutely lost by this mode of cooking. Stewed meat is less easily digest- ed than that which is boiled; it is also more stimulating. Simple stewing, therefore, is 104 UYGIEN2. a mode of cookery well adapted for the food eaten by those of robust frames and laborious habits; but for the food of the se- dentary and dyspeptic it is not so proper. Unfortunately it is for the latter, however, that food is most frequently prepared in this manner, and to render it still more stimulating and indigestible, various spices, butter, wine, and a variety of other ingre- dients, are frequently added during the pro- cess. These additions, however much they may gratify the palate, never fail to di- minish the digestibility of the food, and render it injurious to the health of the sto- mach, and sooner or later, those who par- take habitually of dishes thus prepared, are made sensible of their pernicious effects by the occurrence of painful and dangerous symptoms of disease. MEALS. The quantity of food taken at regular in- tervals, is commonly understood by the term meal. Regularity in the number of meals, and the periods at which they are taken, is of the first importance; on it much of the equable and pleasant enjoyment of health depends. Some medical writers have con- sidered one, others two, three, and even four meals necessary. But it may be laid down as an incontestible rule, that the num- ber of meals should be regulated by the de- grees of exhaustion, and diurnal habits of life to which every individual is subject. In general, three frugal meals, in the course of the day, seem the most desirable, and the best adapted to the wants and constitution of the human frame, while, at the same time, they are best suited to the digestive organs. In the adoption of this salutary rule of diet, Fashion, all powerful as she is, on most oc- casions, has at length yielded to Reason. The periods at which meals should be taken, and the intervals that should elapse between them, deserve attention. The practice which leaves the great bulk of the day without a meal, and then crowds two or three together, is manifestly bad, as it produ- ces in the body a state of exhaustion and fa- tigue, which strongly tends to enfeeble the powers of digestion. To confirm and pre- serve health, whatever may be the number of meals taken, they should be eaten at regu- lar times and stated periods; and they should be regulated by the strength or debility of the stomach, and the quantity and quality of the food taken, or to be taken, at the preceding or following meal. The ex- tremes of too long fasting, and too frequent repletion, should be carefully avoided; for the languor of inanition, and the fever of repletion, are equally injurious to the heal- thy state of the stomach: its muscular fibres are debilitated by excess; while a collapsed state of the organ occasions its loss of tone and energy, and superinduces constitutional weakness. And it should be remembered, that one meal should be duly digested be- fore the ingestion of another into the sto- mach. Those who have weak stomachs will, as Dr. Darwin remarks, be able to di- gest more food, if they take their meals at regular hours, because they have both the stimulus of the aliment they take, and the periodical habit, to assist their digestion. BREAKFAST. The first meal taken in the morning; This is of considerable importance, as many hours have passed since the stomach was J supplied with food; and because the morning j meal is that which is to give strength to the J system for the most active part of the day. Its time, its materials, and accompaniments, are therefore worthy of being well adjusted; : although from the endless varieties of habits, constitutions, and employments, no fixed rules on any of these particulars can be given. During sleep, the whole of the food taken the night before has probably j been digested; and we might expect the appetite to be keen in the morning, from the circumstance of the gastric juice being .J secreted in abundant quantity, and of great ' activity, during the long interval; while the ]fl muscular powers of the stomach are re- 3 freshed by rest, and ready to resume their J functions; but, in general, it is proper to J interpose some time between rising and 1 taking breakfast; though many feel such in- fl anition and feebleness, that they are unfit for any of the duties of life till they have taken some food. In this, every one must decide for himself. The qualfty of the food to be eaten at breakfast is to be regulated by the exercise '^ and labour to be taken, and by the time that is to elapse before dinner. The phy- sician would be much inclined to interdict luncheons; and, therefore, to recommend a considerable proportion of solid food at breakfast. Cold mutton, or beef, or after , the Indian custom, rice, or eggs, may be ' taken at breakfast. Copious breakfasts, • however, are apt to be heavy to many sto- machs, and to occasion heart-burn, especi- ally when a great deal of liquid has been taken along with them; but this does not militate against a proper quantity of dilu- ting drink being taken at breakfast. The expenditure of fluid by insensible perspira- tion, which has taken place during the night, with the greater acrimony of all the secretions in the morning, point out the propriety of a considerable quantity of dilu- 1 ting fluid at the morning meal; and the choice of this fluid must be left, in general, *| to each person's experience of what agrees best with him. Weak tea agrees well with - most people; but with many, it occasions , HYGIENE. 105 heart-burn and acidity; perhaps the fault may not be in the tea, but in the quantity of new bread, or of butter, taken along with it. Trials must be made, by omitting one or more of the articles taken, till it be ascer- tained which of them is in fault. If tea or coffee are found to disagree, milk or gruel may be substituted. LUNCHEON. Food taken during the morning between breakfast and dinner. Generally speaking, when the former meal has been sufficiently hearty, and composed partly of solid aliment, luncheon will be unnecessary; and the habit of partaking of it should, as much as pos- sible, be avoided. But to a healthy person whose digestion is good, who is accustomed to a good deal of active exercise, and who, in the early part of the morning, has taken no very substantial or copious repast, the luncheon will probably be a matter of indis- pensable necessity. It should, however, consist of a very moderate quantity of light and easily digested food. But many of those who take luncheon find it to spoil the digestion of their dinner; much more will this be felt by the dyspeptic patient, who needs his stomach to be undisturbed during the digestion of his regular meals, and who should not exhaust his powers by calling them too frequently into action. If additional food be taken before the former portions are assimilated, the process will be disturbed; and however plausible may be the maxim, that the stomach will be best managed, and the strength improved, by taking small quantities of food very fre- quently, yet this is not found to be true; in fact, the invalid thrives much better by regular meals, at proper intervals, than by that constant throwing in of a supply as fast as a morbid craving calls for it, or as a false theory says, it should be taken. DINNER. Dinner in this country is the principal meal of the day, and is, in general, taken at the close of the morning, or during the first hours of the afternoon. This period for dining appears to be well chosen for the active classes of society more especially. Several hours having elapsed since the morning meal, the stomach may be expect- ed to have disposed of the food then taken, and to demand a new supply, while a suffi- cient period will elapse between dinner and the evening repast, to allow of uninterrupt- ed and complete digestion. Dinner is, in general, composed of meat and vegetables, variously cooked, or of soups. Attention is seldom paid to the character of the food taken at this meal, or, to the proper rules of diet; and hence, it is at dinner that the greatest er- rors are generally committed, \n regard to the quantity and quality of the food taken. Din- ner should always consist of one dish of meat, plainly cooked. Variety of food, like too much seasoning, keeps up the appetite af- ter the wants of the system are satisfied; and hence, the stomach is oppressed by too great a quantity of aliment, and digestion is impeded even to a greater extent than had the same amount been eaten of a single dish. Let it be recollected, also, that dishes compounded of a number of ingredients, the natural qualities of which are completely disguised, by the refinements of cookery, are altogether unwholesome; many of them are little better than poisons. It is all im- portant that sufficient time should be al- lowed for this meal, in order that the food may be properly chewed, without which its digestion will be greatly retarded. In re- gard to the necessity of drinking at table, but little need be said. If the food be suf- ficiently plain and juicy, thirst will seldom be experienced; but when a desire to drink is experienced, a moderate draught of wa- ter will be proper. But no other liquor must be taken—water is the only natural diluent of our food, every other liquor im- pedes its digestion. Hence, the custom in use among some people, of taking drams before dinner, for the purpose, as they al- lege, of whetting the appetite, is highly pernicious, and has quite a contrary tenden- cy to that designed, as it relaxes the sto- mach, and consequently enfeebles it for the operations it has to perform. For the same reason the practice of taking brandy or li- queurs with goose, pig, &c. is objectionable. Nor is the fashion of taking wine, or brandy and water, during dinner, less reprehensi- ble. The use of bottled cider, porter, or beverage, during this meal, is also injurious, as it unnecessarily distends the stomach, and thus prevents its muscular contrac- tions, when they are necessary to be brought into action, and preserved in their full vigour. To say the least of all these vulgar errors in diet, they check the pro- Cess of digestion, and paralyze the powers of the stomach. Coffee may, however, be safely and advantageously taken after din- ner, as it accelerates the operations of the stomach, and assists digestion, provided it does not exceed a small cup or two, and is taken without sugar or milk. SUPPER. The meal taken late in the evening, or just before going to bed. As the powers of the body, and digestion among the rest, arc diminished in their activity during sleep, it is an unsafe measure to load the stomach at bed-time with a large quantity of various kinds of food. When this is done, there is great distension, both from the load thrown 106 HYGIENE. in, and from flatulence; the person is liable to be disturbed with restlessness, or night- mare, and frightful dreams. If tea has been taken in the early part of the evening, no food will be required until the next morn- ing. When a sensation of hunger is felt, however, before bed time, a slight and mo- derate repast only is allowable; an egg, or some preparation of milk, or oatmeal pot- tage, which last, however, is apt to become sour on some stomachs. For dyspeptics, suppers and late hours are peculiarly un- suitable. Under no circumstance should food be taken for two or three hours before retiring to rest. DRINKS. Wc are warned by the appetite of thirst to take in a certain quantit}' of liquid to di- lute our solid food, and to supply the waste of those fluids which are continually ex- pended during the continuance of life. So urgent is this necessity, that we are able to bear hunger more quietly than thirst, and to live longer when deprived of food, than when deprived of drink. The quantity of drink required will vary according to the season and climate, mode of life, the nature of the food, and the peculiarity of each in- dividual. When the-body is exposed to a high degree of atmospherical temperature, a much greater quantity of drink is de- manded, than when the atmosphere is tem- perate or cold. This arises from the stimu- lating effects of heat upon the system; but chiefly by the waste of the fluid portion of the blood, occasioned by the increased per- spiration. For the same reasons, active ex- ercise or labour augments the thirst. Salt- ed, high seasoned, and all stimulating food increase the demand for drink, by stimula- ting the lining membrane of the mouth, throat and digestive organs, and increasing the viscidity and stimulating properties of the blood. The same effects are produced by wine and ardent spirits. Dry food ne- cessarily requires more dilution than that which is moist and juicy; and hence, the greater necessity of drinking, during meals principally composed of the former. In re- gard to the fluid best adapted for an ordi- nary drink, there can be no hesitation in stating, that it is water, and water alone— no other can answer so well as a diluent for our food, and for the preservation of that degree of fluidity in the blood, by which it is best adapted for the nourishment and sup- port of the system. No fluid whatever can be used as a drink, excepting in consequence of the water it contains; and in proportion to its freedom from foreign admixture, or any active ingredient, will it best answer the purposes of a diluent in the animal body. When the taste of man has not been vitiated by the customs of artificial life, his thirst can be satisfied only by pure water; and even under ordinaiy circumstances, when the sensation of thirst is intense, every other fluid is loathed. While pure water consti- tutes the best drink for habitual use^-the addition to it occasionally of farinaceous sub- stances, or of some of the vegetable acids; rendering it slightly aromatic, by infusing into it the leaves of certain herbs, is not in- jurious, and, under certain circumstances, may be advisable. The effects of fluids on the body vary al- so according to their temperature, their vo- lume, and the time when they are drank. Persons in good health, generally take a great portion of their drinks, especially at dinner, of the temperature of the air; but in weaker stomachs, they may be required to be a little warmed, though it is seldom safe to take them habitually very hot; and far less should the energies of the stomach be chilled by cold or iced drinks. The quan- I tity of drink taken, is also of much conse- quence to good digestion; a large volume fl of fluid will prevent the food from being M properly acted upon by the stomach; and if jfl there be too little, the mass will be dry and M hard. Different kinds of food require dif- ferent quantities of liquid;' animal food re- |fl quires more than vegetable, roasted more ,9 than boiled; and baked meat, more still j than roasted. The time of drinking may ■ be generally left to the individual. To load !fl the stomach with drink before a meal is un- wise; but to drink more or less, during a j meal, according to the nature of the food, id variegated soaps, prepared expressly for the toilet, are equal- ly objectionable, in consequence of the ac- tion on the skin of the colouring matter, which is most commonly some metallic salt. From the occasional use, however, of pure white soap, particularly that manufactured solely from soda and olive oil, which is en- tirely without smcll.'liard, and brittle, the fracture presenting a pearly and granulated or crystalline appearance, not the least in- jury to the skin need be apprehended; while it will be found to cleanse it more effectually from all impurities than any of the substitutes for soaps which females, in particular, are too much in the habit of re- sorting to; many of which have a decidedly prejudicial effect. Pure white soap ought, " therefore, to be invariably used in ablutions of the face and hands, or of the surface generally. COSMETICS. Certain washes, sold under different names, which ladies are induced to use, with the hope of beautifying the skin and adorning the person. No regular practi. tioner will give any encouragement to the use of these, as they always do harm, and frequently cause the occurrence of very dangerous accidents. The most noted are some of the preparations of mercury, or so- lutions of sugar of lead or of the nitrate,of silver; and from the use of this last, effecte the very reverse of beautiful take place. Ladies have gone into the bath with a fine v. bite skin, and have come out brown or black, from the chemical action of the wa- ter or its gases on the oosmetic. Gowland's Lotion, a noted cosmetic, is a solution of cor- rosive sublimate in an emulsion of bitter almonds; and whoever is desirous of es- caping the disagreeable consequences re- sulting from the action of a poison on the skin, or its introduction into the blood, . should cautiously avoid all such dangerous"! compositions. * The only cosmetic wash from which no injury need be apprehended, and the effects of which, when conjoined with temperance.' regular exercise, and serenity of mind, wflf^ never disappoint those who may be induced to use it, is that composed of pure spring water of a proper warmth. COLOGNE WATER. An aromatic tincture, of great fragrance and pungency, much used at the female toilet. It receives its name from the city where it has been manufactured for more than a century, by the members of a family of the name of Farina. The Farinas, of course, loudly vaunt their Cologne water as superior to all the imitations of it made in Paris, London, and elsewhere, though the latter are in general so well prepared as to deceive the most suspicious. The following recipe is given to make a tincture, which some persons prefer even to the genuine eau de Cologne: — Take of spirits of wine, half a pound; lavender water, one pound; balsam of Peru, 15 drops; essence of lemons, 6 drachms; i HYGIENE 119 camphor, 15 grains; spirit of rosemary, half a drachm; bergamot, half a drachm; digest for 7 days and strain. Excepting for its agreeable flavour, we know of no useful purpose to which this tincture can be ap- plied. Many females are in the habit of using Cologne water as a wash for the face, in or- der to preserve the skin smooth and free from pimples, and to prevent it from chap- ping. These latter effects will, however, be much more liable to result from the stimu- lation of the skin caused by the alcohol in the Cologne water, than when simple soft water is used. It cannot be too often re- peated, that the objections to the frequent application of water to the skin are alto- gether founded in error. The brilliancy of the complexion, and the beauty and deli- cacy of the skin, can in no way be so well preserved as when frequent ablutions with warm water are resorted to. DENTIFRICES. Substances used for cleaning the teeth; most commonly those which are in the form of powder are so sailed. Of these, there is a great variety, as almost every dentist has his own favourite tooth-powder. Charcoal is much esteemed by some, as it not only cleans the teeth, but is supposed to assist in remov- ing the bad smell from the mouth. In the East Indies, the betel nut is burned to procure a very fine powdered charcoal. It has, how- ever, the disadvantage of producing a blue- ish discolouration of the gum, which is in- delible. Charcoal seems to act too severely on the enamel; for we have seen many cases where, after the continued use of it and of hard brushes, the enamel has been cut into grooves as with a file; and it is well known, that, from its triturating power, it is used by blacksmiths in polishing steel, to take out the file marks. Magnesia, prepared chalk, powder of cuttle-fish bones, orris- root, and similar substances, are also used, either singly or combined, as dentifrices. As a general rule, all hard and gritty powders, and all acid washes, are injurious to the teeth. When, from childhood, a life of temperance and active exercise has been pursued, every species of dentifrice appears to be useless; all the care that the teeth then demand, to preserve them white and to prevent their decay, is carefully remov- ing, with a quill or splinter of wood, any portions of food which may have lodged during meals between them, and then to rinse the mouth fully with tepid water, and to rub the teeth and gums well once a-day, in the morning, with a soft brush. Most of the accumulations about the teeth, as well as their discolouration and decay, are pro- duced by a diseased condition of the diges- tive organs. SECTION VI. SLEEP. Sound refreshing sleep is of the utmost consequence to the health of the body, ancb the vigour of the mental and corporeal faculties; indeed, so great is its value, and so universal its effects, that no substitute can be found for it; and if it does not pay its accustomed visit, every individual, without exception, feels his whole frame sensibly exhausted; his appetite ceases, his strength fails, his spirits become oppressed and de- jected, or irritable and capricious, and, if the deprivation is long continued, he is soon reduced to a state of the utmost misery. Bodily and mental disease are the usual ef- fects of too long protracted wakefulness. By regular and sound sleep, the exhaust- ed constitution is refreshed, and the vital energies restored; the process of assimula- tion, or of nourishment, goes on more per- fectly; the vigour of the mental faculties is renewed, and the body attains its proper growth. Sleep also contributes to the pro- longation of life, and, in many cases, to the restoration of health, and the cure of dis- ease. During the day, the irritability or excita- bility natural to the human frame in an or- dinary state of health, is exhausted by light, heat, sound, and, above all, by bodily exer- cise and mental exertion, and sleep is the method which nature has provided for the re-accumulation of this excitability, and the consequent restoration of the vital energy, which the body had lost by its former exer- tions. Among the marks and symptoms of lon- gevity, that of being naturally a regular and sound sleeper, is justly considered to be one of the surest indications. This appears to be owing to the physical effects of sleep, which retard all the vital movements, col- lect the vital power, and restore what ha3 been lost in the course of the preceding day. Indeed, if great watchfulness, by ac- celerating the consumption of the fluids and solids, abridges life, a proper quantity of repose must tend to its prolongation. The preceding observations, of course, refer only to a proper quantity of sleep, as few things are more pernicious than too great an indulgence in it. This excess brings on a sluggishness, and dullness of all the animal functions, and materially tends to weaken the whole body. It blunts and de- stroys the senses, and renders both the body and mind unfit for action. From the slow- ness of the circulation which it occasions, there necessarily follows great corpulency, a bloated habit of body, and a tendency to dropsy, apoplexy, and other disorders. Under this head, then, we have to consider I-**, y0 120 HVG principally. 1, The number of horn's neces- sary for sleep. 2, The period best calcu- lated for repose; and 3, The means of pro- moting it when wanted. Quantity of sleep.—What number of hours are necessary for sleep, is a question that has occasioned much discussion. The opinion generally entertained by the ablest physicians, is, that although the quantity of sleep must necessarily vary somewhat according to the age and strength of in- dividuals, yet from seven to eight hours, in the four and twenty, constitute the proper time, and that this period should scarcely ever be exceeded by adults. It is indisputable, that the delicate require more than the vigorous, women more than men, and very young children, more than either; but it is worthy of particular remark, that the sick and weakly seldom require more than eight hours, or at the most nine hours, and will rarely, if ever, fail to be injured by a longer indulgence. Every one, therefore, should endeavour to ascertain what quanti- ty of sleep he requires, that is, by what quantity he is rendered most comfortable and vigorous throughout the day; this all may readily ascertain by experiment. Nothing can be more absurd, than for any individual, who wishes to enjoy health, and to accomplish great things, to deny himself the advantages either of sleep or of exer- cise. Many studious men fall into a great and pernicious error in abridging their pro- per time for repose, in order that they may have the longer period for study. This is highly detrimental, both to the mind and body, for the mind that has been much exercised throughout the day, not only seeks to recruit its strength in sound and refreshing sleep, but cannot regain its ut- most energy without it; so that, instead of any advantage being gained by the prac- tice, there must necessarily be a loss. It has been justly observed, that any person can go through as much business as is ne- cessary, for any considerable period of time, by a uniform application, at the rate of eight hours a day; which will leave abun- dance of time for sleep and exercise. It is proper to add, that the opposite ex- treme of indulging in too much sleep, should be carefully avoided. By lying for nine, ten or eleven hours in a warm bed, the flesh becomes soft and flabby, the strength of the digestive organs impair- ed, and the nervous system relaxed and en- ervated. - Time proper for repose.—Nature certainly intended exercise for the day, and rest for the night. This is proved by experience. For they who, in opposition to the dictates of nature, keep up during the night, whe- ther in exercise, riot or in study, the ac- tivity of the various organs of the system, and endeavour to seek repose for them by sleeping durinjppthe day, disturb the whole economy of their bodies, by which their health is ultimately more or less im- paired. Another point to be considered is, that by the custom of sitting up late at night, the eyes suffer severely, day-light being much more favourable to those deli- cate organs, than any artificial light what- soever. Valangin relates a circumstance that sa. tisfactorily proves the advantage of sleep- ing in the night, instead of the day. It is an experiment made by two colonels of horse in the French army, who had much * disputed which period of the day was fittest for marching, and for repose. As it was an J interesting subject, in a military point of "j view, to have it ascertained, they obtained *H leave from the commanding officer to try 1 the experiment. One of them, although it was in the heat of summer, marched in the PI day, and rested at night, and arrived at the ' I end of a march of 600 miles, without the j loss of either men or horses ; but the other, j who thought it would be less fatiguing to I march in the cool of the evening, and part I of the night, than in the heat of the day, at the end of the same march, had lost most of his horses, and some of his men. In hot climates, more especially in the Jl neighbourhood of swampy ground, persons ■ can not too sedulously avoid being out after sun-set, on account of the extremely dele- M terious qualities of the air at that period; fl indeed, in many places to breathe the 1M night air, is certain death, and in most, fl it is powerfully influential in the produc- ^ tion of dysentery, and some of the worst fevers that prevail in those regions. The plan of going to bed early and rising betimes, has been called the golden rule for the preservation of health and the at- tainment of long life, and it is a maxim sanc- tioned by various proverbial expressions. It is an undoubted fact, that when old peo- pie have been examined, regarding the causes of their long life, they have uniform- ly agreed in one particular, that they went to bed early, and rose early. The day-time, and more especially after 1 dinner, it should be remarked, that although many persons, who have enjoyed good health, have long been in the habit of sleep- ] ing a little in the afternoon, yet it is, upon the vyhole, not to be recommended. When individuals in the possession of a good mea- sure of health and strength, find an inclina- tion to sleep after dinner, it is very com- monly owing to their having eaten too much. They who take no more food than is required for the growth and nourishment of the body, find themselves lighter, and more cheerful, after a substantial meal, than before it, and that subsequent heaviness and torpor is a sure sign of excess. Best means of promoting sleep.—Sleep is HYGIENE. 121 so natural to man, that in almost every in- stance, where the individual is in tolerable health, it must be his own-fault, if he does not enjoy it to that extent which is so es- sential for his comfort and happiness. The principal circumstances to be at- tended to, in order to procure refreshing sleep, are, the nature and quantity of our food and exercise; the size and ventilation of the bed-chamber; the kind of bed and clothing; and the state of the mind. It is certain that a full stomach almost in- variably occasions restless nights, and it is, therefore, an important rule to make a very light supper, and not to take any food later than an hour, or an hour and a half, before bed-time. Towards evening the digestive organs seek for repose, in conjunction with every other part of the body; they are then fatigued and enervated by the labours of the day, and, consequently to give them much to do at that period, cannot fail to ir- ritate and disorder them, which irritation, from the stomach being the grand centre of sympathies, is quickly propagated, through the medium of the nervous system, to every part of the body—hence arises general rest- lessness, instead of a disposition to sleep. It is worthy of observation also, that the sto- mach will sometimes be much irritated by a small quantity of indigestible food taken at night, and thus may sleep be prevented as certainly as if the organ were overloaded with food. A sufficient quantity of exercise or mus- cular exertion, powerfully contributes to sleep, and a principal reason why sedentary persons, and students generally, are so dis- tressed for want of it, is from neglecting to take active exercise in the day. With some persons, the most effectual methods of pro- curing sleep will fail, unless exercise be re- sorted to in the open air. Pure air has of itself an exhilarating and soothing effect on the mind, conducive to sound repose. It is an excellent plan to walk up and down a large room, or passage, for half an hour, or more, before going to bed, and the use of the dumb-bells for a part of the time will augment its good effects. The size, free ventilation, and coolness ■of the bed-chamber, and the nature of our bedding, deserve much regard. If, notwithstanding attention to the pre- ceding rules, sleep is still found to be un- sound and unrefreshing, a brisk use of the flesh-brush, before going to bed, or rising from the bed, and freely ventilating it, will often produce a very favourable change. Another excellent practice, in case you have gone to bed, and cannot sleep, is to rise, shake the bed well, draw the upper clothes down to the feet, and walk about the room, warmly clad, till both you and the bed are aired. Exercise, temperance, early rising, and regular hours of retiring to rest, are the best means for procuring sound repose; and if duly persevered in, will never fail of the desired object. Opiates and sleep- ing draughts should never be resorted to, to procure rest—once resorted to, their ha- bitual use will become necessary, as sleep will not occur without their aid"; while by their prejudicial influence upon the stomach and other organs, their employment will never fail, gradually, to undermine the health of the system. The following miscellaneous rules re- specting sleep deserve to be recorded in this place: 1. Many real or imaginary inva- lids.lie long in bed in the morning, to make up for a deficiency of sleep in the night- time; but this ought not to be permitted, for the body must necessarily be enervated by long continuance in a hot and foul air. A little resolution will enable invalids to surmount this destructive habit. By rising early, and going to bed in due time, their sleep will become sound and refreshing, which otherwise they cannot expe"ct. 2. It is an indispensable rule, that fat people should avoid soft beds, and should sleep lit- tle, and rise early, as the only chance they have of keeping their bulk within due bounds. 3. It often happens, that if a per- son has not slept well, he feels a weariness in the morning, which is best removed by exer- cise. 4. Such persons as are subject to cold feet, ought to have their legs better covered than the rest of the body, when they are in bed. 5. We should never suffer ourselves to doze, or fall asleep, before we go to bed, as it must greatly diminish the probability of sound repose, when we wish for sleep. 6. Reading in bed at night is a most perni- cious custom; it strains the eyes, prevents sleep, and injures the health. 7. At large schools, where great numbers of children sleep together, the utmost attention ought to be paid to the nature of the beds, the bedding, the airiness of the apartment, and every thing that can prevent the bad effects' of crowding numbers together, and compel- ling them to breathe a confined and vitiated atmosphere. 8. Remember sleep is sound, sweet, and refreshing, according as the ali- mentary organs are easy, quiet, and clear. BEDS. The materials on which we sleep, are of much consequence, both as it regards our health, and the soundness of our repose. The use of feather-beds is almost univer- sal in this country, yet there can be no doubt that they are highly injurious to health, and have a tendency to prevent sleep, especially in the summer. To the in- valid, and to young persons who are disposed to distortion of the spine and shoulder, they are particularly hurtful. Such as consider them a necessary luxury in the winter, 122 HYGIKNT.. should invariably exchange them for a mat- tress in the spring and summer. The in- jury resulting from feather beds is occasion- ed, principally, by their accumulating too much heat about the body, and in this man- ner, causing a profuse and debilitating per- spiration, and predisposing the system to the influence of slight changes of tempera- ture. By yielding unequally to the pres- sure of the bod)-, the latter is thrown into a distorted position, which being resumed al- most every night is liable to cause in the young and weakly a permanent deformity. Hair mattresses are superior to every-other kind of bed for this country, and it is highly desirable they should be generally adopted. By those whose means will not permit the purchase of hair mattresses, those of straw, or what are still better, those made from the leaves which surround the ear of Indian corn, properly prepared and thoroughly dried, will be found an excellent substitute. Feather beds are more injurious to the health of children, than even of adults, and especially if they are weakly. In very cold climates, feather beds are often necessary, and in the United States, the aged may often require them, in order to preserve or increase their heat, which is sometimes inconsiderable, and if lessened, would prevent their sleeping. The bed-clothes should also be as light and cool as possible in the spring and sum- mer; and in the winter, no more than just sufficient to preserve a comfortable degree of warmth. Young people and invalids, in particular, ought to avoid many, and heavy, bed-clothes. The head should be only lightly, or rather not at all, covered. The use of curtains to the bed, should be avoid- ed; at least, they ought not to hang down low, nor be drawn in any degree around the bedstead. It is impossible to conceive of what utility they can be; they cannot with propriety be used to exclude light or cold, because the former should be excluded by window blinds, or curtains; and as it re- spects the latter, it is far better guarded against by a sufficiency of bed-clothing. Curtains are injurious, by preventing the proper circulation of the air breathed by those who occupy the bed, and by accumu- lating dust, cause it to irritate the lungs. The bed, as well as the bed-clothes, should be kept strictly clean, and carefully guarded against damp. Beds are apt to become damp for want of proper airing when constantly used; from the damp- ness of the room, and from the coverings not being perfectly dry when laid on the bed. Colds, rheumatisms, and even more fatal complaints may be caused by occupy- ing a damp bed. It would be, in general, a more judicious practice if beds, instead of being made up soon after the persons rise from them, were tupped down, or their co. verings were thrown separately over the backs of chairs, and thus exposed to the fresh air from the open windows through the day. BED-CHAMBERS. A bed-chamber ought not to be situated on the ground floor; and an elevated apart- ment is particularly recommended to l.tera- ry and sedentary people. It should be airy, large, and lofty, and never a small con- fined room. Nothing can be more impru- dent or absurd than the conduct of those who have splendid houses, preferring to sleep in small apartments. The more airy a bed-room is, it is certainly the better that it should be exposed to the sun. A bed- room ought to be well ventilated in the day- time, as it is principally occupied in the night, when all doors and windows are shut. The windows should be kept open as much as the season will admit of during the day; and sleep will probably be more beneficial,. in proportion as this rule is practised. In- deed, nothing is more material, not only for invalids, but for persons in health, than the admission of pure air into their bed-rooms by various ways, and in different degrees, according to circumstances. Keeping open the windows of bed-rooms during the night ought never to be attempt- ed, but with the greatest caution. It is imprudent to sleep in a very warm room, as it makes one faint, and relaxes too much the whole system. . Unless there is an apprehension of damp, a a bed-room should rarely have a fire in it, J as it has a tendency to vitiate the air, often f fills the air with dust and ashes, and some- times may be the means of setting the room on fire. If a fire is kept in a bed-chamber, the danger arising from a small room be- comes still greater; numbers-have been sti- fled when asleep, by having a fire in a small apartment. They who live in hot countries ought to be very particular regarding the place they sleep in. The apartment should be roomy, dark, shaded from the rays of the sun and moon; temperate as to heat and cold, and rather inclined to coolness than heat; while a free admission of air is allow- ed during the day-time, the windows should be carefully closed as soon as the night sets in. It is a good rule for those who are obliged on account of business, to spend the day in close towns, to sleep, if possible, in the country. Breathing fresh air in the night- time will, in some measure, make up for the want of it through the day. This practice would have a greater effect in preserving the health of those who reside in cities, than is commonly imagined. It is hardly HYGIENE. 123 necessary to observe, tthat the chilly air of the first, and the noxious exhalations which fill the second; damp and filthy bed-rooms ought to be particularly avoided, and that they are to health in the highest degree in-' jurious. DREAMING. Dreaming indicates an imperfect state of sleep, insufficient to produce that degree of refreshment which is essential to the maintainance of health. Many dreams, al- so, are of a peculiar, painful, disagree- able, or disgusting character; on these ac- counts, therefore, dreaming should as much as possible be avoided. Dreams, especial- ly those of a harassing and disagreeable kind, are most generally experienced by persons labouring under a state of nervous excitement, produced by indolent and lux- urious living—by intemperance, or by the undue indulgence of the passions, and other mental emotions. As a general rule, dream- ing may be prevented by whatever causes perfect and uninterrupted sleep; such as sufficient exercise during the day, temper- ance in eating and drinking, a cheerful and contented mind, and the avoidance of late or heavy supper, or of strong tea or coffee during the evening. It is very generally the individual who retires to bed with his stomach overloaded with food, or labouring under irritation from its contents, though these may be moderate in quantity, but of a very stimulating or indigestible nature, that suffers from attacks of the night-mare, which, independent of the agony they pro- duce, are by no means unattended with danger. It has been presumed, and not without strong probability of truth, that many of the sudden deaths which take place during the night, in persons appa- rently in the full enjoyment of health, are to be attributed to night-mare. Night-mare. A certain uneasy feeling during sleep, as of great anxiety and diffi- culty of breathing, and of strong but inef- fectual efforts to shake off some incumbent pressure, or to relieve one's-self from great inconvenience. The imagination is gene- rally at work to find some cause for the un- pleasant feeling, and pictures some mon- strous shape as the author of the mischief It commonly arises from an imperfect and unhealthy digestion, from flatulence, from heavy suppers, and from a constrained un- easy posture of the body. Such persons as are subject to night-mare should not take supper, should pay attention to the state of their bowels, and should sleep with the head and shoulders raised. R SECTION VII. THE PASSIONS. The passions are a natural and necessary part of the human constitution, and were implanted in it by the Great Creator for wise and useful purposes. Without them, we could have no motive to action, the mind would become utterly torpid, and, there being no foundation for morality or religion, virtue and vice would be nothing more than indiscriminate and unintelligible terms. The passions are only prejudicial when al- lowed to exceed their proper bounds, or are excited by improper objects; and to preserve them within their just limits, and to give them their proper direction, we are furnished, not only with reason and the light of nature, but likewise, with that more certain guide, the light of revelation. From the intimate though mysterious con- nexion between the mind and body, they reciprocally affect each other, and hence the passions exert a powerful influence over health, and in the production and cure of disease. The two great sources of the passions respectively, are desire and aver- sion ; those of the former class tending in general to excite, and of the second to de- press, the powers of the animal system. The chief passions which arise from desire are joy, hope, and love; and the most eminent in the train of aversion, are fear, grief, and anger. Joy is a passion in which the mind feels a sudden and extraordinary pleasure; the eyes sparkle, a flood of animation over- spreads the countenance, the action of the heart and arteries is increased, and the circu- lation of the blood becomes more vigorous. Instances are not wanting, where this pas- sion, when unexpectedly excited and vio- lent, has produced disease, or even imme- diate death; but when moderate, and exist- ing only in the form of cheerfulness, it has a beneficial effect in preserving health, as well as in the cure of disease. Hope. Of all the passions, hope is the. mildest; and, though it operates without any visible commotion of the mind or of the body, it has a most powerful influence on the health of the one, and the serenity of the other: it contributes, indeed, so much to the welfare of both, that if it were extin- guished, we could neither enjoy any plea- sure in this life, nor any prospect of happi- ness in the life to come; but by the bene- ficent will of Providence, it is the last of the passions that forsakes us. Love is one of the strongest and most ab-. 124 HYGIENE. sorbing passions with which the mind is af- fected, and has at its commencement, and when properly guided by reason, a favour- able influence on all the functions of the body; but being often in its progress attend- ed with other passions, such as fear and jealousy, it is liable to become the source of infinite disquietude. No passion undermines the constitution so insidiously, as violent and unreasonable or misplaced love. While the whole soul is occupied with the thoughts of a pleasing attachment, both the mind and body become languid from the continuance of vehement desire; and should there arise any prospect, real or imaginary, of being frustrated in its pursuit, the person is agita- ted with all the horrors and pernicious ef- fects of despair. Love, when violent and unsuccessful, frequently produces a wast- ing of the body, terminating sooner or later in death. Fear has its origin in the apprehension of danger or evil, and is placed, as it were, a sentinel for the purpose of self-preservation. When intense or habitually indulged in, it destroys the energies of both mind and body, retards the motion of the blood, ob- structs digestion,and prevents the proper nu- trition of the body. Violent terror has been known, in an instant, to turn the hair per- fectly white, and in other instances, to pro- duce fatuity of mind, or even instantaneous death. By weakening the energies of the system, this passion disposes greatly to disease during the prevalence of epide- mics. Grief. There is no passion more inju- rious to health than grief when it sinks deep into the mind. By enfeebling the whole ner- vous system, it depresses the motion of the heart, and retards the circulation of the blood, with that of all the other fluids; it dis- orders the stomach and bowels, producing indigestion, consumption; obstinate watch- fulness, is a very common effect of grief. It preys upon the mind as well as the body, and is nourished by indulgence to the ut- most degree of excess. During the violence of its earlier period it spurns at all the con- solations, either of philosophy or religion; but if life can subsist till the passion be alle- viated by time, and submit to the cheering influence of company, exercise, and amuse- ments, there is a prospect of recovery; though grief long continued, often gives a shock to the constitution that nothing can retrieve. Grief, like fear, predisposes to an attack of epidemical diseases. Anger is a passion suddenly excited, and which often no less suddenly subsides. Equally furious and ungovernable in its nature, it may justly be considered as a transient fit of madness. The face, for the most part, becomes red, the eyes sparkle with fuiy, a violent commotion is visible in the countenance, and pervades the whole body. The nerves are unduly excited; the pulsation of the heart and arteries, and with them the motion of the blood, are sometimes so much increased, as to occasion the burst- ing of some of the minute vessels of the brain I or lungs. The stomach, liver and bowels, are often violently affected by intense an- ' gC1-—digestion is always disordered, a vio- lent colic is sometimes produced, and very J often all the symptoms of jaundice. Thus it operates towards the production of fevers, M inflammations, spitting of blood, apoplexy, U and other disorders. As anger is liable to ^ be spent by its own violence, it is common- ly of short duration; but when existing in a more moderate degree, and combined with 1 sadness or regret, it gives rise to fretting, I which is extremely pernicious to the health. I All the passions, but more especially anger 1 and fear are increased in intensity, and 1 caused to exert a more frequent influence 1 over the mind, by a life of luxury and in- J temperance. Hence, an essential means ■ for their subjection, is a regular, active mode of life, a mild and moderate diet, and the abandonment of all intense excitements and stimulating drinks. Anxiety of mind. A state of mind alto- gether adverse to health; when constant- ly indulged in, it destroys the digestive powers of the stomach, impairs the func- tions of the lungs, disturbs the regular cir- culation of the blood, and impedes the nu- J trition of the system. It is a fruitful source, J J in civic life, of chronic affections of the l| stomach, liver, heart, lungs and brain. Even the anxiety induced, in a sensitive mind, by the ill-humour, caprice and unkind treat- ment of others is deeply felt, and proves highly injurious to health. SECTION VIII. CARE OF THE IIAIR. Under the ordinary circumstances of health, in conjunction with temperance and regular exercise, the only safe and effectual | means of preserving the hair and of pro- i moting its growth and beauty, are the fre- f quent use of the comb and brush, and regu- j lar ablution. f Whatever has a tendency to impede the i passage of the fluids by which the hair | is nourished, from the root along the tube I in the centre of each hair, must necessarily 1 prevents its proper growth—render it thin, ' and deprive it of its soft and glossy appear- ance. There can be little doubt that this is the effect, to a certain extent, of the prac- tice of twisting the hair from its natural po- sition, and of plaiting or firmly braiding it, j HYGIENE. 125 pursued, in obedience to the dictates of fashion, by most females. The injurious consequences of such modes of dressing the hair, can only be obviated by a daily re- sort to the comb and a hard brush, which, by disentangling, restores it to its natural direction, and freeing it from every restraint, enables it to receive a due supply of its ap- propriate fluids. The growth of the hair is not, however, always impeded by artifi- cial means: this may result, also, from al- lowing it from neglect to become entangled and matted together—a condition to which it is extremely liable from its peculiar form. Hence, under all circumstances, frequently combing and brushing it through its whole length, is absolutely necessary to its proper preservation. Independent of the good effects of these operations in rendering the hair pervious to the fluids which rise from its roots, they fa- cilitate its development also, by freeing the scalp from accidental impurities, facilitating the circulation through its vessels, and thus enabling it to perform freely its functions. Another means of promoting the growth of the hair and insuring its permanency, is by frequently cutting it. It must be very obvious that when kept short, its fluids are less liable to be obstructed in their passage than when the hair is long—it being diffi- cult in the latter case to preserve it straight and to permit it to have its natural flow. It is in early life, particularly, that frequent cutting will be found highly advantageous. Whenever the hair becomes thin and irregular, or its beauty is otherwise impair- ed, nothing is better calculated to restore its proper growth than cutting it short. Frequently cutting the hair also prevents it from splitting at the ends and growing fork- ed—the Recurrence of which, so common in young persons, gives it an extremely in- elegant and ungraceful appearance. In children, keeping the hair short is a circumstance of no little importance—and should not from any light consideration be neglected. Their health, and in some re- spect their beauty also, is prejudiced by a contrary practice. Nothing is more com- mon than to see a luxuriant head of hair ac- companied in children by paleness of com- plexion, weak eyes, and frequent complaints of headach. Upon this subject we find the following excellent remarks in a little work entitled " Advice to Young Mothers, by a Grandmother." We recommend their at- tentive perusal to every parent. " The hair in children should be cut short until they are eight or nine years old— as the cooler the head can be kept, the less danger there is of many maladies peculiar to that partof the body, especially water on the brain. Besides, there is good reason for believing, that children who have a great quantity of hair, are those most liable to eruptions, as scald head, &c.: it is at least certain, that in them eruptions are very dif- ficult to remove. The trouble, also, of keeping long hair sufficiently clean, and the length of time necessary for this pur- pose, is often a cause of much ill humour and many cross words, between children and their attendants, which it would be bet- ter to avoid. " Mothers, whose vanity may be alarmed lest repeated cutting the hair for so many years should make it coarse, may be as- sured they have no cause for this apprehen- sion, provided the hair be kept constantly brushed. I have never seen softer, finer - hair, than on girls who have had it kept short—like that of school boys—until tiiey were in their tenth year." When there is any tendency to sores or eruptions on the head of children, fine combs are very apt to promote them. There is no doubt that the heads of young per- sons, which are never touched by them, may be preserved much cleaner, by strict attention, than such as are scratched and scraped every day. If any dirt appears on a child's head, which a brush will not re- move, that particular part should be rubbed with a towel, and soap and water—but in general, the brush will be found quite suf- ficient to keep it perfectly clean. The sel- domer, indeed, a fine comb is applied to the head of an infant, the better: when, however, those of ivory, tortoise shell, or bone are used, the greatest care is neces- sary lest they wound the skin and produce a sore, or by unduly irritating it augment the production of the scurf they are often intended to remove. PRESERVATION OF THE SIGHT. The following are the general rules for preserving the sight unimpaired for the longest possible period. 1. All sudden changes from darkness to light, and the contrary, should be avoided as much as possible. 2. Avoid looking attentively at minute objects, either at dawn or twilight, and in dark places. 3. Avoid sitting near a dazzling or intense light, as of a lamp or candle, and facing a hot fire. 4. Avoid reading or sewing much by an imperfect light, as well as by artificial lights of any kind. 5. Avoid all dazzling and glaring sun- shine, especially when it is reflected from snow, white sand, or other light coloured bodies. 6. Avoid dust, smoke, and vapours of every kind, which excite pain or uneasi- ness. 7. Avoid rubbing or fretting the eyesin any 126 HYGIENE. manner, and wiping them with cotton hand- kerchiefs. 8. Avoid much exposure to cold north- west or easterly winds. 9. Avoid all spirituous and heating li- quors, rich and .highly seasoned food, and every species of intemperance, all of which invariably injure the eyes and impair their sight. 10. Some persons living in cities wrho have weak eyes, find permanent relief only by a change of air to that of the country. Persons of this description will find an advantage in wearing some defence before their eyes, especially when exposed to heat, sunshine, or glaring lights. This will be best if of a green colour. Spectacles that do not magnify, of the same hue, are well suited for this purpose. CARE OF THE BOWELS. Regularity of the bowels in reference to their natural discharges is of very great im- portance to health and comfort. An evacu- ation once in the twenty-four hours is the best standard of frequency—this, in gene- ral, takes place whenever the digestive or- gans are in a state of health. Some persons, it is true, are naturally inclined to costive- ness, and without feeling any inconvenience pass several days without a stool. In gene- ral, however, a costive state of the bowels arises from errors in diet—want of exercise —intemperance, or in fact from whatever reduces the tone of the system generally, and of course that of the digestive organs. Confinement to a diet composed chiefly of dry animal food, or of food highly seasoned —the use of fresh bread, and of warm rolls and cakes, very generally induces a costive state of the bowels. It is very common also in persons who use little exercise, or who pass the greater part of the day within doors in occupations of a sedentary character— hence, females are much more subject to it than males. Lying in bed to a late hour in the morning is unfavourable to a regular condition of the bowels: it causes costive- ness, not only by increasing perspiration, but also by creating an inactive condition of the system generally. Early risers, who pass several hours of the morning in walking abroad in the open air, if they be temperate withal, seldom complain of any want of regularity in their stools. The daily use of wine, especially the red or astringent varieties, retards very mate- rially the natural discharges of the bowels. The same effect takes place in persons who pass the greater part of their time in com- pany, and who from a false delicacy resist the calls of nature. They who ride much on horseback, or in a carriage, or when at sea, are said, also, to have a habitually sluggish state of the bowels. The means of obtaining a regular condi- tion of the bowels will be readily perceived from the foregoing enumeration of the causes by which costiveness is induced. In addi- tion to early rising, daily exercise of the body in the open air, and abstinence from wine and ardent spirits; the diet should be composed principally of vegetable food. Plain soups, especially of veal and mutton, with the addition of the ordinary culinary vegetables, well boiled and not too highly seasoned, will be found a very excellent diet for those inclined to costiveness. Fresh fruits, perfectly ripe, or fruit cooked, with or without the addition of sugar or molas- ses, are gently laxative, and hence very proper articles to be eaten by such indi- viduals. Spinach, when in season, and pro- perly boiled, is also a very pleasant and wholesome vegetable in costive habits. The same may be said of well boiled cab- bage and sourcrout, when these agree perfectly with the stomach. Bran bread, or wheaten bread with an admixture of rye or Indian meal, is better suited to the ha- bitually costive than bread composed en- tirely of fine wheat flour. For drink, those troubled with costiveness should make use of water, either alone, or with the addition of a smaii quantity of sugar or molasses, or water slightly acidulated with some of the vegetable acids. A very pleasant drink is made by dissolving currant jelly in water, or by pouring boiling water upon sliced ap- ples or peaches, and allowing it to stand until cold. This acts gently upon the bow- els, and hence tends to obviate costiveness. Buttermilk, or sweet whey, may likewise be occasionally drunk with advantage by those whose fecal discharges are defective: all ar- dent spirits and wines, especially those of an astringent nature, should be carefully avoided. The method recommended by the celebrated Locke, for procuring a re- gular discharge from the bowels, is founded on correct principles, and should not be neglected; it is, "to solicit nature, by going regularly to stool every morning, whether one has a call or not." Such a practice will very often induce a habit which in time be- comes natural. To remove costiveness, individuals should be extremely cautious in resorting to purga. tives, or those medicines, under whatever name they may be sold, which have the ef- fect of inducing evacuations from the bow- els. The frequent use of these articles, however mild they may be, tends to disturb the stomach and bowels; and consequently, to vitiate or retard digestion. As a conse- quence, the costive habit, to obviate which they are resorted to, is in fact increased, and with it the necessity for repeating the medicine more frequently, or of increasing HYGIENE. 127 its activity; and finally, a stool can never be procured without its use. In a very short time, in fact, they become invariably productive of more injury than the original complaint. It is always, therefore, more safe to remove costiveness by a proper diet and regimen than by medicine; and unless the costiveness is dependant upon some deep seated disease of the bowels, stomach, liver, or some other organ, by a proper at- tention to the latter means, and perseve- rance in their use, it will very generally be overcome. THE FEET. The proper care of the feet consists in de- fending them from cold and w et, by stockings and shoes of a proper texture and thick- ness, and so adapted in shape and size as to allow perfect freedom to the motions of the feet in walking, while they do not press un- necessarily on any part. The feet are ex- tremely subject to the impression of cold, and when chilled, in consequence of the close sympathy between them, and other parts of the body, disease is apt to be occa- sioned in some one of the internal organs. Hence, not only should they be protected always from cold and damp, but when ac- cidentally wet, the shoes and stockings should be immediately changed, and the feet bathed in warm water, or rubbed per- fectly dry with a coarse cloth. Tight and misshapen shoes are injurious, as well by preventing the individual from walking se- curely and with sufficient ease, as by causing a thickening of the cuticle over the joints of the toes, forming what are called corns, and which, by. pressing upon the parts be- neath them, are the cause of very considera- ble pain vvhenever walking is attempted. It is essential that the feet, as well as every other part of the body, should be kept per- fectly clean by frequent ablutions. USE OF TOBACCO. Tobacco, nicotiana tabacum. A well known plant, which derives its generic name from Nicot, a French ambassador, and its specific name from the island of To- bago, whence it was brought in 1560. It is at first nauseous and disgusting; but in one or other of its forms, it has become one of the most generally used articles of luxury, exhibiting a remarkable illustration of the wonderful power of custom, in reconciling us to those things which are at first most disagreeable. Tobacco has fascinated all ranks of men, and the natives of every cli- mate. The attractions of tobacco seem to be owing to its narcotic properties, by which irritability is soothed, and serenity induced, as by opium and some other substances. In large quantities, and in those who are un- accustomed to it, stupor, giddiness, nausea, and vomiting are produced. The effects of tobacco, though they re- semble in many respects, are considerably different from those of any other inebriating agent. Instead of quickening, it lowers the pulse, and, when used to excess, pro- duces languor, depression of the system, giddiness, confusion of ideas, violent pain m the stomach, vomiting, convulsions, and even death. Its essential oil is so intensely • powerful, that two or three drops inserted into a raw wound, would prove almost in- stantly fatal. But when used in moderation, tobacco has a soothing effect upon the mind, disposing to placid enjoyment, and mellow- ing every passion into repose. Its effects, therefore, are inebriating; and those who habitually indulge in it may with propriety be denominated drunkards. In whatever form it is used, it produces sickness, stu- por, bewilderment, and staggering, in those unaccustomed to it; and in those who habitually indulge in it, the digestive pow- ers and tone of the stomach are always more or less impaired. There is no form in wdiich it can be taken that is not decidedly inju- rious and disgusting. In the form of snuff, although a moderate quantity, taken now and then, may do no harm, yet, in the extent to which habitual snuffers carry it, it is positively pernicious. The membrane which lines the nose gets thickened, the olfactory nerves blunted, and the sense of smell consequently im- paired. Nor is this all, for, by the strong inspirations which are made when the pow- der is drawn up, some of the latter is pretty sure to escape into the stomach. This or- gan is hence directly subjected to a pow- erful medicine, which not only acts as a narcotic, but produces heartburn, and every other symptom of indigestion. If it were attended with no other inconvenience, the black, loathsome discharge from the nose, and swelling and rubicundity of this organ, with other circumstances equally disagree- able which it produces, ought to deter every man from becoming a snuffer. The smoker, while engaged at his occu- pation, is even a happier man than the snuf- fer. An air of peculiar satisfaction beams upon his countenance; and as he puffs forth , volumes of fragrance, he seems to dwell in an atmosphere of contented happiness.— Smoking, nevertheless, pollutes the breath, blackens the teeth, wastes the saliva which is required for digestion, and injures the complexion. In addition to this, it is apt to produce dyspepsia, and other disorders of the stomach; and, in corpulent subjects, it disposes to apoplexy. The observations made upon the effects of snuffing and smoking, apply in a still stronger degree to chewing. This is the 128 HYGIENE. worst way for the health in which tobacco can be us'ed. The waste of saliva is greater than even in smoking, and the derange- ments of the digestive organs proportiona- bly severe. All confirmed chewers are more than usually subject to dyspepsia and hypochondriasis; and many of them are af- flicted with liver complaints, brought on by their imprudent habit. SECTION IX. TRAINING. Amoxg the nations of antiquity, distin- guished by their genius and political sa- gacity, it was a great object with their law- givers and statesmen, to direct the education of youth, so as to produce in them the great- est possible aptitude for war. To this end, most of their celebrated games were direct- ed; and the combatants in these, while they afforded to the moral philosopher examples of patriotic and generous emulation, furnish- ed also to the painter and the statuary the finest models of the human form, and to the natural historian some curious results of the effect of external agents, in promoting the growth and activity of the animal economy. It may be stated, in general terms, that the efforts of the athletae were directed to regu- late their diet, exercise, and sleep, in such a way as to produce the greatest possible strength of action and power of endurance; and we have the testimony of an inspired writer, that they who were ambitious of a crown in the Grecian games, "were tem- perate in all things." In our own time, this art of bringing up the human constitution to its highest pitch of muscular vigour, and capability of enduring fatigue, pain, and hardship, has been brought almost to a science; and though the ends to which it is commonly directed are far from sublime or virtuous, being principally those of prize- fighting, or walking for a wager, the whole process, and its results, present some curious facts in physiology, and illustrate in a very striking manner the importance of well re- gulated diet and regimen as a means of pre- serving health and increasing the vigour of the constitution under all circumstances; and the important.service a well directed system of training would render to the dys- peptic, and others labouring under chronic . affections, or a general reduction of the powers of life, produced by irregular or se- dentary lives. In a course of training, the great point is to regulate carefully the diet, and to give such food, as is at once nutritive and easily digestible. As we have repeatedly stated in different parts of this work, animal food is the most nourishing,! but requires a due proportion of vegetable aliment, to prevent bad effects on the constitution. Beef, mut- ton, and venison are the most easily digest- ed kinds of meat; the young of animals, as veal and lamb, and fat oily food, as pork, are deficient either in their powers of nutri- tion or digestibility. The vegetables to be taken are potatoes, brocoli, or turnips. Stale bread is preferable to new. Pastry, pies, and puddings are to be avoided, and all the varieties of spices and sauces. Vine- gar and salt are the only condiments allow- ed. The quantity of food cannot be spe- cified; it must vary with the constitution of every individual. The drink allowed in training is pure soft water. If wine is taken, it is in very mode- rate quantity, largely diluted with water, and white is preferred to red. Spirits in any shape, either plain or diluted, are never allowed. The most essential particular in the art of training, is to regulate the exercise, and to take plenty of it. Both within and with- out doors, exercise of various kinds must be taken. Walking, riding, fencing, quoits, tennis-ball, the dumb-bells, may all be prac- tised. As long as the perspiration is mode- rate and not debilitating, exercise may be persevered in from four to six hours a-day,. with the most decided increase of general health and muscular vigour. Pure air is an essential requisite. The noviciate in train- ing is recommended to go to bed early and to sleep from seven to eight hours. The above precepts contain the principal means for raising the body to its highest de- gree of health and perfection; and the dili- gent practice of them must, as experience testifies, have the best effects on the expan- sion and motions of the chest, on the func- tion of digestion, and on all the secretions of the body. BLEEDING. The artificial abstraction of blood is often resorted to by persons in health, either to prevent the formation of too much blood in the system, or more generally to prevent disease. But such a practice is in the high- est degree impi-oper; it can answer neither end; on the contrary, it is attended with the most injurious effects. Persons so constituted as to make much blood, should carefully avoid all those causes which tend to augment it, especially an in- dulgence in animal food, wine, and malt li- quors; and when they are sensible of a con- siderable increase in the quantity, they should confine themselves to a light frugal diet, consisting principally of vegetables, or for a time solely of bread and water—should sleep but very moderately, and take much active exercise. Nothing can be more HYGIENE. 129 opposed to reason and experience, than for such individuals to have recourse occasion- ally to the abstraction of blood by the use of the lancet, or cupping glasses, in order to prevent too considerable a formation of this fluid; for habitual blood letting invariably begets, under such circumstances, habitual plethora, which calls incessantly for a repe- tition of the same supposed remedy. Some persons are in the habit of being bled every spring or fall, or at both these seasons; but, however robust the constitution, this is not a practice to be recommended, since, like all other periodical or repeated bleedings, it proves only a palliative remedy, which sooner or later greatly enervates the body, deranges its functions, induces a premature old age, and calls for a more frequent re- course to the operation. HABIT. This term, when applied to corporeal subjects, signifies the effect of frequent re- petition in facilitating the performance "of certain motions or trains of actions. A con- spicuous illustration of the power of habit, is seen in the practice of musicians on va- rious instruments. To play on any of these, required at first the closest attention to exert the power of volition in directing the various muscular motions required; but by habit, those motions return in their proper order, without the slightest apparent effort; and even while the performer can think and talk on other subjects. When a child be- gins to learn the art of reading, the form of every letter, and the power of every sylla- ble demands his attention; but in maturer years, the eye glances over the page with the rapidity and certainty of instinct, and seizes the words before it, without the con- sciousness of an effort. The effects of cus- tom or habit on the mind and body are in- teresting in a metaphysical, ethical, and physiological point of view. We are all the creatures of habit, and our circles of actions, as Dr. Darwin calls them, return with as- tonishing and noiseless regularity ^ When the time of meals or of sleep arrives, though the stomach be not empty, nor the limbs fatigued, though the mind be occupied with other things, the usual sensation of hunger or drowsiness comes on, and we feel the want of something to which we have been accustomed. The repetition of certain mo- tions renders the muscles that perform them quick and strong, or delicate and steady in their action; hence the dexterity and skill of the watchmaker or philosophical instru- ment maker; hence the ease of the mechani- cal part of their art to the painter or sculp- tor; and the steadiness of the limbs and acuteness of vision of the mason and sailor, in the execution of their perilous occupa- tions. Good habits, early begun, contribute much to the preservation of the health. Early rising, temperate meals, and regu- larity in the alvine discharge, when early practised, and diligently persevered in, will give a degree of comfort and vigour, un- known to the irregular and careless liver. Infants can very soon be taught the habit of feeding at regular times, and of performing the usual evacuations. The action of medi- cines on the living body is much influenced by habit. A person who is accustomed to take emetics or purgatives, requires after a time to have their quantity increased; and the opium-taker and dram-drinker require their poison to be either augmented in quan- tity or activity, to produce the usual effects. By habit, the most nauseous substances lose their disagreeable effects, and infectious principles lose their power; thus, the use of tobacco is a luxury; and the culprit has been known to occasion fever in others, by bringing an infectious miasm from his cell, where he himself had been in the habit of inhaling it with impunity. Idiosyncrasy is a peculiarity of consti- tution, rendering a person liable to be affected by certain agents, differently from the generality of mankind. Thus some persons are incapable of using butter or cheese; some are purged by honey; others cannot wear flannel without, intolerable irritation; some have a violent fever and eruption by the use of certain kinds offish, or certain fruits, or malt liquors. Some peo- ple have idiosyncrasies with respect to me- dicines; thus, opium has such very distressing effects on some patients, that it cannot be used by them as by others. Idiosyncrasies are to be discovered only by experience in each individual case; and where they are matters of indifference, it is needless to waste time in combating them; but where they may lead to disease, or interfere with methods of cure, a prudent physician will endeavour to correct them. SECTION X. MANAGEMENT OF INFANTS. 1. Navel-string. When the infant is se- parated from the mother, and the navel- string is tied, the part attached to the child should be wrapped in a piece of soft linen rag, to keep it from fretting the skin of the neighbouring parts. In five or six days after birth, this portion of the cord drops off, leaving the part below a little tender, but this goes off in a week or two merely by the application of a rag spread with a little simple cerate. 2. Washing. It is very proper to wash the new-born infant with warm soft water, 130 HYGIENE. as there may be various impurities about its surface; frequently a thick layer of white viscid matter covers a great part of its body. This washing should be very gently performed, and we need not be anxious to have every part of the skin quite clean. What does not come off* at the first washing, will readily come off at the next. No spirits should be put on any part of the body; they are apt to cause a fretting and soreness of the skin. The idea that this pre- vents the child from catching cold is per- fectly ridiculous. 3. Clothing. The good sense of modern times has abolished the absurd and danger- ous practices of swathing and binding in- fants in the light manner it was formerly done. Their dress should be light and easy, adapted to the climate and season; and in the night, they should be kept comfort- able, but not too warm. The dress should be fixed, as much as possible, with tapes, and not with pins; and though a consider- able extent of motion should be allowed to infants, their hands should not be suffered to scratch their face and eyes; and a flannel roller should be kept round the belly for a protection to the navel, at which there is apt to occur a rupture from their violent crying. 4. Purging of Infants. The bowels of new born infants contain a large quantity of a dark, viscid, tenacious matter, which medical men call meconium. In general, it is brought away by the first portion of milk which the child sucks, which acts as a pur- gative, and cleans the bowels more effectu- ally than the sugar and water with which it is usual to cram a child the moment it is born, with great injury to its health. When it is retained too long, it may be pro- ductive of considerable inconvenience. In such cases, an injection of warm water, a little molasses and water, or a spoonful of perfectly fresh melted butter, will be pro- per. 4. Putting the child to the breast. In a few hours after delivery, if the labour has terminated naturally, the mother will be suf- ficiently rested to have the child put to the breast. This should always be done as soon as it conveniently can, even though no milk has as yet been secreted. The milk first secreted, as we have already remarked, is calculated to relieve the infant's bowels from the dark viscid matter which they contain at birth; the nipple also is drawn out by the action of the child, and prevent- ed from becoming imbeded in the breast, as this swells with the flow of the milk into its vessels; and painful affections of the nip- ple and breast are less liable to occur. 5. Temperature of the child's body. A young infant is peculiarly susceptible to the impression of cold. When exposed to too low a temperature, it not only suffers great pain and uneasiness, hut its growth is liable to be stunted, and diseases of a most fatal character are often produced. Hence, its body should be kept comfortably warm by sufficient clothing, by a proper temperature of the room, and by washing it in warm wa- ter. It is not only a ridiculous but a mis- chievous supposition, that the strength and vigour of an infant is increased by exposing it to cool or cold air, and plunging its ten- der body in cold water. A robust infant may preserve its life through such a course of treatment, but if the infant be delicate, it will most certainly perish. 6. Cleanliness. It is essential that the skin and clothing of a child be kept per- fectly clean. It cannot thrive unless this be attended to. Hence, the necessity of washing it all over every day with warm water, and those parts of its body that may be accidentally soiled more frequently. Its clothes should be frequently changed, and always the moment they have contracted filth from any cause; and the same clothes and diapers should never be put on it again, until they have been washed, and thorough- ly dried. An infant should always be kept quite dry. 7. Food of infants. For the first nine or ten months, the infant should be confined entirely to the breast of the mother, or to that of a healthy nurse. The pap which is given at an early period to infants, is apt to turn sour upon their stomach, and to cause griping pains and disorder of the bowels. If at any time it is necessary to feed the child, it should be with fresh cow's milk, boiled with an equal quantity of water, and sweetened with loaf sugar. Just before weaning, it may be necessary to accustom the child, by degrees, to other food than that of the breast. The best for this pur- pose will be well baked stale bread, or crackers, grated, and boiled in milk, soft plain custard, milk boiled and thickened with rice flour, a soft boiled egg, or beef tea, thickened with grated bread, or bis- cuit. 8. Air and exercise for infants. Nothing is of more consequence to infants than good air, but they must not be exposed to the open air too soon; not for three weeks or a month, unless the weather be unusually fine. When infants are first taken out of doors, they should not be kept out long at a time; the person who has charge of them should walk gently, and be careful to avoid standing still, especially in a current of air. Exercise is also essentially necessary. At first, the common operations of washing, and being dressed, morning and evening, are sufficient exercise; then the playfulness of a healthy infant, so delightful to its mo- ther, and so readily indulged by it, ac- complish the same purpose; as the limbs get stronger, the exercise may be extended HYGIENE. 131 still further. All coastrained postures, and long confinement in any one situation, should be avoided; and the infant should not always be carried on the same arm, nor be laid always on the same side. A healthy infant is fond of exercise. He should be moved gently up and down, but without any shocks. On this account, the modern cot is preferable to the cradle, for the child may be shook by the latter into a stupor, which an inconsiderate nurse will take care to do, as it saves her the trouble of at- tending to the infant's play. In dandling. the child, great inconveniences arise from compressing the breast. When the child sits on the left hand, to prevent accidents, it is made to lean forward against the right, placed on its breast, and if the nurse is timid, or if the child starts, the only security is.to clasp the breast, by which the ribs are often compressed. If, however, the right hand is placed under the arm, with the thumb over the shoulder, an active child may even start from the other hand without danger. The right hand will support it, or convey it gently to the ground. Swinging seems to give children an uneasy feeling; and even being carried quickly down stairs, will make them shrink to the nurse's breast. Gentle friction is an excellent addition to exercise, and peculiarly grateful to infants. A healthy child scarcely ever cries. This position, we know, will be disputed; and a child is said to be peevish, fretful, and un- easy, when the nurse is careless and inat- tentive. Dispositions undoubtedly differ; but. the pavp-nt who finds a child constantly crying, should suspect her nurse, and even herself. One cause of this fretfulness is the opinion that the nurse knows when the child should sleep, or eat, better than itself. It is forced to feed when not Jiungry, and to sleep when eager for play or amusement. We have often cured this disease, by cor- recting the attendant. It indeed happens, that some children will not sleep by night, but even this may be conquered by manage- ment; for the healthy child may be amused during the day, and his amusements may be gradually protracted till night approaches. Disposition and fancies show themselves very early to the attentive observer; and when reason has not yet attained its power, to correct them with violence, irritates without amending. Even at an early age, children may be soothed into regularity and obedience; they cannot be forced. If a child screams suddenly, or frequently, he is undoubtedly ill, and should be carefully at- tended to. The fault will generally be found to consist in its having been over fed, or upon improper food, or in want of clean- liness, or in exposure to a cold or impure air. Cradles. Some physicians think it is very doubtful, whether the practice of allowing infants to sleep in cradles, be at all neces- sary or proper. They suppose that rocking favours sleep, merely by inducing a certain degree of giddiness and determination to the head. Nothing certainly can be more absurd or dangerous, than the violent, long continued, and noisy rocking to which chil- dren are often subjected; and there cannot be the smallest hesitation about condemn- ' ing this. Yet the cradle, in every nation, and from the remotest antiquity, has been so universally employed, and such countless multitudes of children have been rocked without any injury, that experience does not furnish a sufficient reason for prohibiting a careful use of the cradle, wherever it may be thought convenient. All violent rock- ing, on hard and unequal floors, should be avoided. Swinging cradles are preferable to those made with rockers. The usual covering made over the head of a cradle is improper, as it tends to prevent a free circulation of the air which the infant breathes; this is still further impeded, by the improper practice of hanging a curtain in front of the cradle. WEANING. The change of an infant's diet from the mother's or nurse's milk to solid and liquid food, is a circumstance of great importance with respect to his future health. The pe- riod of weaning will depend on the con- sideration of various particulars, as the state of the child's health, and of that of the nurse; the condition of the infant, with re- spect to teething, the season of the year, the prevalence of epidemic diseases, &c. When both mother and child are in good health, there is no advantage gained by suckling the child above nine or ten months. If she is in delicate health, or is suffering from the effects of nursing, or much debili- ty, the child may be weaned before that age. The winter is an inconvenient time for weaning, as the infant cannot be amused in the open air through the day, and is like- ly to be fretful during the long nights. The summer, likewise, ought to be avoided, par- ticularly in cities. The heat predisposes the infant to bowel complaints, which are best prevented by confining it solely to its mother's milk. If the child is teething, and feverish, and uneasy in consequence, it is not proper to wean him, and add the loss of his accustomed gratification to the other sources of his annoyance. If the child is of a feeble constitution, or if the parents are scrofulous, or otherwise unhealthy, the child should be nursed for sixteen or eigh- teen months, not, however, by its mother, but by another woman, of a healthy and sound constitution. 132 HYGIENE. The great point to be attended to in weaning is, that it be not done abruptly, and that the child be duly prepared for be- ing deprived of its milk, by having its sto- mach, for a considerable time before, accus- tomed to different kinds of wholesome food. For some weeks previous to weaning, it should be, in a great measure, fed upon spoon-meat, and the milk allowed should be gradually diminished. No harsh or disgust- ing methods should be used to make the child loathe the breast. If it be in good health, and be taken out in the open air, and amused,—if*its diet and bowels be at- tended to, it will soon be independent of the milk; of which we suppose, it has for some time been daily more and more de- prived. If the weaning be ill managed,—if it be too abrupt,—and if the food we give do not agree with the infant, disease of the sto- mach and bowels, of a more or less danger- ous character may be the consequence. When an infant is weaned, it is improper and unnecessary to give medicines, unless some urgent symptoms demand attention. The bowels should not be teazed with lax- ative drugs, nor should opiates ever be given merely to stupify the child, and keep it quiet during the night. When rest- lessness occurs, which will seldom be the case when the child is fed on light whole- some food, and properly nursed; the infant ought to be taken out of bed, and carried about through an airy room. The child should early be accustomed to regularity in the periods for taking meat and drink; and of these, very little should be given du- ring the night. Spirits and water, as well as wine or beer should never be given to children on any pretence whatever. .After weaning, the food of infants should consist of weak beef-tea, panado, light pud- ding, and the various preparations of milk. Rusk biscuit ought, generally, to be used, instead of ordinary bread. Frequent ex- posure to the open air when the weather is favourable, and an increased degree of ex- ercise, and perfect cleanliness, are highly beneficial to newly weaned infants. MANAGEMENT OF CHILDREN. The period of childhood is of great im- portance, being the time - hen habits are formed, and the foundation laid for infirmi- ties and diseases, that materially affect the comfort, health, and usefulness of the indi- vidual in after life. Children, in civilized society, cannot be left to the care of nature, like the young of the lower animals; but must be directed and controlled in many things, by the prudence and experience of those who are older and better informed than themselves. The principal points de- manding attention are the regulation of the diet, sleep, clothing, cleanliness, and exef > cise. » Diet. Between the period of weaning and the seventh year, the diet should con. sist principally of farinaceous food, and milk; with a very moderate allowance of animal food once or twice a-week; always taking care that it be dressed in the most plain and simple way, with the rigid exclu- sion of all savoury sauces, or heating cond> ments; such as would either tempt them to eat too much, or be heating and irritating to the mouth and stomach, and that would raise a feverish excitement, or cause them to drink too much fluid. A soft boiled egg, rice or bread puddings, milk, sago, pana- do, or arrow root, will form a pleasing va- riety in the diet of children. Oatmeal por- ridge has been the food of many a healthy and thriving child. They may be allowed to eat perfectly ripe fruit in moderate quan>- tity; the stone fruits, however, are objec- tionable, being very apt to produce bad ef- fects on the stomach. Their drink should be plain water, milk and water, toast wa- ter, or whey. After the seventh yeai^ when the exercise is more violent, and the rapid growth of the body requires more co- pious nutriment, the allowance of animal food may be somewhat more liberal; but through the whole period of childhood, and indeed almost through life, great quantities of animal food, or of butter, or smoked and stimulating food should be avoided, together with all kinds of pastry, made dishes, and their sauces. Bowels. To keep tKc bo possessed of a bitter taste, which are use- I ful both in diet and in medicine. They 1 produce a tonic effect on the digestive or- j gans, and through them on other parts of j the system. Bitters seem to be necessary to promote digestion in animals who live on herbs, as cattle do not thrive upon grasses which do not contain a portion of bitter MATERIA MEDICA. 147 principle. In man, slight bitters produce also invigorating effects on the stomach, and increase the digestibility of vegetables. The purest bitters, and those which are most used as medicines, are chamomile flowetrs, gentian, quassia, and Colombo. Chamomile flowers are used in the form of infusion, made by pouring a quart of boiling water on a handful of the dried flowers. Of this infusion, a tea-cupful may be drank twice a day. There are different ways of using Gentian. The infusion of the root in hot water is one of the most agreeable bit- ters we can employ; and the flavour will be improved by infusing along with the gentian some orange peel or the rind of le- mons ; from one to two ounces may be taken twice a day. The extract of gentian is used in the dose of from ten grains to • thirty, made into pills. There is a wine of gentian made by macerating for twenty-four hours, in proof spirit, four ounces of the following ingredients: half an ounce of gentian root; an ounce of Peruvian bark, two drachms of dried orang-e peel, and an ounce of cariella bark. After the macera- tion, two pints and a half of white wine are to be added; of this, one or two dessert- spoonfuls may be taken twice a day. The tincture of gentian is also very much em- ployed. But a serious objection to using bit- ters in the form of wine or tincture, is the re- semblance which such practices bear to dram-drinking, and the danger of inducing that habit. Quassia is an excellent bitter, used in the form of infusion made by a drachm of the bark and wood of the plant to a pint of water: a cupful may be drank several times a-day. Colombo may be used in powder or in tincture; ten grains of the former, and a tea-spoonful in a glass of wa- ter, of the latter. Bitters are improper, however, and will not, restore strength to the stomach, unless that organ is perfectly free from inflammation and irritation, and the other portions of the digestive appa- ratus perform freely their respective func- tions. It is important, also, to remark, that the long continued use of bitters is pro- ductive of very serious injury to the stomach. BLOOD-LETTING. Blood-letting signifies the taking away of blood by artificial means, and is either ge- neral or local. General blood-letting is performed by the? opening of veins or arte- ries by the lancet; and local blood-letting by the application of leeches or cupping- glasses. The great power of blood-letting in the cure of diseases can not be quite sa- tisfactorily explained. Even in pretty large bleedings, the quantity taken away does not bear a great proportion to the whole of the circulating mass; and blood-letting seems to do good principally by somehow altering that excited state of the system U which occurs in robust constitutions, and which is marked by a full, strong pulse, and a florid look, with firmness and activity of the muscular system. This excited state, pushed a little farther, passes into inflam- mation, general or local. When the fulness of the vessels is taken off by blood-letting, their coats contract less strongly, and the excited action is lowered. Blood-letting seems to have great effect by its action on the nervous system, as we see in the faint- ing which is brought on in many cases by a very small bleeding. The taking away of blood, in whatever way it acts, is ascertained by long and uni- versal experience to be one of our most powerful remedies. The particular cases to which blood-letting is applicable, may be considered as ranking under the heads of diseases of excitementj of fulness, and those which arise from tension or irritation. Blood-letting is useful in the following dis- eases. 1. Fever. As there are fevers of various kinds, and as the same disease in different stages presents very various symp- toms, the remedies which would be useful at one period, and in one kind of fever, would be destructive when the circum- stances are altered. To no remedy is this remark more applicable than to blood- letting. At one time, it may be the means of a perfect cure; at others, it may occa- sion a waste of the vital powers which can not be repaired. It therefore requires much discrimination to determine the kinds of fever, and the periods of the' disease in which it is proper, and to guard lest bad consequences follow the loss of blood. In inflammatory fever, where there is a strong-, quick, and full pulse, much flush- ing of the face, throbbing at the tem- ples, delirium, thirst, and heat of the skin, we should not hesitate to bleed largely. There is a disease now well known to the people by the name of typhus fever, where the pulse is small, weak, and fluttering, the tongue black, the skin dry, the patient de- lirious and insensible; in this fever, or to speak more correctly, at this stage of the fever, it would be insanity to bleed larg-ely. But whatever may be the danger of bleed- ing at that stag'e of the disease, or however the physicians of forty years ago would have shuddered at the thought of bleeding a patient in typhus, it is well known that this disease often begins with symptoms of high excitement; and there is reason to believe that the blood is irregularly distri- buted and accumulated in certain organs. At this early period, blood-letting is one of the most effectual remedies we can employ; and when prudently and moderately em- ployed, it prevents the sinking of strength which frequently succeeds to high ex- citement when too long continued. Much caution is requisite not to bleed too often. 14S MATERIA MEDICA. nor when the disease has continued for se- veral days; as this would have a tendency to bring on a dangerous and fatal sinking of the strength, or the true typhoid state. Against inflammation of every organ, blood- letting is the chief, and almost infallible re- medy. Other auxiliaries have been found, but our main reliance is upon blood-letting. In acute rheumatism, or what, is popularly called a rheumatic fever, it is generally proper to begin our treatment by a prefcy free discharge of blood; and it is vain to expect success from the sweating practice, unless the high action of the vascular sys- tem be first reduced by this or other means. There are certain states of the system in which, after a period of what is called high health, feverish symptoms come on; and then a discharge of blood, generally clear and florid, spontaneously takes place from some part of the body. Thus wre have bleeding at the nose, spitting of blood, or a discharge of blood by stool, or urine. Such discharges of blood are called active hae- morrhages; and, however paradoxical it may appear to cure a discharge of blood by taking away more, yet by this operation the physician has it in his power to relieve the system, and to diminish the danger which might occur in organs liable to be injured by the too great activity of the circulation, or likely to become the seat of diseases which may ultimately prove fatal. Instances of active haemorrhage are seen in bleeding . from the nose, and from the lungs. There are bleedings again where the system is in a state quite the reverse of activity and ex- citement, and where artificial blood-letting would be improper. These hemorrhages are termed passive. Such are the true sea- scurvy, and the too copious flow of the monthly discharge, when accompanied by weakness and a broken state of health. In apoplexy, blood-letting is absolutely neces- sary also. In convulsive diseases, especially if there is an appearance of any tendency to the head; and in certain kinds of dropsy, occasionally in asthma,- in short, in any dis- ease, by whatever name it may be called, where there is a necessity for quickly re- ducing feverish action, or diminishing the quantity of blood circulating in the system, or reducing local inflammation. Quantity of blood to be taken. With re- spect to the quantity of blood to be taken away, no general rule can be given; differ- ent diseases are to be treated with different quantities, and in two persons labouring under what might appear to be the same disease, a quantity that would have little effect in the one case would cure the other. In an adult of good strength, a pound of blood, or sixteen ounces, is a moderate bleeding; twenty-four ounces, a full bleed- ing; and from thirty-two to forty ounces, a large one. Some inflammations are so vio- lent, and demand such^active treatment, that in one day the blcecSqg may require to be repeated from three to six times, the quantity taken away in a day varying from sixty to eighty or ninety ounces, and at one bleeding from thirty to fifty ounces. In general, we are not to be regulated by mea- surement, but by the effect produced on the disease, and on the general system. Mode of bleeding. The veins from which blood is most commonly taken, are those at the bend of the arm; there the veins are in general pretty numerous and easily got at, and a ligature is easily put round the limb to fill the veins. In diseases of the head, we may consider it advisable to take blood from the external jugular vein, or from the tem- poral artery. In some cases, we find it dif- \ ficult to get enough of blood from the arms, and we try it from the superficial vein of the foot. In bleeding at the bend « of the arm, when the blood appears to run less freely, its flow is increased by the pa- t tient squeezing the hand, or grasping some- J thing in it, by which the blood is forced % from the deep to the superficial veins. Sometimes we are prevented from getting the proper quantity by the patient fainting; in this case wc are to lower the head and shoulders, to stop the orifice for a little, and J then to let the blood flow when the patient is in the horizontal posture. Sometimea M the patient, from mental emotion, faints al- J most immediately on the arm being tied up; fl and sometimes we must for the present be W content with the diminished action of the system, of which this fainting is the proof.,..*} Sometimes the veins are so small, or so im- ' 9 bedded in fat, that it is impossible to get ,3 the quantity of blood we wish. This is often the case in children. We are obliged£.,^fl therefore, to resort to other methods, as" opening the temporal artery, or leeches, or cupping. Accidents that sometimes follow blood-let- ting. A dark livid swelling sometimes takes '% place at the wound made in blood-letting. It looks alarming to those who are not fa- miliar with it; but it is not in general a cir- cumstance of much consequence, as it arise*]1. ^| merely from the blood getting under the cellular substance and skin. It sometimes swells so fast that the proper quantity of blood can not be obtained. In this case, we must take off the bandage, and apply com- d presses wet with a cooling lotion, as of vi- '] negar, or cold water, to the swelling, retaining them by a slack bandage. The effused blood will in time disappear; and if i we have not got enough of blood, it must be taken from the other arm. Sometimes there is inflammation of the skin in the neighbourhood of the wound. This is to be treated with cooling applications, and rest; and by a poultice, if there is a tenden- cy to suppuration. Red lines are sometimes MATERIA MEDICA. 149 seen extending from the wound; these are inflamed absorbents, and are painful on pressure; sometimes the inflammation reach- es to the arm-pit, causing the swelling of a gland there, and perhaps suppuration. In- flammation may spread along the course of the vein, and produce symptoms of the most alarming, and even fatal* nature. The fascia, or membranous expansion on the fore-arm, may become inflamed, and give rise to great pain, tension, and febrile symptoms. Poultices are to be applied, and an extensive incision made through the fascia, to relieve the tension, and to give vent to matter. A nerve maybe wounded,' and this may give rise to convulsions, vio- lent pain, and other symptoms of nervous irritation. In every puncture of the skin, a nerve of some size or other must be wounded; and it is thought to be in conse- quence of the partial wound of a nerve of some considerable size that these violent accidents occur after blood-letting. The artery of the arm may be wounded, giving rise either to a dangerous bleeding, or to aneurism. After enumerating so many accidents that may arise from blood-letting, we may surely be allowed to blame the rashness of those numerous dabblers in surgery, who pretend to be competent to the perform- ance of this operation, but who are ignorant of the precautions they ought to observe, and aghast when the painful or dangerous consequences follow. It should be remem- bered, that as bleeding is one of the most salutary remedies, when timely and pro- f;'f: perly applied, so it is one of the most dead- (':■ ly and destructive when exhibited in wrong circumstances; and though, from its fre- quency, it must be often performed by those whose skill and experience is but .small, yet it may be attended with accidents which require the utmost boldness, address, and promptitude, to counteract their fatal tendency. Blood-letting should not be employed but for the cure of disease, or for the prevention of it when manifestly impending. Many persons who have no particular illness, ap- ply to a surgeon to have blood drawn from them. In Europe, and among country peo- ple, blood-letting is habitually employed at certain seasons, with the view of preserving their health; but it is a practice that should not be followed, as it is apt to induce a dan- gerous habit; and instead of diminishing the quantity of blood, it ultimately rather in- creases it. Fulness of the system may be prevented by safer means, such as purging; but even this preventive would be wisely superseded by temperance in eating and drinking, and avoiding the provocatives of modern luxury. When apoplexy appears to be likely to make an attack, as indicated by the throbbing of the temples, ringing in the ears, flushing of the face, and headache, then a precautionary bleeding will be very proper. Also, when feverish symptoms oc- cur in those who are known to be subject to spitting of blood. CARMINATIVES. Carminatives are those medicines which dispel flatulency of the stomach and bowels by stimulating the inner coat of these or- gans. They produce only temporary re- lief, for if the' diseased condition of the alimentary canal be not removed by appro- priate remedies, it will very speedily be- come again distended with flatus. The articles generally employed as carminatives are infusions or tinctures of the aromatic seeds and vegetables. The use of these articles is decidedly injurious in every in- stance in which the stomach or intestines are in the least degree inflamed, or when their sensibility is morbidly increased.— They are very favourite prescriptions with nurses and mothers, to allay the gripings with which young children are so frequently afflicted, and under these circumstances a great deal of mischief is caused by their in- discreet administration. Wholesome food, cleanliness of person, protection from cold and damp, and sufficient exercise, will most generally prevent a flatulent state of the bowels of infants; when, however, it depends upon the disease of those parts, carminatives will seldom do much good, but will often increase the suffering of the little patient. CATAPLASMS. Cataplasms are external applications of a pulpy consistence, and some what tenacious. They are of various kinds; either stimulant, as when made with equal parts of common mustard and crumb of bread, moistened with vinegar; or when common salt is ap- plied externally with bread or meal: or antiseptic, and applied with a view to cor- rect putrescency, as the yeast poultice, or the carrot poultice. Anodyne cataplasms made with hemlock, henbane, or foxglove, are applied to scrofulous or cancerous sores, to allay irritation and pain. Refri- gerant cataplasms are made by moistening crumb of bread with a solution of sugar of lead. Emollient cataplasms are most com- monly known by the name of poultices. Poultices are soft emollient applications applied warm to a part, with a view to re lax and soften it, and to promote suppura- tion by the continuance of a due degree of heat and moisture. One of the best appli- cations of this kind is the common bread and milk poultice, of a consistency thick enough to prevent its spreading farther than is intended, but not so hard as to fret 150 MATERIA MEDICA. or irritate the skin. Common Indian mush, with the addition of hog's lard, makes also a very good poultice. Poultices should be applied warm, and changed frequently when it is our desire to bring on suppura- tion quickly. A variety of substances are in popular use as poultices; many of these, however, act upon the part to which they are applied as stimulants, and hence, under ordinary circumstances, are injurious. All that is required in a poultice is softness, moisture and warmth, and as all are com- bined in the bread and milk, or mush poul- tice, these should be preferred to most others. CATHARTICS. All medicines which accelerate the action of the bowels, or increase the discharges by stool, are termed cathartics. These reme- dies, from a general difference in their modes of operation, have been classed un- der two divisions, namely, laxatives and purgatives. The former operate so mildly that they merely evacuate the contents of the intestines, without occasioning any ge- neral excitement of the body, or even sti- mulating the exhalant vessels of the canal; the latter produce a considerable discharge of fluid from these vessels, and extend their effects to the system in general; and when these effects are very violent, the purgative is further distinguished by the name of drastic. Laxatives may then be said sim- ply to open the bowels, and to carry off ex- traneous matter, which is already present in their cavity; but purgatives, as they occa- sion more extensive effects, may be made subservient to many important purposes in the cure of diseases. Many medicines which in their usual doses act as purges, may in diminished doses be made to act as gentle aperients. An ounce of Epsom or of Glauber's salts dis- solved in about four ounces of water, and taken pretty warm, will purge strongly; but half an ounce in the same or even a larger quantity of water will operate r.3 an aperient or laxative. Caster oil, in the dose of from half an ounce to an ounce, is a good aperi- ent, or a dessert-spoonful of sulphur, or.a dessert-spoonful of equal parts of sulphur and cream of tartar, with molasses; or an infusion of senna, with or without a small spoonful of tamarinds or a tea-spoon- ful of cream of tartar, or diminished doses of any of the purging salts, may be taken as aperients. The cases in which it is de- sirable or necessary to use aperients and not purges, are in persons of a sedentary life, women in the state of pregnancy, and those who are subject to piles, or where we do not wish to reduce the strength of. the patient, or produce increased irritation of the intestines. Purgative medicines as distinguished from laxatives in their effects, may be said to produce a considerable influx of fluids from the exhalant vessels which open into the intestinal canal, and hence to extend their action to the system in general. rl he ef- \ fects of purgatives depend either on their stimulating the muscular fibres of the in- testines to a quicker motion, by which the contents of the bowels are more speedily and completely discharged; or on their sti- mulating the exhalant vessels and the mouths of the mucous glands, which open into the bowels, by which there is an in- creased discharg-e both of serous and mu- cous fluids; or purgatives may so stimulate -3 the neighbouring viscera, as to occasion a more copious discharge of the bile and pan- .;j| creatic liquor. Different purgatives have M different powers of producing these several J effects. Sulphur, maguesia, and manna, M evacuate the bowels without any great in- "^ crease of serous discharge; while others, as 4 the neutral salts, and some vegetable pur- | gatives, as gambog-e and elaterium, produce , large watery evacuations, and are thence ^| denominated hydragogues. The mercurial / purgatives, as calomel, seem to act chiefly j by promoting an increased flow of the bile, and hence are called cholagogues. . The use of purgative medicines is of jj great importance in the preservation of ijfl health, and the cure of disease. They can ■•« be so managed and selected, as either sim- 1 ply to promote the discharge of the fecu- 1 lent matter, or to cool the system by ab- M stracting watery fluid, and withdrawing the 1 action from the upper parts of the body; or | to promote the flow of dropsical water by j stimulating the absorbents and exhalants, ■ which open in such prodigious numbers on the inner surface of the intestines. J The neutral salts furnish many useful M purgative medicines; as the sulphate of j soda, the sulphate of magnesia, the phos- J phate of soda, the tartrate of soda; these a are commonly given to purge and to cool | the system, and are useful in inflammatory disorders. The usual dose of them is an , ounce, dissolved in about four ounces of tepid water: they should be taken in the morning, and not too warm, as in that case they will either be thrown up, or pass off too quickly by the bowels. The purgatives from the vegetable kingdom are very nu- merous, as aloes, jalap, rhubarb, gamboge, scammonj', colocynth, and others; and in addition to these, we have calomel, and J perhaps a few more, from the mineral ( kingdom. Castor oil is a mild and safe j purgative, more commonly ranked as a ' laxative; and there is another vegetable oil, 1 the croton, famous for its activity in doses so small as a single drop or two. Purgatives are combined together with great and manifest utility; not with the re- MATERIA MEDICA. 151 suit of adding the powers of one to another, but of making the desired effect more com- plete, certain, and advantageous. Thus five grains of calomel will purge, and twenty grains of jalap will purg4> separately; biit by giving in one close five grains of calo- mel and twenty grains of jalap, we do not produce a double evacuation, but the one modifies the other, and produces the effect intended with certainty and expedition. It is unnecessary in this general article, to speak of the different kinds of purgatives, as we shall detail under each of them, their properties, and the reasons of prefer- ring any of them in particular cases. We may say here, that it is not a good habit to take frequent purgatives; they relax the intestines and debilitate the digestive sys- tem, as wrell as the whole body; but in some constitutions, the bowels are so torpid, that it is absolutely necessary for the preserva- tion of health, to take some medicine or otheripretty constantly; directed, not so as to produce copious thin stools, but gently to stimulate the intestines, and excite them to evacuate the proper feces. CLYSTERS. Substances thrown into the rectum by mechanical means. The principal clysters are those of the purgative, the emollient, and the anodyne kind; and in some cases, we attempt to convey nourishment into the system by means of a clyster. The instru- ments used are either a large syringe, or a bladder and pipe; and the kind and quan- tity of the matter thrown in, is to be regu- lated by the age of the patient, and the purposes to be answered. A purgative clyster may be made of the infusion of senna, adding to a pound, of such'infusion, an ounce and a half of Epsom salts; or a quantity of gruel with a spoonful of common salt; to which a little butter, or sweet oil, or castor oil may be added. Though pur- gative injections are of excellent service in many ca->es, and produce the evacuation of the rectum, and sometimes of a larger ex- tent of the bowels, yet-in few cases of dis- ease should we rest satisfied with them, but should generally endeavour to give purga- tives by the mouth. Emollient clysters are made of gruel or barley water, and are used in cases of colic, and in certain stages of in- flammation of the bowels, to act as internal fomentations or poultices. A large quantity should be given, and in general as warm as can be easily borne. Emollient clysters are sometimes very useful in quickening the progress of lingering labours. Anodyne clysters are of essential benefit in many severe and painful affections. They should be given in small quantity: a tea-cupful of thin starch or gruel, with a tea-spoonful or even more of laudanum, is to be injected, and as little irritation as possible should be caused in the administration of it; and if the patient is of discretion enough, he should make every exertion to retain it. Such a clyster is of excellent benefit in looseness, after any offending matter has been cleared away; it is necessary in straining, and allays that most troublesome symptom. In some unhappy cases, when nourishment can not be taken in by the mouth, an attempt is made to convey it into the system by nutri- tive clysters; and the composition of such is strong beef tea, yolks of eggs, and a quantity of laudanum to assist the power of retention. Such injections may prolong life for a little, but can never be expected to do much. Sometimes carminative or antispasmodic injections are given; these are made of the tincture or infusion of assa- foetida; and give relief in cases of spasm or flatulence of the larger intestines. A very powerful, but very dangerous injection is sometimes necessary in cases of rupture. It is made by boiling a drachm of the cut leaves of tobacco for ten minutes in a pint of water; but on account of its highly debi- litating effects, and the violent vomiting which it excites, the tobacco injection should never be administered, except in the presence of a practitioner of judgment and experience. COLLTRIA. Washes applied to the eyes when dis- eased are termed collyria. In inflamma- tions of the eyes, the best application is cold water, or an infusion of the pith of sassafras in boiling water, after it has be- come cold. When the inflammation has been somewhat abated, rose water, lead water, or similar astringent washes may be advantageously resorted to, and in certain chronic affections of the eye, applications of a stimulating kind are required. CUPPING. An operation in which glasses exhausted of air are applied to any part of the body; and the pressure of the surrounding exter- nal air forces the blood and fluids to that part. The air may be exhausted, either by heat excited by burning, within the glass, paper or cotton steeped in spirits of wine, or by a syringe acting as an air-pump. When the part upon which the cupping- glasses are applied has been previously scarified, blood may be very conveniently drawn from that place; and as we may have cupping-glasses of any shape, we have it in our power thus to abstract blood from surfaces, whether they be flat or prominent. Cupping is useful in disorders of the eyes; and in this case, blood may be taken from the temples, from behind the ears, or at the back of the neck. Cupping is also useful 152 MATERIA MEDICA. in apoplexy, epilepsy, and other convulsive disorders; and in all cases where there ap- pears too great a determination of the fluids to any particular part. Dry cupping signi- fies the application of the exhausted glasses to a part, without abstracting blood. Its tendency is to invite the fluids from the in- ternal parts to the place where the glass is applied- The operation should be-repeated till the part is red and somewdiat painful; its effect, in some measure, resembles that of blisters. Cupping is seldom dexterously perform- ed, except in the hands of professed artists. The difficulty consists in exhausting the glass only so far as to let the vessels under it be filled, but not to suffer its edges to press so firmly round as to impede the cir- culation. DEMCLCIENTS. Medicines suited to prevent the action of acrid and stimulating matters upon the mu- cous membrane of the throat, lungs, sto- mach or bowels, or upon the skin, when either is the seat of disease; and that, not by correcting or changing the properties of the substances coming in contact with these parts, but by enveloping them in a mild and viscid matter, which prevents their action upon the morbidly irritable surfaces; or, as is most generally the case, by covering and shielding the latter. Demulcients are prin- cipally employed in catarrh, dysentery, stone, gravel, inflammations of the kidneys and bladder, and in certain diseases of the skin. As they possess no active powers, they may be taken in such quantities as the stomach will bear. Mucilages, as gum wa- ter, flaxseed tea, infusion of quince seeds, water gruel, and the mild expressed oils of vegetables, are the principal demulcients employed. They are sometimes thrown by injection, into the rectum; the best for this purpose is thin starch, flaxseed tea, or olive off. DIAPHORETICS. These consist of medicines which, from being taken internally, increase the per- spirable discharge by the skin. When this is carried so far as to be condensed on the surface, it forms sweat; and the medicines producing it arc termed sudorifics. The operation in both cases is the same, differ-. ing only in degree, from increase of dose, from the employment of more active arti- cles, or from the use of auxiliary means. This class of remedies may be divided into, 1. _ Antiphlogistic diaphoretics, or those which reduce the action of the heart and arteries; these are principally the antimo- nials, small doses of ipecacuanha, nitre, and the saline mixtures. 2. Stimulating dia- phoretics, as the volatile salts, essential oils, serpentaria, contraycrva, fuiacum, opium, and camphor; these are proper only in cases where the circulation is languid, the skin below the natural temperature, and the general sensibility of the system is reduced. 3. Dilutent diaphoretics, as a weak infusion of balm, chamomile, or common tea, toast water, whey, and the like. These are best adapted to cases of fever, after depletion, towards the decline of the hot stage; they are likewise useful in increasing the action of the other diaphoretics. 4. External dia- if| phoretics, as the warm or vapour bath; or the application of cold water to the skin when the latter is very hot and dry. Fric- , tions may likewise, in many cases, be ranked j under this head. A The proper employment of diaphoretics, •*■ as well in regard to the diseases in which j they are demanded, the period of the case „j when they are resorted to, and the particu- ■ lar kind of diaphoretic to be resorted to, "fl demands a great deal of judgment. By ^ many persons they are considered to be re- -j medies adapted to all cases of disease, * whenever the skin is dry and hot; this mis- take causing them to be resorted to under improper circumstances, has caused not a ;.f little mischief. In those affections, attended'-lfl with a dry and burning skin, and violent action of the heart and arteries, the only 9J diaphoretics to be depended upon, are the 9 lancet, cold drinks internally, the applica- M tion of cold to the surface of the body, and J after the violence of the disease has in this 1 manner been broken, small doses of the an- "M timonials, combined with nitre, or some other neutral salt. In diarrhoea and dysen- '^flj tery, as well as in rheumatism and catarrh, accompanied with a dry, harsh skin, the "— temperature of which is not much above flj that of health, the warm bath, and com- binations of opium and ipecacuanha should . ■! be preferred. il When diaphoretics are resorted to, the patient should be confined to bed; the temperature of the room should be kept at , a medium point, and sudden transitions A from a warm to a cold air carefully avoided - 1 after the sweating has subsided. -1 DIET. ' ,1 In the cure of disease, a proper regula- a tion of the diet is not less important than -M the administration of appropriate remedies. H In many cases, a cure is impossible, unless ] a due attention be paid to the food and j drinks taken by the patient. In fevers, and all inflammatory complaints, the diet should '• be confined to the mildest diluents, taken in moderate quantities. In chronic diseases of the stomach, the food should consist of a moderate allowance of such articles as are nutritive, readily digested, and without any MATERIA MEDICA. 153 stimulating properties. In bowel com- plaints, simple demulcents, or decoctions of the farinaceous seeds, with or without milk, according to circumstances, are all that it is proper to allow. In the treatment of dyspepsia, gout, various nervous affec- tions, the early stages of consumption, scro- phula and scurvy, a proper diet is all im- portant, and in conjunction with exercise, pure dry air, and appropriate clothing, constitutes the chief means for their remo- val. DILUENTS. Simple watery fluids, by themselves, ren- dered slightly acid, by the addition of lime or lemon juice, or combined with some bland mucilage, are called diluents; they increase the fluidity of the blood, render several of the secreted and excreted fluids of the body less viscid, and promote the ac- tion of certain of the glandular organs. There are certainly few remedies, whose operation is more simple, obvious and im- portant; and yet there are scarcely any whose value has been more underrated, or whose application has been so frequently neglected through the suggestions of false theory. Water is the universal beverage of animals, and the necessity of its supply, in many diseases, is indicated by an intolera- ble sensation of thirst. Diluents are given in fevers and inflammations, to lessen the stimulant quality of the blood, as well as to moisten the mucous membrane of the fauces and alimentary canal, which is, in general, morbidly dry and hot. They are used, also, to promote the action of various remedies, as purgatives, duiretics, and diaphoretics. DIURETICS. Medicines which increase the secretion by the kidneys, and by consequence the flow of urine. This is an effect which, in many cases of disease, we are very anxious to accomplish, and which has a very saluta- ry tendency. In dropsy, it is always very desirable to increase the flow of urine, and in several species of that complaint, it is the chief indication of cure. The principal diu- retic medicines are the following: cream of tartar, squill, foxglove, acetate of potash, nitrate of potash, carbonate of soda, spirit of nitrous ether, turpentine, juniper, tobacco, and mercury. These various diuretics have their'pecu- liar modes of operating. Some, as potash and its combinations, nitre and cream of tartar, squill, juniper, and turpentine, seem to act by directly stimulating the kidneys, being carried, more or less decomposed, to these organs. Others, as mercury, stimu- late the absorbents primarily, and seconda- rily the kidneys; others appear to act first on the stomach and digestive organs, or the bowels, and afterwards on the absorbents; such are tobacco, jalap, gamboge, elateri- um; while others, by reducing the action of the heart, and emptying the blood-vessels, increase the action first of the absorbents, and secondarily that of the kidneys. Their effect is to be aided by moderate cold to the surface of the body, and we, therefore, prefer giving them during the day-time. It is to be remarked, however, that we are by no means certain of always procuring a diuretic effect by any medi- cine whatever, and that even those which, in general, have the highest character, fre- quently fail. ELECTRICITY. The efficacy of electricity in the cure of several diseases, is supported by many very respectable authorities. It acts upon the body as a stimulant, augmenting considera- bly the circulation of the blood, and exci- ting the action of many of the glands and of the absorbents. It has been found most beneficial in palsy, gout, chronic rheuma- tism, deafness, tooth-ache, violent swel- lings, suppression of the menses, nervous head-aches, contraction of the muscles, stiff- ness of the joints, &c. It has generally been found injurious, in all acute diseases, inflammatory affections, and where there is great irritability, or robustness of constitu- tion. It should be applied by directing a stream of the electric fluid to the part in which the disease is seated. Shocks, in general, should be avoided, or at least they should be very slight. EMBROCATIONS. Medicines applied to an external part of the body by friction, either to produce a stimulating effect upon the skin, in which case they are termed rubefacients,- or, with the view of the article employed, being ta- ken up by the absorbents, and carried into the system, or acting upon the part to which they are immediately applied; thus mercurial ointment is frequently used as an embrocation to produce salivation; iodine to dispel scrophulous and other indolent tu- mors, and anodyne embrocations are often resorted to, to relieve painful affections of the muscles. EMETICS. Substances capable of exciting vomitingy independently of any effect arising from the mere quantity of matter introduced into the stomach, or of any nauseous taste or flavour. The susceptibility of vomiting is veiy differ- ently modified in different individuals, and is often considerably varied by disease. 154 MATERIA MEDICA. Emetics are employed in many diseases. When any morbid affection depends upon, or is immediately connected with, over dis- tension of the stomach, or the presence of acrid or indigestible matters, vomiting gives speedy relief. Hence, their utility, when too much, or improper food has been taken, in cases of intoxication, and of poisoning. They are serviceable, also, in jaundice, ari- sing from calculi, obstructing the course of the bile in the gall ducts; in the early sta- ges of catarrhs, consumption, diarrhoea, and dysentery, and in the forming stage of various febrile affections. In nauseating doses, they are useful in aires.ing dischar- ges of blood from the lungs, bowels, and uterus, in dropsies, swelled testicles, bu- boes, &c. Their administration is injurious and dan-^ gerous in every case in which there is a de- termination of blood to the head, especially in full habits—in inflammation of the brain, stomach, and bowels—in the advanced sta- ges of pregnancy—in persons affected with hernia, or prolapsus of the womb, and whenever extreme debility is present. The frequent use of emetics produces irritation of the stomach, and^mpairs digestion. An emetic should, in general, be administered in a fluid form, and its operation may be promoted by drinking any tepid diluent, or weak bitter infusion, as that of chamomile flowers, &c. The principal emetics are tartarized antimony, ipecacuanha, sulphate of copper, sulphate of zinc, mustard seed, muriate of soda, and squill. EMMENAGOGUES. Medicines supposed to have the power of acting on the womb, and promoting the menstrual discharge. It is now acknow- ledged by all judicious physicians, that we know of no substance which has a direct and specific action on the womb; and that whatever success any means may appear to have had, in producing the monthly dis- charge, this is owing to some action on the whole system, or on the neighbouring parts, from which that action has been communi- cated, by sympathy, to the womb. The non-appearance of the menses in young women, or their obstruction in those who have had them established for some time, is generally owing to some disorder of the system; and whatever removes this, and produces the wished-for discharge, may be ■styled an emmenagogue. Sometimes to- nics, sometimes purgatives, have this effect; or if the system be too plethoric, bleeding may contribute to bring on the discharge. Electricity, aloes, cantharides, turpentine, cupping on the loins, or warm fomentation, may all be useful, when directed by a prac- •titioner of skill, who knows the proper time and manner of their exhibition. Sometimes good air, exercise, and a regulation of the diet, are all that is required to establish the monthly discharge. Women arc very apt to lay a great stress on *he importance of this function, and to be very uneasy if it be too long in becoming regular; but there is no fixed period for its beginning, and while the health is uninjured, they should not take strong medicines with the view of for- cing on the discharge. EMOLLIENTS. Emollients are those remedies which, when applied to the solids of the body, ^ render them more soft, lax, and flexible.' Ijj These are principally oily substances, ap- plied by friction in a warm state, or they are the various forms of fomentations and J poultices. ERRHI^ES. Substances which, when applied to the lining membrane of the nostrils, occasion a discharge of mucous or serous fluid. They have been considered useful in certain af- fections of the head, in consequence of the evacuation they occasion; but, in this re- spect, their value has been greatly over- rated. They have been recommended in ' cases of obstinate head-ache, pains of the ear, inflammation of the eyes, and chronic} affections of the brain—and some writers state, that they have derived advantage from their use under these circumstances. The principal articles of this class are, white and black hellebore, tobacco, sulphate of mercury, asarabacca, ipecacuanha, and mar- joram. EPISPASTICS, on BLISTERS. The local effect of a blister is well known; when applied to the skin for a sufficient length of time, it produces an inflammation of the latter, marked by redness and a burn- ing heat, which is followed by the effusion beneath the cuticle of a serous fluid, fur- nishing what is termed a vesicles the cuticle being detached to the full extent of-the ve- sicle, from the cutis, or skin beneath. The article most generally employed to produce a blister, is the Spanish flies made into an ointment. A similar effect will, however, result from the application to the skin of various other substances, as mustard, oil of turpentine, nitric acid, and hot water. Blis- ters constitute an important remedy in va- rious diseases. They are considered by many as evacuants, in consequence of the discharge of serum which they produce. ' When applied to an inflammation, seated immediately beneath the skin, it is probable that some good may in this manner be ef- fected. When they are kapt open by stimu- MATERIA MEDICA. 155 lating applications, so that a constant secre- tion of pus takes place from their surface, they produce unquestionably very consider- able depletion, and may be advantageously resorted to in many cases, where depletion by the lancet, or purgatives is not advisa- ble. But the remedial effect of blisters, in the greater number of diseases in which they are employed, arises from their deter- mining a greater quantity of blood to the vessels of the surface, and thus unloading the blood-vessels of the internal organs, when these are the seat of inflammation or congestion. Thus, when the brain, the throat, the pleura, lungs, or peritoneum are inflamed, blisters applied to the scalp, neck, chest, or abdomen, by causing the blood to flow more freely into the vessels of the skin, from the overloaded vessels of the in- ternal membrane or organ, in this man- ner aid in reducing the disease of which they are the seat. Blisters applied to indo- lent tumors, cause their dispersion by stimu- lating the absorbents of the parts. In af- fections of the brain, as apoplexy, palsy, delirium, violent head-ache, and convul- sions, blisters applied to the back of the neck, or to the ankles, produce often the very best effects. In all fevers, blisters appear to do good by transferring to the skin a part of the irritation under which the internal organ may happen to labour. In the early stages of consumption, and in ob- stinate catarrhs, blisters to the chest, kept open for a considerable time, are beneficial, by determining the blood from the small ves- sels of the lungs. In all internal inflamma- tions, they constitute an important remedy by relieving the overloaded vessels of the part affected. Blisters have, also, been advantageously applied to the skin when affected with erysipelas; to arrest the pro- gress of mortification—to the stomach, in cases of violent vomiting, and along the spine in various spasmodic complaints. In some persons, blisters are very apt to pro- duce strangury, or a difficulty in voiding the urine; this painful affection may in most cases be prevented by drinking plentifully of some mild demulcent fluid. In fevers, and inflammations, the proper period for applying blisters is, after the violence of the disease has been abated, by bleeding and other direct means of evacuation; if applied while the skin is very hot and dry, and the pulse strong and quick, the irrita- tion they excite is very apt to prove inju- rious by increasing these symptoms. A ve- sicatory of cantharides, in general, requires to be kept on twelve hours in an adult, be- fore it produces its full effect. When the vesication has occurred, the cuticle should be divided, at the most depending part, by a pair of scissors, the serum allowed to es- cape, and the blistered part is then to be dressed with sweet oil, fresh lard, or simple V cerate, or if it be desirous to produce a greater discharge, or keep up the inflam- mation for some time, it may be covered with a wilted cabbage leaf, or a cloth spread with basilicon, or savine ointment. ESCHAROTICS. Escharotics are substances used to de- stroy a portion of the surface of the body, by the formation of an eschar or slough, or to keep down spongy granulations, or re- move diseased parts. Though the contact of heated metals has this effect, the term escharotics is more generally applied to the lunar caustic, and caustic potash, blue vi- triol, red precipitate, and burnt alum. The mineral acids are also escharotics, but are less used, in consequence of the difficulty of confining their action to a particular part. Escharotics are used in a variety of chronic diseases, to produce a degree of irritation, and a continued discharge from the surface, with the view of relieving in- ternal organs—hence, they act in the same manner, precisely, as a permanent blister. They are sometimes used to open abscess- es, when there is great dread of a cutting in- strument; but it is almost always preferable to open them with a knife or lancet. The chief diseases in which escharotics are employed, are palsy, chronic, deep seated pains of the head, chronic affections of the chest and eyes, and convulsive maladies, as chorea, epilepsy, &c. They are generally termed, when resorted to as remedies for disease, issues. . EXPECTORANTS. Medicines which are supposed capable of facilitating the excretion of mucus from the chest, that is, from the wind-pipe, air- cells and passages of the lungs. They are chiefly employed in catarrh, inflammation of the lungs, croup, asthma, consumption, and hooping cough. The greater number of expectorant medicines, are those which, in larger doses, prove emetic: namely, squills, ipecacuanha, antimony, and ammo- niacum. Besides those medicines which are more commonly called expectorants, there are various other remedies which in- directly have the same effect. Thus, bleed- _ ing, blistering, the warm bath, and nausea- " ting doses of emetics, mucilaginous and demulcent fluids, slowly swallowed, as gum-water, liquorice, linseed tea, barley- water, and oily emulsions, and the inhalation of the steam of hot water, have the effect of promoting expectoration, by relieving the irritation of the lining membrane of the fau- ces, windpipe and lungs, and restoring its healthy secretions. Opiates, also, by remo- ving any remaining irritation of the respira- tory organs, after depletion has been carried 156 MATERIA MEDICA. to a sufficient extent, may be considered as, in some measure, an expectorant. Other substances promote expectoration, by di- rectly stimulating the mucous membrane of the trachea and lungs. These can only be resorted to in the absence of inflammation, or in those cases where there is habitually an excessive secretion of fluids in the lungs, which, by its accumulation, impedes respi- ration, and causes a constant and trouble- some cough; this is particularly the case in chronic catarrhs, in certain cases of asthma, and in the catarrhal affections, occurring in old persons. The principal stimulating expectorants, are the fumes of burning tar, the vapour of vinegar, the balsams of co- paiba, and tolu, seneca root, garlic, Indian turnip, assafoetida, &c. FRICTION. A topical remedy, applied by the dry hand, by a dry cloth, or by a flesh brush. Friction is particularly useful in indolent stiffness of the joints, and in rickets; it is said, when diligently employed, to cure both. The effects of friction, are to deter- mine the blood to the surface, to promote the healthy action of the skin, to relieve pains from torpor, to give tone and strength to the system, and to excite the absorbents to increased action. Friction is an excellent remedy in chronic diseases of the chest, in- digestion, diarrhoea, costiveness, disposition to colic, pains of the joints, chronic rheu- matism; in certain diseases of the skin, swellings of the legs, and nervous affec- tions generally. In most cases, premising the use of the warm bath, will increase the efficacy of this remedy. GARGLES. A gargle is a wash for the mouth and throat. This is highly useful and necessary in many diseases of those parts. In the common inflammatory sore throat, astrin- gent gargles should be used at the very commencement, and, in many cases, a threatened sore throat is prevented by their timely use. They may be made of vinegar and water, sweetened with honey or sugar; or of diluted sulphuric acid and water, or the infusion of red rose leaves, to which some drops of sulphuric acid have been added. Sage tea, alum and honey, makes a very useful gargle. In the ulcer- ated and putrid sore throat, which accom- panies scarlet fever, the gargles must be of a very stimulant nature; thus an infusion of cayenne pepper with vinegar, may be fre- quently employed as a gargle; it is made by taking a table-spoonful of cayenne pepper, and a like quantity of common salt, infusing them in a pint of boiling water, then strain- ing the liquor, and adding half a pint of vinegar. Much of the benefit of a gargle is derived from its being used frequently; and the patient should be encouraged to do so, notwithstanding the temporary inconve- nience it puts him to. HTDRAGOGUES. Purgatives which produce large watery evacuations from the bowels, and in this manner cause the removal of dropsical col- lections from the different cavities of the body. The principal hydragogues are, cream of tartar by itself, or combined with jalap, gamboge and elaterium. LEECHES. The leech is a well known species of worm that lives in water, and is applied to various parts of the body, to draw blood for the cure of disease. The medicinal leech has a flat slimy body, composed of rings, tapering towards the head; it is commonly about two inches long, about the thickness of a goose-quill; but it can lengthen and shorten itself very much. The bite of those leeches, which are found in stagnant waters and marshes, is said to cause pain and inflammation; such leeches, therefore, as well as the horse-leech, are not used, and those are preferred which are taken'in the summer season, in waters having a clear sandy bottom. A leech attaches itself to any substance to which it wishes to fix, by an apparatus, constructed on the principle of a leather-sucker, which it has at both ends; the one at the head being like a horse-shoe, with a triangular mouth in the centre, and that at the other end being cir- cular. When they fix on the body, they inflict a small wound of three little flaps, from which they suck blood until they are gorged, or till they are forced to quit then? hold; this is best done by sprinkling on them a little salt. The cases are very numerous in which leeches are useful; and in children, where it is so difficult to get blood from a vein, leeches furnish an excellent resource. Leeches are useful in the various inflamma- tory diseases, as ophthalmia, sore throat, rheumatism, tooth-ache, inflammation of the bowels, and uterus; in measles and scarlet fever, in hooping-cough, in head-ache, in bruises and in piles. It is sometimes difficult to get leeohes to fix; they should be kept hungry, and taken out of the water for some minutes before they are to be used, and should be dried with a soft cloth immediately before they are applied. The part should be well washed with soap and water, then with milk and water, and wetted with blood or syrup, and if there be many strong hairs, they should be shaved off. A large leech will MATERIA draw about an ounce of blood, that is about a. table-spoonful; and when they come off, the bleeding may be encouraged to a con- siderably greater extent, by^ bathing the parts with warm water, or by 'applying large poultices of bread and milk, or ap- plying cupping glasses. It is sometimes difficult to stop the bleeding, and the sur- geon is sent for in great alarm, especially when leeches have been applied to young children. The bleeding may generally be stopted by proper pressure, with a little lint, or similar downy substance, for a due length of time, though this is sometimes very diffi- cult, when there is no bone to press against; touching the wound with lunar caustic, will almost certainly succeed; but we must take care that the flowing blood do not wash the caustic down about the neighbouring parts. Sometimes the wounds made by leeches, give rise to a good deal of pain, swelling, and extensive hvnammation. The best ap- plication is a cooling lotion of sugar of lead, or diluted alcohol and water, or vinegar and water. If the pain and tension continue long, an emollient poultice of bread and milk will be useful. Salt has been thrown on the animal to make it disgorge the blood which it has sucked, but the leech is generally killed in the experiment. A more easy way to dis- charge the blood, and save the animal, is to hold it in the hand, and gently squeeze it in a napkin, from the head downward; the blood flows copiously from what may ap- pear the anus, or through the ruptured ex- tremity of the intestinal canal, and the worm is not essentially injured. Leeches are best kept in a bottle, half filled with pure spring or river water, co- vered with gauze or fine muslin. It is better not to put bran or any other substance into the water, but to change it pretty frequent- ly. Leeches are said to be very sensible to the electrical changes of the atmosphere. LITHONTRIPTICS. Medicines supposed to have the power of dissolving a stone in the bladder. The perfection of a lithontriptic medicine would be, that it could be easily taken into the stomach, pass through the various organs of the body, till it reaches the kidneys and bladder, and there dissolve the stone, or break it down into particles small enough to pass by the urethra. But the existence of such a substance is against all probabili- ty. Even when a stone is thrown into a very active fluid, out of the body, it is not easily nor totally dissolved; and the fluid which has power on one stone has no pow- er on others; and it is against all the known laws of the animal economy, to suppose that any such dissolving fluid could reach the bladder, without destroying many parts; MEDICA. 157 and if it did get there, it would infallibly destroy the bladder itself. The only medi- cine having the most distant pretensions to do good in stone, is potash, or its carbo- nate; and this it does, not by reaching the calculus in such a state as to dissolve it in the same way as muriatic acid would dis- solve a lump of marble, but by preventing that acidity in the stomach and first passages, on which the formation of the stone seems in many cases to depend. This takes place in the following way: in healthy urine, there is a considerable proportion of an acid, called lithic, or uric acid, which is so com- bined with the other ingredients, that the whole continue in solution. But if the di- gestion is bad, another acid is formed, and being carried to the kidneys, combines with the materials there, and the uric acid is precipitated in an insoluble form. This may happen in the kidney, or ureter, and accordingly uric acid will be deposited in the bladder, and other matters may gather round it, and form a large stone. In order, there- fore, to hinder the formation of unhealthy acid, and the consequent deposition of the uric acid, we aid the digestion by bitters and tonics, and correct acidity by alkalies and lime-water. As several salts are dis- charged by sweat and insensible perspira- tion, so if the functions of the skin are not duly performed, these salts may find their way to the kidneys, and occasion the depo- sition of the uric acid. The perspiration, therefore, is to be regulated by diaphoretic medicines, by exercise, and proper clothing. We judge of the presence of an excess of uric acid, by examining the sediment de- posited from the urine, or the small frag- ments which are sometimes passed with it. The uric acid generally leaves a red depo- site. In this state of the system, alkalies are the best remedies. Ten drops of the solu- tion of caustic potash, are to be given three or four times a day, in a cup-full of beef tea, or other convenient liquid. It is found that the carbonates of the alkalies answer the purpose of counteracting the tendency to form uric acid, equally well with the pure alkalies, and they are not so apt to disagree with the stomach. The bi-carbonate of pot- ash may be given in the dose of a drachm four times a day, dissolved in two ounces of water, and flavoured with liquorice or cin- namon-water. The carbonate of magnesia has been given as a lithontriptic, or as a counteractor of the tendency to stone; but it is not to be recom- mended, as it is rather insoluble, and though it may correct acidity in the stomach, no part of it will be absorbed to readi the kid- neys or bladder. Lime-water has also been much recommended as fulfilling the same indications. When calcareous or magne- sian salts prevail in the urine, acids are to be given; and we judge them to be proper. 158 MATERIA MEDICA. when the phosphates are deposited as a white sediment. The muriatic acid is as convenient as any other. But some calculi are composed alternately of acid and alka- line layers; in these, neither acids nor alka- lies alone will be the proper lithontriptics. We are to give sometimes acids, and some- times alkalies, as the deposites of the urine may direct us. The proposal which-has been made, of injecting solvents for the stone into the bladder, would be an excellent one, could we insure the bladder from injury; but the irritable state of that organ renders it quite impossible to keep the solvent long enough in contact with the stone to do any service. MINERAL WATERS. Those waters which, running over certain soluble substances in their course, become impregnated with the taste, smell, and other properties of these substances, and, there- fore, are of service in the cure of diseases, or in the regulation of the health. The most celebrated waters are those of the fol- lowing classes: cold, hot, sulphurous, cha- lybeate, saline and purgative. Some of these act as tonics; some promote the se- cretions of the liver and alimentary canal; some excite the healthy action of the skin, &c. They are used both internally, and as a bath, externally. The principal circum- stances under which they are directed, are for the removal of chronic diseases, affec- tions of the skin, and during convalescence, from nearly all diseases. They are valua- ble remedies in that condition of health, vaguely termed nervous. Without enter- ing upon the curative properties of each of these waters, it may be proper here to men- tion some particulars which are common to all, and to detail some reasons why mineral waters are so often recommended by phy- sicians. The diseases in which mineral waters are directed, are chiefly those which are well known by the name of nervous; and they generally occur in those who are of an opulent rank in life, who alone have it in their power to go to watering places. Their complaints generally arise from the want of active and interesting employment, from deficiency of exercise, and from indul- gence in easy and luxurious living. Placed by their fortune above the need of bodily or mental labour, and in early life having had ample means of sensual or intemperate en- joyment, they have acquired no taste for the cheap and easy pleasures of learning and virtue; and are, therefore, fain to indulge in the pleasures of the table, to wear away the tedious hours for which they cannot find a proper use. Hence arise indigestion, fla- tulence, costiveness, obesity, gout, hypo- chondriasis, and all the uncomfortable and alarming feelings which originate from such affections. When such patients are sent to a watering-place, they are benefited in a variety of ways. Their usual indolent ha- bits are broken in upon; they see other scenery; the unhealthy air of the town is exchanged for the pure air of the country; they must make some personal exertion, were it merely to walk to the spot where the water is drawn; and however powerful money may be, there are many of their for- mer means" of dissipation which they can not procure in their new abode. Add to this, that the physical effects of various waters are of the most salutary kind, promoting the regular discharge from the bowels, strengthening the stomach by their cold- ness, or their chalybeate properties; or even in some cases, a nausea, or disgust at food is created, which prevents patients from taking in more than the stomach can digest, and thus gives that important, but over wrought organ time to recover the '• \ tone and activity it had lost. -j NARCOTICS. Narcotic medicines are those which have the property of diminishing the action of the nervous and vascular systems, and .of ^ inducing sleep. These medicines are also called sedatives, anodynes, and soporifics. They appear to act by first exciting the en- ergy of the nervous- and vascular systems, and this excitement is followed by a degree , of collapse altogether disproportioned to 4 the excitement. This depression is so rapid, that the previous excitement is not perceiv- 1 ed, and hence, many physicians regard cer- m tain substances as direct sedatives. The principal substances possessed of narcotic '| properties, are opium, hyoscyamus, (hen- bane,) belladonna, camphor, hemlock, fox- . , glove, stramonium. Each of these substan- ces seems to have some peculiar manner of operation; and when one narcotic fails, an- , i other will often induce sleep. 1 ' ;i RUBEFACIENTS. t Remedies which excite the vessels of the skin, and increase its heat and redness. They act precisely in the same manner* as blisters, excepting that they prbduce no vesication, hence they are employed like them to relieve internal irritations, inflam- mations, and congestions, or to excite the I absorbents of some external part. The principal rubefacients are, dry frictions, or \ frictions with some volatile liniment, as the liniment of ammonia, soap liniment, decoc- tion of turpentine and cantharides, frictions with salt, or dry mustard, mustard poul- tices, &c. SEDATIVES. Medicines which have the power of al- laying the actions of the system generally, MATERIA MEDICA. 159 or of lessening the exercise of some par- ticular function. It is not believed by some physicians that any such medicine exists; it being contended that the articles which ex- ert, apparently, a sedative effect, are in re- ality stimulants; and that it is only the exhaustion remaining after the preceding excitement, that gives them the appearance of having acted as sedatives. There are, nevertheless, certain substances which have the effect of allaying inordinate action, par- ticularly of the heart and arteries, and which may hence be ranked as sedatives. The principal of these are, blood-letting, cold, tartarized antimony, in minute doses, digi- talis, prussic acid, and opium. SIALAGOGUES. Medicines which increase the flow of the saliva. This may be produced by chewing various acrid substances, as tobacco, ginger, &c, which, by stimulating the termination of the ducts, excite the glands to the secre- tion of an augmented amount of saliva. The principal sialagogue, however, is mer- cury; which taken into the stomach, or in- troduced into the system by inunction, acts on the salivary glands with peculiar energy, and causes the discharge of immense quan- tities of saliva, producing at the same time vio>«r>t inflammation of the gums, tongue and cheeks. There are few, if any diseases in which the production of salivation is use- ful. STIMULANTS. Medicines or other circumstances capable of exciting the vital energy, whether as ex- erted in sensation or motion. These are of various kinds. 1. They are such as are applied to the stomach: alcohol, tinctures, wine, &c. In certain states of debility and disease, a very small portion of the mildest food will act as a stimulant. 2. Diffusible stimulants, or such as are easily extended over the whole frame: hartshorn, heat, elec- tricity, and galvanism. 3. Tonics, mustard, cantharides. It will be seen from the above slight enu- meration, that in speaking of substances of the first class, we use the term stimulants to denote nearly the same thing as cordials; and that the other classes are arranged along with them on account of the similarity of their action. The cases in which general stimulants are useful are those of torpor and debility; but the power of some stimulants is so great, and the constitution is at times so easily affected by them, that much skill and caution is required in their exhibition. Suppose a person debilitated and torpid, after along continued fever, or other illness; it would be desirable, no doubt, to restore his strength as quickly as possible. But this is not to be effected by strong stimu- lants; to him, the use of such in any con- siderable quantity would probably be fatal. In all diseases of excitement, as inflamma- tions and fevers, stimulants are to be avoid- ed; as well as in all cases in which the stomach is labouring under irritation, or any affection of the brain is present. SUPPOSITORIES. Medicinal substances, introduced in a solid form, into the rectum. Sometimes they are given to produce a discharge from the bow- els, and may be applied even to very young infants. A small bit of soap may be used for them. Suppositories are also employed to destroy the worms called ascarides; aloes and soap are good in this case.. Opium may be introduced as a suppository, to re- lieve pain and irritation, arising from dis- eases of the bladder, the womb, and parts in the neighbourhood. TONICS. Medicines which are supposed to increase the tone or healthy action, or strength of the, living system. Under this head might, in fact, be included nearly all the remedies employed for the cure of disease. The term, however, is restricted to a certain class of remedies, the action of which is not properly understood, but the ultimate effect of which is to increase the energy of the muscles, and to promote the functions of digestion, assimilation, and nutrition; and in this manner, the general energies of the system. Tonics are chiefly useful in that state of debility which remains after the re- moval of irritation, or inflammations of in- ternal organs, and are hence chiefly prescri- bed in the intervals between the paroxysms of intermittent fever, and in the stage of convalescence, subsequent to long con- tinued and debilitating diseases. The prin- cipal tonics are the vegetable bitters, bark, and various preparations of iron. SECTION II. Individual Bemedies. ACIDS. Acids are substances possessed of the following properties. They are sour to the taste, change the blue and purple colours derived from vegetable substances to a red; they form neutral compounds, called salts; with alkalies and earths, in which the pe- culiar properties of both the components are lost, -and they unite with the metallic oxydes, constituting a peculiar class of salts. They also unite with water in any propor- tion, with the exception of the muriatic 160 MATERIA MEDICA. and prussic acids, which are compounds; the one of chlorine and hydrogen, and the other of cyanogen and hydrogen : all the other acids employed as medicines, are sup- posed to consist of oxygen, with one or more combustible substances. The names of the acids formed from the same base, change their terminations in proportion to the oxygen they are presumed to contain; thus, when sulphur is united with its full proportion of oxygen, the acid is termed sulphuric; when combined with a smaller proportion of oxygen, it is called sulphur- ous acid—the terminations ic and ous, de- noting the quantity more or less of oxygen or acidity they contain. The mineral acids, or those obtained by the combination of oxy- gen with a. mineral base, are employed in medicine principally as tonics and astrin- gents; the vegetable acids, as vinegar or acetic acid, citric acid and tartaric acid, are chiefly administered, largely diluted with water, as a grateful and cooling drink in fevers, or as a remedy in the cure of scur- vy. The prussic acid is given in very mi- nute doses as a sedative, and the muriatic and nitric acids have been supposed to ex- ert an alterative effect on the system. Acetic acid, or vinegar. Vinegar is ob- tained by causing certain vegetable juices containing mucilage and sugar to undergo the acetous fermentation—in this state, however, the acid is very impure, contain- ing a quantity of water, mucilage, tartaric acid, sugar, extractive matter, tartrite of potash, and some alcohol. To rid it of these it is submitted to distillation; Acetic acid or distilled vinegar, is capable, of dis- solving all those vegetable principles which are soluble in water, and in some cases, as in squills, colchicum, and several aromatics, the medicinal properties of the vegetable are extracted by the acetic acid for use: hence vinegar of squill and of colchicum, are constantly employed in the cure of diseases. The strongest distilled vinegar has a very pungent smell, and when applied to the skin causes it to become red and inflamed, or if its application be continued for a suf- ficient length of time, it will raise a blister; hence its fumes are sometimes applied to the nostrils in fainting, asphyxia, hysterics, and head-aches. It is also used as a rube- facient, or as an exharotic for destroying warts. Internally, acetic acid largely di- luted with water, is used as a drink in fe- brile diseases, and scurvy; also to counter- act the effects of opium and narcotic poi- sons, after the latter have been ejected from the stomach, to relieve the consecu- tive stupor and delirium. The steam of vinegar is also inhaled in certain cases of catarrh of long standing; in chronic in- flammations of the throat, in putrid sore throat, &.c. It has also been directed as a wash to hasten the sepauation of dead bone in caries. Aromatic vinegar, or vinegar holding in | solution the essential oils of lavender, sage, \ rosemary, and cloves. It has a pungent aromatic odour, and is used as a stimulant to the nostrils in fainting and sick head ache, and as a grateful perfume in sick rooms; it was formerly called the vinegar 1 of the four thieves, and was supposed to be a preventive of infection. , Carbonic acid. When charcoal is burned ] in oxygen gas, provided the materials are in due proportion, the oxygen gas disap- pears, and in its stead we obtain a gas J equally colourless and transparent, but ] possessed of very different properties. The new formed gas extinguishes flame, and is \ fatal to men and animals who breathe it. It is this gas which arises when charcoal is yj burned in small ill-ventilated rooms, and ' which so often causes the death of persons j who occupy them, and which also occasions i fatal accidents in breweries, and other m places where fermentation goes on; being m extricated in great profusion during the process of the fermentation of vegetable Jl juices. It also taints the air of mines; and | is called by the miners the fire-damp. ! When a person is exposed to breathe this ^ acid, the first sensation is a slight feeling of ^1 weakness, and a degree of giddiness, yrithi'^BJ a glow in the face and neck. Shortly after, h he falls down, becomes insensible, and $1 breathes loud as in apoplexy. Unless re- a lief be obtained, death very quickly en- J sues. There is usually foaming at the .9 mouth, with great suffusion of blood over the face and neck, and other marks of ac- cumulation of blood in the vessels of the^l brain. If discovered in time, the persoifljfl must be brought to the open air, and the chest compressed to expel the noxious air, which will not easily escape of itself, as it i9 heavier than common air. A quantity of blood must be drawn, and cold water ap- plied to the head. Mustard poultices ap- t plied to the feet, will assist in the relief of ' the patient. Though carbonic acid applied to the lungs be thus deadly, it has very salutary | and beneficial effects when taken into the stomach. The mineral waters commonly called acidulous, and which sparkle when j first drawn, or when poured from one glass j to another, owe this property to the car- ] bonic acid which they contain; and hence not only the natural sources of these waters are resorted to with great benefit in sto- mach complaints, but artificial imitations of them are in frequent use, under the name of soda water, aerated alkaline water, and the like. The waters sold under the name of soda water, really contain little or no soda, and are chiefly water impregnated MATERIA MEDICA. 1G1 with carbonic acid. It is carbonic acid that gives the briskness to malt liquors, to ci- der, and to champagne. Carbonic acid is rapidly taken up by lime water; and as there is always a small portion of carbonic acid in the air, lime- water can not be kept pure, unless the at- mospheric air be completely excluded. Hence a certain way of clearinir confined places from carbonic acid, is by pouring large quantities of lime-water from one ves- sel into another, from a considerable height, and in a broken stream. Citric acid. The acid obtained from oranges and lemons. It is also found in many other fruits, as the cranberry, the bird's cherry, and the fruit of the dog-rose. Strawberries, raspberries, and gooseberries also contain it, mixed with the malic acid. The simple expressed juice of lemons will not keep, on account of the syrup, muci- lage, and other matters which it contains, and which cause it to ferment. This is much to be regretted, as lemon-juice is the great specific against sea-scurvy, and is pos- sessed of virtues sufficient to disarm that dreadful scourge of all its terrors. A method was invented by the great Swedish chemist Scheele, of obtaining the citric acid pure and crystallized; and by his pro- cess, or some similar one, it is manufac- tured in great quantities, and sold under the name of the concrete salt of lemons. The process is the following: Powdered chalk is added to lemon juice, the carbonic acid is disengaged, and the lime combines with the citric acid, forming citrate of lime. To this, sulphuric acid is added, and a sul- phate of lime is formed, which being in- soluble, falls to the bottom, and the citric acid remains in solution in the water. This is evaporated and crystallized. Lemon juice is used in making the saline effer- vescing draughts, so useful in many cases of vomiting; and when lemon juice can not be procured, the crystallized citric acid, dissolved in water, will answer the purpose. For sea-scurvy, the lemon juice, as nearly pure as possible, is the best; but in some situations we must be content with the crystallized acid. The citric acid is an ex- cellent refrigerant, and, as such, is given in many feverish disorders. Lemonade, or diluted lemon juice, sweetened with sugar,, is a pleasant drink in fever. Muriatic acid. Muriatic acid is generally in a liquid form, having a strong and pun- gent smell, and a taste very sour and caus- tic; exposed to the air, it emits white fumes. It is a solution of the muriatic acid gas in water, which deserves attention in a medi- cal point of view, as being employed in fu- migation for destroying contagion. It is extricated for this purpose by pouring sul- phuric acid on cpmmon salt, by which the fumes of muriatic acid are disengaged, and sulphate of soda is formed. Muriatic acid has been successfully administered in ty- phus and scarlet fever, in the proportion of a drachm to a pint of gruel or barley-water, with sugar or syrup to correct its acidity, and to render it more palatable. This mix- ture is to be used for common drink; but must not be put into a leaden or pewter vessel or spoon. It is recommended as good against worms, in the dose of from five to twenty drops in a strong infusion of quassia, frequently repeated. Nitric acid, or aquafortis. A strong min- eral acid, highly corrosive. When applied to the skin, it gives a yellow stain. It has been used in medicine largely diluted, and with reported good success, in a variety of diseases. In low nervous fever, it may be used to acidulate the drink; and in liver complaint, and in syphilis, it has been thought capable, by some, of even super- seding the use of mercury. It is at least a good auxiliary in the cure of these diseases, taken to the amount of two drachms daily in water, or any other vehicle that may be agreeable to the patient. In some obstinate diseases of the skin, it is used as a vesicatory, to a small portion of the skin at a time. The fumes of nitric acid have been em- ployed to destroy febrile contagion, by pouring sulphuric acid on nitrate of potash; the nitric acid is disengaged, and rises in vapour through the apartment. It is thought that the caustic quality of undi- luted nitric acid w'ould render it a good means of destroying the poison introduced by the bite of a mad animal. Nitro-muriatic acid. Nitro-muriatic acid, is a mixture oftwo parts of muriatic acid, and one of nitric acid, and is famous under the name of aqua regia, as having the power of dissolving gold. Of late years, a bath of nitro- muriatic acid has been recommended as an alterative, in the hepatic affections so com- mon to those who have resided long in warm climates. The acid should be di- luted so as to have nearly the acidity of strong vinegar, and is to be applied to the body by a sponge, or used as a bath to the feet and legs; it generally produces a little heat of skin, thirst, and a peculiar taste in the mouth: the bowels, after a time, be- come affected, and the head-ache, the irri- tability, and pain of the side, gradually give way. Oxalic acid. The acid of wood sorrel* obtained from many vegetables by certain; process. It is obtained in a concrete form? and becomes an object of considerable in-- terest, from the resemblance of its crystals to Epsom salts. From its being employed to clean boot tops, it is kept for domestic use, and is too often mistaken for salts, and acts as a virulent poison. The symptoms produced are those of great pain, and a burning sensation at the stomach, vomiting. 162 MATERIA MEDICA. inflammation, and bloody stools. When a person is discovered in time to have swal- lowed oxalic acid, the most likely means of relief is to give very plentifully of lime- water or chalk, by which an oxalate of lime is formed, that will be comparatively in- noxious. The danger and the frequency of this accident call strongly for the most minute attention on the part of apothecaries and druggists. There is no test so good as the taste, which should always be exercised when there is any doubt. The Epsom salts are crystallized in large crystals, which the druggists very properly say can not be mistaken for oxalic acid; but it would be still better if they could impart some strik- ing distinction to the oxalic acid, as there is no great danger to life though the salts should be used, where the acid is intended; but very great risk when the acid is taken as sulphate of magnesia. Pyroligneous acid, or acetic acid ob- tained by the destructive distillation of wood of any kind. When purified, it has a grateful and very pungent odour, and an acid and acrid taste. The impure pyro- ligneous acid, which is contaminated with tar, has it is said, been very successfully employed as a lotion in leprosy, scrophu- lous ulcerations, chronic inflammation of the eye, and edges of the eyelids, and for promoting the suppuration of indolent ul- cers, or those connected with carious bone. It has also been injected into sinuses to promote their healing. Mr. Monge, a French chemist, discovered that the impure pyroligneous acid, has the property of preventing the decomposition of animal substances; it being sufficient for this purpose to plunge the meat for a few moments in the acid, to preserve it as long as required. Putrefaction, it is said, not only stops, but retrogrades. Prussic acid. A colourless transparent liquid, but occasionally having a yellow tinge; it has a peculiar odour, which, When diffused through the air, resembles that of bitter almonds; its taste is bitterish and pe- culiar, but its properties are soon lost by exposure to air and light. Modern che- mists have ascertained, that prussic acid contains a gaseous and highly inflammable compound of carbon and azote, which they term cyanogen, and which is rendered acid by combination with hydrogen. Its compo- sition is indicated by its name of hydrocya- nic acid. It obtained the name of prussic acid, from its being one of the constituent parts of the dye called Prussian blue. Prus- sic acid is one of the most virulent and rapid poisons known. According to the French physiologist Magendie, if a single drop of the concentrated acid be put into the throat of a dog, the animal makes two or three deep hurried respirations, and instantly drops down dead; it causes death almost as instantaneously when dropped under the eyelid; and when it is injected into the jugular vein, the animal drops down dead at the very instant, as if struck with a can- non-ball, or with lightning. The effects of the diluted acid are the same, when the dose is large, but somewhat different when smaller doses are given. Nausea, saliva- tion, hurried pulse, giddiness and convul- sions ensue. It is probable that very large doses occasion death in a few seconds, and at all events, a few minutes will suffice to extinguish life when the dose is considera- ble; but if the individual survive thirty or forty minutes, he will very generally reco- ver. Prussic acid acts strongly in several of its combinations, as for instance, prussiate of potash or of ammonia; but the triple prussiates are not poisonous. The proper treatment of a case of poi- soning with prussic acid consists in the use of the cold affusion, and the inhalation of diluted ammonia or chlorine. Venesection is also probably, indicated by the signs of congestion in the head. It is right to re- member, that on account of the dreadful rapidity of this variety of poisoning, it will rarely be in the physician's power to resort to any treatment soon enough for success; and farther, that his chance of success must generally be feeble even when the case is taken in time, because when hydrocyanic acid is swallowed by man, the dose is gene- rally so large as not to be counteracted by any remedies. This peculiar acid exists in a great variety of native combinations in the vegetable kingdom, as in bitter almonds, cherry-lau- rel, the kernels of the peach-tree, and of various fruits, especially in the thin skin which covers the kernel; and the distilled water and essential oils of some of them are nearlv as rapidly destructive as the acid itself. Prussic acid has been introduced into medicine in pulmonary and other inflamma- tions, and in heart-burn and other stomackj complaints, and as a lotion in some diseases of the skin; but it has not been found very useful, and is not much employed. The dose is from two to four or six drops of the diluted acid, in any convenient vehicle. Sulphuric acid. The acid composed of sulphur and oxygen, obtained by burning sulphur in the presence of oxygen gas. It is commonly called Oil of Vitriol. It is possessed of highly corrosive qualities; but when properly diluted, it is a very useful cooling and astringent medicine. It is kept in the shops diluted with seven times its weight of water; and of this diluted acid, ten drops in a glass of cold water may be taken twice a-day, in discharges of blood from the stomach or lungs. Or it may be mixed with simple syrup* or syrup of Tolu, in the proportion of one dfachm of the acid MATERIA MEDICA. 163 to four ounces of syrup, and the patient's drink may be acidulated with the mixture. To prevent it from injuring the enamel of the teeth, it may be sucked through a quill, and the mouth must be carefully washed after taking it. The infusion of red rose leaves, acidulated and coloured red by this acid, is an elegant form for administering it, either internally, or as a gargle. When sulphuric acid has been swallowed by mistake, the consequences are inflam- mation of the stomach, and all its attendant dangers and sufferings. Little can be done; but we may try large dilution with carbon- ate of potash dissolved in warm water, and then endeavour to excite vomiting by irri- tating the fauces with a feather, or by thrusting a finger down the throat. The after-treatment must be directed by the symptoms. Tartaric acid. Tartaric acid is obtained from cream of tartar, by adding to the lat- ter thirty parts to the hundred of powdered chalk, and then dissolving the mixture in ten limes its weight of boiling water. Inso- luble tartrate of lime is thus formed, which is to be washed three or four times with cold water. To it is then to be added con- centrated sulphuric acid, equal in weight to the chalk employed. Insoluble sulphate of lime and tartaric acid in solution, are thus obtained; the latter may be crystallized by evaporation, and purified by re-solution and evaporation. The taste of tartaric acid is very sour, but agreeable. It is used as a cheap substitute for the concrete acid of le- mons in the formation of soda and Seidlitz powders. The white papers of the soda powders in the shops contain tartaric acid, and the blue contain bi-carbonate of potash. ACONITE. Wolf's bane—iconitum Napellus. A plant found in different parts of Germa- ny, and cultivated in our gardens. Its ef- fects on the animal body are narcotic or stupefying-; its active qualities appear to reside chiefly in the root. When chewed, a slight sensation of acrimony is first per- ceived, afterwards the point of the tongue appears to lose its feeling, and a sharp heat of the mouth succeeds, followed by trembling and chilliness. The fatal symp- toms are convulsions, giddiness, loss of rea- son, violent purging, faintings, cold sweats, and death. If it be soon discovered that a person has swallowed any of this poisonous substance, the stomach must be quickly evacuated; and one of the readiest means of doing this, is to give thirty grains of sul- phate of zinc, (white vitriol) dissolved in water. If this is not at hand, a spoonful of table mustard, or large draughts of warm water may be tried; but when the poison itself has brought on the vomiting and W other bad symptoms, we must endeavour to allay them by brandy, ether, or other cordials, though our hopes of doing so can not be sanguine. About sixty years ago, this substance was employed in medicine, first by Dr. Storck of Vienna; and, like most substances newly discovered or newly applied, was highly extolled; but it is now less used than formerly. The extract or inspissated juice is said to have a beneficial effect in some cases of chronic rheumatism, and in some of intermittent fever, connected with disease of the viscera or internal or- gans. The dose is from half a grain to two grains. ACORN COFFEE. A coffee made from one ounce of roasted acorns and a pint of boiling water, and used in the dose of three or four tea-cupfuls in the day, is highly extolled by the Germans in scrophula, disease of the mesenteric glands, commencing rickets, asthma, and cough. ADHESIVE PLASTER. A plaster which, when spread on linen, is used by surgeons to retain the edges of wounds in contact, to promote the healing of ulcers, after granulation has commenced, and for other purposes. It is applied across the wound or ulcer in narrow strips, which are placed a small distance apart, to allow of the escape of whatever discharges may occur. It is made by boiling together se- mi-vitrified oxide of lead, olive oil, and wa- ter, over a gentle fire, of the product, when cold, six parts are melted with one of yel- low resin. ALOES. A well known and veiy useful purgative medicine. It is a gum resin, or substance soluble in diluted spirits, and is obtained from a plant which grows in Barbadoes, at the Cape of Good Hope, and in the island ofSocotra in the Indian Ocean. It is pre- pared by pulling off the leaves, from which the juice is squeezed out, and afterwards- boiled and skimmed. Its taste is intensely bitter and disagreeable, though it has an aromatic flavour. Aloes is a warm, stimu- lating purgative^ and it acts chiefly on the large intestines, seldom producing any wa- tery or fluid stools, but merely promoting the easy evacuation of the bowels. It ge- nerally agrees well with the stomach, and by its bitterness promotes appetite and di- gestion; and it is remarkable with regard to it, that it operates as beneficially in a small as in a large dose; one or two grains will often produce one considerable stool, and twenty grains will do no more^ except- ing in the last dose, the operation will be 164 MATERIA MEDICA. attended with griping. Aloes is one of the best remedies against habitual costiveness: it is extensively employed by those of studi- ous, sedentary habits, and by females of all classes of society; and from its very general use, and from its certainly acting chiefly on the great intestines, it is not wonderful that many instances are known of its seeming to produce piles and other irritations of the lower belly and neighbouring parts. It will have this effect when frequently used; and therefore, however useful aloes may be as a mild and certain evacuant, it will be right for those whose constitutions require fre- quent purgatives, to interpose, occasionally, a dose of neutral salts, or compound pow- der of jalap, or infusion of tamarinds with senna. In indolent habits, where costive- ness is accompanied by languid circulation, loss of appetite, disinclination to exertion of mind or body, fretfulness of temper, and those symptoms which the unlearned under- stand so well by the term nervous, aloes, in some of its various combinations, is one of the most valuable medicines we possess, The cases in which aloetics should be avoided, are those of persons subject to piles, to discharges of blood, and where in- flammation or irritation exists in the bowels. From their action on the uterine system, they are used in eases where the monthly discharge is obstructed; and for a similar reason, should be used with caution in a state of pregnancy. The dose of aloes is from three to fifteen grains, but from its disagreeable and bitter flavour, it is never given alone, but combined with aromatics or bitters, or made into pills. The following are some of the most use- ful forms in which aloes may be taken, with the particular purposes, and times of the day proper for each. They are kept in the shops of apothecaries, under the name pre- fixed to each of them. Aloetic pills,- aloes and castile soap equal parts; for costiveness without any peculiari- ty of symptoms: two pills for a dose at bed- time. Aloetic pills with assafaztida,- aloes, assafce- tida and soap, equal parts; for hysterical affections, with costiveness and flatulence: two pills every second night at bed-time. Aloetic pills with colocynlh, commonly called colocynth pills,- when the simple aloe- tic pills are found too weak: two pills or three at bed-time. Pills of aloes with myrrh, or pilulx Rufi,- in female constitutions, in the full, com- plexion and sluggish habits attendant on the suppression or non-appearance of the monthly discharge: two pills or three may be taken twice or thrice a day. Rhubarb pills, or stomachic pills,- these contain a small portion of aloes; they are useful for strengthening the stomach, and gently opening the bowels, and may be taken to the extent of two pills every fbr«- noon, and two in the evenmg. The far-famed Anderson's pills consist of Barbadoes aloes, with a proportion of jalap and oil of aniseed: one or two for a dose. There is another kind of pills, which seem a slight variation of the pills called i dinner pills, or Lady Webster's, or Lady I Crespigny's pills, made of equal parts of \ rhubarb, aloes, and mastich. This last in- gredient is not of much virtue in itself but makes the solution of the others in the bowels gradual and equal. The dose of • these pills, which have not received any particular name, is two or three, and the time for taking them is immediately before dinner; they then mix with the food, pre- i vent flatulency, and are usually found to operate next morning after breakfast. ALUM. | A salt composed of sulphuric acid, and a 4 peculiar earth abundant in clay, with a 1 quantity of potassa. It has a sweetish but j powerfully astring'ent taste; and from its j astringent qualities, it is considered useful in restraining discharg-es of blood, or immode-' Jfl rate secretions; but it is highly dangeroufjj to use large doses of it in fluxes from the^^l intestines. When it is thought advisable to -J use alum in discharges of blood, from ten to 'm fifteen grains may be given, and repeated i every hour or half hour, for four or five Ja times; but there are few bleedings where jflj it would be safe to trust to this; and in J every case attentive discrimination must jf be employed to ascertain \the nature and cause of the bleeding. Burnt alum is used ,| externally in the form of powder as a mild caustic, to prevent the growth of proud , flesh; it is also used in solution as a wash to the skin, and in some cases as a wash for the eye. A styptic wash, of which alum is ' a principal ingredient, is used for stopping bleedings at the nose; and for this purpose, cloths or pieces of sponge steeped in the a liquor are to be applied to the part. By J agitating a grain of alum with the white of 1 an egg, a curd is formed, and this is useful in some cases of inflamed eyes, being ap- I plied to the eyelids between two folds of S fine linen. An astringent gargle is made I from alum, sage tea, and honey; a more elegant prescription, however, is three and M a half ounces of infusion of roses, ten grains fl of powdered alum, and three drachms of ■ oxymel, mixed together. ■ AMBER, THE OIL. ™ By distilling amber, an oil is obtained, of j a pungent and acrid taste, and of a pecu- J liar, but not very unpleasant odour. It is J seldom used except as a liniment; and it is ! one of the ingredients in an empirical re- I MATERIA MEDICA. 165 medy called Roche's Embrocation, much used in hooping-cough. Either that or the following may be rubbed on the chest three times a day: take equal parts of tincture of camphor, laudanum, and oil of amber, and form a liniment. AMMONIA. The pungent volatile substance known by the name of hartshorn. Ammonia in its pure state is a gas or permanently elastic fluid, which may be separated from sal- ammoniac by mixing quick lime with it and distilling, when the ammoniacal gas rises. It must be passed through mercury, as wa- ter rapidly absorbs it. It is composed of three parts of hydrogen and one of azote. Ammonia is usually kept in combination with water, and this solution, commonly called spirit of hartshorn, agrees in its pro- perties with the other alkalies, neutralizing acids, forming soap, and changing the ve- getable blues to green. Ammonia, in two at least of its combinations, affords the cu- rious example of two aerial bodies forming a solid when they meet. The muriatic acid gas, and the ammoniacal gas, two invisible transparent fluids, when brought within the sphere of each other's influence, form the solid white substance sal-ammoniac. Car- bonate of ammonia also is the production of a gaseous acid, and a gaseous alkali. It is in the form of carbonate or sub-carbonate, that we find it most convenient to employ ammonia for medicinal purposes, as the pe- culiar properties of ammonia are so little diminished by the addition of the carbonic acid, that it may be disregarded. Ammonia is one of the most useful sti- mulants we possess. Ammonia in water, or the carbonate of ammonia, is useful for arousing the suspended faculties in cases of fainting. It is often used with good effect to stop the fits in hysterical women, and it is applied also, though with less certainty of success, in convulsions or epilepsy; and in cases where spirits, wine, or internal stimulants would be dangerous, ammonia to the nose in the form of gas, may be benefi- cially employed. Ammonia is a powerful corrector of acidity in the stomach, even more so than the fixed alkalies, and is useful in those af- fections of the stomach which are the con- sequences of irregular living. In hoarse- ness, proceeding from a relaxed state of the throat, it is highly useful. It may be taken dropped into syrup, to the amount of ten drops four times a day. When sore throat is threatened, a gargle of properly diluted water of ammonia in the proportion of one ounce of ammonia to six of pure water, will often prevent the inflammation from pro- ceeding far; and' the same gargle, with an additional ounce or two of water, may be used in the relaxed and swelled state of the tonsils, which some people are subject to in damp cold weather. A mixture of harts- horn and oil is a good embrocation in sore throat, and in other cases, where a heating liniment is wanted, as in palsy, rheumatism, and internal pains. The dose for internal exhibition is from five to ten drops of the undiluted solution of hartshorn, called aqua ammonia, or from five to eight grains of the sub-carbonate made into pills. The ammo- nia may be increased or diminished accord- ing to the degree of stimulus required. In some cases of head-ache, ammonia dissolved in spirits, with a proportion of volatile es- sential oils, is beneficial, in the dose of from ten to forty drops, three or four times a day. The beautiful blue colour in the large jars exhibited in the shops of druggists is pro- duced by adding a quantity of liquid am- monia to a solution of blue vitriol (sulphate of copper) in water. Muriate of ammonia—Sal-ammoniac. A. salt formed by the combination of muriatic acid and ammonia. It has an acrid, bitter, and cool taste. It is seldom given inter- nally, but as an external application, it is used dissolved in vinegar or water, in dis- eases of the brain, as violent head-ache, apoplexy, delirium; to discuss indolent inflammations and tumours; in the treat- ment of chilblains. In the form of a gar- gle, it is directed in some diseases of the throat. AMMONIACUM. The name of a gum used in medicine as a stimulating expectorant, either alone, or combined with squill. In the coughs to which aged persons are sometimes subject, unattended by inflammatory action, but with some degree of spasm, and the secre- tion of much tough mucus, difficult to bring up, ten grains of ammoniacum, three times a day, seem to have proved of service in allaying the spasm, and causing the mu- cous matter to be easily spit up. For a similar purpose, the mixture of ammonia- cum made by rubbing the gum with water, may be used in doses of from half an ounce to an ounce; and the same may be given to females in whom it is wished to increase the activity of the uterine system. In long and obstinate colics, proceeding from viscid matter lodged in the intestines, ammonia- cum alone, or combined with rhubarb, has produced happy effects. Six grains with ten of rhubarb are a proper dose. The squill pill, which is so useful an expecto- rant, has ammoniacum as one of its ingredi- ents. It would be as well if this gum had another name, not so similar to ammonia, with which it has no affinity or resemblance. 166 MATERIA MEDICA. ANGUSTURA BARK. Is obtained from the cusparia febrifuga of Linnxus, the bonplandia trifoliata of the modern botanists. It is stimulant and tonic to the organs of digestion, but does not cure intermittents, as was at one time be- lieved. It increases the appetite for food, and does not oppress the stomach as the Peruvian bark is apt to do. It is given in powder, in doses of from five to twenty grains, or in infusion, one drachm to four ounces of water; or in tincture, in the dose of one or two drachms, or in the form of watery extract. There is a substance called fine angus- tura, which is the bark of a different plant, the brucea antidysenterica, and contains an active poison. Its virulence depends on an alkaloid body, to which its discoverers, Pel- letan and Caventou, have given the name of Brucea. It is said to produce tetanus, without affecting the intellectual faculties. It is characterized by having its outer bark covered with a matter which has the ap- pearance of rust of iron. ANTIMONY. A metal from which are derived some of the most celebrated and useful substances employed in the practice of physic. The ancients were acquainted with an ore of it, which was called stibium,- but it does not appear that they considered this substance as containing a metal, or that they knew what modern chemists call antimony, in a state of purity. It is said to have obtained its name, which signifies hostile to monks, from the alarming and destructive effects it produced among the inhabitants of a cer- tain monastery, to whom it was given by Basil Valentine, one of their brethren, who had observed that some pigs who had eaten of madder, with which some ore of the me- tal was accidentally mixed, became thriving and fat. He wished to produce the same healthy and respectable appearance on his brethren, but the subjects of the experiment not being precisely the same, what fattened the swine, killed the monks. No metal, not even mercury itself, has been tortured into such a variety of forms by chemists; no drug has excited more the attention of physicians. Some considered it as a specific for every disease, others contended that it should be detested as a virulent poison. The parliament of Paris condemned it by public authority; and by a singular coincidence, their great monarch, Louis XV. nearly lost his life by an overdose of this medicine; at least, this is told by Guy Patin, who wrote against antimony with great virulence. After many plans pro- posed and rejected, modern pharmacy is contented with a very few preparations of antimony ; and practitioners find them sufficient for every useful purpose, and freed from the uncertain doses and danger- ous forms which annoyed their predeces- sors. Antimony, as a medicine, is valuable for its emetic powers; and by skilful manage- ment it is made a useful sudorific, and is also employed to diminish too great excite- ment of the vascular system. Emetic tartar. The preparation of anti- mony most to be depended on is tartar emetic, so called because we boil the cream of tartar and crocus of antimony together in water, and thus prepare the salt so generally used in medicine. Its chemical name is the tartrate of antimony and potash. Tartar emetic is given in doses of from one grain to three, dissolved in water; and in these doses it proves powerfully emetic, occasioning very complete clearing of the stomach, considerable depression of strength, and paleness of the countenance; and be- sides, enough is frequently left to pass into the bowels, and to prove purgative. Two grains are to be dissolved in four ounces of water; and a tablespoonful of this solution given every ten minutes or quarter of an hour, till vomiting takes place, is a good way of giving tartar emetic. By giving the same solution in rather smaller doses, and at longer intervals, as of two hours or three hours, instead of vomiting, the effect is pro- duced of bringing out a gentle perspiration, which is of the greatest benefit in many diseases, especially feverish diseases. Antimonial wine. Tartar emetic is also given dissolved in wine; an ounce of the antimonial wine contains two grains of tar- tar emetic; but it is not so often given as the watery solution, because in febrile com- plaints the wine might be improper. Antimonial powder. Another antimonial much used with the view of promoting gen- tle perspiration in febrile complaints, is the antimonial powder, of which the dose is three or four grains every four hours. A preparation of a very similar kind to this, is the celebrated James's powder, which has maintained its reputation for nearly a hun- dred years. Antimony, conjoined with some narcotic medicine, is a better sudorific even than when employed alone; the dose for this purpose is thirty drops of laudanum, with forty of antimonial wine, to be given in an ounce of water at bed-time. When an emetic is wanted for children, antimoni- als are seldom those we should employ. Tartar emetic does not often lie on the stomach, but if in large doses it should do so, it acts as a virulent poison: its expulsion must be promoted by oil and warm water, or its effects counteracted by takingrthe decoction of yellow bark, which renders MATERIA MEDICA. 167 the tartar emetic inert. A cordial is some- times required after the operation of tartar emetic, even in the small doses used in this country. When it has acted too violently, opium may be given to allay the nervous symptoms; and when the exhaustion from vomiting has been great, a little wine or other cordial may be given to relieve it. The continental physicians give tartar eme- tic in doses which appear terrible to an Ame- rican practitioner: this can be accounted for only by knowing that its activity is dimi- nished or destroyed by substances given along with it, especially bitters and the bark. Twenty grains of tartar emetic, with an ounce of Peruvian bark in decoction, does not usually excite vomiting. Tartar emetic ointment. Tartar emetic, when well mixed with lard, in the propor- tion of one or two drachms of the substance to an ounce of the lard, forms a very irritat- ing ointment, which occasions a pustular eruption, something resembling the vesicles of cow-pox, and proving very serviceable in deep-seated inflammation. The pustules are very painful, and should they become much irritated, a soft poultice of bread and milk will in general give relief. Frictions with this ointment at the pit of the stomach have been much recommended in hooping- cough. ARABIC, GUM. Gum arabic, or gum acacia, is one of our best demulcents in cases of catarrh, con- sumption, diarrhoea and bowel complaints generally; in inflammation of the stomach, caculous affections, and strangury. It is prepared for use by dissolving the gum in warm water. In the form of mucilage, it is an excellent medium in which to administer various medicines taken in a fluid form. ARSENIC A metal famous for affording one of the most virulent, and, unhappily, too accessi- ble poisons known. As it is a substance whose fatal effects are too frequently ob- served, and as it is the instrument with which revenge or malignity often accom- plishes its detestable purposes, we shall give a pretty full detail of what is known concerning this noted mineral. Arsenic, in strict chemical language, is a metal of a blueish-white colour, not unlike that of steel, and has a good deal of bril- liancy. It is the softest of all the metallic bodies, and so brittle that it may be redu- ced to a fine powder by pounding in a mor- tar. It has no sensible smell when cold, but when heated, it sends forth a strong smell of garlic. Like other metals, it has no effect on the living body in its metallic state; but when combined with oxygen, its properties are very different indeed. When the metal is exposed to a moderate heat, in contact with air, it rises in the form of a white powder, and the garlic smell is per- ceived, not from the oxide, but from the metal, in a state of vapour. This white powder is the oxide of arsenic, and is what is generally known in commerce, and in common language, by the name of arsenic. It has a sharp acrid taste, which at last leaves an impression of sweetness, and is a very vi- rulent poison. Symptoms produced by swallowing arse- nic. The symptoms produced on the living body by a very small dose of arsenic, are some of the following: within about half an hour after taking the poison, there occur spasmodic pains of the stomach and bowels, with a sensation of heat in the mouth, and tightness about the throat, a feeling of tenseness of the skin of the head, and of the eye-lids, inflammation of the eyes, and itching of the face and neck. To these succeed incessant vomiting and purging, attended by excruciating pain of almost every part of the body, but especially of the stomach, bowels and head; the pulse, which at first was full, hard, 'and frequent, sinks, and becomes irregular; clamminess of the skin; cold sweats, purple spots, and con- vulsions precede death; or if the sufferer does not die, hectic fever, palsy, and weak- ness of mind and body, distress him during the rest of his life. It is said, that in cases of poisoning by arsenic, the body runs sud- denly into putrefaction. Treatment of those who have swallowed arsenic. The great object is to procure its expulsion from the stomach as quickly and easily as possible. If a practitioner be called in before vomiting has come on, it may be proper to excite it by tickling the throat with a feather, or by giving a dose of white vitriol, sufficient to excite instant vomiting. The dose for this purpose is from twenty-five to thirty grains, or five grains of blue vitriol, (the sulphate of cop- per) may be given; the advantages of these emetics are, that they act quickly, and re- quire little dilution for their action, which is of great importance, as preventing the absorption of the arsenic; and as blood-let- ting favours this absorption, we must be cautious not to employ it while any portion of arsenic remains in the body. But, in general, the vomiting has begun before a practitioner is called. Lime-water then should be plentifully given. The bowels must be emptied by the mildest means, as by castor oil, alone, or with olive oil or in mutton broth. Opium, in the dose of one or two grains, or forty drops of laudanum, or five grains of camphor, or a glass-full of camphor julep, or half a tea-spoonful of ether, in water, may be given to quiet the nervous irritability; and when the action of 168 MATERIA MEDICA. the heart is feeble, ammonia in pretty large night, or every second night. In the fit of doses has been found useful. But the pro- hysterics, a draught of the solution of assa- bability is, that inflammatory action will take foctida will sometimes put a stop to it itnme- place in the stomach and intestines; and, diately. When there is costiveness, with therefore, we must be very cautious how much distention of the bowels from wind, we treat the patient with stimulating sub- or colic pains, a drachm or two of assafa-tida stances. We must, when these mflamma- may be added to a clyster, consisting of tory symptoms appear, have recourse to about a pint of gruel or infusion of senna, bleeding, but with great caution, aware of with very good effect. In spasmodic cough, the debility that may rapidly follow; we the administration of a mixture, composed must give mild laxatives, employ a cooling of thirty grains of assafoetida, two ounces of regimen, and the usual remedies and ob- the water of acetate of ammonia, and two servances against increased arterial action, ounces of peppermint, may be given in as detailed in the article Antiphlogistic Re- doses of one or two spoonfuls; and the same gimen. The debility, the palsy, and im- paired health, are to be treated with bark anil wine, strengthening medicines, sea- bathing, light nutritious diet, and country air, with moderate exercise. Notwithstanding the destructive powers has also been found of service in hooping- cough. ASARABACCA. The leaves of the asarurn Eurqpaeumpos- of arsenic, it has been used as an article of sess both emetic and purgative properties;,'! the Materia Medica, and employed for the but they are principally used as an errhine, cure of intermittent fevers, periodical head- in cases of obstinate head-ache, and other aches, and in several diseases of the skin, chronic affections of the head, to produce a The safest form under which it can be em- copious secretion of mucus from the lining ployed in the cure of diseases, is the ar- membrane of the nostrils. According to senical solution of Dr. Fowler, beginning Dr. Cullen, the leaves of the asarabacca con- with the dose of four drops, and increasing stitute the most useful errhine we possess.. r. it gradually to thirty drops twice a day. The dose is from one,to three grains of the H The addition of a few drops of the wine of powdered leaves, taken like snuff at bed- opium is said to render its operation safer time. 1 and more efficacious. The precise manner of explaining the action of arsenic in the azedarach. cure of diseases, is not agreed on by physi- cians. "When there is a tendency to inflam- The bark of the root of the melia azeda- matory action, it should be avoided. Most rach, or pride of China. This beautiful of the plasters, salves, and powders adver- tree is a native of Japan, but has been natu- tised by quacks for the cure of cancer, are ralized in many parts of Europe, and in the mixtures of arsenic. Their use is always southern portions of the United States. The attended with great danger. Many cases fresh bark of the root is recommended as an of palsy, and even of death, have been re- active anthelmintic, in the form of a decoc- corded from the application of arsenical tion, made from four ounces of the bark plasters and ointments for various purposes, boiled in a quart of water, until the latter is And even where the skin is unbroken, poi- reduced to one-half. The dose is from half sonous effects may be produced. ASSAFOSTIDA. an ounce to an ounce, every two or three hours. It is very apt, however, to produce violent vomiting and purging. The berries of the azedarach are said to possess equal efficacy, in cases of worms, with the root. They may be eaten without any particular A gum resin from a plant growing In Per- sia, the ferula assafetida,- procured by cut- ting the top of the root across; and when regard to the dose. the juice is exuded, it is scraped off, and a second cut is made across. This operation azote is repeated till the root is entirely exhausted of juice. This drug has a strong disagree- A gas which forms a large proportion of able smell, somewhat like that of garlic, the atmosphere, 100 parts of which contain with a bitter acrid taste. It is one of the 79 of azote. It extinguishes flame, and is most common remedies for spasms, in hys- hostile to animal life; hence, the name given terical complaints, and in irregularities of to it by the French chemists, which signi- the monthly discharge. In asthma and fies destruction of life. Some later che- other kinds of difficulty of breathing, in mists call it nitrogen, from its being an in- hysterical cases, attended with much fiatu- gredient in nitric acid. Though azote is lence and costiveness, assafoetida is usefully principally described by negative proper- given; in this last case, joined with aloes, in ties, it is gas of great importance. Me- the pills, called the pills of aloes with assa- chanically mixed with oxygen in the air we fcetida, of which two may be given every breathe, it tempers the too great stimulus MATERIA MEDICA. 169 of that gas; combining with oxygen in a closer union, and in other proportions, it forms nitric acid, and other acids of remark- able properties; and united with inflamma- ble air (hydrogen) it constitutes the volatile alkali. It is an abundant ingredient in the composition of the muscles, and some other parts of the animal body. Azote was dis- covered by Dr. Rutherford in the year 1772. BALSAMS. This term is now generally restricted to signify compounds of resin and benzoic acid; but in the shops, and in common discourse, it is applied to some substances that are not strictly so compounded, which is the case with the article next mentioned, as it con- tains no benzoic acid, but consists of resin and essential oil. Canadian balsam. This is a species of turpentine, procured from the pinus balsa- mea,- it is improperly called a balsam, as it contains no benzoic acid. On account of its agreeable flavour, it is preferred for in- ternal use to common turpentine. It acts as a stimulant, diuretic and cathartic, when taken internally; and like the copaiba, is re- commended in gleet, fluor albus, chronic inflammation of the bladder, chronic ca- tarrh, and internal piles. It is best admin- istered in the form of an emulsion, with mucilage of gum arabic, or the white of an Balsam copaiba is obtained by wounding the bark of a tree, the copaifera officinalis, which grows in the Brazils, and in some of the West Indian islands. It has the consis- tency of oil, but it is more viscid and gluti- nous; it has a pale yellow colour, an aro- matic odour, and a pungent nauseous taste. Copaiba has been much used in the cure of gleets, of the whites, and of similar dischar- ges, where there is not much active inflam- mation. Of late, it has been thought of ser- vice to those who are troubled with piles. It may be given in doses of fifteen to forty drops, twice or thrice a day, in water, or rubbed into an emulsion with gum arabic, or the yolk of an egg. When given for the cure of piles, it is in doses of a drachm three times a day, and in this dose it commonly purges. A little aromatic water, or a drop or two of some volatile oil, as cinnamon or peppermint, may be taken with each dose, to prevent the sickness which copaiba occa- sions in some people. Balsam of Peru. This is obtained by boiling in water the twigs of a tree which grows in South America, the myroxylon peruiferum. It is of a brown colour, a fra- grant aromatic smell, and a pungent bitter- ish flavour. This balsam has been recom- mended in doses of, from half a drachm to a drachm, as a stimulant in chronic rheuma- tism. It may be given diffused in water by means of mucilage, or made into pills with some vegetable powder. It is said also to be a useful expectorant in chronic asthmas, and old dry coughs, but it should not be employed where there is any inflammatory action. Baham of Tolu. This balsam is also ob- tained from South America, from the tolui- fera balsamum. It has an agreeable Smell and taste, and is supposed to be expecto- rant; but it is now principally used to give a pleasant flavour to syrups, lozenges, and mixtures for coughs. The-balsam of tolu is one of the ingredients in the vulnerary balsams, intended to imitate what was once so famous under the title of Friar's balsam, Jesuit's drops, &c. But it is not easy to say, what advantage can be got from the application of such compounds to a recent cut, in which the vulgar commonly recom- mend them. BARK. When used without any addition, bark signifies the celebrated medicine obtained ' from South America, and known by the name of Peruvian bark, or Jesuit's bark. It is the bark of certain trees, called by bo- tanists, cinchona; and of its numerous spe- cies, there are three or more particularly used in medicine. Its medicinal virtues are said to have been discovered by the follow- ing circumstance: some cinchona trees be- ing' blown into a pool of water, remained there long enough to make the water so bitter, that the neighbouring inhabitants de- sisted from using it. One of them, in a pa- roxysm of fever, happened to drink of it, and obtained a speedy cure. Others who were ill, made use of the same remedy, and found it equally successful. A remarkable cure having been performed in 1638, on the countess of Cinchon, wife of the Spanish viceroy at Lima, it came into general notice, and from this lady the plant derived its pre- sent generic name. The species now called lancifolia, is that which furnishes the pale, or common Peruvian bark of the shops. It is imported chiefly in rolled up pieces or quills, mixed with larger and flatter pieces. The small and fine quilled pieces, are con- sidered the best. This bark is covered with a gray outer skin, internally it is of a deep cinnamon colour. Its smell, when fresh, is peculiar, and slightly aromatic; its taste is harsh and bitter. This is the spe- cies which has always been most esteemed in the cure of agues, and in the treatment of diseases attended with debility; and it is deservedly reckoned superior to all other tonics and bitters. In the cure of ague, the Peruvian bark is a medicine of great value. It should be taken in substance, and in sufficiently large 170 MATERIA MEDICA. doses, in the intervals of the fits; when given in the paroxysms, it is apt to disagree with the stomach. A large tea-spoonful should be taken every two hours; it may be mixed with water, or with milk; and this persisted in, till the fits postpone the period of then- attack, or cease to return altogether. By some stomachs it is apt to be rejected, and various contrivances have been fallen upon to obtain its virtues in a concentrated form, that would not disagree with the stomach; the tincture has been tried, but it is quite insufficient for the cure of intermittent fever; and, with more confidence, the ex- tract has been employed. This is pre- pared by boiling the powder, and evapora- ting to a proper consistence^ it is believed that a great proportion'of the active ingre- dients of the bark is obtained in this form, but in all probability there must be much loss of them in the preparation; the extract may be given in the form of pills, or of bolus, in the dose of from ten to twenty grains. The decoction of bark, is made by boiling an ounce of the powder of bark for ten minutes in a pint and a half of water, and straining the liquor; the dose of the de- coction is one or two ounces, repeated ac- cording to the effect intended; if for the cure of agues, in the same frequency as the powder; if for debility, it need not be so often used. The infusion of bark generally sits well even on stomachs that will not bear the bark in substance. It is made by pouring a pound of water upon an ounce of bark in powder, and allowing it to stand for twenty-four hours. The dose is the same as of the decoction, from one to three or four ounces. The dexterity of modern chemistry has succeeded in obtaining the virtues of the bark in a very concentrated form. In the pale bark, there is found a substance called dnchonin, or cinchonia, and in the yellow bark, a substance called qui- nine, or quina, which are analogous to each Other, like the alkalies potash and soda; and like them, are capable of combining with acids. Quinine, united with the sul- phuric acid, forms the sulphate of quinine, of which eight grains are considered equi- valent to an ounce of bark. A wine of qui- nine may be formed, by adding five grains of the sulphate to a pint of sherry; and a tincture, by dissolving the same quantity in eight fluid ounces of rectified spirit. We have thus a very easy and manageable way of exhibiting the bark; and it seems to have been ascertained by experiment, that these concentrated preparations of the bark are ■not, like those of some other vegetable sub- stances, possessed of deleterious properties, but may be safely used in the cure of dis- eases; and we are thus enabled to employ the bark in the complaints of children, where formerly it was so difficult to get them to take it in sufficient quantity. 11 c» sides intermittent fever, bark has been used in a great variety of ailments; and another 1 instance of its remarkable efficacy is seen in the treatment of gangrene. In gangrene, we can hardly be too desirous to get the bark thrown into the system in large quantities; and unexpected benefits sometimes result '■ from it. In gangrene, accompanied with de- ', bility, and in low states of fever, port wine may be taken at the same time with the bark. In the high excitement which sometimes co- exists with gangrene, and in typhoid dis- eases, while the skin is hot and dry, and high inflammatory symptoms are present, it is dangerous to use the bark, and more es « pecialiy to conjoin it with wine. In all jl cases, where we intend to continue the f bark for some time, it is wise to begin with B clearing out the stomach and bowels by an < emetic and purgative; and then to'take care y that it does not disorder the stomach, or j pass off by stool, as it is in some constitu- * tions ready to do. Where the bark proves purgative, a small dose of laudanum, as ten ; drops, or one-fourth, or half a grain of solid ' opium may be given with each dose. The other diseases in which bark is use- fully employed are very numerous; chiefly those accompanied by great debility. In bad small-pox, when there are both typhoid \im\ symptoms, and a gangrenous tendency, the j bark has been extensively used; but as it M frequently occurred in children, it was very JJ difficult, before the discovery of quinine, ^ from the disagreeable taste of the bark, to get them to swallow a sufficient quantityjj| It is best given to children in some sweef^jl liquid; or in the form of glysters, though 41 with much inferior efficacy. Quinine, how-|#fl ever, will render those expedients unnece's-'*>■ saiy. In consumption, it has been given; jflj but its tendency to disagree with the sto- mach, and to increase inflammatory symp- flj toms, require much caution in its exhibi- jjfl tion. It is generally prudent to discontinue H the use of bark when cough is present. It j has been given in rheumatism, but it is all , important to premise bleeding, and other means for reducing inflammatory action, be- ' j fore the bark is prescribed. j In all diseases that appear to come on peri- j odically, and to have some of the habits no- j ted in intermittents, the bark is sometimes j useful; of this nature are certain head-aches, 1 pains of the limbs, spasms, and coughs. In j gangrenous sore throats, the bark should be ] given internally; and a gargle made of the decoction is also to be used. In passive hae- j morrhages, and in dropsy, when seemingto arise from general debility, without any lo- cal disease, it is usefully alternated with diuretics, and the other means used for the evacuation of the water. Some form of the bark is useful in stomach complaints, either MATERIA MEDICA. 171 alone or combined with sulphuric acid, or iron. Sulphate of Quinine. Quinia is a vegetable alkaloid body, discovered by modern chemis- try in the yellow Peruvian bark, {cinchona cordifolia.) It is a white powdery substance, sparingly soluble in water, but dissolved by warm alcohol, from which it is not deposited in crystals. Quinia unites with acids, and forms salts, the most important of which is the sulphate. It is soluble in water, and crystallizes. It is now much employed in medicine, being found to answer all the purposes of bark; and as a small dose is ne- cessary, it does not produce the unpleasant effects of the bark in powder, or infusion. Eight grains are considered equal to an ounce of the powdered bark. Quinine mixture. This is made from twelve grains of the sulphate of quinia, one drachm of elixir of vitriol, and four ounces of cinnamon water. The dose is a teaspoon- ful three or four times a day. Syrup of quinine. Take twelve grains of sulphate of quinine, four ounces of sim- ple syrup, and one ounce of ginger syrup. The dose is the same as of the mixture. Extract of quinia, or more properly, ex- tract of bark, possesses all the properties of the Peruvian bark, and may be given in a pill of one grain as a dose. BARYTES. The name of an earth, remarkable for its great specific gravity, and for furnishing an ingredient of some salts which have been recommended in the treatment of scrofula. Of these, the principal is the muriate of barytes, the dose of which is from five to fifteen drops of the saturated solution in distilled water, taken twice or thrice a day. As all the preparations of barytes are acrid and poisonous, their exhibition must be conducted with due caution. BASILICON. A salve made by melting together five parts of yellow resin, eight parts of lard, and two of yellow wax. It is employed as a dressing to indolent ulcers and to burns. BELLADONNA. A perennial plant, with a herbaceous stem; growing in mountainous and woody situations, and often cultivated in gardens. The whole plant is poisonous; and the ber- ries, which are very beautiful, and of a fine red colour, sometimes tempt children to eat them; in consequence of which, they are seized with very dreadful symptoms, as a trembling of the tongue, dryness of the mouth, distressing thirst, difficulty of swal- lowing, fruitless efforts to vomit, and great anxiety. Delirium and convulsions come on: the pupil is dilated, and the eye is in- sensible to light. The face becomes swollen and of a dark red colour. Inflammation attacks the stomach and intestines; and the former becomes insensible to stimulants, so that it is in vain to give emetics to evacu- ate the poison, which is therefore very commonly fatal. Sulphate of zinc, to the extent of thirty grains, should be tried, or sulphate of copper, six grains; and it is said that vinegar and other vegetable acids, ho- ney, milk, and oil, are useful auxiliaries in the cure. In some children who recovered by this treatment, the delirium was suc- ceeded by deep sleep, and starting of the tendons; the face and hands became pale and cold, and the pulse was small, hard, and quick. Blindness continued a consi- derable time, but at last went off. The part of the plant used in medicine is the leaf, which has a nauseous bitterish taste, and is given at first in the dose of a grain a day in powder. Besides its narcotic power, it is thought to possess considerable influ- ence on the excretions of sweat, urine, and saliva; but as an overdose of it is so dan- gerous, and as we have other safer medi- cines which produce similar effects, it seems very doubtful whether its internal use" should be recommended. A plaster, com- posed of equal parts of extract of belladonna and common plaster, is often of effectual relief in the case of local pains arising from chronic rheumatism; and the powdered leaves, sprinkled upon unhealthy sores, or an infusion of them employed as a fomenta- tion, has allayed the pain of such sores. Half a drachm of the dried leaves, infused in half a pint of water, furnishes a liquor, which, when dropped into the eye, causes the pupil to dilate for a considerable time; and those who operate upon the eye, take advantage of this circumstance to facilitate their operations. Persons who are afflicted with a beginning cataract may, by having the pupil dilated by this infusion, have their sight improved for a time, as the dilated pupil will allow some of the rays of fight to fall on the retina. BENNE LEAVES. The leaves of the Sesamum orientale. When fresh, they are infused in water, which they render mucilaginous. This con- stitutes an excellent demulcent drink in fevers, diseases of the stomach, and bowel complaints. BISMUTH. A bright metal, of a leafy texture, and having a reddish yellow tint. Its oxyde or subnitrate is employed as a remedy in pain- ful affections of the stomach, as water brash, 172 MATERIA MEDICA. and for the cure of dyspepsia. It is gene- rally ranked among the tonics. BITTER-SWEET. A shrub, the twigs of which were former- ly used in medicine, and much esteemed for their power in the cure of cutaneous diseases, such as are commonly, though im- properly, termed scurvy spots; of rheu- matic affections, scrofula, and ill-conditioned ulcers. Bitter-sweet has principally been used in decoction as a diet drink, in the dose of two or three ounces three times a day, gradually augmenting the quantity, tiff a pint be taken daily. The strength of the decoction is an ounce of the twigs to a quart of boiling water. A stronger decoc- tion may be used externally as a lotion in the above-mentioned complaints. BLACKBERRY ROOT. The root of the rubus villosus, especially its bark, in the form of an infusion, affords a useful astringent in cases of chronic dysen- tery and diarrhoea, and in the latter stages of cholera infantum. BLISTERING PLASTER. A very excellent blister may be obtained by spreading on a piece of leather a layer of basilicon ointment, and then sprinkling the surface thickly with powdered cantha- rides; but the most common blistering plas- ter is made of equal parts of bees-wax, ro- sin and olive oil, melted together, into which is to be well stirred a quantity of powdered cantharides, equal to two thirds by weight of the other ingredients. BLOOD ROOT. The root of the sanguinaria canadensis, a plant which grows abundantly in every part of the United States. The root is red and tuberous, and of an acrid taste, which remains upon the fauces, some time after it has been chewed. According to the dose and form in which it is administered, the blood-root acts as a tonic, narcotic, stimu* lant and emetic. In large doses, as of 8 to 20 grains, it excites nausea, heat of the sto- mach, vertigo or faintness, indistinct vision, and finally puking. In smaller doses its ef- fects upon the circulation resemble those of digitalis. Given in doses insufficient to produce nausea, it acts as a stimulant and tonic. Applied in the form of powder to fungous granulations, it acts as an exharatic. The diseases in which it has been recom- mended, are long continued affections of the chest; those of the fiver; catarrh, hooping-cough and croup; rheumatism, hydrothorax. It is a remedy, howeyer, which can not fail to do harm, excepting in the hands of a skilful physician. BONESET. The eupatorium perfoUatum; a plant indigenous to the United States. Every part of it is intensely bitter, but without either astringency or acrimony. Its active properties are soluble in water. Taken internally, it acts as an emetic and purga- tive, a diaphoretic and mild tonic accord- ing to the dose. In slight cases of catarrh, a weak infusion may be drank warm on go- ing to bed, with a very good effect. In rheumatism, a weak infusion acts as a valu- able auxilary to the other diaphoretic reme- dies employed. BORAX. A salt composed of boracic acid, soda, and water of crystallization. It is found in Thibet in an impure state, and is purified by gentle calcination, solution, and crys- tallization. Its principle use in medicine is in the formation of gargles, and to mix with honey to be applied to the sore mouths of children; equal parts of borax and clari- fied honey, with the addition of a little tinc- ture of myrrh, is a good application for the thrush. A good gargle for the mouth and throat, when under profuse salivation, is made by taking two drachms of borax, dis- solving it in eight ounces of rose water, and adding a little honey and tincture of myrrh. Modern chemistry has derived some curi- ous facts from the decomposition of the bo- racic acid. A particular substance of an inflammable nature, called boron, has been extracted from it. Boron is a brown in- soluble powder, and burns with much bril- liancy when heated to 600°. BROWN MIXTURE. An expectorant mixture, made by dis- solving two drachms of extract of liquorice and gum arabic in boiling water, and when cold, adding sweet spirits of nitre, and anti- monial wine, of each two drachms, and tinc- ture of opium forty to sixty drops. The dose is a table spoonful occasionally. It is a use- ful prescription in catarrhal affections at- tended with a harassing cough, after the active symptoms have been removed by bleeding. BUCKBEAN. The root of the menyanthus trifoUata, is employed as a tonic, cathartic and altera- tive. MATERIA MEDICA, 173 BUCKTHORN. A tree or bush which grows in hedges, flowering in May and June, and ripening its fruit in September or the beginning of October. The berries have a nauseous bit- ter taste, and were long in considerable es- teem for their purgative effects, and were Celebrated in dropsy, in rheumatism, and the gout. They produce griping and sick- ness, with dryness of the mouth and throat, and long continued thirst. A syrup made by adding two parts of the clarified juice of the berries, to one of white sugar, is frequently prescribed to children in the dose of one or two tea-spoonfuls; but buck- thorn may easily be dispensed with in any shape; and children5 will take aloes sus- pended in treacle, and retain it on their stomachs as easily as syrup of buckthorn. BUGLEWEED. The lycopus virginicus,- a plant growing spontaneously about creeks and low lands. It has been recommended in the treatment of haemoptysis, coughs, and other diseases of the lungs. burdock., The root of the arctium lappa,- it is mu- cilaginous, without smell, with a sweetish slightly bitter taste. A decoction of bur- dock made by boiling one ounce in a pint of water, has been recommended as a gen- tle laxative, diuretic and sudorific in cases of gout, syphilis, scurvy, and calculous com- plaints. BURGUNDY PITCH. A resinous matter obtained from various kinds of fir-trees. In the form of a plaster, it is a very usual application to the chest, stomach, back, and limbs, in chronic af- fections of those parts. Its good effects are to be ascribed to its keeping up a degree of warmth on the suface, and thus acting the part of a mild rubefacient, without ex- citing redness of the skin, or producing ve- sication as in the case of sinapisms and blisters. BUTTERFLY WEED. , The root of the asclepias tuberosa. A plant indigenous to the United States, bet- ter known by the popular appellation of pleurisy root. The root has a slightly bit- ter taste, without any indication of astrin- gency, and yields its active properties to boiling water. It acts when taken into the stomach, as a diaphoretic and expectorant. It also exhibits a slightly tonic action, and in large doses is gently laxative. In pleu- risy, catarrh, and other diseases of the chest, it is greatly extolled. It has also been employed in bowel affections. About a gill of a strong decoction of the root may be taken as a dose. BUTTER-NUT. An extract made from the inner bark of the root of the juglans cinerea, either alone or in combination with calomel, jalap, soap or other purgatives, constitutes an excel- lent cathartic in all cases in which evacua- tion of the bowels is required. The dose of the extract is from fifteen to thirty grains. CAJEPUT OIL. A volatile oil of a greenish colour, with a smell resembling camphor and turpentine, said to be obtained from the melaleuca leu- codendron. It is a powerful medicine, and much esteemed in India in painful chronic diseases. Taken into the stomach in doses of five or six drops, it is heating and stimu- lating, and also diaphoretic. It is thought useful in various convulsive and spasmodic complaints. It has also been used both in- ternally and externally in palsies, rheuma- tism, gout, tooth-aches, deafness, and in hysterical and hypochondriacal affections. It is said to be destructive to the insects which infest the collections of natural his- torians. CALAMINE. An ore of the carbonate of zinc, and an article of the materia medica. It is roasted and calcined, to free it from any arsenical or sulphurous particles it may contain; and, when properly prepared, it is used in cer- tain eye ointments; and dusted on moist ulcers, to prevent the spreading of the acrid matter. It is also the basis of the useful cerate,'commonly known by the frame of Turner's cerate. CALOMEL. A preparation of mercury; and one of the very best products of that remarkable and useful mineral. It is a compound of the black oxide of mercury with muriatic acid, the acid being in less quantity than is sufficient to neutralize the base; or accord- ing to the more modern view, it is a chlo- ride of mercury. Calomel is one of the most useful mer- curial preparations we have. It is princi- pally used as a purgative; and there are * few purgatives more convenient. It may be administered to patients of every age, and in a great variety of complaints. It is a medicine which, on account of its efficacy in a very small bulk, and4ts having no nau- 174 MATERIA MEDICA. seous taste, is excellently adapted for child- ren. To infants from a few weeks to a year old, it may be given in doses of from half a grain to two grains, according to their age. Though it is thus so safe and manageable a purge, it is to be observed, that it is not to be rashly given nor obsti- nately persisted in ; we must never for- get that it is a preparation of mercury; and as this active mineral, if not carefully ad- ministered, may prove a poison instead of a remedy, it ought to be alternated with some purgative of quite a different character; and given only occasionally, and at inter- vals. As mercury is apt to exert its pecu- liar action on the mouth, we must be care- ful not to order it in cases of thrush and ulceration of the mouth, to which children are subject. In disorders of the digestive organs in children, accompanied with wast- ing, pale colour, picking of the nose, and the symptoms commonly supposed to indi- cate worms, very small doses of calomel combined with magnesia, or prepared chalk anil ipecacuanha, will often produce very beneficial effects when aided by a proper diet and the warm bath. When the child is really troubled with worms, especially the long round worm, or the small white ones, three grains of calomel, with six or eight of jalap, form a good vermifuge. In croup, it was at one time thought to be a very efficient practice, to give calomel to the amount of five grains every hour, even till a hundred grains were taken in a day; but this practice does not seem to have kept its ground; as croup requires very ac- tive treatment for its inflammatory and spas- modic symptoms, and can not wait for the mercurial action of calomel; nor does there seem any specific power in calomel against croup. In inflammation of the bowels, it has been recommended to give doses of calomel so large as twenty or thirty grains; but there seems no peculiar advantage in this plan; indeed many practitioners have doubts whether any effect whatever results from such doses. When we wish the pur- gative effects of calomel in an adult, the best way is to combine it with jalap, rhu- barb, scammony, or the extract of colo- cynth: five grains of calomel to fifteen of jalap or rhubarb; or eight of scammony or aloes, (increasing the quantity of both in- gredients if necessary) form a very valuable purge. Calomel is frequently employed with the intention of introducing mercury into the system; and for this purpose, the dose is one grain, or two, taken night and morning; and it is administered very con- veniently in the form of a pill. To prevent its passing off by the bowels, as even' in this small dose it is in some cases apt to do, it is proper to conjoin a small quantity of opium with each pill, as half a grain; tak- ing care to obviate costiveness by the oc- casional use of suitable purgatives. It would be difficuJt to enumerate the great variety of diseases in which calomel is used; they may in part be understood, from the general purposes which we have mentioned , it as fulfilling, viz. a purgative and an alter- ative effect; but it appears possible to cause it also to act on the kidneys, by combining it with diuretics; hence, it is used in combi- J nation with squill, in some species of drop- CAMPHOR. j A substance obtained by distillation from J a species of laurel which grows in great M abundance, and to a considerable size, in T the forests of Japan; the laurus camphora. , ICELAND MOSS. Lichen. The name of a genus of plants of the class cryptogamia; familiar to the sight, by at least one species of it, forming ] the green or gray covering of old walls or j ruins. There is one species called the I lichen islandicus, which has obtained some i reputation as a remedy in consumptions, | coughs, dysenteries, and diarrhoeas. It is principally at Vienna that these good ef- J fects have been celebrated; but the article 1 has been admitted into the London Phar- i macopoeia. It consists of a bitter matter, and a kind of mucilage, by which it acts as a tonic, and an article of nutrition; but it has no title to any estimation as being a re- medy in consumption. The form in which MATERIA MEDICA. 189 it is used is in decoction, to the extent of one or two ounces; the bitter part being first extracted by steeping it in warm wa- ter. INDIAN TOBACCO. The lobelia inflata, or Indian tobacco, Is a plant indigenous to the United States, in most parts of which it grows in great abun- dance. The leaves and capsules are ex- tremely acrid, and when hekl in the mouth for a short time, produce giddiness, and pain of the head, with a tremor of the whole body; at length, extreme nausea and vomit- ing occur. It is employed as a very active emetic, producing great relaxation of the system, copious perspiration, and often purging. The tincture has been recom- mended in asthma, in doses of a tea-spoon- ful. The lobelia is one of the remedies in great repute among the Thompsonian prac- titioners. It is, however, an active and dan- gerous remedy, from an over-dose of which the most serious effects may be produced. INDIAN TURNIP. The root of the arum triphyllum, or Indian turnip, when fresh, is extremely acrid, pro- ducing, when taken into the mouth, a smart- ing pain of the tongue and fauces, which continues for many hours. This acridity is lost by drying. The dried root has chiefly been employed as an expectorant in dis- eases of the chest, unconnected with active inflammation, or fever. In the chronic asth- mas of old persons, it is also said to be a good remedy. IODINE. A chemical substance, discovered at Paris in 1812, obtained by certain processes from the ashes of marine plants, and introduced into medicine with considerable advantag-e, in the case of swellings of the glands of the neck. The burnt sponge was formerly pre- scribed for such swellings, and had totally lost its reputation when the discovery that it contained iodine, restored hope of its being of some benefit, and showed the grounds on which such a hope rested. The forms in which iodine is used, are the tincture, of which the dose, at first, is ten drops a day in any viscid liquor, as gum, syrup, or gruel; or the hydriodate of potassa, of which the dose is about the same quantity. Ointments are also made with iodine, in the propor- tion of one drachm of hydriodate of potassa to three drachms of lard; and of this oint- ment, a piece, about the size of a hazel-nut, is to be rubbed in upon the swelling night and morning. Very unexpected diminution of enlarged glands has followed the use of this substance. In some cases, it produces feverish symptoms, thirst, restlessness, and diarrhoea; in which event, it should be dis- continued, and the proper remedies applied to these injurious symptoms. IPECACUANHA. The root of a plant found in Brazil, which: furnishes us with one of the best and safest of our emetics. The introduction of this celebrated root into medical practice was chiefly owing to Helvetius, grandfather of the celebrated author of the work De PEs- prit, who came from Holland to Paris very young to practice medicine. He attended and cured a drug merchant, who paid him with a packet of the root from Brazil, called ipecacuanha. After some experiments in the hospitals, Helvetius found it possessed the virtue of curing dysentery. Before the end of thirty-two years, he had made 100,000 crowns by the cure of that disease. Louis XIV. gave him a thousand lpuis for his secret. So famous was the success of the root, that it obtained the name of radix anti-dysenierica. It does good in pure dy- sentery, by maintaining a steady motion of the intestines downwards, and by determin- ing to the skin; but in modern practice, we do not trust the cure of that very distressing, and, in warm climates, dangerous disease, alone to ipecacuanha or any one remedy. For every purpose for which an emetic is- advisable, no better than ipecacuanha can be desired. Even an over-dose has merely the effect of producing too hasty an evacua- tion of the stomach, but without any bad ef- fects. It may be given as an emetic to very young children, and is not followed by the debilitating exhaustion induced by metallic and other emetics. The root is reduced to powder, and the dose for a grown-up per- son is from fifteen to twenty grains; for a child above a few weeks old, from six to twelve grains, according to the age. White wine extracts the emetic properties of ipe- cacuanha; and the ipecacuanha wine is a very good form of administering it, pro- vided there be no degree of fever present. To a child a tea-spoonful of the wine may be given every ten minutes, till it operates. Like other emetics, or perhaps with virtues superior in this respect, it proves an excel- lent expectorant; and may be taken for this purpose, in doses of three or four grains three times a day; or made up into lozen- ges, with some sweet or aromatic substance; the ipecacuanha lozenges contain half a grain each. In nauseating doses, ipecacu- anha is very useful in haemorrhages from the lungs and uterus. In dysentery, it may be used as an auxiliary to other means. Combined with opium, it forms the cele- brated Dover's powder, now called the powder of ipecacuanha and opium, a very effectual sudorific; and for its soothing 190 MATERIA MEDICA. effects in colds, rheumatisms, and various instances of disordered bowels, one of the most salutary compositions of the pharma- copoeia. This metal, so widely diffused through nature, so essential in its metallic form, and its larger aggregations, to the comfort, and even to the existence of civilized society, is capable of entering into various chemical combinations, which render it fit to be taken into the body, and capable of producing various salutary effects. These are princi- pally of a tonic or strengthening nature. The preparations of iron most in use, are the carbonate, the sulphate, and the tinc- ture of muriate of iron; steel filings are also used, in the view of their being oxidated in the stomach and intestines, in consequence of the minuteness of their division. The doses of the various preparations of iron, when used as tonics, are the following: of the carbonate, from ten to fifteen grains may be taken in any tenacious substance, as jelly, honey, or the like; of the sulphate, one or two grains may be rubbed together with aromatic powder, and taken, at first, once, then twice a day; of the tincture of muriate of iron, ten drops may be given in water twice a day, increasing them to twen- ty or thirty. The metallic iron for internal use is commonly inclosed in sweetmeats, and known by the name of steel caraways, the dose of which is a matter of no great nicety. The carbonate of iron has of late been celebrated for other virtues than those of a mere tonic, and has been thought ser- viceable in the painful affection of the face, called the nerve pang, and also in can- cer. The dose for this purpose igwtcn grains, four times a day. A watery solu-.-.' tion of the tartrate of potass and iron, is re- commended as a chalybeate, particularly suited to children from its tasteless quality. Patients who are using any of the prepara- tions of iron are apt to be very much alarjn- ed at the black appearance of the stools; but it is merely a consequence of\he iron^., and will go off when it is discontinued. drastic or active purge, as may be desirable in some affections of the head, or with the view of bringing off a large quantity of wa- ter in dropsies, a purge may be formed by joining together six grains of aloes, ten of jalap, and five of scammony or gamboge; the watery stools produced by such a dose are sometimes of a surprising quantity, and give very great relief. Compound powder of jalap. Another most useful form of employing jalap, is by combining it with cream of tartar; constitu- ting the compound powder of jalap, one of the most manageable of purgatives, which, with most persons, acts very speedily and safely, and not only evacuates the bowels, but, for the time, increases the flow of urine. The proportions are, one part of jalap to two of cream of tartar; and the dose of the compound powder is from forty grains to sixty. It may be taken in plain water, gruel, syrup, or any mild liquid most convenient for the patient. > JUNIPEn. The fruit of the juniper contains an es- sential oil, possessed of diuretic powers; and it is this oil that gives to gin its diuretic pro- perties, and causes it often, improperly, to,, be given to patients labouring under drop- sy. The essential oil of juniper may be given to promote the flow of urine, in the dose of from two to ten drops upon white sugar, or formed into an emulsion, with a drachm or two of the sweet spirit of nitre. KENTISH OtNTMENT. This preparation, made by mixing tc gether two ounces of basilicon, and two' drachms of turpentine, has long been cele- brated as a dressing for burns and scalds. Care should be taken to prevent its contact with the sound skin, surrounding the bum or scald; for though a soothing application to the latter, in the surrounding parts, it will be very apt to produce severe inflamma- tion. A plant growing at Xalapa, in Mexico, the powdered root of which is a very useful and much employed purgative. The dose is from ten to twenty grains, but it is not often used by itself, but commouiy conjoin- ed with calomel, in the proportion of one part of calomel to two of jalar/;the dose of such a purge for an adult, of£p6d strength, is five grains of calomel, to Sixteen of jalap, to be taken in jell}-, honey, or any viscid substance, to prevent the calomel falling down by its great weight. To form a very An astringent substance obtained from an African plant. It was long uncertain what plant furnished kino; but it is thought now to be proved, that it is the pterocarpus eri- nacea. It is used to check diarrhoea, and for the other purposes for wdiich astringents are employed, in the dose of twenty or thir- ty grains of the powder, or two drachms of the tincture. One part of powdered kino to four of alum forms a styptic powder, which in the dose of from ten to twenty grains twice a day, is recommended in chronic menorrhagia and the whites. MATERIA MEDICA. 191 LAUDANUM. The tincture of opium; it is one of the most manageable forms of administering opium, whose narcotic and other virtues render it so essential in the practice of phy- sic. Under the article opium, is a very full account of the source from whence it is de- rived, of its various preparations, of their effects, and the cases in which they are use- ful; and it will, therefore, be necessary to . do little more in this place, than to state the doses of laudanum proper to be given on various occasions, and the methods to be pursued when an overdose has been swal- lowed. Uses and doses of laudanum. When we wish to procure sleep, the dose for a grown up person is from twenty-five to forty drops, taken in a little water, either plain, or sweetened, or in peppermint-water, cinna- mon-water, gruel, or the like. To allay griping pains in the bowels, from fifteen to twenty drops; but not repeated above once, or at the most twice, at an interval of half an hour. When there is a harassing, tick- ling cough, and no inflammatory symptoms forbid its use, ten or twelve drops may be very cautiously given, and repeated after an hour-, or two, till the second or third time. It is to be most particularly noticed, that although we consider it as right that every person, especially those who have the care of families, should know the doses of lauda- num which are proper on various occasions, we would urge most strongly, that it should never be given, except in cases of absolute L' necessity; and, if possible, always under the "sanction of a medical man; and we would caution parents never to allow it a place in the nursery; nor to put it in the way of ser- vants or others, whose ignorance or rash- ness might render it productive of the most baneful effects. Treatment of those who have swallowed an \ over-dose of laudanum. The primary ob- ject is to remove the poison from the sto- mach. This is proper, even in the rare cases in which vomiting takes place sponta- neously. The removal of the poison is to be accomplished in one of three ways, by emetics administered in the usual way, by the stomach-pump, or by the injection of emetics into the veins. By far the best emetic is the sulphate of zinc, in the dose of half a drachm, or two scruples, which may be repeated after a short interval, if the first dose fails to act. In order to insure its action, it is of great use to keep the patient roused as much as possible—a point which is often forgotten. The sulphate of copper is by no means so certain as the sulphate of zinc. Besides, as it is a much more viru- lent poison, it may prove injurious if retain- ed too long in the stomach. Tartar emetic, from the uncertainty of its action when given in considerable doses, is even worse adapted for such cases. Emetics should be prefer- red for removing the poison from the sto- mach, provided the case be not urgent. Even then, however, they sometimes fail altogether. The best practice in that case, is to endeavour to remove the poison with the stomach-pump; and this, in urgent cases, should be the first remedy employed. The last method for removing opium from the stomach is a desperate one. It is the injection of an emetic into the veins. Tartar emetic answers best for this purpose, and its effect is almost certain. A grain is the dose. While injecting it, care must be taken by the operator not to introduce air into the vein. The next object in conducting the treat- ment of poison with opium, is to keep the patient constantly roused. This alone is sufficient when the dose is not very large, and the poison has been discharged by vo- miting; and in every case, it forms, next to the evacuation of the stomach, the most important part of the treatment. The best method of keeping the patient roused, is to walk him up and down between two men, who must be cautioned against yielding to his importunate intreaties and occasional struggles to get free and rest himself. The duration of the exercise should vary accord- ing to circumstances, from three or six to twelve hours. When he is allowed, at length, to take out his sleep, the attend* ants must ascertain that it is safe to do so, by rousing him from time to time; and if this should become difficult, he must be turned out of bed again, and exercised as before. When the'opium has been completely removed, the vegetable acids and infusion of coffee have been found useful in reviving the patient, and subsequently in subduing sickness, vomiting, and head-ache. LAURO-CEHASUS. The leaves of the cherry-laurel, prunus laurocerasus, have a flavour resembling that of bitter almonds, or other kernels; and from this circumstance, an infusion of the leaves has been employed to give flavour to custards, puddings, and other articles for the table. But as it is undoubted that the cherry-laurel has poisonous qualities, such dangerous seasoning should never be used. One woman who lost her life by drink- ing laurel-water, thinking it to be a cor- dial, in a quarter of an hour after drinking two-thirds of two ounces, complained of a violent disorder in her stomach, soon after lost her speech, and died in about an hour, without vomiting or purging, or any con- vulsion. By experiments on brute animals, it appears that this poison is destructive to 192 MATERIA MEDICA. life, not only when taken into the stomach, but also on being injected into the intes- tines, or applied externally to different or- gans of the body. The discoveries of mo- dern chemistry render it probable, that the destructive properties of cherry-laurel water are owing to its containing prussic acid. And after the well authenticated proofs of its de- leterious effects, it is to be hoped that it will never find a place in the arrangements of housewifery. LEAD. Like other metals, lead must be oxidated or combined with an acid, before it exerts any action on the body. When the salts of lead are introduced into the system, their effects are of a very singular and injurious nature, occasioning the severe and pain- ful affection of the bowels, called colica pictonum, or painter's colic. There are a va- riety of ways in which lead may be intro- duced into the body, so as to be injurious, viz: by a person being exposed to the fumes of lead, in the various operations per- formed on that metal; by rum or other spi- ritous liquors being drank, that have passed through stills with leaden worms; and, in some cases, though we should hope rare- ly, by sugar of lead being employed to adulterate wine. The disease induced by the poison of lead, is, cftT'^terized by gri- ping, costiveness, sickncl.?..1.1^nd a wasting of the muscles of the thumbs, and of the calf of the leg. These symptoms, and the mode of treating them, are fully detailed un- der the article painter's colic. Though lead is therefore to be sparingly used internally, it is an excelle it and useful refrigerant when applied externally, as in the form of Goulard's extract, or the solution of sugar of lead. This last preparation has even been used internally; and, in the hopeless diar- rhoea of consumption, it seems, when com- bined with opium, in the proportion of two grains of sugar of lead, to one of opi- um, to check it a little, though it cannot cure it. ACETATE OF LEAD. Sugar of lead. The compound of acetic acid and lead, so called from its sweet taste. It is of great use as an external application in inflammations, bruises, and diseases of the skin. It is generally applied in solution by means of cloths soaked in it, or mixed with crumbs of bread. A drachm to five ounces of water is a strong solution, and with double that quantity of water, a weak one. A little vinegar should be added, if the water be not quite pure. It is thought that the value of the applications of lead in common inflammation, arises from a partial palsy of the nerves of the part, produced i by the sedative power of the lead. It should \ not be applied to recent wounds, nor to ul- cers, where there is much debility, or any j tendency to gangrene. Though the inter- 1 nal use of the salts of lead is a circumstance j attended with considerable danger, yet, un- 1 der careful management, the acetate of lead i given internally, has been found a very valu- I able and manageable remedy, especially in haemorrhages from the lungs and uterus, and from the bowels. The diarrhoea which attends the closing stage of consumption, 3 has been greatly mitigated by its use. The 1 dose is from half a grain to a grain, with half J a grain of opium; and it is recommended ■ that nothing but a little cold water, or vine- !fl gar and water, be swallowed for at least an hour after the pill is taken. Sugar of lead M with lard, forms an excellent cooling oint- ment. ': * LENITIVE ELECTUARY. i;l A very gentle and agreeable laxative in fl cases of simple costiveness. It is made by fl rubbing together in a mortar an ounce of 'fl senna leaves, and half an ounce of coriandetfljflj seeds; then sifting ten ounces of the pow- J der through a sieve. The remainder, with flj the addition of three drachms of liquo- '9 rice root, and two ounces of figs, is to be jfl boiled in half a pint of water, until the whole jfl is reduced to one-half. The liquor being 'fj pressed out and strained, is to be evapora- fl ted to one gill, and to this is to be added 9 four ounces of sugar, and a syrup made in 1 the usual manner; one ounce of the pulp offl prunes, the same quantity of tamarinds, andflf. of purging senna being well mixed togetheflfl in a mortar, are to be added to the syrup, jfl and the whole well combined with the sift- j ed;powder. The dose is a portion of the fl size of a nutmeg, or a dessert-spoonful. LETTUCE. A plant whose leaves are generally eaten 1 with other herbs, in the form of a salad, J dressed with oil and vinegar. Lettuce con- 1 tains a narcotic principle; and those1 who f use it, with a view to procure sleep, should U not use vinegar with it, as vinegar counter- I acts its soporific power. Lettuce has jfl lately been brought into notice as an article flj of the materia medica, by its affording an fl extract having some of the properties of fl opium; and capable, in some cases, of being fl substituted for it. This extract is called 9 lactucarium, or lettuce-opium, and its dose is from three to five grains, and of the tine- fl ture from fifty to eighty drops. It is thought I to have the anodyne, without the constipa- 1 ting effects of opium. \ MATERIA MEDICA. 193 tIME-WATER. Lime is soluble in water, though it takes a great quantity to dissolve it; and this solu- tion is called lime-water, and has been a good deal employed in the cure of diseases. t . *}.llas been used in various symptoms of in- t-i .digestion, asin acidity combined with loose- ness, and in calculous complaints. The quantity may be from a pint to two pints daily. In the complaints of infants, connect- ed with disordered bovvels, lime-water, mix- ed with an equal quantity of milk, may be given in doses of a tea-spoonful three or four times a day. Lime water has great effect in dissolving the slimy mucus, with which disordered bowels are infested. It is on this principle that it has been used against the stone, with the view of dissol- ving the animal mucus which cements the parts of the concretion together. Equal parts of lime water and linseed oil, is an ex- cellent application to burns. LiaUORICE. The root of the glycyrrhiza glabra, a plant growing in Spain, which yields a great quan- tity of a very sweet substance, called liquo- rice; which is advantageously employed both to sweeten nauseous drugs, and by it- self, as a good demulcent. As such, it is much used in coughs, colds, and other affec- ' tions of the wind-pipe and lungs; and when h formed into lozenges of a convenient size, fe containing each about the sixth part of a t grain of opium, it forms a very soothing ap- B; plication to the throat and larynx. These Bjk! lozenges may be given to the extent of six or eight in the day. They are known by the name of troches of liquorice, with opium. LISBON DIET-DRINK. v A decoction of various plants, which was |'' at one time much employed in the cure of H syphilis, and for the strengthening of the *■'• constitution, after a course of mercury. The plants used were sarsaparilla, sassafras, gui- ac, liquorice, and mezereon. What is called in the pharmacopoeias, the com- pound decoction of sarsaparilla, is now commonly prescribed instead of the Lisbon diet-drink. LOGWOOD. The wood of the hxmatoxylum campechi- anum, or logwood, has a sweet astringent taste, and a decoction made from it, is es- teemed an excellent remedy in protracted diarrhoea, and in the last stage of dysentery. Its powers are, however, very trifling. We possess numerous other astringents in near- ly all respects preferable to this. LUNAR CAUSTIC Nitrate of silver; it is formed by dissolving silver in nitric acid, evaporating the solution to the consistence of oil, and then pouring it into iron tubes, greased on their inside with tallow. When the cylinders of nitrate of silver are cooled, they have a dark gray colour, and when broken across, present a crystalline structure. The taste of nitrate of silver is very bitter, harsh, and metallic. It tinges the skin black, and is one of the most active and manageable caustics we possess; it is employed to remove fungous growths, the callous edges of sores, stric tur'es in the urethra, and the like. It is em- ployed frequently to tinge the hair black, and it forms the basis of indelible marking ink. A solution of it is applied to indolent ulcers and fistulous sores, and has appeared to do much good in ringworm. It is also used in certain stages of chronic ophthal- mia. A strong solution has been injected into the urethra in gonorrhoea, but this is a practice by no means to be followed. The nitrate of silver has been given internally for the cure of epilepsy, but it has not been attended with very remarkable success. The dose, at first, is the eighth of a grain, increased gradually to one grain. Several cases are recorded, where the colour of the skin was altered to a dark hue, by long con- tinuance of its internal use. MAGNESIA. A species of earth, of great benefit in cor- recting acidity of the stomach. It is of the class of what are called alkaline earths; and having an affinity for acids, it attracts to it- self whatever acid it finds in the stomach, and forming with it a purgative salt, it pro- duces several easy motions of the bowels, and so removes the acidity, heartburn, and other unpleasant symptoms. Magnesia may be taken to the extent of a tea-spoonful twice or thrice a day, according to the ur- gency of the symptoms; and it may be mix- ed with water, or peppermint-water/or any similar fluid, to diminish its insipidity. Mag- nesia, may be safely and usefully given to children, even when very young, mixed with their panado, or thin gruel. The best magnesia is what is called burnt or calcined magnesia. Magnesia is either found in na- ture, combined with the carbonic acid, or it is obtained in that combination in the pro- cess of preparing it from Epsom salts, which are magnesia combined with sulphuric acid. This carbonate of magnesia answers the purpose of correcting acidity, andis cheap- er; but, in some cases, may be disadvanta- geous, on account of there being an escape of carbonic acid, which gives rise to flatu- lency in the stomach and bowels. By ex- 194 MATERIA MEDICA. posing the carbonate of magnesia to a strong heat for a proper length of time, the carbo- nic acid is driven oft", and the pure magne- sia remains, which is then termed pure, calcined, or burnt magnesia. Double the quantity of the carbonate is required to produce the same effect as the calcined magnesia. MAGNOLIA. The bark of all the species of the mag- nolia possesses tonic and astringent proper- ties, which renders it a valuable remedy in nearly all the diseases in which the Peru- vian bark is indicated. By most physicians, it is esteemed, however, inferior to the bark of the dogwood. MANNA. Manna is the concretic juice of an ash growing in Sicily, and the southern parts of Europe. A similar juice may be obtained from the larch tree. It contains a consider- able amount of saccharine matter, mucilage, and aroma. It is merely employed as a gentle laxative for children, or weak per- sons; its action upon the bowels is, howev- er, so trifling that it will scarcely ever act without the addition of some other article. It is a well known addition to the senna tea; its place here may be advantageously supplied by common brown sugar, or the pulp of tamarinds. For use, the whitest, lightest, purest, driest manna, and that which has a crystalline appearance when broken, a sweet taste, and rather biting to the tongue, is to be preferred. This is called flake man- na, to distinguish it from the common sort. MARSH MALLOW. The leaves and root of the althaea is em- ployed in decoction as an emollient and demulcent, in affections of the lungs, ali- mentary canal, and urinary organs. Exter- nally, the leaves and root are applied as a fomentation or poultice. MAY APPLE. The podophyllum peltatum, or May apple, is a very common plant in most parts of the United States. The fruit is eaten, and, by many persons, esteemed delicious. The leaves are poisonous. The root, dried and powdered, in doses of from fifteen to twenty grains, acts as a very certain purga- tive. It may be employed in conjunction with calomel, chrystals of tartar, or cream of tartar, in all those cases in which jalap by itself or in combination is directed. MEnCTRY. A fluid metal, of great importance in the arts, in chemistry, and in the Materia Me- dica. It furnishes a variety of medicines of the most active kind, and has been employ- ed with success in a great number of dan- gerous and common diseases. The con- spicuous effect of mercury, when intro- duced into the system, is to increase the flow of saliva; and when this effect is pro- duced, or when the glands which secrete the saliva are evidently affected, we judge the mercury to- be pervading the whole system, producing a change on the whole of its fluids, as well as on the nervous and muscular systems. Mercury, method of introducing. The modes of introducing mercury into the body, so as to produce its peculiar effect, are various. Like all other metals, it is inert in the metallic state, and requires to undergo various preparations to fit it for acting upon the animal economy. If mer- cury be thoroughly mixed with conserve of roses, equal parts of each being taken, the globules disappear, and the metal is proba- bly converted into an oxide; and by the addition of a little starch and water, is fit for internal use; it is made up into pills, known by the name of the blue pills, each contain- ing a grain of mercury. These pills are given to the extent of two in the day; or four, two at night and two in the morning, provided they have not too great a purga- tive effect on the bowels; and if this should take place, it must be counteracted by opium. Another way of introducing mer- cury into the system so as to produce its specific effect, is to give calomel, the sub-4 muriate of mercury, preventing its purga- tive effect either by diminishing the dose, or by combining it with opium. It is more than suspected, that many of the nostrums which are said to cure some diseases where mercury is useful, without any of that mi- neral, contain a portion of the oxy-muriate; as this, from its activity in a small bulk, is easily disguised. Mercury may also be in- troduced into the system by rubbing it on the skin. The ointment for this purpose is made by rubbing the mercury with some unctuous body, generally mutton suet and lard, till the globules disappear, using one part of mercury to four of the fat; and rubbing upon some convenient part of the body, a piece about the size of a hazel- nut, morning and evening. It is generally directed to be rubbed in upon the inside of the thigh, till it almost completely disap- pears; and to prevent chafing and erup- tions, the hair should be shaved, and one thigh rubbed at. alternate times. It has sometimes been thought of consequence to introduce mercury into the system with MATERIA MEDICA. 195 great rapidity; and this is done by burning cinnabar, which is a combination of sulphur and mercury, and exposing the patient to receive the vapour, both by the skin and the lungs. Mercury, effects of. By whatever method mercury is introduced into the system, its effects are those of a strong and general stimulant; it increases the activity of the cir- culation, and brings on a degree of feverish- ness; it increases the quantity of all the se- cretions,-and especially that of the saliva, .producing an evident enlargement of the glands that open into the mouth, and when it has been pushed too far, occasioning very painful swellings and. ulcerations of the mouth and fauces. The breath has a pe- culiar fetid smell, the flow of saliva is ex- ceedingly increased, and a very restless and uncomfortable feeling is produced in the bod)-. Sometimes an eruption takes place on the skin,, of a very painful description, for which the greatest attention must be directed to avoid all irritation, to keep the patient in a cool but dry air, to give mild laxative medicines, and to use the sulphuric acid. In some constitutions, mercury sud- denly produces very pernicious effects. There ensue, from a very small quantity of the medicine, great depression of strength, anxiety about the chest, frequent sighing, trembling, a small quick pulse, vomiting, pale countenance, and such debility that a very small exertion of muscular strength is sometimes suddenly fatal. In such cases, all farther administration of the mercury is to be suspended, the patient is to be ex- posed to a cool and free air, tonic medicines are to be given, with light but nourishing diet; and if the disease for which mercury was given be still going on, it must after- wards be resumed with the utmost caution, that we may judge whether it be safe to go on with it, or to change our plan of cure altogether. Mercury, use of in Syphilis. So many active medicinal preparations are furnished by mercury, and their combinations are ca- pable of effecting so many different pur- poses, that there are few diseases in which it may not be employed; but we do not mean here to speak of any of its prepara- tions or effects as purgative, diuretic, dia- phoretic, &c, but only of those peculiar to itself, and which are known by their ap- pearances on the salivary glands and their secretions. The most remarkable and ce- lebrated instance in which mercury has been used, has been in the core of the ve- nereal disease. Very soon after the intro- duction of this disease, when the nations of Europe were filled with horror at its rapidly destructive progress, several persons afflict- ed with it, happened at the same time to be using mercury for diseases of the skin, in which complaints it had been employed A 2 by the chemical physicians; and finding they were cured of the syphilitic ailments while under the influenceof mercury, phy- sicians were induced to try that active mi- neral for the cure of syphilis, in which it succeeded to their utmost expectation. For above three hundred years, experience has uniformly attested the almost unvarying success with which mercury has been at- tended m this disease, with the exceptions which may be looked for in every disease and every remedy, from the ever varying peculiarities of the human constitution in different men, and in the same individual at different times. Profuse salivation not necessary. Mercury was too often rashly and superfluously em- ployed in the cure of syphilis; such quan- tities were thrown into the system as to produce the most lamentable effects; in short, it was too often managed so as to be- come a poison instead of a remedy. A mercurial course, as it was called, was a terrible thing, both in its preparation and its continuance, and too frequently left the constitution shattered beyond recovery. To procure all the salutary effects of mercury, it is not necessary to throw in so much as to occasion the wasting salivations formerly in use, but merely to keep the mouth ten- der for the proper period, as an indication that the system is under its influence; and we judge of the length of time during which we are to continue this, by the ef- fects produced on the disease for which we are giving it. The great tenderness of the mouth and of all the neighbouring glands, renders them peculiarly liable to be affect- ed by cold; and it is therefore proper to be on our guard against exposure to cold- during a mercurial course, lest the glands should be seized with inflammation and swelling; but this precaution and fear are carried too far by the common people, who are afraid to take a calomel purge lest they should be injured by being exposed to cold. When the mouth is very sore from mercury, with profuse salivation, much ulceration, general fever and irritation, the best treat- ment is to give saline purges, or castor oil, with a solution of borax as a gargle for the mouth; and if it be deemed advisable still to keep the system under the influence of mercury, a little more is to be given when the mouth is beginning to heal, and so con- tinuing it till our purpose is attained. In diseases of the liver, mercury has been employed; and, indeed, in the hardness of that organ, it is the only remedy we can depend upon. In dropsy, a course of mer- cury is frequently an excellent plan of cure. In chronic dysentery, it has been sometimes found advantageous to bring the system under the influence of mercury. In certain obscure and unexplained cases of bad health, what is called an alterative course of 1 196 MATERIA MEDICA. medicine, is often a good way of inducing a better action in the system; and mercury, cautiously given, is unquestionably one of the best alteratives. It has, perhaps, been too indiscriminately used as such; but in proper cases, and when not pushed too far, it is of essential benefit. MEZEREON. A plant cultivated in gardens for its flower. The bark of the root has a sweetish taste, and when chewed, it occasions a sensation of burning in the mouth and throat. The bark contains an acrid sap, which irritates the skin. It was formerly used in the Lisbon diet drink, and had some reputation for curing nodes and some other venereal symptoms which had resisted the use of mercury. It is now veiy little es- teemed in medicine. The berries are very acrid, and have produced fatal effects on children who have been tempted by their beauty to eat them. When it is discovered in time that they have done so, an emetic should be given immediately, followed by copious diluent and demulcent drinks. MINERAL WATERS. Those waters which, by running over certain soluble substances in their course, become impregnated with the taste, smell, and other properties of these substances, and therefore are of service in the cure of diseases, or in the regulation of the health. The most celebrated waters are those of the following classes: cold, hot, sulphur- ous, chalybeate, saline and purgative. Some of these act as tonics, some promote the secretions of the liver and alimentary canal; some excite the healthy action of the skin, &c. They are used both internally, and as a bath externally. The principal circumstances under which they are direct- ed, are for the removal of chronic diseases, affections of the skin, and during coma- lescency from nearly \all diseases. They are valuable remedies in that condition of health vaguely termed nervous. Without entering upon the curative properties of each of these waters, it may be proper here to mention some particulars which are com- mon to all, and to detail some reasons why mineral waters are so often recommended by physicians. The diseases in which mi- neral waters are directed, are chiefly those which are well known by the name of nervous; and they generally occur in those who are of an opulent rank in life, who alone have it in their power to go to water- ing places. Their complaints generally arise from the want of active and interesting employment, from deficiency of exercise, and from indulgence in easy and luxurious living. Placed by their fortune above the need of bodily or mental labour, and in early life having had ample means of sensual or boisterous pleasures they have acquir- ed no taste for the cheap and easy enjoy. ments of learning and virtue; and are there- fore fain to indulge in the pleasure of the table, to wear away the tedious hours for which they can not find a proper use. Hence arise indigestion, flatulence, costiveness, . obesity, hypochondriasis, and all the un- comfortable and alarming feelings which originate from such affections. WJien such patients are sent to a watering-place, they are benefited in a variety of ways. Their usual indolent habits are broken in upon, they see other scenery; the unhealthy air of the town is exchanged for the pure air of the country; they must make some personal exertion, were it merely to walk to the spot where the water is drawn; and how- ever powerful money may be, there are many of their former accommodations which they can not procure in their new abode.. Add to this, that the physical effects of va-' rious waters are of the most salutary kind, promoting the regular discharge from the bowels, strengthening the stomach by their, coldness or their chalybeate properties; or even in some cases, a nausea cr disgust at food is created, which prevents patients from taking in more than the stomach can digest, and thus gives that important but over wrought organ time to recover the tone and activity it had lost. MORPHIA. A chemical principle contained in opium, and which possesses nearly all the proper- ties of the latter, without its nauseous tastei. and other objectionable qualities. It is sparingly soluble. It unites with the acetic, sulphuric, and hydrochloric acids. It is the sulphate of morphia which is principally employed as a medicine: dose, from a fourth to a third of a grain. To induce sleep, or abate pain, in cases where anodynes are proper, either of the following prescrip- tions may be used. Syrup of morphia. Acetated syrup .of morphia, four grains, and clarified syrup, one pint, well mixed together. Dose, a dessert spoonful for an adult. Syrup of sulphate of morphia. Sulphate of morphia, four grains, clarified.syrup, one pint, well mixed together. Dose, two tea- spoonfuls for an adult. Anodyne drops. Take acetate of morphia, sixteen grains, distilled water, one ounce, acetic acid, three or four drops, and alcohol one drachm. Dose, thirty or forty drops for an adult. A very fragrant substance, obtained from MATERIA MEDICA. 197 an animal of the deer tribe, which inhabits the inland parts of Asia. Musk had at one time great reputation as an antispasmodic, a stimulant, and cordial; and as such, was employed in various nervous diseases, and in the last stages of typhus fever and other diseases of debility. The dose is from five to ten grains. It may put an end to spasms by its strong and fragrant odour, and fur- nish a little stimulus, alone or combined with other medicines; but it has no particu- lar virtues worth its high price and the trouble of procuring it genuine; and the physician has so many more powerful drugs to answer the purposes which musk has been thought good for, that he may, without regret, allow the perfumer the entire mo- nopoly of this costly substance. MUSTARD. A plant of the class tetradynamia, whose seeds, when bruised, form a powder of -a pungent smell and acrid taste; this, when mixed with water, is used as a sea- soning with our food, and when taken in considerable quantity it proves an emet- ic ; hence it is often useful in domestic practice, when any poisonous substance has been swallowed. Another useful purpose to which we apply mustard, is to act as a kind of blister, to stimulate the skin for the cure of internal diseases in a manner quick and effectual, without the tedious waiting, and the destruction of the outer skin which follow the application of common blisters. To use it in this way, equal parts of table mustard and crumb of bread may be mixed with vinegar and water, and applied to the place till the patient feels it becoming hot and itchy, which will generally be in about a quarter of an hour or twenty minutes. Mustard poultices are also applied to the feet, to quiet delirium, and remove the tendency of blood to the head, and to act as a stimulant when the powers of life seem much diminished in their energy. Such applications are called sinapisms. The seeds of the white mustard taken whole, have been long used in a variety of complaints, and some persons have been very sanguine as to their powers in a great many more. They have been given as a stimulant to the stomach, and to the system in genera], in cases of palsy. They act as a tonic and mild laxative; probably very much from their mechanical effects, as like other seeds, they pass through the intes- tines unchanged; only the outer covering being somewhat softened, and parting with a quantity of mucilage. Mustard-seed is cei'tainly very harmless, and may be tried in various diseases of debility and indiges- tion. It may be taken to the extent of a tea-spoonful three times a day, in a little milk, gruel, or water. It is to be swallowed whole, and not broken or masticated. MYRRH A gum-resin obtained from a plant not yet described. The best myrrh is brought from Abyssinia, but it is also produced" on the east coast of Arabia Felix, whence it comes to us by the East Indies. Myrrh is a heating and stimulant medicine. It some- times occasions a perspiration, and it is sup- posed to be beneficial in diseases of the uterine system. It may be given in powder, or made into pills, in doses of from ten to forty grains; or in the form of tincture, in doses of one or two drachms; but it must not be given in water, as it will not continue in solution in that fluid; it should be given in milk or mucilage. The tincture is a good addition to some gargles, and is also a fa- vourite application to the teeth. Myrrh, when combined with aloes, forms a good tonic, as in the pills called pills of aloes with myrrh, of which the dose is from two to four pills taken at bed-time. A mixture with some myrrh in it, called Griffith's myrrh mixture, had at one time great re- putation in the cure of consumption, but it has not maintained its ground. Some ob- ject to it as not founded oh chemical prin- ciples, but Dr. Pains thinks it affords an in- stance of a valuable composition of drugs which experience has ascertained to be of great value, though theory would lead us to reject it. He thinks the compound mix- ture of iron of the London Pharmacopoeia is nearly the same as the anti-hectic mixture of Dr. Griffith, and that it is permanently serviceable in chlorosis, and the numerous sympathetic affections connected with it. In the painful swellings which infest the breasts of chlorotic young women, it has been found almost a specific. The dose is from one to two ounces. NEUTRAL MIXTURE. This mixture is one of the.most agreeable, mild diaphoretics we possess, in cases of fe- ver. It is made from recent lime juice, one ounce and a half, saturated with sub-carbon- ate of potass, with the addition of a drachm or two of white sugar, and three ounces of pure water, or mint-water. The dose is a table-spoonful every two or three hours. Its powers are decidedly augmented by the addition of a grain of tartar emetic; or when this is not thought advisable, by adding a drachm or two of sweet spirits of nitre. NITRATE OF POTASS. A salt of a cooling, refrigerant, and diu- retic quality. It forms a very safe and ex- 19S MATERIA MEDICA. cellent addition to drinks in feverish cases, in the dose of twenty to thirty grains to the pint of water; or it maybe a little in- creased, and so given as a diuretic, dissolved in a considerable quantity of water. Or it may be given in doses of three or four grains, four times a day, and assisted by large draughts of toast water, or barley wa- ter, linseed tea, and the like. Sometimes an ounce or more of this salt has been given by mistake for some purgative salt, and the effects have been very dreadful. Severe griping, bloody stools, vomiting, and death have ensued. The best way to coun- teract this, is to give carbonate of soda in large quantities of fat mutton broth, or to give a dose of castor oil, followed up by copious draughts of gruel. Opium and aromatics are also to be given. NUX VOMICA Is a flat roundish seed or kernel, about an inch broad and a" quarter of an inch thick, the produce of a large tree in the East Indies, the strychnus nux vomica. These seeds contain a virulent poison, which, according to the French physiolo- gist Majendie, seems to exert its influence on the spinal marrow, without directly in- volving the functions of the brain. The symptoms produced, are great anxiety, convulsions, paralytic symptoms, retching, and increased action of the heart and lungs. Nux vomica has been said to produce bene- fit in the plague; the German writers also strongly recommend it in mania, epilep- sy, and hydrophobia, as well as in chronic rheumatism, gout, scrofula, syphilis, and cutaneous eruptions. In the French hos- pitals it has been employed in palsy. The dose is four or five grains of the powder; in pills, during the day. The French chemists have discovered in this substance a peculiar proximate prin- ciple, to which its virulence is owing. This they have called strychnia. It is highly alkaline, and so powerful as even to be perceptible when a grain is dissolved in eighty pounds of water. In doses of half a grain, it occasions serious effects, and in larger ones, convulsions and death. It is perhaps the most powerful, and next to prussic acid, the most rapid of poisons. It has been given in epilepsy and palsy, in doses of one-twelfth of a grain, but is a most dangerous remedy. OAK BARK. The bark of the oak contains a great deal of a very astringent matter, which renders it valuable as an ingredient in various gargles; and also in moderate doses internally, when astringents tire necessary, as in obstinate diarrhoeas. The infusion or decoction of oak bark is also used for the same purpose in the way of clyster. OLIVE OIL. This is prepared from the fruit of the olive when fully ripe, by pressing it gen- tly; it then yields the purest oil, but an in- ferior kind is procured by heating the re- mainder, and squeezing the fruit more strongly. Olive oil enters largely into the diet of many nations, and is much used in medicine and pharmacy. When good, it is of a pale yellow colour, of a bland taste, and without smell; when long kept, it be- J comes rancid. When taken internally, it \ acts as a mild laxative, but not many sto- machs can retain enough for this purpose. M It is sometimes given in pretty large doses . 9 for the expulsion of worms, particularly |« some kinds of taenia or tape-worm. And it W may also be given internally in small doses, fl with mucilage and other additions, as an jl emulsion in cases of catarrh and sore throat. ■ In cases where certain poisons have been J swallowed, large quantities of oil are given fl to correct the acrimony of the substance^fljj swallowed. When applied externally, it ^flj acts as an emollient, and forms a good me- "fl dium for frictions which are designed to fl promote absorption, and to discuss indolent fl swellings. Warm oil rubbed on die belly, fl gives much relief in dysentery and other fl abdominal complaints; and the same appli- 'fl cation is one of the best means for dispers- fl ing the knots in the breasts of lying-in^flj women, in the first days of their confine-JBJ ment. Olive oil is an ingredient in manyflfl plasters and ointments. Combined withfll hartshorn, it forms the volatile liniment, so vflj useful as an external stimulant. Some have .fl said that anointing the body with oil pre- i'flj vents a person from receiving the infection - flj of the plague. flj OPIUM. A medicine of inestimable value, and in- if dispensable for the successful practice of physic. Speaking generally, we may say Jj it is a narcotic medicine, but may be so managed as to procure various other saluta- ry effects in a great variety of diseases. Opium is obtained from the white poppy; ,j, papaver somniferum,- and is chiefly pre- I: pared in Turkey, Persia, and India. The - plant grows also in many parts of Europe, |-j but the opium obtained in the places first '_ mentioned, is what is chiefly valued in me- lp dicine. Opium is procured in the follow- * ing manner: when the seed capsules are \ about half grown, two or three longitudinal j incisions are made at sunset in each cap- sule, but so as not to reach the internal ca- | MATERIA MEDICA. 199 vity; a juice exudes, which is removed as fast as it concretes; this is put into earthen pots, and afterwards dried in the sun. Opium should be of a rich brown colour, a tough consistency, and rather smooth and uniform in its texture. Its heavy narcotic smell should be strong, and free from all mustiness; and there should be no burnt odour. Its taste is bitter, and a little acrid. Opium has been produced in England, of a very good quality; but the moist and changeable nature of the climate renders it impossible to procure it good and abundant enough to supply the demand for it. Opium, preparations of. The principal forms in which opium is used, or prepared for combination with other substances, are the crude opium, and the tincture, which is made with proof spirit, commonly called laudanum. The wine of opium is a spir rituous solution of the extract, combined with various aromatics. The dose is- the same as that of the tincture. It is some- times locally applied to the eye, when the vessels remain turgid after active inflamma- tion has been subdued; two or three drops are dropped into the eye, night and morn- ing. Chemists have discovered in opium, among other substances, a peculiar alkaline body, to which the soporific virtues of the drug are owing; and which has received the name of morphia, from Morpheus, the god of sleep. There is one other preparation of opium which deserves to be mentioned: black drop. This preparation has been long known and esteemed, as being more pow- erful in its operation, and less distress- ing in its effects, than any tincture of opi- um. The manner of preparing it is tliis. Take half a pound of opium sliced, three pints of good verjuice, (juice of the wild crab) and one and a half ounce of saffron. Boil them to a proper thickness, then add a quarter of a pound of sugar, and two spoonsful of yeast. Set the whole in a warm place near the fire for six or eight weeks, then place it in the open air until it becomes a syrup; lastly, decant, filter, and bottle it up, adding a little sugar to each bottle. One drop of this preparation is considered equal to about three of the tincture of opium; it is probable that an acetate of morphia is formed. Opium, effects of. The effects of opium on the human body are those of a narcotic, anodyne, or sedative. Some medical writers assert its powers to be stimulant; others as strenuously maintain that they are exclu- sively sedative. The truth is, that by di- minishing the quantity of opium taken at one time, it may be made to produce a stimulant or at least an intoxicating effect; and it is on this principle we are to explain the fondness of the Turks and other eastern nations for opium, who being, by the reli- gion of Mahomet, precluded from the use of wine, are glad to seek in the consump- tion of opium a medium of inspiring cou- rage, dissipating care, and procuring all the effects of intoxication. By this, also, we are to account for the lamentably increased use of opium among many persons, par- ticularly females, in this country; who, cheap as ardent spirits unhappily are, find the ex- citement and dozing produced by opium, even more cheap and more pleasant. The symptoms and mode of action of opium have been long made the subject of dispute, both among physicians and toxico- logists; and in some particulars our know- ledge is still vague and insufficient. The effects of opium, through whatever chan- nel it may produce them, are exerted chiefly on the brain and nervous system. The effect of a small dose seems to be ge- nerally in the first instance stimulating. The action of the heart and arteries is in- creased, and a slight sense of fulness is caused in the head. This stimulus differs much in different individuals. By repeat- ing doses of thirty to a hundred drops when the usual torpor is coming on, the stimulus may be kept up for a considerable time in some people. In this way are produced the remarkable effects said to be experi- enced by opium eaters. These effects are always in the first instance stimulant, the imagination being rendered brilliant, the passions exalted, and the muscular force increased, and this state endures a consi- derable time before the usual state of col- lapse supervenes. A very poetical, but we believe also, a very faithful, picture of the phenomena now alluded to, is given in the Confessions of an English Opium Eater; a work published not long ago, by a gentle- man who writes from personal experience. It is singular that our profession should have observed those phenomena so little, as to be accused by the author of having wholly misrepresented the action of the most common drug in medical practice. In reply to this charge, the physician may simply observe, that he seldom administers opium in the way practised by the opium eater; that when given in the usual thera- peutic mode, it rarely causes material ex- citement; that some professional people prefer giving it in frequent small doses, with the view of procuring its sedative ef- fect with greater certainty, and undoubt- edly do succeed often in attaining their object; that in both of these medicinal ways of administering it, excitement is oc- casionally produced to a very great degree, and of a very disagreeable kind; that the latter phenomena have been clearly traced to idiosyncrasy; and, therefore, that the effects on opium eaters are probably owing either to the same cause, or to the modify- 200 MATERIA MEDICA. ing power of habit. This much at all events is certain, that opium seldom produces a material excitement in a single small dose; and does not always cause continuous ex- citement when taken after the manner of the opium eaters. The effect of a full me- dicinal dose of three grains of solid opium, or a drachm of the tincture, is to produce in general a transient excitement and ful- ness of the pulse; but in a short time after- wards torpor and sleep, commonly succeed- ed in six, eight, or ten hours by head-ache, nausea, and dry tongue. Opium, uses of. Neglecting all the dis- putes and theories "which have had their day, we proceed to mention the purposes for which opium is employed in the prac- tice of physic, and to enumerate a few of the diseases, or other states of the system, in which it may be given. » In combination, says Dr. Paris, the medical powers of opium are wonderfully extended, so that there is scarcely a disease in which it may not, dur- ing some of its stages, be rendered useful. Opium is very generally given when we wish to procure sleep. Its dose for this purpose is from twenty-five to forty drops of laudanum, or ten of the black drop, given in water either plain or sweetened with syrup, or flavoured with peppermint or cinnamon; or one grain of crude opium, alone or joined with liquorice and pepper, as in the Edinburgh formula. It is fre- quently prescribed to procure rest in fever, in agues, in burns, in small-pox, in dyspep- sia, and in a great variety of cases of watch- fulness and irritation; taking care that it be not administered, or at least very cautiously, when there is fulness of the system, an in- flammatory state of the body, costiveness, or a tendency of the blood to particular or- gans. Opium is much employed to mitigate pain, and there is no substance whatever, which has such extensive and seldom-failing powers as this. As an anodyne, it is em- ployed in griping of the bowels, in cramps, in gall-stones, jaundice, dysentery, and diarrhoea; and in the pain from wounds, fractures, burns, and poisons, and even in some inflammations, provided we have pre- mised proper blood-letting. Opium is given to check immoderate discharges in diarr- hoea, in dysentery, in cholera, in water- brash. It is used to allay inordinate action, and so to act as an antispasmodic in convul- sions, in tetanus, in asthma, in hysterics, in colic; and as a relaxant, it is used with other mean* in the attempt to relieve the urgent symptoms of strangulated hernia. Opium can be absorbed from the surfaces of sores, and so exert its peculiar powers on the system. Opium, disadvantages of. With all its excellencies, opium has some properties, which require to be watched and corrected. When continued too long, it is apt to induce costiveness, a flow of blood to the head, and dyspeptic symptoms. These are to be coun- teracted by proper laxatives, or by discon- tinuing the medicine, or substituting some other substance, which will answer the purpose as nearly as possible. Thus, hen- bane will sometimes answer the purpose of opium in procuring sleep, but its dose is larger, and it is more uncertain. It is very dangerous to get a habit of taking opium, as its effects on the moral character are of the most pernicious tendency; and on the body, a complete destruction of its powers is too frequently induced. All the symp- toms of the worst dyspepsia, hollow sunk eyes, tremors of thcwhole body, a vacant look, and exhausted strength, characterize the hardened opium taker. Medical men should consider it strictly as a necessary medicine, and never" give it merely to in- crease the comfortable sensations of their patients. With some persons, opium does not pro- duce sleep, but induces a mild and pleasing delirium, in which unreal objects are vividly pictured to the mind's eye. With others, the delirium presents nothing but scenes and figures of terror and impending dan- ger, as rocks ready to fall, or torrents about to overwhelm them. Opium, as Mr. Brande very properly ob- serves, if ever administered to children, re- quires to be given with more than ordinary caution; it should never be resorted to in any form, except upon emergencies; and all opiates, especially syrup of poppies, and some nostrums containing opium, which are but too frequently used to quiet children, should be imperiously excluded from the list of nursery medicines. Opium, in combination with other sub- stances. There are several most useful me- dicines, in the composition of which opium is the principal ingredient. As an external application for allaying pain, the tincture of soap and opium is an excellent remedy. To allay irritation in coughs and other dis- eases of the chest, when all fear of inflam- mation is gone, the medicine known by the name of paregoric elixir is given with advantage. A narcotic medicine combined with an emetic is found to make one of the most effectual sudorifics, and not a more powerful and certain sweating medicine can be contrived, than .that which is known by the name of Dover's powder, which con- sists of one part of opium and one of ipeca- cuanha, joined with eight parts of an in- noxious neutral salt to aid their mechanical division and intimate union; of this powder, ten or twelve grains are to be given, and the perspiration to be promoted by drink- ing warm gruel or other diluent liquors, but not immediately after the powder, for MATERIA MEDICA. 201 fear of exciting vomiting. A liquid sudorific may be made of twenty-five drops of lauda- num and thirty drops of ipecacuanha or an- timonial wine; but if there be inflammatory symptoms present, opium must be avoided, and other sudorifics employed. Opium.with prepared chalk, is given to check diarrhoea. Twenty-five drops of laudanum with half a drachm of ether, often relieve spasmodic asthma. Opium, effects of an overdose of. By mis- ■ take or design, opium is sometimes swal- lowed in such a quantity as to produce very alarming effects. The principal of these are giddiness, a bloated and flushed appearance of the face, a slow full pulse, and oppressed breathing, as in apoplexy. There. are also troublesome dreams, start- ing, or convulsions, cold sweats, vomiting, hiccup, and fainting. As soon as this acci- dent has been discovered, the stomach should be emptied by the stomach-pump, or by a speedy emetic, as thirty grains of the sulphate of zinc, or eight of the sulphate copper, dissolved in three or four ounces of warm water; and its operation is to be assisted by drinking chamomile tea. When the stomach is evacuated, drowsiness must be prevented by keeping the patient in continual motion; strong coffee has been found to diminish the head-ache and stupor; and bleeding, especially from the jugular vein, should be resorted to, for the purpose of relieving the apoplectic symptoms. After this, ammonia and other stimulants are to be tried. If the patient can not swallow; or if the emetics do not empty the stomach; if the pupils are dilated, the breathing sterto- rous, and the system in a state of torpor from which it can not be roused, there is every reason to fear that death will be the consequence of the poison. In all cases of poisoning with opium, dashing cold water over the face, head and shoulders, is a pow- erful remedy. The ordinary duration of a fatal case of poisoning with opium, is from seven to twelve hours. Most people recover who outlive twelve hours. The dose of opium requisite to cause death, has not been de- termined; it is very much altered by habit. Those who have been^accustomed to eat opium, are obliged gradually to increase the dose, otherwise its usual effects are not produced. OPODELDOC. A substance used for external application to bruises and pained parts. The tincture of soap and opium is as good a one as can be used. Steer's opodeldoc is made of castile soap, rectified spirit, camphor, oil of rosemary, oil of origanum, and solution pf ammonia. OXYGEN. Is a substance of such general and impor- tant operation, that though it strictly be- longs to chemistry, we may be allowed to say a little of it here. Oxygen gas, or vital air, is one of the component parts of our at- mosphere, of which it forms about twenty- one parts in the hundred. It is that part of the air by which it is rendered fit for the breathing of animals, and for the combus- tion of burning bodies; in oxygen gas, in- flammable bodies burn with great brilliancy. Oxygen enters into combination with a very great variety of bodies; with several com- bustible bodies it forms acids; with two metals it forms the two fixed alkalies, and with the majority of metals, it forms oxides, or earthy looking substances, which combi- nation is necessary before these oxides unite with acids, to form the metallic salts. Oxy- gen entering into combination with hydro- gen, or inflammable air, forms water. OXYMEL. Vinegar and honey boiled together to the consistence of syrup. It is used as an ape- rient and expectorant, and is given as such, in asthma, and other diseases of the chest. The dose is one or two drachms, and it may be added to any diluent fluid, or to tepid water. Oxymelof squills is made by boiling honey and vinegar of squills, instead of common vinegar, and has virtues of the same kind as the last substance, but higher in degree. If given in too great quantity, it will prove emetic. To prevent its having any nausea- ting effect, it may be given with a little cinnamon water; or a little powdered gin- ger or nutmeg may be sprinkled in the draught. parsley. • A decoction or infusion made from the recent roots of the common parsley, (opi- um petroselinum,) is strongly recommended as a valuable diuretic in dropsies, and affec- tions of the urinary organs. It is at least a useful auxiliary to whatever diuretics may be employed. PHOSPHATE OF SODiE. A neutral salt of a purgative quality, valuable on account of its not having the nauseous taste of some other purgative salts; and, therefore, being fitter for delicate sto- machs. It may be given in broth or beef- tea; and if we season these liquids with it, instead of common salt, it will scarcely be perceived that we are giving medicine. To compensate for this useful property, we 202 MATERIA MEDICA. must add, that its price is considerably greater than Glauber's salts, or Epsom salts. The dose of phosphate of soda, is from four drachms to an ounce. PH05PHORUS. Phosphorus is a peculiar substance of a cheesy texture, and a pale yellow colour, exhibiting, when broke, a fracture like glass. It is luminous in the [dark, and ex- tremely combustible, inflaming at the ordi- nary temperature of the atmosphere. It has an acrid taste, and a strong smell like gar- lic. It liquifies in hot water, assuming the appearance of oil. It is also solu- ble in the essential and fat oils, and in sulphuric ether. When applied to the skin, it produces burning pain, and inflam- mation. Taken inwardly, in doses of from an eighth to a fifth of a grain, it acts as a stimulant and diuretic; and in larger doses, it produces inflammation of the stomach and death. It is hence a most active corrosive poison. It has been recommended in a va- riety of diseases; but must be considered as an uncertain and most dangerous prescrip- tion. PINK ROOT. The root of the spigelia marylandica, or pink root, ranks among our most active an- thelmintics. The spigelia is indigenous to the United States, and is produced in great abundance. The root has a bland, and somewhat nauseous taste; it contains a con- siderable portion of mucilage, but little or no resinous matter. Its active principles are exfracted by water. It is now fully as- certained that the spigelia possesses a nar- cotic property, in consequence of which it is liable, when taken in an over-dose, to pro- duce unpleasant, and even alarming symp- toms. The pink root may be given either in powder, or in decoction—the last form is the best. Of the powder, the dose for a child is from ten to twenty grains. The de- coction is made from one ounce of the root to a pint of water; of this, the dose is a tea- cup full every three hours. The exhibition of the pink root should be followed by a dose of some active purgative. PIPSISSEWA. The leaves of the chimaphila umbellata, or winter green, a plant common to every part of the United States, have been recent- ly introduced as a tonic and astringent of very considerable powers; and likewise, as a useful and efficacious diuretic. The leaves may be given in the form of decoction, of which a pint may be taken in the day. PITCH. Is obtained from the pinus, or fir-tree. A conical cavity being dug in the earth, com- municating at the bottom with a reservoir, billets of fir-wood are placed both to fill the cavity, and to form a conical pile over it, which is covered with turf, and kindled at the top. This wood is made to burn down- wards, and is converted into charcoal, and ' the smoke and vapours are made to descend into the excavation in the ground, where they are condensed, and pass into the re- ceiver with the melted matters, and this mixture is called tar. By long boiling, tar is deprived of its volatile ingredients, and is then denominated pitch. Pitch is used as an external application in scalled head, and some other diseases of the skin, either by itself, or mixed with the citrine ointment; and pills of pitch have been given in certain stages of consumption, with strong asser- tions of their utility. The vapour also of pitch or tar has been diffused through the apartments of consumptive patients, and the inhaling of this vapour has also been thought of sen ice in chronic affections of the lungs. BURGUNDY PITCH. A resinous matter, obtained by exuda- tion from various kinds of fir-trees, when an incision is made through the bark into the wood. Burgundy pitch gives its name to a plaster, composed of itself, and various other resinous and aromatic substances. It is a very common popular application in pectoral complaints, in disorders of the liver, and in rheumatic affections. Its good effects, which are unquestionable, are to be ascribed to its keeping up a degree of warmth, and so acting the part of a mild stimulant and blister, without going the length of either reddening the skin, or occasioning a collection of sevum, as mustard poultices or Spanish flies do. plummer's pills. A medicine composed of antimony and mercury, contrived by Dr. Plummer, of Edinburgh, and used as an alterative in general derangements of the health. The dose is one or two pills night and morning. POISON OAK. The swamp sumach, or rhus toxicodendron, is a very common shrub in the United States, inflaming the skin, to a very alarm- ing extent, of those who happen to touch it, or even approach close to it. It does not appear to be poisonous when taken inward- ly. The poison oak has been employed principally as a remedy in palsy, consump- MATERIA MEDICA. 203 tion, and some diseases of the skin. It may be given in substance, or in the form of ex- tract. The dose of the powdered leaves is from one to ten grains, and of the extract twenty grains, to be gradually increased, until some effect upon the system is evi- dent. POKE. The poke, phytolacca decandria, is a well known shrub, growing in waste grounds, and by the road side in most parts of the United States. It bears in the fall large bunches of scarlet or purple berries, the juice of which gives a purple dye. All the parts of the plant are endowed with medi- cinal properties: The cases in which the poke is employed, are rheumatism, espe- cially when occurring in syphilitic patients, and piles, and externally it is applied for the cure of itch, scald head, and foul ul- cerations. The leaves or roots are given in the dose of from eight to ten grains. The saturated tincture in the dose of a table- spoonful. In the treatment of piles, a watery infusion is employed, which may also be injected into the rectum. An extract is made by boiling down the root in the same manner a&cther extracts. The young shoots of the poke are eaten as a substitute for as- paragus. POMEGRANATE BARK. The rind of the fruit of the pomegranate (punica granatum), is recommended as a_ tonic and astringent in all cases in which medicines of this class are required, in the dose of ten to ninety grains; or it may be used in decoction. As a remedy for tape- worm, the bark of the root of the pomegra- nate is employed in India, and of its efficacy as an anthelmintic, we have the strongest evidence. It is given in decoction, made by boiling two ounces of the fresh bark in a pint and a half of water, until only three- quarters of a pint remain. POTASS. The name of one of the alkalies; which class of bodies are distinguished by their peculiar taste, their power of changing the vegetable blues to green, of neutralizing acids, and forming soaps with oil. As a medicine, potass is of considerable impor- tance. When pure, and deprived entirely of water, it is used as a caustic, to destroy the skin for the formation of an issue; or its solution of a definite strength, as directed in the pharmacopoeia, in the proportion of twenty drops to two ounces of wa- ter, may be given internally in cases of a tendency to stone or gravel. Carbonate of potass. Potass is more gene- 2B rally used in combination with the carbonic acid; by which it is rendered milder, and still the alkaline properties are to a consider- able degree preserved. The carbonate of potass is given in dyspeptic cases, in the dose of a drachm three or four times a day,' in water, or infusion of chamomile flowers; and in cases of stone, ten grains may be given as often. The carbonate of potass is used in combination with lemon-juice, to form the effervescing draughts, useful for stopping vomiting, and for determining to the surface of the body. POTATO FLY. The lytta vittata, an insect which feeds principally on the potato plant, upon which it is seen in great quantities towards the be- ginning of August. It is said to be found no where but in the United States. It re- sembles outwardly the cantharides, though smaller, and of a rusty colour; as a vesica- tory, it is equal, if not superior, to the Span- ish fly. PRECIPITATE, RED. When a chemical mixture is made among several substances held in solution, and one of them being insoluble, after the mixture falls to the bottom, it is called a precipitate. The substance, commonly called red preci- pitate, is an oxide of mercury, which is used as an escharotic, and is a very common ap- plication to chancres. When mixed with lard, in the proportion of five grains of the precipitate, to a drachm or a drachm and a half of lard, it forms a very valuable stimu- lating ointment, which is useful in various kinds of ophthalmia. For whatever pur- pose it is used, it should be very finely pow- dered. aUASSIA. A species of wood imported from the West Indies, the infusion of which forms a very useful tonic bitter. The strength of the infusion is two drachms of the rasped wood to a pint of boiling water, infused for four hours, and strained. As it does not, like many vegetable infusions, blacken the preparations of iron, chalybeates may be joined with it very commodiously. The dose of the infusion is from half a pint to one pint in the day. There is also a decoc- tion made by boiling six drachms of the bark in two pounds of water. A Wine- glaslful may be taken three times a day. aUININE, OR Q.UINIA, Is a vegetable alkaloid body, discovered by modern chemistry in the yellow Peru- vian bark, (cinchona cordifolia). It is a 204 MATERIA MEDICA. white powdery substance, sparingly soluble in water, but dissolved by warm alcohol, from which it is not deposited in crystals. Quinia unites with acids, and forms salts, the most important of which is the sulphate. It is soluble in water, and crystallizes. It is now much employed in medicine, being found to answer all the purposes of bark; and as a small dose only is necessary, it does not produce the unpleasant effects of the bark in powder, or infusion. Eight grains are considered equal to an ounce of the powder. The root of the krameria triandria, or rhatany, contains a peculiar modification of tannin, with a slight trace of gallic acid. In all its forms, it is eminently astringent, and has been used with much success in leucorrhoea, and in atonic hemorrhages, from the uterus. It may be exhibited either in decoction or tincture. The latter form may be prepared by macerating two ounces of the root in a pint of alcohol. An extract is also prepared from the root which retains all the active properties of the latter. RHUBARB. A plant, the root of which is much used in medicine. All the rhubarb of commerce grows on the mountains of Chinese Tartary. It is imported into Russia; and what comes to us from thence is always good, as much attention, both in purchasing and transport- ing it, is paid by order of the government. It is improperly called Turkey rhubarb. Rhubarb has been cultivated in Europe for medical use; but it has not been produced by any means equal to the Asiatic. Rhubarb is a mild cathartic, which oper- ates without violence or irritation, and may be given with safety, even to pregnant wo- men, and to children. In some people, however, it occasions severe griping. Be- sides its purgative quality, it is celebrated as an astringent, by which it increases the tone of the stomach and intestines, and proves useful in diarrhoea, and disorders proceeding from laxity. Rhubarb is exhibited, 1. In substance, in the form of powder. It operates more pow- erfully as a purgative in this form than in any other. The dose for an adult is about a scruple or upwards. On account of its great bulk, it is sometimes unpleasant to take a sufficient dose; its laxative effects are therefore often increased by the addi- tion of neutral salts, or other more active purgatives. In smaller doses, (from three to six grains) it often proves an excellent stomachic. 2. In infusion. Rhubarb yields more of its purgative property to water than to alcohol. The infusion is, however, con- siderably weaker than the powder, and re- quires double the dose to produce the same effect. It is well adapted for children, but must be always fresh prepared. 3. In tinc- ture. On account of the stimulating nature of the menstruum, this preparation frequent- ly cannot be exhibited in doses large enough to operate as a purgative. Its principal use is as a tonic and stomachic. The virtues of rhubarb are destroyed by roasting, boiling, and in forming the ex- tract. Rhubarb is one of the medicines most usefulry given to children.- As a laxative, it may either be given to them alone in doses of from five grains to ten, in water, gruel, or jelly; or two grains of calomel with six of rhubarb may be given; or it may be combined with magnesia, four grains of rhubarb to ten or fifteen of magnesia; or in the form of Gregory's mixture, one part of rhubarb to two of magnesia, with a fourth part of ginger. The compound rhubarb pills are compo- sed of rhubarb, aloes, and myrrh, flavoured with a little oil of peppermint. They are an excellent stomachic, and may be taken to the extent of two pills every forenoon, while there is weakness of the digestive powers. ROCHELLE SALTS. Tartrate of potass and soda; a purgative salt of great utility, as being an excellent cooling laxative, without the nauseous taste that some other of the neutral salts pos- sess. The crystals are large and beautiful; the dose is from six drachms to an ounce, or an ounce and a half. They get their, name from having been originally made at Rochelle, by an apothecary of that town, named Seignette, whence they are also called Sal Seignetti. SARSAPARILLA. A plant growing in South America, the roots of which had great celebrity many years ago, for their power of curing syphi- lis. It is now agreed, that sarsaparilla has no power whatever in the cure of true sy- philis, though it has some good effects in certain cutaneous disorders. It is of service to those anomalous pains in the bones and joints, the sore throat, and other symptoms, which appear to be owing to the combined effects of mercury and syphilis. In spread- ing sores, in some forms of scrofula, and in debilitated constitutions, it has done good. The best way of using it is in decoction, or compound syrup, of which a pint is to be taken daily, or an ounce of the powder. It produces a pretty copious perspiration, and in weak constitutions, this may require to be checked by the addition of a little sul- phuric acid, or elixir of vitriol, 1 i MATERIA MEDICA. 205 SASSAFRAS. The wood, root and bark of the laurus sassafras, a well known tree, growing abun- dantly over the whole United States, have all a warm, sweetish, aromatic taste, and a fragrant aromatic odour, which is destruc- tive to many insects. It is reported to be both diuretic and diaphoretic; and has been employed in cases of scurvy, rheumatism, and in various diseases of the skin; it was formerly esteemed as a remedy in syphilis. It is, also, a warm stomachic, increasing the force of arterial action, and in weak infu- sion, may be considered a valuable auxiliary to diaphoretic medicines, in all cases unat- tended with fever, or inflammation. The pith of the small branches of the sassafras in- fused in water, renders the latter mucilagi- nous, and forms an excellent demulcent drink in many diseases, and a valuable wash for the eyes when inflamed. SAVINE. The leaves of the savine (juniperos sabinas), have a strong, disagreeable smell, and a hot, bitter, acrid taste. They give out a great part of their active matter to water, and the whole to alcohol. Distilled with water, they yield much essential oil, which pos- sesses all the properties of the savine. The savine is employed as a stimulant, diuretic, and emmenagogue. On the vessels of the uterus it has a powerful effect. It is a pro- per remedy in chlorosis only, when the system possesses some degree of tone, while the vessels of the womb are still inert; upon the whole, however, it is to be considered a dangerous remedy, unless administered with the greatest judgment and caution. Savine ointment. An ointment made from the powdered leaves of the savine, is used as a stimulating application to blisters and issues when a permanent irritation and dis- charge is required to be kept up. SCAMMONY. A resinous substance of a purgative qua- lity, obtained from a plant which grows in Syria and other countries of the east, con- volvulus scammonia. Its purgative' qualities are pretty strong and effectual. It may be given in powder from three to eight grains, combined with calomel or with jalap; and it forms an'active ingredient of the very useful pills, termed the compound colo- cynth pills. Scammony is good for clean- ing the bowels of children when loaded with slime; for this purpose it is given com- bined with calomel; and a compound of equal parts of calomel, jalap, and scammo- ny, much used for this purpose, is known by the name of pu/vis basilicus. SEA WATER. Is principally a solution of muriate of soda, with a small portion of muriate of magnesia, muriate of lime, and sulphate of soda. Its effects on the body, when taken internally, are of a purgative nature; but it is seldom prescribed, as we have many purgatives more agreeable and effectual. As a cathartic, a pint is the usual quantity, which should be taken in the morning, at two doses, with an-interval of half an hour between each. SEIDLITZ POWDERS. These consist of two different powders; the one, contained in a white paper, con- sists oftwo drachms of tartarized soda, and two scruples of carbonate of soda; that in the blue paper, of thirty-five grains of tar- taric acid. The contents of the white paper are to be dissolved in half a pint of spring water, to which those of the blue paper are to be added; the draught is to be taken in a state of effervescence. The acid being in excess renders it more grateful, and no less efficacious as a purgative. This pre- paration can not be said to bear any other resemblance to the mineral water of Seid- litz, than in being purgative. SELTZER WATER. A water slightly alkaline, highly acidu- lated with carbonic acid. It is thought to remove many of the symptoms of hectic fe- ver, eruptions of the skin, disorders of diges- tion, acidity and heartburn, and spasmodic pains of the bowels. It is much recom- mended in diseases of the urinary organs, especially those in which gravel is formed. The dose is from half a pint to a pint. SENEGA. The polygala senega is a native of the United States, and a most important article of the materia medica. As an emmena- gogue, the root is strongly recommended in the form of decoction, made from an ounce of the root boiled in a pint of water until two-thirds' are dissipated; three or four ounces of which are a dose. As a diu- retic and expectorant, the senega root is alsy highly esteemed, in all cases unattend- ed with inflammation and fever. SENNA. The leaves of the cassia senna have a faint sickly smell, with a slightly bitter, sweetish, nauseous taste. They constitute one of our most certain and useful purga- tives. They may be given in the form of 206 MATERIA MEDICA. infusion, made from one ounce of the leaves to a pint of boiling water, - of which the dose is a wine-glassful every two hours un- til it operates. To avoid griping and sick- ness, it is customary to add some mild aro- matic. A very excellent form for the ad- ministration of senna, is, take of the senna leaves one ounce, manna, or brown sugar, half an ounce, cream of tartar, three drachms, cinnamon bark, one ounce; infuse the whole in a pint and a half of boiling water, in a covered vessel. SERPENTARIA. The polygala senega, or Virginia snake root. The roots of this plant are almost entirely destitute of smell, with, at first, a sweetish taste, but afterwards hot and pun- gent, producing a very peculiar tingling sensation in the fauces. It is used either in substance or infusion. Of the powdered root, the dose is twenty to thirty grains; of the infusion, one to two drachms. In its effects upon the system, it is reputed a sti- mulant, tonic, and diaphoretic. The dis- eases in which it has been found most bene- ficial, are the lower grades of fever, inter- mittents, used in combination with the bark; typhus pneumonia, bilious pleurisy, &c. SOAP. Soap is employed as a purgative, lithon- triptic, and alterative, in the dose of from twenty to fifty grains, twice a day. As a pur- gative, soap, aloes and assafoetida, or soap, aloes and gamboge, are excellent prescrip- tions. Soap liniment. A combination of two ounces of the soap liniment of the shops, one ounce of water of ammonia, and half an ounce of tincture of opium, forms a most admirable rubefacient in many cases of chronic rheumatism, and chronic pains. SODA. One of the fixed alkalies, commonly called the .mineral alkali, as distinguished from potass, the other fixed alkali, which is usually obtained from vegetables. Soda is very seldom used in a separate state; but more commonly combined with carbonic acid, from which it is easily disjoined, as the carbonic acid readily quits it when a stronger acid is brought into contact with it. Soda powders, as they are called, are use- ful in various disorders of the digestive or- gans. Their good properties are owing not to the soda, but to the carbonic acid, which is disengaged from the carbonate of soda by the application of a stronger acid, either the citric or the tartaric. The me- thod of using them is this. Dissolve the carbonate of soda, about one drachm in two ounces of water; and an equal quantity in another glass; put the two solutions to- gether, and when they are in the act of effervescing, let them be drank speedily^ or they may be taken separately, and the effervescence or disengagement of carbonic acid will go on in the stomach. ^ Soda water is water strongly impregnated i with carbonic acid, disengaged from the carbonate of soda. By proper pressure, water can be made to take up six times its bulk of carbonic acid. Soda water is brisk and sparkling, of a pleasant sub-acid taste, j but should not be drank during dinner, or immediately after it; as the great quantity jfl of carbonic acid (fixed air) which it con-' ■ tains, being disengaged, inflates the sto- - mach, and prevents those muscular actions which are necessary for the conversion of the food into chyme. sauiEL. The root of the sea-onion, or squill, is « used in medicine as an expectorant, and to 1 give relief in complaints from the lungs; it i is also used as a diuretic. It is apt to occa- jj sion sickness and vomiting; and in too large Jj a dose, the vomiting is followed by bloody fl stools, vertigo, syncope, and death. The dose of squill, as a diuretic, or expectorant, J is from one to two grains, twice a day; and J it is conveniently given in the form of the % squill pill of the Edinburgh Pharmacopoeia; i in which one grain of squill is united to *'« three of ammoniacum, three of caraway fl seeds, and three of extract of liquorice, fl The dose is two pills, morning and evening, fl They are useful in catarrhal complaints, in Tj asthma, in several dropsical cases, and other % diseases. Squill imparts its virtues to vine- j gar; and the vinegar of squills is a conve- ' * nient mode of giving it in a liquid form; a pectoral mixture may be made by adding an ounce of squill'vinegar to three ounces of the syrup of tolu, and three or four . '}\ of cinnamon-water, or peppermint-water. ■< With common syrup, it makes syrup of squill. STRAMONIUM. The name now in general use for the datura stramonium, or thorn-apple, a plant having narcotic properties, very poisonous when taken in an overdose, and which has of late years been much extolled for its virtues in asthma, when smoked like tobac- co. The leaves and the lower part of the • plant are thus used; the patient falls asleep, and awakens recovered from the paroxysm. In some cases, a perfect cure is effected; but in general the relief is only temporary. Dr. Bree, who writes on disordered respira- tion, says that the indiscriminate use of the smoke of stramonium has occasioned dan- MATERIA MEDICA. 207 gerous and hurtful effects in frequent in- stances. In some cases of aged or apoplec- tic subjects, death has been the conse- quence. In chronic diseases, attended with acute pain, the extract, from an eighth of a grain to a grain, is said to lessen power- fully, and almost immediately, sensibility and pain; but its place may well be sup- plied by more safe narcotics. STRENGTHENING PLASTER. This is a plaster made from olive oil, beeswax, resin, lead plaster and the red oxide of iron. Though in many cases it may do good, as a very gentle rubefacient, it has no power to communicate strength to the part upon which it is applied. STRYCHNINE Is an alkaloid discovered in several spe- cies of Strychnos, as the Strychnos nux vo- mica, S. Sandi Ignatii, S. Colubrina, and S. Triente, which yields an Indian poison, the Upas Triente. Strychnine has an in- tensely bitter taste, which is perceptible, it is said, when a grain is dissolved in eighty pounds of water. It is very sparingly solu- ble in water, but easily soluble in alcohol and the volatile oils. Except the prussic acid, no poison is endowed with such de- structive energy as the strychnia. There ' is little doubt that half a grain thrust into a wound might kill a man in less than a quar- ter of an hour. It acts in whatever way it is introduced- into the system, but most energetically when injected into a vein. The symptoms produced are very uniform and striking. The animal becomes agitated and trembles, and it is then seized with stiffness and starting of the limbs. These symptoms increase, till at length it is at- tacked with a fit of violent general spasm, in which the head is bent back, the spine stiffened, the limbs extended and rigid, and the respiration checked hy the fixing of the chest. The fit is then succeeded by an in- terval of calm, during which the senses are quite entire. But another paroxysm soon sets in, and then another, till at length a fit takes place, more violent than any before it, and the animal perishes suffocated. The first symptoms appear in sixty or ninety seconds when the poison is applied to a wound. Precisely the same symptoms are pro- duced by the nux vomica; half a drachm of the powder killed a dog in forty-five mi- nutes, and a grain and a half of the alcoholic extract thrust into a wound, killed another in seven minutes. The cause of death ap- pears to be prolonged spasms of the mus- cles of respiration; the diaphragm partakes in the spasm of the external muscles. Strychnine and the alcoholic extract of the nux vomica have been used for the cure of diseases of debility, for palsies, and amaurosis. The commencing dose is half a grain of the extract in the evening, formed into a pill, and gradually increased to four or six grains. Of strychnine, the dose is one-twelfth of a grain, or six drops of the tincture. SULPHUR. An inflammable substance found in vol- canic countries. Sulphur, or brimstone, as it is generally called, is procured in the form of cylinders, and in fine powder. It has neither taste nor smell; but when rub- bed it has a faint peculiar odour. It is of a yellowish colour; but when procured by precipitation, it is white, probably owing to its containing water. It is purified by sub- limation; and when thus purified, it is called flowers of sulphur, in which form it is used as a mild purgative, which purpose it completely answers. The dose is about one or two drachms. It may be given in syrup, treacle, or conserves; and when combined with an equal portion of cream of tartar, it forms one of the mildest and best laxatives for those who are troubled with piles. Sulphur has long been famous for its power of curing diseases of the skin, and for being a specific in the itch. For this purpose, it is applied in the form of oint- ment; the sulphur being mixed with some greasy substance, and rubbed over the parts affected, or as much of them at a time as may be judged proper. At the same time, the patient may take a little sul- phur internally. The rubbing for the itch may be continued for four or five days, when the disease is commonly removed. There are great popular apprehensions about exposure to the air when using sul- phur. It no doubt pervades the pores of the bod}-; this is evinced by the smell it ex- hales, and by blackening silver in the pock- et; but while under its influence, there is no more needed, than the usual precautions against taking cold. Sulphur is a favourite remedy with the common people in mea- sles, and other eruptive diseases. It is very harmless; and may, by acting gently on the bowels, be of some service in the com- mencement of these diseases, though it will not answer the purpose for which they in- tend it, that of bringing out the eruption more speedily and completely. Sulphur counteracts the activity of mercury, and should, therefore, never be used to assist the apothecary in extinguishing it, in order to make the blue ointment. TANSY. The tansy, (tanacetum vulgare,) was for- merly employed as a tonic and emmena- 208 MATERIA MEDICA. gogue, but is now seldom used, excepting as a vermifuge, in the form of a strong in- fusion of the leaves. TAR Is obtained by condensing the smoke and vapours which issue from fir-wood when it is burned. The vapour of tar is recom- mended to be diffused through the apart- ments of those afflicted with- consumption and other disorders of the lungs; and in some cases this inhalation has appeared to do good. We may mention here, what we should have stated under Pitch, that that substance, according to Dr. Bateman, has in some instances been beneficial in ichthy- osis, or fish-skin disease, having occasioned the rough cuticle to crack and fall off, leaving a sound soft skin underneath. This medicine made into pills with flour, or any farinaceous powder, may be taken to a great extent, not only without injury, but with advantage to the general health; and affords one of the most effectual means of improving the languid circulation, and the inert and dry condition of the skin. The quantity to begin with may be ten grains, three times a day. The unpleasant pitchy flavour of the pills is materially diminished, if they are kept for some time after being made up. Tar-water. Water impregnated with the smell and taste of tar, by infusing tar in water, stirring it from time to time, and pouring off the clear liquor. It was once a remedy in great vogue, and the learning and genius of Bishop Berkeley were em- ployed to recommend it as an almost uni- versal medicine. It is now used occasion- ally as a drink, in chronic affections of the lungs. Tar ointment. An ointment made by melting together tar, resin and mutton suet, has been found useful in various diseases of the skin. For the cure of scald head, the following will often be found useful: one ounce of tar rubbed up with half an ounce of citrine o'.ntment. TIN Is sometimes used for the purpose of ex- pelling worms from the intestines. It is used in its metallic form, reduced to a very fine powder. The dose is from one to two drachms, and it is thought to act merely by its mechanical properties disturbing the worms, and by its bulk and roughness car- rying them before it. It is now very little used. TOBACCO. The leaves of the tobacco are powerfully narcotic; but being altogether unmanagea- ble as a medicine, tobacco is seldom admin- istered internally. A tincture of tobacco has, however, been recommended, princi- pally as a diuretic, or in larger doses, as a powerful sedative, in dropsy, and'in cases of violent inflammation. Of its remedial powers, in either respect, we have little evidence. Diuretic drops of Ferriar. These are composed of half an ounce of the tincture of tobacco, and the same quantity of the oxymels of squill and colchicum, and sweet spirits of nitre. Given in dropsies, in the dose of a tea-spoonful, four times a day. Tobacco poultice. A poultice made of the moistened leaves of the tobacco, has been recommended to be applied to the pit of the stomach to produce vomiting, and to destroy worms. It is, however, a most dangerous prescription. Tobacco salve. Snuff rubbed up with lard, is sometimes used in cases of scald head, and chronic affections of the skin. It has in some cases produced the most vio- lent effects, sometimes death. Tobacco injection. A strong infusion of tobacco thrown into the rectum, is employ. ed by surgeons to aid in the reduction of strangulated hernia, and in some cases of obstinate costiveness. Its violent effects, renders the tobacco injection a very unsafe prescription. turner's cf.kate. A very useful dressing to produce the healing of simple ulcers, excoriations, slight burns, blisters, &c. It is made by melting together half a pound of yellow wax and two pounds of lard, and stirring into the mixture, while fluid, half a pound of prepared carbonate of zinc. turpentine. A liquid resinous substance, obtained from various species of the pine tribe. The oil of turpentine is obtained by distilling turpentine, when this volatile oil rises. The oil of turpentine has of late been success- fully used for expelling the tape-worm. The dose is from an ounce to an ounce and a half; it has even been given to the extent of four ounces at one, without any percep- tible bad effects, or so much inconvenience as would follow from an equal quantity of gin. It generally acts as a speedy pur- gative, and discharges the worm, in all cases dead. In obstinate constipation, it is of singular benefit. • In inflammation of the bowels, colic, and various spasmodic affec- tions of the viscera of the abdomen, oil of turpentine has been given with excellent effect, both by the mouth and by way of clyster. Turpentine is given in affections of the urinary organs, in doses of from ten MATERIA MEDICA. 209 drops to a drachm. Oil of turpentine is applied externally either alone or mixed with olive oil, to indolent tumours and pa- ralytic limbs. It is applied also as a styptic to stop bleeding; and some practitioners use it in burns and scalds, and when the part is completely destroyed, it is often benefi- cial. In cases of deafness from deficiency of wax, a portion of a mixture, made by adding ten drops of turpentine to an ounce of almond oil, may be introduced into the ear upon a little cotton. TUTTY. The oxide of zinc; a dry powder, used to prevent excoriation in children, at the folds where surfaces are apt to come in contact, as the groin, the arm-pits, behind the ears, &c. vxje ursi. A small evergreen shrub, the -green leaves of which, when picked from the twigs, and dried by a moderate heat, yield a powder whose taste is at first smartly as- tringent and bitterish, and at length leaves a flavour like liquorice. The effects of this powder are astringent and tonic; and it is used in whites, and in diseases of the urina- ry organs, attended with a flow of mucus along with the urine. The dose of the powder is from twenty to sixty grains in water, milk, or gruel, three or four times a day. VALERIAN. The root of the wild valerian is celebrat- ed as an antispasmodic and tonic remedy, and as such is used in various nervous and hysterical affections. It is given in powder to the extent of twenty or thirty grains, but it is more advisable to give it in infusion or decoction; or, as it is kept in the shops, in the form of the volatile tincture, in which the valerian is combined with ammonia. The odour of valerian is particularly attrac- tive to cats. WARMING PLASTER. This plaster forms an excellent local ir- ritant, in cases in which the action is wished to be kept up for a long time, without ex- citing vesication. It is composed of Bur- gundy pitch and Spanish fly cerate, seven parts of the first and one of the latter, melt- ed together, and then spread on leather. warner's cordial. This is an excellent purgative in persons troubled with a weak stomach, flatulence, or tendency to cramps of the bowels. It is composed of an ounce of rhubarb, two drachms senna, a drachm of coriander, and the same quantity of fennel seed bruised; red saunders, two drachms, saffron and li- quorice, of each, half a drachm, stoned rai- sins, half a pound, and diluted alcohol, three pints; to be steeped together for two weeks, then strained through paper: dose, half an ounce or an ounce. WORM SEED. The seeds of the worm seed, or chenopo- dium anthelminticum, are employed as a destroyer of worms, in the dose of from twenty to forty grains, powdered; or a tea- spoonful of the fresh juice of the plant may be given. The essential oil procured from the seeds, is likewise an active vermifuge; three to five drops, or more, may be given to a child two or three years old, mixed with mucilage and sugar. The worm seed is unquestionably one of our very best an- thelmintics. It is said to have succeeded even in cases of tenia. WORM WOOD. A plant having a strong and peculiar odour, and an intensely bitter and disagree- able taste. Infused in ale, it forms the drink called purl. It may be used as a tonic and stomachic from its bitterness, and had its reputation and its name from being suppos- ed to be good against worms. The dose is from one to two drachms of the powder of the stalk, or an ounce of the infusion made by an ounce of the plant to a pint of water. YEAST. Yeast is employed in medicine as a pur- gative, in cases of typhus fever, in the dose of a wine-glassful, and as an application to gangrenous ulcers. Yeast poultice. To one pound of flour add half a pint of yeast, and mix them well together. ZINC Is a metal of a bluish white colour. When it is rubbed for some time between the fingers, they acquire a peculiar taste, and emit a very perceptible smell. As zinc is one of the most easily oxidized metals, it is employed in the formation of galvanic batteries. When zinc is alloyed with cop- per, in different proportions, it forms brass, pinchbeck,- Prince Rupert's metal, &c. Acetate of zinc. A solution of this salt is used as a wash in ophthalmia, and as an in- jection in gonorrhoea. Carbonate of zinc, calamine, lapis cake- minaris, is usually of a grayish, yellowish, or pale reddish colour. One part of this- 210 MATERIA MEDICA. substance very finely powdered, and added to five parts of simple cerate, forms an ex- cellent application for cutaneous ulcera- tions and excoriations; and is a good dress- ing for burns, after the first violence of their symptoms is over. This cerate resem- bles that called Turner's cerate. The pow- der of calamine is sometimes sprinkled on ulcerating surfaces. Oxide of zinc. This oxide has been used in epilepsy, in the dose of from two to ten grains, two or three times a day; but with no very remarkable effects. An impure oxide of zinc, well known by the name of tutty, is dusted upon the parts of infants which are liable to be chafed by rubbing against each other, as the groins, neck, arm pits, &c. „ Sulphate of zinc, white vitriol, is tonic and astringent, and in large doses, acts as an emetic. It produces very speedy vo- miting; and is, therefore, used to evacuate ' the stomach when an overdose of lauda- \ num, or other vegetable poison, has been j swallowed. The dose for this purpose is thirty grains. In doses of two grains, twice jl a day, it is used in indigestion. In hooping- fl cough, and other spasmodic coughs, one "| grain of the sulphate of zinc, and four je grains of myrrh, twice a day, have a good fl effect. It is used, of the strength of two fl grains to the ounce of spring water, or rose water, as a wash for the eyes; also foflsore nipples, and as an injection in the whites. The white vitriol of commerce should not ji be used in medicine, as it generally con- * tains impurities, principally the sulphate of <„, copper. - V PART IV. SURGICAL DISEASES AND ACCIDENTS The term abscess signifies a tumor, or circumscribed cavity containing pus; or a collection of purulent matter in any part of the body, which has been previously the seat of inflammation. Abscesses form, after inflammation, both in the internal parts of the body and in those which are in sig-ht. Common abscess. An abscess formed on some external part of the body, which has been previously the seat of inflamma- tion. When inflammation occurs, it would be better, by proper remedies, to remove it, before it causes suppuration, or the for- mation of an abscess; but if this latter can not be prevented, we must endeavour to accelerate its progress by warm fomen- tations, and By poultices. These are to be made of bread and milk; oatmeal or lin- seed meal and water; and to promote the ripening of an abscess in the inside of the mouth, a roasted fig or apple may be used. When the tonsils (.or almonds of the ear) are tending to suppuration, the patient should draw into the mouth the steam of boiling water, alone, or have a little vine- gar added to it. In general, those poul- tices are best which retain their heat the longest, and they should be frequently changed, to prevent their becoming cold, and thus having a contrary effect to what we wish them to have. The tendency to suppuration may be known by the inflam- mation continuing long; bv the stretching 2C " pain becoming less; by a throbbing sensa- tion, and the patient's being affected with cold shiverings. When an abscess forms in a place under our inspection, it is accom- panied with swelling, whiteness, or yellow- ness of the skin, and a soft feel, as if ther* were a thickish fluid in a bag. When mat- ter is formed,, it must be discharged,, and nature endeavours to accomplish this by causing the matter to have a tendency to the nearest outlet: thus an abscess formed in a fleshy part of the body will point to the skin, one in the lungs will burst into the air cells, and one in the liver, either into the belly, or externally through the side. When the abscess is quite ripe, which is known by the pain being lessened, and the matter pointing, it is, in general, best to give it vent by opening it with a lancet, or other clean cutting instrument; and this, in the position or situation which is lowest, on pur- pose to let the abscess empty itself by the weight of the fluid. It is better to have a free vent of our own making, than to allow the matter to find its way under the skin, to distant and inconvenient parts, or to allow the matter to discharge itself by a ragged and irregular opening. It is almost always proper to make the cut large, as a small one is nearly as painful, and as it is liable to close too soon, and thus occasion the neces- sity of repeating the operation. When the abscess is large and deep, a small piece of lint should be put between the lips of the wound, that it may close from the bottom; and 212 SURGICAL DISEASES AND ACCIDENTS. this is to be renewed at each dressing. The poultices are still to be continued, till the thick yellow appearance of the matter changes into a thin watery discharge; after this it is proper to discontinue them, and to dress with cerate, or healing ointment. In scrofulous abscesses about the neck or face, especially in females, it is a matter of difficulty to determine whether it is best to allow them to burst of themselves, or to make an opening with the lancet. Which- ever of the methods is employed, the dis- charge is commonly of an unhealthy kind, and continues long; and a scar remains, for which the surgeon is blamed if he has given vent to the matter by an incision. Another way of letting out matter from an abscess is by caustic, viz. the application of some acrid substance, which burns or corrodes the skin, and makes an opening-. Some persons are so afraid of a cutting in- strument, that this seems to them a prefer- able way of opening an abscess; but it should rarely be done, as the pain is great- er, and the likelihood of deformity is in- creased. When it is wished, as much as possible, to exclude the air from the inside of an abscess, an opening is made by passing a broad cutting needle, for the purpose of bringing through the sides of the abscess a skein of silk or cotton. This is desirable, particularly in lumbar abscesses, or those collections of matter which come from the inside of the belly, and point at the upper part of the thigh; as air admitted into them is often found to be the cause of hectic fe- ver, and consequent general ill health. The degree of danger which attends an abscess, depends on its situation and its consequences. If it is situated in the lungs, it may burst into the air cells, and prove fa- tal by suffocation; or if in some of the vis- cera of the belly, it may be effused in the cavity of the peritoneum, or investing mem- brane of the bowels, and excite inflamma- tion there. Large abscesses are dangerous by the wasting discharge with which they are accompanied ; and by the hectic fever and general symptoms which, in certain constitutions, follow them. Boil. A boil is a small tumour common to every part of the surface of the body; hard, circumscribed, acutely tender to the touch, and suppurating with a hard core in the centre. It is chiefly found in persons of a full habit, and great vigour; but is some- times met with also in debilitated patients, who are evidently suffering from ill health. When it occurs in the strong and vigor- ous, they should be put on a low diet, and some cooling opening medicine should be given, as a solution of salts, or cream of tar- tar, or senna tea with the addition of salts. If the boil be large, and attended with con- siderable swelling, pain and fever, bleed- ing will be proper. A common poultice should be applied to the boil till it suppu- rates and breaks, when it may be dressed twice a day with Turner's cerate, or satur- nine ointment, till it heals. If the ulcer gets into an indolent state, and wants stimulating, in order to its healing, w-e may apply the ba- silicon ointment, or one composed of two parts of spermaceti ointment, and one part of the ointment of nitrate of mercury. Boils not unfrequently arise in weakly habits, and where the constitution is evi- dently in an unhealthy state: in such cases, the patient should be put on a nourishing diet, chiefly of milk and farinaceous ali- ment—he should take daily exercise, if pos- sible, in the open air, and use the warm bath j and frictions to the surface every other day. \ An alterative pill, composed of blue mass and soap, of each five grains, and ipecacu- anha one grain, given every night, or every other night, will be found of great service. The compound decoction of sarsaparilla is ■'■% likewise an excellent medicine, and may be fl taken at the same time. Gum-boil. Gum-boils are sometimes * limited to the substance of the gums, andfl| sometimes connected with the decay of a Jj tooth, or its socket. In the first variety, it fl is a disease of only a few days duration, and flj ceases almost as soon as the boil bursts, or Tfe is opened; in the second, it will often con--fll tinue troublesome till the carious tooth isflf extracted, or the carious socket has exfoli- i ated, or the whole of its texture is absorbed."H Gum-boils, when connected with an un-^B healthy condition of the subjacent teeth, 1 rarely disperse without passing into suppu-^fl ration, and it is, therefore, generally bettejfli to encourage this process by the use of ? warm fomentations, or cataplasms, than to H repel it. An early opening of the tumour Sl(j is of importance, as, from the structure of *1 the parts concerned, the walls of the ab- j scess are mostly tough and thick, and the \ confined matter seldom obtains a natural exit with sufficient freedom. A little mild opening medicine, as salts, cream of tartar, rf or senna tea, every other day, will be found j useful; and after the abscess has burst, or been opened, washing the mouth twice or thrice a day with an astringent lotion will tend materially to make the cure perma- nent. Twenty grains of sulphate of zinc, dissolved in half a pint of rose-water, will be a suitable lotion for this purpose. Mammary abscess. An abscess seat- ed in the female breast, affecting chiefly women after confinement, or during the period of suckling. Previous to the birth of the child, a great quantity of blood is sent to the womb to supply materials for the growth and nourishment of the em- bryo; but when the child is born, and requires food of another sort, the blood SURGICAL DISEASES AND ACCIDENTS. 213 then flows in great quantity to the breasts, and occasions, in some constitutions, a smart febrile attack, known by the name of the milk fever,- and, in others, severe local pain of the breasts, followed by suppuration. Independent of the milk fever, inflamma- tion and abscess of the breast may arise from.checking the How of milk at too early a period, from exposure to cold, fright, mental anxiety; too great motion of the arm when the breast is large and distended; blows, and pressure from tight clothes. But the abscess of the breast often occurs, when no obvious cause can be assigned. The pain arising from the inflammation of so large and tender a struc ure is very great, and occasions very severe distress. The breast sometimes puts on the appearance of several distinct swellings, has a knotted feel, and the pain often extends to the aim- pit. At first, we must endeavour, if possi- ble, to put a stop to the inflammation, and to prevent its coming the length of suppu- ration. This is to be done by giving fre- quent doses of cooling laxatives, as of salts; by applying cold or tepid fomentations to the breast, and by attempting to have the milk regularly drawn off. We are also to apply leeches in great numbers, and to rub the breast gently with a little warm oil. The diet is to be very spare and cooling. If we fail in relieving the inflammatory state, our next endeavour is, to promote the suppuration by poultices, and to discharge the matter, when ripe, by a large opening. When a suppurating breast is left to itself to break, it too frequently allows the mat- ter to work itself into various winding holes, and to make its way out by different open- ings, occasioning a long and wasting dis- charge; to prevent this, there is no method so sure as making a large and free incision, and laying open through all their depth, the hollows from which the matter flows. When a hardness remains in the breast, after in- flammation and abscess, it is to be disper- sed by frictions with camphorated oil, or mercurial ointment; attention being paid to the avoiding of external injury; and the general health and state of the bowels is to be looked after. Lumbar abscess. A collection of mat- ter forming at the loins internally, and making its appearance along the psoas muscle, at the upper part of the thigh. At the commencement of the disease, there is some difficulty of walking, and uneasiness is felt about the loins; but, in general, there are large collections of mat- ter formed without much previous pain, and without any indication of disease, till it begins to show itself by an external swel- ling-. It is sometimes connected with disease of the bones of the vertebral column; but in many cases there is no such combination. It very often occurs in scrofulous constitu- tions without any obvious cause, and it may proceed from blows on the back and loins, and from exposure to cold and damp, as by lying on the ground when wet. If we have any symptoms to lead us to suspect the complaint coming on, we are to endeavour to prevent it by the application of leeches or cups, by blisters, and purgative medicines. The great difficulty in the treat- ment of this disease is, to determine on the mode of opening the abscess, when we have decided that such a measure is proper. It is found by very general experience, that when these large collections of matter are freely opened, and admission is given to the external air, very terrible consequences en- sue; and that there are produced hectic fe- ver, wasting discharges of matter, and, at length, death. A plan which has been adopted with success for opening them, is to make a puncture large enough to dis- charge the flakes of matter and clots of blood from the cavity, then to cover the wound, and get it to heal as quickly as pos- sible. When the matter collects again, a fresh opening is made, and the same meth- ods pursued as before. When the abscess has been opened, or when it has burst, which we must always endeavour to antici- pate and prevent, the strength of the patient is to be supported by nourishing diet, and by a liberal allowance of bark, and, in some cases, the use of wine; at the same time, moderating the hectic fever, by sponging the body with vinegar and water, and by paying a proper attention to the action of the stomach and bowels, ACniLLEs' TENDON. The strong sinew which is continued from the fleshy part of the back of the leg to the bone of the heel, is sometimes broken by the action of the muscles, in dancing, leaping, and other violent exertions. The patient seems to hear a crack as of a whip, or as if he had broken a nut with his heel. Sometimes awkward reapers cut the tendon of their companion's heel with the sickle. When this tendon is cut or ruptured, the power of extending the foot is lost, and the patient becomes lame. The cure depends on keeping the broken ends together, by a contrivance which bends the knee, and ex- tends the foot or ankle joint. The following, which was used in the case of the first, by Dr. Monro, will give some idea of the con- trivance alluded to: a foot-sock, or slipper, was made of double-quilted ticking, from the heel of which a belt or strap projected, of sufficient length to come up over the calf of the leg. A strong piece of the same materials was prepared, of sufficient breadth 214 SURGICAL DISEASES AND ACCIDENTS. to surround the calf, and this w-as fastened on wi h lacings. On the back part of this was a buckle, through which the strap of the foot-stock was passed, so that the foot could be exten led, and the calf brought down at pleasure. It must be remembered that the bending of the knee joint is partly per- formed by the upper part of the muscles of the calf, which are inserted into the ends of the thigh-bone, and, therefore, if the knee be stretched, this will tend to draw asunder the separated portions of the injured ten- don. Much caution is requisite for many weeks, or even months after the accident; and even through life, it is prudent to ab- stain from all violent and irregular exer- cise. ALV1N!: CONCRETIONS. Surgical writers have recorded many in- stances, in which concretions of various sizes, and producing a series of very bad and even fatal complaints, have been form- ed round plum and cherry stones in the ali- mentary canal. The knowledge of the dan- gerous consequences, which may ensue from swallowing such indigestible bodies, cannot be too extensively diffused; for, it is certain, that this pernicious habit of chil- dren and thoughtless persons, is by no means uncommon, and must be a more fre- quent occasion of ill-health, if not of death, than is generally supposed. The symptoms induced by the lodgment of concretions, of the above kind, in the bowels, are of a formidable description: se- vere pains in the stomach and bowels, diar- rhoea, violent vomitings of blood and mucus, a discharge of thin fetid matter from the rectum, a difficulty of voiding the excre- ment, an afflicting tenesmus, extreme ema- ciat on, and debility. The concretions may become so large as to be incapable of passing onward to the rectum, and, of course, occasion fatal com- plaints. Sometimes, patients ultimately get well by voiding the concretions, either by vomit- ing, or stool. Mr. Charles White gives us an account of some such instances; in one, fourteen concretions on plum-stones were discharged from the anus; in another, twen- ty-one similar bodies were ejected from the stomach. 'I he latter gentleman concludes some in- teresting cases, with warning practitioners, and mankind in general, of the great dan- ger of swallowing fruit-stones; and he doubts not, that many persons have lost their lives from this cause, when the disor- der has not been understood, but been mis- taken for the colic. Whenever fruit stones are inadvertently swallowed, a brisk purgative, as of castor oil, should be given, in order to procure, without delay, their discharge. ANEUniSM. Signifies a soft swelling, having a pulsa- ting motion, corresponding to the beating of the arteries. To the ignorant observer, it does not seem a very formidable thing to be afflicted with a small colourless swelling, free from pain, and not hindering the mo- tion or the functions of any part; but the surgeon knows that it is the commencement of a process, which, unless counteracted by the most skilful treatment, must almost in- fallibly terminate in the destruction of the unhappy sufferer. He knows that this tu- mour proceeds from a diseased artery; that the unremitting activity of arteries presents obstacles to the recovery, which unassisted nature can seldom overcome; that the tu- mour must continue to exist, nay, to in- crease, till, finding its way through the skin and other coverings, the blood bursts forth, and thus ends the life of the patient. Arteries have three coats, a villous, or smooth coat along which the blood moves^ a muscular coat; and outermost of all, a cel- lular coat. It may happen that the whole of the three coats may be enlarged, and the calibre of the artery increased; this is con- sidered by surgical writers, as the only true aneurism; but it more frequently happens that from some disease of the inner coat, a piece is ulcerated and absorbed from it, and the constant force of the blood pushes out the muscular coat, and leaves nothing but the cellular coat to contain the blood. This more common form of the disease, is called false aneurism. % This disease of an artery may be in such ■ a situation as to present no external tumour to give any alarm; it may be within the ca- vity of the chest, or of "the belly; and the same fatal progress will go on, till the blood bursting into some of these cavities, will be as much out of its due place, and as fatally lost, as if it had been spilt on the ground. There are some situations where aneurisms occur more frequently than others, and from their situation they derive their names. A few of these shall be enumerated: 1. The popliteal aneurism is that which is seated in the ham, and is one of the most frequent that occurs. 2. The carotid in the neck. 3. The axillary in the arm-pit. 4. The subclavian, in the artery under the collar- bone. 5. Internal aneurisms of the aorta, the large arterial trunk issuing from the heart, frequently occur. Several methods have been proposed for the cure of aneurism, some constitutional and others local: the principal one acting on the general system is that of extreme low living, which is said to have succeeded in SURGICAL DISEASES AND ACCIDENTS. 215 some instances. The only way in which it could act, must have been by diminishing the quantity and force of the blood, and so allowing the diseased part of the artery to heal; but it has not often been successful. It is now universally allowed that a cure of aneurism is rarely to be expected, unless by -some means or other the canal of the artery be obliterated in its course, nearer the heart than the tumour. Sometimes this takes place spontaneously, from the tumour occa- sioning a pressure in so favourable a part of the artery, that it occasions an adherence of its sides; but we do not know when to expect this,.and the fewness of the instan- ces in which it has happened, does not war- rant our waiting for it in any case. We must put in practice the methods which the well directed observation of modern sur- gery has contrived; and the best way of ef- fecting the obliteration of the canal of the artery, is by tying a fine ligature tightly round the vessel. The effect of this is to cut through the two inner coats as if a knife had done it; inflammation is excited, a clear fluid called coagulable lymph is thrown out, and by this means a plug is formed which prevents the blood from going any further along that portion of the artery. The pul- sation of the tumour is immediately stopped; the limb, for a short period, becomes cold- er, but in no long time regains its heat, or increases it. The continual action of the heart and arteries enlarges the smaller col- lateral vessels, and this enlargement con- tinually going on, renders them capable of supplying the limb with blood. The tu- mour gradually diminishes by the action of the absorbent vessels, which remove out of the system what is decayed or useless, so that it gives no farther trouble. When an aneurism is out of the reach of an operation, life may be prolonged by oc- casional bleedings, a spare diet, and avoid- ing every thing that would too much stimu- late the action of the heart and arteries. ANIMATION, SCSPENDED. A total suspension of all the mental and corporeal functions may arise. 1. From suffocation produced by hanging or drown- ing. 2. From the inhalation of carbonic acid, or some other noxious and irrespira- ble exhalation. 3. From a stroke of light- ning or electricity; and, 4. From intense cold. In death, from hanging or drowning, the face is turgid and suflused with livid blood, especially in the former case. When it arises from the inhalation of irrespirable gases, the countenance is pallid; when from a stroke of lightning or electricity, it is also pale, the limbs being flexible, and the blood in- coagulable; and when produced by intense cold, it is pale and .shrivelled, and the limbs rigid. In the first variety, or asphyxia, from' hanging or drowning,-the chief immediate cause is suffocation, or a total obstruction to the respiration. Some physicians have considered apoplexy to be the principal cause of death in hanging, and others have said, that it is owing to the dislocation of one of the vertebrae of the neck, which, in be- ing driven out of its placfe, presses upon the spinal marrow, and thus insures immediate dissolution; but these opinions are now clearly ascertained to be erroneous, and the great majority of professional men of the present day regard the obstruction to res- piration, to be in nearly all instances the chief^ and in very many examples, the only cause of death, both in hanging and drown- ing. In hanging, the aperture of the wind- pipe is closed against the entrance of air by the pressure of the cord round the throat, and in drowning by a rigid spasm of its muscles. In drowning, it was formerly supposed that the suffocation was produced by a rush of water into the cavity of the lungs, but it is now well ascertained, that in many cases of death from submersion, not a drop of water enters into the lungs ; that where it does enter, the quantity is, for the most part, very small; and that, whether small or large, it passes the windpipe after death, instead of before it, and consequent- ly cannot be a cause of death. In the second variety of suspended ani- mation, op that from an inhalation of nox- ious vapours, death, in many cases, takes place instantaneously, and from an utter destruction of the irritability and sensibility of the nervous system. In this case, there is not only a cessation of the action of the heart from the want of the necessary stimu- lus of the blood afforded by the lungs', but there seems a total abstraction of the nervous power, and this as completely in one part of the frame as in another. The most fatal gases of the description before us, are the carbonic acid, hydrogen, nitrogen, and several of a more compound kind, which are thrown forth from putrefy^ ing animal and vegetable substances, and especially from cemeteries, on opening- fresh graves. The most common of these gases is the carbonic acid, wdiich is chiefly found, as a suffocating vapour, in close rooms where charcoal has been burnt; at the bottom of large beer-casks, or wells; in cellars where a large quantity of wine or other liquors are in a state of fermentation, and in many natu- ral caverns on the earth's surface. As it will not support flame, the common and easiest test, where it is suspected to exist, is that of a lighted candle, which is well known to be extinguished immediately, if this gas be 216 SURGICAL DISEASES AND ACCIDENTS. present in a quantity sufficient to be inju- rious to respiration. In the third variety, the whole system ap- pears not so much rendered inirritable to stimulants, as to be suddenly exhausted of its entire stock of nervous power, like a Ley- den phial upon an application of the dis- charging rod; in consequence of which the limbs are flexible, and the blood does not coagulate. Asphyxia, from intense cold, is always pre- ceded by an insurmountable desire to sleep, which the utmost exertion of the will is un- able to overpower. The sleep is, in most cases, fatal, and becomes the sleep of death. Extreme cold being one of the most formi- dable sedatives, carries off the heat of the body far more rapidly than it can be recruit- ed, exhausts it of its irritability and sensi- bility, and death thus insensibly takes place. When suffocation has been produced by drowning, the two grand means by which we are to operate, are those of warmth, and inflation of the lungs. The body should be immediately and quietly conveyed to a warm and dry situation, and rubbed all over with moderate stimulants, as flour of mustard, mixed with an equal quantity or more of common flour, or some warm em- brocation, as soap or camphor liniment, with a small addition of oil of turpentine; while the nostrils are plied with volatile am- monia, and the eyes exposed to a strong light. But as a restoration of the action of the lungs is chiefly and directly to be aimed at, a full expiration of warm air from the lips of a by-stander should be repeatedly forced into the patient's mouth, and his nostrils held close, to prevent its escape by that channel. Inflation may also be at- tempted by a pair of common bellows; or which is far better, if it can be readily pro- cured, by a pair of bellows communicating with a pipe, introduced through the nose or mouth into the windpipe, or, as some have judiciously recommended, into an aperture made between the rings of the windpipe. If the lungs cannot be fully inflated by the other means advised, this aperture in the windpipe should invariably be made, and without much loss of time, since effectual inflation is more certainly secured by it than any other method, and the operation, if carefully performed, is quite safe; but if the efforts at inflation are too violent, or unskil- fully performed, rupture of the lungs may result. Injections of assafoetida and oil of turpentine, or other stimulants, mixed with warm water, should, at the^same time, be thrown into the rectum. And, if it be pos- sible, some warm cordial, as volatile tinc- ture of valerian, volatile alkali, brandy and water, or the compound spirit of lavender, should be conveyed into the stomach, by means of a canula, or catheter; or what may probably in this case answer better, by a piece of sponge impregnated with one of these fluids, fixed to the end of a small rod of whalebone; for the sides of the stomach may be, so to speak, mopped round, by the sponge thus charged, and stimulated in every direction. Blood-letting was formerly recommended by many able physicians, and is stil^a com- mon resource with the unthinking; but a very large majority of the best informed practitioners of the present day dissuade from its employment in the first instance. In the generality of instances, blood-letting is a mean of little efficacy; in many, it can not fail to be injurious. It must not be for- gotten, that it is one of the most direct and powerful means of lessening the heat of the body, and the force of the vital principle, and is, therefore, clearly opposed to the ob- ject which we have to accomplish in the present case. It ought never to be resort- ed to, unless by the direction of an intelli- gent medical practitioner. A few years since, it was also the prac- tice to administer tobacco injections, either in the form of infusion or smoke; but this. is now universally and justly condemned; for tobacco, being a powerful narcotic and sedative, has, like blood-letting, a direct ef- fect in depressing the energies of life, and is, therefore, invariably injurious under the present circumstances. Returning life is first usually discover- able by the symptoms of sighing, gasping, twitching, slight palpitation or pulsation of the heart; in effect, by a weak action in most of the organs. Our efforts should here be redoubled, for the feeble spark still requires to be solicited and nourished into a permanent flame, and has often disap- peared from a relaxation of labour. A spoonful or two of warm wine, or wine and water, should now be given by the mouth, as soon as the power of swallowing is suffi- ciently restored; and should be shortly succeeded by light, warm, and nourishing food of any kind, with a well-heated bed, and perfect tranquillity. In attempting the recovery of those who have hung themselves, the same means are to be resorted to. Here, bleeding from the jugular vein may be more frequently found necessary than in the drowned; since, in hanging, there is a greater tendency to apo- plectic symptoms, than in drowning: yet, even here, the quantity abstracted need not be large, and should rarely exceed six or eight ounces. How long the living principle may, under the foregoing circumstances, remain at- tached to the animal frame, and afford a chance of recovery, is not ascertained with any degree of accuracy; it exists, in many instances, how ever, longer than is generally SURGICAL DISEASES AND ACCIDENTS. 217 supposed; and there are some undoubted cases of recovery, both from drowning and hanging, after such a lapse of time, as ought to teach us the useful lesson of "the necessi- ty of not despairing too early. If the sub- mersion has not exceeded five minutes, per- sons will be usually found to recover with- out much difficulty. After a quarter of an hour, or twenty minutes, recovery is not common; and after half an hour, it is nearly hopeless. Yet, of twenty-three instances, of the recovery of drowned persons at Paris, one was restored to life after having been three-quarters of an hour under wa- ter, four after having been half an hour, and three, after a quarter of an hour. Mr. Glo- ver, a surgeon in London, relates the case of a man who was restored to life after twenty-nine minutes hanging, and continu- ed in good health for many years after; but his exertions for the recovery of this per- son were continued, unremittingly, for four hours and a half, before any signs of return- ing life were visible. In a suspension of animation, arising from the inhalation of noxious airs, the patient, if any degree of sensibility remain, should be freely exposed to the open air, instead of to a heated atmosphere, as in the preceding variety; and, if he can swallow, acidulous liquids, as lemonade, Sic. should be given him. If insensible, cold water should be largely dashed on his face; strong vinegar, and especially aromatic vinegar, be rubbed about his nostrils, and held under them, and stimulating clysters of assafoetida, or oil of turpentine, &c. mixed with water, be in- jected. The lungs should be inflated with the warm breath of a healthy man, as ad- vised under the preceding variety, or with oxygen gas. The inflation with oxygen gas is highly to be recommended. But it appears that the employment of the concentrated chloride of soda, or of lime, is the most speedy and certain means of restoring persons who have been suffo- cated with carbonic acid gas, in any shape or combination, as it arises, for example, from burning charcoal, or from accumulated filth, or is encountered in descending into wells or cellars, or in opening extensive public sewers, &c. The patient should be brought into the open air, and a bottle of the concentrated chloride held close to his nostrils, so as to cause him to inspire it, which should be continued until the patient has fully regained his consciousness, and the power of walking, which he should be kept doing for some time in the open air. Aci- dulated liquors may, with propriety, be given at the same time. A proper use of electricity is also, in ma- ny instances, found very serviceable. The fluid should be transmitted along the chan- nel of the nerve, from the seat of the phre- nic nerve in the neck, to the seat of the diaphragm, or that of the par vagum and great sympathetic nerve, immediately un- der the sterno-mastoid mu:-cle. Little ad- vantage is likely to accrue from passing the electric aura, across the chest, directly through the heart and lungs, which is a common practice. The general plan of medical treatment proper, when animation has been suspended from a stroke of lightning, has been detailed under the first variety. Stimulants of the most active kind should be resorted to, without loss of time, as volatile alkali, and the stimulating liniments, externally; and brandy, and volatile tincture of valerian, internally. But of all stimulants, that of electricity seems to be.especially called for in the present case. Dashing cold water oyer the patient's body, particularly the head and face, will, in many cases, if imme- diately resorted to, rouse the patient, and supercede the necessity of all other reme- dies. In the treatment of a person who has been so long exposed to extreme cold, as to be in a torpid, and apparently lifeless state, great cautisrti is necessary in the em- ployment of warmth, since its too quick and free application will undoubtedly pro- duce mortification, and endanger life. The body should be first rubbed all over with snow, or very cold water, and after active friction of this kind has been continued for a quarter of an hour, it should be wiped perfectly dry, and submitted to the friction of warm hands, several persons being en- gaged in the process simultaneously. The body ought not, in the first instance, to be brought into a warm room; but after the friction with cold water has been continued for the period specified, and the body been wiped dry, then removal will be very pro- per and necessary, and it should be laid in flannel. Warm air may then be breathed into the lungs, and a little lukewarm wine and wTater conveyed into the stomach. Per- sons who have been buried in snow for a considerable time, or so exposed to intense cold, as to be deprived of animation for some hours, have been perfectly restored by these means; and it would be highly criminal in any professional man to relax his exertions to recover such persons, until his efforts had been strenuously exerted with- out effect for several hours. In the treatment of infants who have been oveiiayed, or otherwise suffocated by the carelessness or inattention of their nurses, and of persons who suddenly expire in faint- ing fits, precisely the same plan should be pursued as is laid down under the first va- riety, or suspended animation from drown- ing. Here, as in suffocation from drown- ing, the two grand agents of restoration are 218 SURGICAL DISEASES AM) ACCIDENTS. warmth, and inflation of the lungs; and if these means are resorted to with judgment and perseverance, many of such cases will terminate favourably which would be lost under a less vigorous and patient treat- ment. ANUS. DISEASES OF TUB The principal diseases of the anus which call for surgical aid are, fistula, prolapsus, and piles. Fistula. A name applied to a sore which runs some way under the skin, and dischar- ges a thin matter from its sides, which are converted into secreting surfaces. A fistula may occur in any part of the body, but it is chiefly frequent and troublesome in the neighbourhood of the anus, where one or more of such sores run a long way under the surface, and penetrate within the gut. This is a very disagreeable, though not a dan- gerous affection, and people are naturally very anxious to get rid of it. The cure consists in making such an incision through the internal surfaces of the fistula and neighbouring substance, as shall induce a degree of inflammation, and so cause the sides to grow together, and obliterate the fistula. When the sore communicates with the gut, the surgeon must pass his finger into the gut, and use it for a director to in- troduce a cutting instrument, by which he is to lay open the whole extent of the fistu- la; and then by proper dressings to encour- age such a suppuration as shall end in a union of the parts. The operation is not particularly dang-erous or painful, but in unhealthy constitutions, as in those which have been broken down by intemperance, or in old age, there is such a degree of in- flammation produced as to bring the patient into very great danger. Fistula is some- times connected with diseases of the blad- der and other neighbouring parts, aud this adds to the inconvenience and danger. There are many diseases that may take place near the anus, that are apt to be dreaded by the ignorant as fistula, but the true fistula is as we have described it. Prolapsus of the anus. When a portion of the rectum is protruded out of the anus, in a preternatural degree, the disorder is termed prolapsus ani. Sometimes, only a very small part of the gut is thus displaced; on other occasions, there is a very consider- able portion of it. The most common cause of this disease, is the too frequent employment of aloetic me- dicines, the action of which particularly af- fects the large intestines. The same thing results from small worms, known by the name of ascarides, and which, lodging about the lower part of the rectum, occasionally cause excessive irritation. Habitual costive- ness; long continued diarrhoea; chronic dy- sentery; hemorrhoids; in a word, every thing, which, by stimulating the rectum, excites too violent an action of this intes- tine, may, however, induce the complaint under consideration. There are numerous instances in which a prolapsed portion of the rectum has remain- ed, for a long while, unreduced; and in which, notwithstanding such neglect, no serious bad consequences have ensued. But, we ought never, on this account, to omit doing every thing in our power for the immediate reduction of the intestine. Authors of surgical works have, not un- commonly, recommended fomenting the prolapsed part with emollient and astringent decoctions, before making an attempt to reduce it. They even advise the operator, for the purpose of succeeding with more ease, to cover his fingers with linen, smear- ed with wax and oil. But, all such prepa- rations are useless; and, when a surgeon is called to a patient afflicted with a prolap- sus ani, the greatest service he can render, is to put back the displaced part, as quick- ly as possible, into its natural situation, Without leaving the intestine exposed to the dangerous effects, which may arise du- ring the time wasted in employing fomen- tations, fkc. Also, as much greater manual dexterity can be made use of, when the tin- • gers are perfectly uncovered, than when they have greasy gloves on, it is best not to follow the latter method. However, if it should be judged proper to cover the hands with any thing-, a piece of fine cotton will *»,1 best answer the purpose. >i The patient being in bed, lying upon his *'* side, or, what is better, on the abdomen, while his buttocks are raised rather higher than the rest of the body, the surgeon is to make strong, but equal pressure, with the palm of his hand, on the lower portion of the prolapsed intestine. By continuing such pressure, the intestine may, in general, be easily reduced. But if this plan should not suffice, the upper part of the protruded in- testine must be compressed with the fingers of one hand, while the lower part is pressed upwards by the palm of the other one. In this way, we are almost sure to succeed. It is true, that if, in consequence of having too long delayed the reduction, or from some other cause, the gut has become much swollen and inflamed, it will be impossible to reduce the part, before such symptoms have been subdued. For this purpose, it may be proper to take some blood from the patient, in such quantity as his strength will allow. The intestine may also be fomented with a warm solution of the acetate of lead. When the swelling has been diminished by these means, there will be no difficulty in SURGICAL DISEASES AND ACCIDENTS. 219 replacing the parts, by pursuing the plan already explained. The greatest difficulty is not the return- ing of the intestine, but keeping it in its place. The latter object often gives a great deal of trouble. For, after the bowel has frequently descended, the sphincter some- times becomes so weakened, that it can no longer keep the part supported. Hence, the complaint not only recurs whenever the patient goes to stool; but, even whenever he walks, or places himself in an erect pos- ture; as there are many examples. Ddferent bandages have been devised for supporting the anus after its reduction. But it is not an easy matter to invent one, which is in every respect adapted to what such an inconvenience requires. A compress, dou- bled several times, is usually applied to the anus, and supported in this position by means of a bandage. In many cases, this method of keeping up the intestine answers very well. When the intestine is protruded at the time the patient is at stool, the part is to be immediately replaced. This the patient should accustom himself to do, without as- sistance, and then the bandage is to be ap- plied. To obtain relief from this disagreeable, and often dangerous relief, various means have been proposed. In the first place, by a well regulated diet, proper exercise, and such remedies as the case may demand, it is important to remove any disease of the bowels under which the patient may labour. A lax condition of the bowels is all impor- tant, and to obtain this, where nothing is present to forbid its use, a diet of rye mush and molasses, is generally sufficient. The patient should be cautious not to strain when at stool; and if a child, should be made to evacuate his bowels in an erect, rather than iu a sitting posture. When there is great irritability of the rectum, in- jections of cold water, and at night an ano- dyne injection of thin starch, with a quanti- ty of laudanum adapted to the age of the patient, will often be beneficial. Astrin- gent injections, particularly such as are composed of an infusion of gall-nuts, or oak bark, are also, frequently, very serviceable. In many cases, good effects will result from dashing cold water daily over the hips and buttocks. Piles. Hemorrhoides, or piles, consist in a diseased state of the blood-vessels of the rectum and anus, attended with tumors, and generally with a flow of blood, which often takes place at stated intervals. The tu- mors, forming the piles, are either seated within the anus, or at its verge; and occa- sionally, one tumid ring surrounds it com- pletely. When no blood is discharged from these tumors, they are popularly de- 2 D nominated blind piles. These are, in fact, portions of the external edge of the gut, strongly injected with blood, and. in a state of chronic inflammation. This state of en- gorgement and inflammation causes the he- morrhage, with which piles are so generally attended, and thus gives temporary relief by evacuating the overloaded vessels. Piles are sometimes preceded by a sense of weight in the back, loins, and lower part of the abdomen, together with uneasiness of the stomach, flatulency of the bowels, and other symptoms of indigestion. On going to stool, a pungent pain is felt in the funda- ment, and small tumors are found to pro- ject beyond its verge. If a quantity of blood is discharged from them, considera- ble relief from the pain and uneasiness is obtained. If, however, no hemorrhage oc- curs, the patient experiences great torture every time he goes to stool, and feels an in- convenience when sitting down on any hard seat. Frequently, however, the symptoms are less severe, but nevertheless very trou- blesome, as the patient is, from time to time, annoyed by their becoming engaged within the sphincter of the gut, and causing intense pain; considerable uneasiness is, also, frequently suddenly experienced, when the patient is walking, or has been standing long. Piles may sometimes con- tinue for a long time, without the general health of the patient being much affected, while, in other cases, particularly in weak and irritable constitutions, the health suf- fers considerably; the face becomes pale, the eyes appear sunk, from the dark circle which surrounds them; the functions of the stomach are impaired; the feet swell, and there is a sensation of coldness, with shi- vering, experienced by the patient, with a hard, quick pulse, dryness of the mouth, thirst, &c. The piles, also, occasionally cause abscesses to form in the vicinity of the anus, terminating in fistula. Piles are not unfrequently met with in persons predispc- sed to, or labouring under consumption! they are a frequent accompaniment also of chronic diseases of the liver, indiges- tion, &.C. The general causes of piles are long continued sedentary habits; food of a stimuj lating or indigestible kind; habitual costive- ness; hard riding on horseback; the abuse of purgatives, especially those containing aloes; intemperance; the pressure of the pregnant womb, &o. The blood discharged by piles is most generally of a brilliant red, excepting in a few rare cases, in which the veins about the anus are dilated, and accidentally burst; when the blood is dark, and often mixed up with the feces. Those individuals who have been for a long time subject to piles, especially those 220 SURGICAL DISEASES AND ACCIDENTS. attended with a discharge of blood, should be extremely cautious not rashly to suspend the evacuation, as this may be productive of dangerous, or even fatal consequences; apoplexy, spitting or vomiting of blood, vio- lent fevers, inflammations of the abdominal viscera, or, in the predisposed, consumption of the lungs, have been known to result al- most immediately upon an imprudent sup- pression of the hemorrhoidal flux. When, however, they are strictly a local disease, unattended with other affections of the sys- tem, or any predisposition to disease of the head, or chest, and especially when they are of recent origin, by a proper treatment they may be removed without 'any injury, but much benefit to the patient. In the commencement, the symptoms at- tendant upon piles, are of an inflammatory nature, and in the young and plethoric, re- quire bleeding from the arm, or by cups, from the lumbar region, a low spare diet, and perfect rest upon a settee or sofa. The bowels should be kept regularly open by means of equal parts of sulphur and cream of tartar, in the dose of a tea-spoonful, three or four times a day, or by a diet of rye mush and molasses. In regard to the local treatment; in some cases, a judicious appli- cation of leeches to the inflamed tumors about the anus, will be advisable, followed by cold applications; as compresses wet with cold water or lead water, and injec- tions of cold water into the rectum. Even when leeches are not considered advisable, the application of cold water will be found beneficial. When the discharge of blood is very considerable, which, however, is seldom the case, it may require for its sup- pression a compress to the bleeding pile, if it be external; or if internal, the insertion into the anus of a portion of a wax candle, or of the gut of some animal, subsequently in- jected with cold water and tied. When the disease has been recent, and the consti- tution sound, by these means, with a careful avoidance on the part of the patient, of the exciting causes by which it was produced, and a well regulated diet and regimen, the return of the piles may, in general, be pre- vented. But when the disease has been of long standing, the general system debi- litated, and the extremity of the rectum is found to be surrounded with several firm, indolent, but painful tumors, it is important for the surgeon to attempt their removal by local means. These consist of certain as- tringent applications, compression, or a sur- gical operation. Astringent applications have been often found mghly beneficial; one of the very best is, perhaps, the gall ointment; but a strong solution of sugar of lead, or of white vitriol, or a decoction of oak bark, as a wash, may likewise be used. In Italy, the pulp of gourds is a common application to piles. Cataplasms of baked apples, and the pulp of rotten apples or lemons, have also been highly recommend- ed. In some cases, puncturing each pile with a lancet will occasionally cause the entire removal of the disease. Compression is chiefly resorted to when the piles are seated within the anus; an instrument called a rectum bougie, is employed to produce the necessary compression. To prevent the descent of the piles, and their consequent strangulation by the sphincter, it has been recommended to apply layers of wetted lint, gradually increasing in breadth, until their surface is nearly on a level with the buttocks. When a surgical operation is decided upon for the removal of piles, they may be cut off by the knife or scissors, or strangulated by a ligature passed around them at their base. The comparative ad- vantages of these two modes of operating, and the particular cases to which one or the other is especially adapted, must be left en- tirely to the judgment of the surgeon. When a sudden or imprudent suppres- sion of the hemorrhoidal flux is followed by violent head-ache, pain of the chest, or ab- domen, the premonitory symptoms of apo- plexy, or a discharge of blood from the lungs or stomach, the remedies are bleed-d ing from the arm; active purgatives by the mouth, as. aloes, soap and gamboge combin- ed; purgative injections into the rectum; warm fomentations to the anus, either by poultices or by the patient sitting over the steam of hot water. If these means fail, leech- j es should be applied around the anus, and the patient's feet and legs immersed in a hot bath, to which a tea-cupful of mustard has been added. The utmost attention must for some time be paid by the patient to hi* diet and regimen. His food should be light and spare; his drink water; and he should use daily exercise in the open air. BEE STING. Sometimes veiy painful symptoms arise in consequence of a sting from a bee; such as great swelling extending to the neigh- bouring parts, and even over a whole limb, thirst, restlessness, and other feverish symp- toms. When an enraged swarm attacks a person, the consequences may be very alarming indeed. Such accidents are to be treated by cooling local applications; as so- lutions of hartshorn in cold water, in the proportion of twenty grains of the carbon- ate of ammonia to six ounces of water; or what is commonly sold by the name of hartshorn, or vinegar and water, may be applied; or the muriate of ammonia (sal ammoniac) dissolved in water, or lime juice. Laxative medicines of the cooling kind, as Epsom salts, Rochelle salts, and cream of tartar, are to be given, and the patient is to SURGICAL DISEASES AND ACCIDENTS. 221 be kept at rest in a cool place, and on a spare diet. BONES. DISEASES OF THE The bones are liable to fracture, caries, exfoliation, necrosis, and softening. Fracture. A broken bone is said to be fractured. Fractures are either simple or compound. A fracture is termed simple when the bone alone is broken, without any ac- companying wound of the skin, muscles, or soft parts; and it is called compound, either f when the same viol ence which has broken the bone has injured the soft parts, or the bone itself has been pushed through any of them. A fracture being compound, adds very much '»},• to its danger; and the degree of danger is |i to be estimated by the violence which in- U flicts the injuiy, and the extent or import- ance of the soft parts injured. When a j| person has, either by a fall, a bruise, or any (other accident, broken a bone, great care should be taken in removing him from the place of the accident; he should be carried in the easiest manner possible, and this seems to be by the strength of men, while I the patient is'lying on a flat board. A car- riage, or even a litter with springs, is not so good. The patient, unless under the influence of drunkenness or insensibility, ■ generally finds out the position which is easiest for himself. The plan of cure in §| simple fractures, is to place the injured E limb in such.a way that the broken ends of W the bones may be kept as near each other m as possible; a certain matter is thrown out from the ends of the bone, which gradually hardens, and the bone becomes as strong as before. To keep the limb in the-proper position, it is to be firmly bound with * ' splints, flat pieces of wood or iron, lined i; with cotton or quilt to keep the soft parts from being chafed, and fastened with tape ;• or rollers. When the fracture is compound, |*- ■ the state of the soft parts requires atten- jgjy tion. If there is much crushing of the bone, so that it is broken down, as it were, into fragments, or when there is much laceration | of the soft parts, it is very unlikely that the i cure will go on well; and it is generally \ necessary at once to amputate the limb, in order to preserve life. When the sur- geon sees this-to be absolutely necessary, it | is better to perform the operation without delay, as there is a likelihood of fever and [ other symptoms of gTeat constitutional ir- i ritation soon coming on, which will proba- bly render it impossible to perform the operation. It may appear a very harsh and rapid mode of proceeding, to propose at once cutting off a limb which has been subjected to a severe accident; but it af- fords the only probable means of preserving life, and in that view it is really merciful. If the compound fracture have a sharp pro- jection of bone, pushing through the skin, it will be impossible to place the bone in a favourable position for healing, till this im- pediment is removed by the bone-nippers. A blood-vessel may be wounded, and this must be secured either at the place of the accident or nearer the heart, and the blood cleaned out from the wound; the limb is then to be secured in the usual way. We do not think it necessary to detail the symptoms and cure of particular frac- tures, but shall mention a few circumstances respecting fractures of the skull. Every injury of the head, more especially those inflicted with such violence as to fracture the skull, is to be considered as of an alarm- ing nature; yet the mere circumstance of a fracture, and even a pretty extensive one, is not to be considered as the most formida- ble concomitant. Unless the soft parts are very much torn, there may be a long fissure of the bones of the skull, without much danger; but if there is not only fracture, but. also depression, or beating in of the skull upon the brain, then the danger is unquestionably more urgent. Caries. The rottenness or partial mortifi- cation of a bone is termed caries; this dis- ease being to the bone what a foul ulcer is to soft parts. This happens, when the bone is deprived of its investing membrane called the periosteum. The bone then becomes yellow, brown, and at last black. As the disease advances, the bone is corroded, and discharges an acrid matter, which inflames and ulcerates the neighbouring soft parts. There are various diseases of which ca- ries of the bones forms'a symptom, as sy- philis, scrofula, scurvy; and it may be the consequence of abscesses, wounds, or con- tusions. Its cure is to be attempted by whatever is proper to be done for the original disease, or exciting cause; and local applications are to be used to promote what is called the exfoliation or scaling off of the diseased bone. The actual cauteiy, preparations of mercury, spirits of wine, or other stimula- ting applications are sometimes necessary. Exfoliation signifies the separation of a dead piece of bone from the living. One part of a bone is never separated from another by the rotting of the dead part, for that which comes away is as sound as it ever was. Ex- foliation takes place soonest in bones which have the fewest cells, and whose texture is the closest. Before any part of a bone can be thrown off by exfoliation, it must be dead. But even then, till the process of exfoliation begins, the bone adheres as strongly as ever, and would remain for years before it could be separated by pu- trefaction alone. A dead bone acts on the system in the same manner as any extra- neous body. It stimulates the adjacent living parts, in consequence of which such a pro- 222 SURGICAL DISEASES AND ACCIDENTS. cess is begun, as must terminate in its being thrown off. Neither caustics, nor the actual cautery hasten exfoliation; they only pro- duce death in a part of the bone, which is the first step towards exfoliation. Exfolia- tion is not a necessary consequence of a bone being laid bare, and being deprived of its investing membrane. If the bone be in other respects healthy, it may heal without the smallest exfoliation being thrown off, especially in young subjects. But if caustic or stimulating applications be made use of, the circulation in the surface of the bone will be disturbed and destroyed, and that part will be separated and cast off by the process of exfoliation. The best mode of attempting to prevent an exfoliation from occurring at all in a bone that has been ex- posed by a wound, is to cover the part again, as soon as possible, with the flesh which has been detached. When the ex- posed bone can not be covered, it should be dressed with the mildest and simplest applications, with plain lint, or lint spread with spermaceti ointment. Necrosis. By necrosis is meant the entire death of a bone, or part of a bone, the dead bone being replaced by a new one. Unless the fact had frequently occurred, we should never have expected that a bone so large as the thigh bone or the shoulder blade would die, and be replaced by a new growth, and the old one taken away by absorption, without the feeling or motion of the limb being impaired. The following are the symptoms of necrosis. At its commence- ment, a deep seated acute pain is felt, which is soon followed by a rapid enlarge- ment of the parts along the course of the bone. An inflammation, and one or more abscesses take place, which do not heal, but become fistulous sores. The openings are generally situated over the most super- ficial part of the bone. These abscesses are situated within the newly formed bony shell, and aprobe can be seldom introduced into them, so as to discover any loose pieces of bone; but sometimes small pieces make theirway out through the abscesses. Some- times the abscesses heal up, and the old bone being absorbed, is never seen, but only a permanent thickening of the part remains. This is the most favourable way for the case to terminate; but at other times, the old bone makes its way through the new bone, and through the skin, with different degrees of inflammation, pain, and suppuration. The old part, called the se- questrum, may be moved by shaking it; and in some favourable situations may be easily pulled away; in others, it may be necessary to make an opening to discharge it. The period of life most subject to this disease, is from twelve to eighteen years of age. The bones most liable to necrosis are those of the extremities; the clavicle, the scapu- la, and the lower jaw. In general, there is no external apparent cause for the disease; but sometimes blows, acrid substances ap- plied to the teeth, and the effects of mer- curv, give occasion to necrosis of the lower jaw. Softening. Mollifies ossium. A general softening of the bones; the consequence of an unhealthy state of the system brought on by a poor diet, cold damp lodging, and se- dentary employment, as at manufactories and . similar works." One of the most distressing consequences of this softening of the bones, is the distortion of the female pelv is, which sometimes takes place, rendering delivery impracticable. When softening of the bones is discovered in time, the persons must use a nourishing diet, with bark and chalybeates; they must continue in as easy a posture as possible, till the bones get a little hardness and consistency, and then gradually take such exercise as they can bear. Node. A hard circumscribed tumor on a bone, occasioned by a swelling of the perios- teum; appearing commonly on those bones which are thinly covered with soft parts, a»u the forehead, the forearm, and the shin-bone. 1 They are generally symptomatic of old sy- philitic complaints, and when they continue long, they are apt to occasion a caries of the bone. They are to be treated by mer- cury; and it is generally necessary to give at the same time decoction of sarsaparilla, and to keep up the strength by nourishing diet, bark, and wine. BRAIN. INJURIES OP THE Injuries of the brain from blows, falls, or *. other external violence, may be divided into the two states of concussion of the brain (commonly called stunning), and compres- sion. Concussion. The symptoms of severe con- cussion are, total insensibility, the patient scarcely feeling any injury that may be in- flicted upon him,—loss of voluntary mo- tion,—difficult breathing, but in general ■ without the stertorous noise,—intermitting pulse,—cold extremities,—contracted pu- pil; after a longer or shorter time, there is sickness,—the pulse and breathing become better, and though not regularly performed, are sufficient to maintain life, and to diffuse a little warmth over the extreme parts of the body,—the feeling of the patient is now so far restored, that he is sensible if his skin be pinched, but lies stupid and inattentive to slight external impressions. As the stu- por goes off, inflammation of the brain very frequently arises. Compression. If the injury to the head be such that a portion of bone is driven inwards, or blood is poured out on the surface of the brain, symptoms often occur denoting com- SURGICAL DISEASES AND ACCIDENTS. 223 pression; they are insensibility and loss of vo- luntary motion,—laborious breathing, with a stertorous noise,—slow labouring pulse, but not generally intermitting, —cold ex- tremities,—pupils of the eyes much dilated, but no sickness, at least till the compres- sion is removed by the use of the proper instrument, or other means. There is no return of feeling, so that the patient is in- sensible to pinching, or other injuries in- flicted, until the pressure is taken off from the brain. The best treatment at the commence- ment of a violent stunning, or concussion, is to place the patient in a warm bed, to ap- ply bladders of hot water over the region of the heart and stomach, and to employ gentle friction to the limbs. When he be- gins to recover, a little warm slop may be given, but no brandy, wine, nor other sti- mulants; for all severe injuries of the head are liable to be followed by inflammation, and we should have our eye to this probable consequence for many days after the re- ceipt of such an injuiy. It was formerly a common practice in cases of concussion to apply strong stimulants to the nose, and to administer them internally; but these are now abandoned by all good surgeons, for the reasons just given. The patient must be kept quiet, and have his bowels opened by an injection. If, as he recovers sense and the power of motion, he grows irrita- ble, and has pain in the head, and flushing of the face, we should anticipate inflamma- tion by taking a pint of blood from the arm, and by giving some more purging physic; and should active inflammation of the brain supervene, the means noticed under that head must be rigorously enforced. In compression, it will frequently be ne- cessary to employ an instrument called a trephine, in order to raise the depressed portion of bone, or to remove blood which may have been poured out and be pressing down the brain, which operation falls, of course, to the province of the surgeon. It sometimes happens, however, that a man will fracture his skull without any decided symptoms of compression taking place, at least immediately; men have walked to a public hospital after such accident. In this case, it appears to us the soundest practice not to trephine, unless symptoms of com- pression of the brain should subsequently appear; for patients who have been tre- phined under these circumstances, without evident signs of compression existing, have generally died, while those upon whom no operation has been performed, have as fre- quently recovered. In all wounds and lacerations of the scalp, it is now the universal practice of well-in- formed surgeons to free the torn piece from dirt, or foreign bodies, and restore it as quickly, and as perfectly as possible, to its natural situation. No cutting away any part of the scalp is, at this time, ever ad- vised; and it is very rarely that sewing is necessary, the application of slips of adhe- sive plaster being almost invariably suffi- cient to insure the union. BRONCHOCELE. The goitre, or swelled neck, which so frequently occurs among the inhabitants of mountainous regions. It is a common dis- order in Derbyshire, Eng., and among the inhabitants of the Alps, and other hilly coun- tries in their neighbourhood; also in the valleys of Savoy, and at Milan, and among the Pyrenees, and Cevennes in France. The swelling in bronchocele is at first with- out pain or any evident fluctuation, and the skin retains its natural appearance; but as the swelling advances, it grows hard and ir- regular; the skin becomes yellowish, and the veins of the neck put on a distended and winding appearance; then the patient com- plains of frequent flushings of the face, with head-ache, and pains darting through the tumor. When the disease has continued long, and the swelling is great, the cure is difficult; and from the largeness of the ar- teries which supply it, we can hardly ven- ture on its extirpation by the knife; but in the early stages of the disease, something should be attempted by internal medicines, assisted by frictions with camphorated mer- curial ointment over the tumor. We may also apply blisters, cooling lotions, and soap plasters; but we are also to use internal re- medies; and of these the most successful is the burnt sponge. It was long a question, on what ingredient of its composition its virtues depended; but it seems now to be ascertained, that it is owing to the iodine which enters into it; and this iodine may be employed separately under the form of so- lution in alcohol, by which its dose can be ace tately divided and ascertained. Thirty- six grains of iodine may be dissolved in an ounce of alcohol, and of this, ten drops may be given three times a day in any viscid liquid; this dose may be gradually increased to twenty drops. This substance may also be used in the form of hydriodate of potassa; forty -eight grains are dissolved in an ounce of water, and from ten to thirty drops are given of this solution. Iodine has also been employed externally in the form of ointment, when the stomach has refused it internally. Half a drachm of hydriodate of potassa mixed intimately with an ounce amd a half of hog's lard may be used as an ointment; rubbing in upon the tumor, night and morning, a piece the size of a garden bean. In decided goitre, the effects of iodine are very remarkable; it softens the tumor, and gradually promotes its ab- sorption; but it is proper to alleviate any 224 SURGICAL DISEASES AND ACCIDENTS. local inflammatory action, and to strengthen the constitution by tonics.. If any feverish symptoms occur, the iodine should be dis- continued ; and also where it occasions cough, restlessness, laxity of the bowels, and emaciation. It is an interesting subject of inquiry, what circumstances render the inhabitants of certain districts more especially liable to this disease. As it has been observed, that districts abounding with saline and mineral springs exhibit more instances of this dis- ease than other places, the impregnated waters of these parts have been supposed capable of producing- the disease in ques- tion. The use of snow water has been thought to give rise to swelled necks; but this is rendered improbable, by the frequent occurrence of the disease in Sumatra, where snow and ice are never seen; and it is re- markable, also, that the disease rarely oc- curs in Thibet, though the rivers there are chiefly supplied by the melting of the snow, with which the mountains are al- ways covered. Bronchocelc is believed, like scrofula, to be a disease transmitted from the parents to their offspring; and its occurrence among the inhabitants of certain districts, is ascribed to their being in some measure excluded from the rest of mankind, and intermarrying.with each other. The swelled neck is in very many cases con- nected with cretinism or fatuity; although in frequent instances the bronchocele is totally unaccompanied by any degree of idiotism. BUBO. A swelling in the glands of the groin; the swelling of glands in the arm-pit is also sometimes called by the same name. The swelling of these glands arises from differ- ent causes, from irritating matter absorbed in some part of their course, by the lympha- tics which pass through the glands, from certain diseases, and from local irri^ ion. A remarkable instance of general disease occasioning bubo is seen in the plague; a conspicuous symptom of which is the in- flammatory swelling of the groin, and occa- sionally of the axillary glands, or of the pa- rotids. Buboes sometimes appear on the first day of the complaint, sometimes a few days later; and it is thought that the cases are worse when no buboes appear. These - buboes vary in the rapidity with which they advance to suppuration; when this takes place, the swelling should be opened with the lancet, and the matter discharged. Buboes from the absorption of morbid mat- ter. The most common instance of this, is the swelling of the glands in the groin from the absorption of the venereal virus. Such buboes inflame and suppurate, sometimes very rapidly; but in some constitutions, as the scrofulous, the progress is slower, and it is also retarded by mercury, employed for the cure of the venereal disease. The pain.is acute, and the skin is of a bright red colour. When the surgeon sees a bubo not very near to suppuration, he is to attempt the resolution of it, if possible. This is to be done by diminishing inflammatory action, by purgatives, leeches and tepid applications to the swelling, and by a general bleeding if there is much fever. When we design to cure the original disease by mercury, we are to rub it upon the thigh; and also, if possible, on the parts between the sore and the in- flamed gland; and, generally, when the disease is taken in time, the buboes will disperse, and the sores heal; the mercury being continued prudently for some time after the buboes have disappeared. When they have suppurated, they arc to be open- ed by the lancet, and poulticed for a day or two; and the mercury must be continued until the sore assumes a healthy appearance^ but we need not always continue it till tbes bubo is quite healed. Sometimes buboes.' degenerate into very foul and extensively corroding ulcers. Much doubt is entertain- ed whether this, is owing to the venereal poison, or to the combined influence of the poison and mercury. Different" methods are to be tried in this instance. The use of mercury must be suspended; poultices of hemlock are to be applied to relieve the pain and irritation; and sarsaparilla in pow- der, or decoction, is to be given internally. Bark, and the preparations of iron, with a nourishing diet, are to be given when there is much debility. BURNS AND SCALDS. From the frequency of their occurrence, and the destructive effects they produce, burns and scalds form an interesting sub- ject to every medical practitioner; and from their very frequent occurrence in do- mestic life, and in the ordinary occupations of society, it is highly expedient, that every , person not professional, should know what is to be done at the moment of such an ac- cident, in order that neither any thing im- proper should be applied, nor precious time lost in waiting for the coming of the surgeon. To speak accurately, we should apply the word burn to injuries from heated solids, and scalds to injuries inflicted by heated liquids. The first effects of burns or scalds are, very acute pain, inflammation of the skin and adjacent parts, a raising of the outer skin with one or more "blisters be- low it, extensive redness of the skin, fol- lowed by suppuration and great discharge of matter, the parts healing with great diffi- culty. The appearances presented by burns differ according to their violence and extent. Some may only irritate the skin, SURGICAL DISEASES AND ACCIDENTS. 225 while others destroy the skin and' parts more deeply seated, as the muscles, ten- dons, &c. The injuiy from scalds is gene- rally more extensive, though not so deep as that from burns; and the danger appears to be in proportion to the extent more than to the violence of the injury; or rather it is to be estimated by considering the extent and violence together. The worst burns that occur, arise from the burning of inflamma- ble gases, from gunpowder, from the boil- ing over of hot fluids* as painters' oil, or fluids in laboratories; from the dresses of females taking fire, from children pulling over on themselves tea, broth, or boiling water, and such like accidents. Burns which only irritate the skin without destroy- ing it, are very similar in their effects to the substances used in medicine for blisters and rubefacients. The vessels of the injured part pour out a fluid under- the cuticle, which is raised into one or more blisters. But when the skin has been destroyed, no vesicles appear, but a black dead slough. This is detached after some time; and a sore is formed more or less deep, according to the degree of the injury. When a large surface is burnt, mortification sometimes makes its appearance with great violence, very quickly after the accident; but in ge- neral, the occurrence we have to fear, is great inflammation, and consequent suppu- ration. In many cases, the inflammation is not merely local, but gives rise to general fever, requiring strong constitutional reme- dies. Soon after an extensive burn, the patient is affected with great nervous irrita- tion, and trembles violently; there is cold- ness of the surface, paleness of the skin, and sometimes vomiting. The extensive sympathy between the lungs and the skin as excreting org-ans, renders an asthmatic affection not an unusual attendant on burns; and from extensive burns the stomach also is much affected. There is no part of surgery on which there has been greater difference of opinion, than the treatment of burns; and even the remedies popularly trusted to are very va- rious. It must be admitted, however, that while medical writers have suggested ap- plications, absolutely pernicious, in spite of all the plausible theories with which they have recommended them, the remedies known among the people are all more or less salutary; and common sense has pre- served them from the improper practice of applying stimulants or turpentine, indis- criminately, to an injury requiring to be treated by far gentler means. It is not our intention to enter into any discussion of the comparative merits of the different applica- tions that have been recommended, but simply to state what in general the most judicious practitioners have found to be successful. We shall first suppose that a person has received a pretty extensive scald, and that assistance is promptly at hand. Supposing the skin unbroken, whe- ther blisters are rising or not, we would strenuously recommend the instant applica- tion of cold to the injured part. A ready mode of doing this, is by adding one part of vinegar to one part of water, taking a towel or many folds of soft linen, dipped in this mixture, and keeping it constantly wet to the part, continuing this cooling treatment for a longer or shorter period, according to the continuance or abatement of the pain. We have mentioned vinegar and water, as a good means of applying cold, because, besides its intrinsic excellence, it is gene- rally at hand; but supposing it not to be readily got, we may attempt the same effect by cloths soaked in cold water alone, or spirits and water; always on the supposition that the injuiy does not destroy the skin, or at most only the outer skin.' If there is a deep injuiy, any acrid substance added to the water, as vinegar or spirits, would be too painful to be borne, and would only add to the irritation; it is therefore better to use oily applications, and of these the most famous is made by mixing equal parts of linseed oil and lime water; this is to be plentifully smeared on the place burnt, with a feather or hair pencil, and a single fold of linen placed over it to prevent the access of air. Immediately after the first applica- tion of the cooling wash, or oily matter, if the chilliness and shivering be great, a full dose of laudanum should be given, propor- tioned to the age of the patient. During the cure, the diet should be moderate; and no strong drink allowed. In many cases, the application of cold will accomplish the resolution or cure of the burn without fur- ther trouble; the skin will not rise in blis- ters, and at the worst the outer skin will dry and peel off. Or supposing blisters have arisen, when the pain has ceased, they may be pricked with a needle, and the fluid allowed to escape, keeping the skin on as long as possible. It may happen that the pain abates, and the skin comes off, leaving the part below in a state of ulceration or suppuration; in this case, emollient poul- tices are to be applied tiff the suppuration appears inclined to cease, and then the sores are to be dressed with cerate, lard, Goulard's extract, or the like. In the dress- ing of burns, care must be taken to keep the raw surfaces from contact, to prevent them from growing together. Thus, the fingers must be dressed separately; joints should be extended so as to prevent them. from being permanently bent; and the chin must be kept from growing to the breast. It is a disagreeable and frequent character- istic of burns, that they are apt to be ac- companied with great rising of proud flesh, and to leave unsightly scars, much above 226 SURGICAL DISEASES AND ACCIDENTS. the level of the skin. The rising flesh must be eaten down by blue vitriol, by lunar caustic, or other escharotics; and the new skin kept to its level by proper bandaging and adhesive plaster. When the clothes are set on fire, or when, as too often happens, persons intoxicated, or incapable of taking care of themselves, fall into the fire, deplorable consequences ensue. Large eschars arc formed and drop off, extensive ulceration and exhausting suppuration take place, and death at a longer or shorter pe- riod follows. We must dress the sores with all the care and skill possible; and support the strength with bark and nutritious diet, to give the constitution, if possible, the power of supporting the copious discharge. A remedy which has in some cases ap- peared to do good, and has of late been much celebrated, is to apply cotton to ex- tensive burns. The good effects of this are owing to its protecting the tender nervous extremities of the injured part, from the contact of the external air. The subject of this article is one of the highest importance, whether we consider the dreadful sufferings attending the dis- ease, the interesting character of the sex who are the most frequent victims of it, or the variety of the remedies which have been proposed and abandoned. This is a disorder which, above all others, has called forth the quackery of numerous impostors, who by their extravagant praise of various remedies, have deceived the hopes of the credulous and miserable. With unblushing impudence, empirics have published their success in what appeared the most hopeless circumstances; and race after race of hap- less sufferers have found reason to deplore their bitter disappointment. Cancer is of two kinds, the occult or scirrhous, and the open or ulcerated; but these may be more properly regarded as different stages of the same disease. By occult or scirrhous cancer, is meant a hard tumor, for the most part accompanied by sharp darting pains, which recur more or less frequently. This tumor, in the course of time, breaks and ulcerates; and then is more strictly denominated cancer. The parts of the body subject to cancer are the following: the female breast and uterus, the lips, especially the lower one, the tongue, the skin, the tonsils, the lower opening of the stomach, and some other parts chiefly glandular. Chimney sweepers are subject to a cancerous affection of the scrotum. Of these organs, it attacks most frequent- ly the female breast; and, as in this part the disease has been the most accurately inves- tigated, the remainder of this article shall be chiefly devoted to the description of cancer, as it appears in that organ. In gene- ral, cancer begins at a small spot, and ex- tends from thence in all directions. Its progress is more or less quick in different instances; and very able writers think, that when cancer has once begun, it may be checked, though it will not be removed, by the means which are employed to discuss other swellings. Others again believe, that in some cases they have succeeded in com- pletely dispersing tumors, which had all the appearance of being cancerous. In general, it is too true, that scirrhus is seldom or never dispersed; and that it brings the neighbouring parts, whatever their nature may be, to put on the same diseased action; and thus the skin, the muscles, the cellular substance, are all involved in the same de- structive process. In consequence of this ' morbid action, the skin above a cancerous tumor becomes attached to it, and the tu- mor is also attached to the muscles below. The tendency to this unhealthy action be- gins in the neighbouring parts, even before it can be distinctly seen; of which the me- lancholy proof is, that if the tumor be cut out, the disease will re-appear in those neighbouring parts; and hence the neces- sary rule in operating, to take away a con- siderable portion of the surrounding sub- stance. As the swelling increases, it be- comes knotty and unequal on its surface, and this inequality has been considered as characteristic of the disease; almost in every case, a darting pain is experienced. The hard swelling which is likely to terminate in cancer, is attended generally by the fol- lowing assemblage of symptoms: the skin Is puckered and of a dull livid colour, the part is knotted and uneven, occasional dart-A*' ing pains shoot through it; it is attached to the skin above, or to the muscles beneath; and in some cases, there is a peculiar un- healthy look about the patient. When the swelling is moved, the whole breast moves along with it. The structure of the swelling is different in the various stages of the dis- ease. In the first stage, the following ap- pearances present themselves: the centre is more compact, harder, and of a more.*-/, uniform texture than the rest of the tumor, and appears almost like gristle. From this centre, narrow white ligamentous bands stretch out like rays in every direction. In the spaces between those bands, the sub- stance is different, and becomes less com- pact towards the outer edge. When the disease is further advanced, the whole of the diseased part has a more uniform struc- ture, there is no conspicuous central point; the external edge is more defined, and dis- tinct from the surrounding gland, and the ligamentous bands in different directions are very apparent. When the tumor has advanced to that state corresponding to suppuration in other sores, its appearance SURGICAL DISEASES AND ACCIDENTS. 227 is then totally different from that formerly described. In the centre is a small irregular cavity, filled with a bloody fluid, and the edges of this cavity are ulcerated, jagged, and spongy; beyond these, there is a radi- ated appearance of ligamentous bands, di- verging towards the circumference; but the tumor near the circumference, is more compact, and is made up of distinct por- tions, each of which has a centre, surround- ed by ligamentous bands. It is not easy to say, what peculiarity of constitution is most subject to cancer; nor why, in some women, a slight blow on the _ breast should give rise to the fatal hardness which is to degenerate into cancer, while in others, an injury much greater shall pro- duce no bad effects. In many cases, no preceding local injury can be traced as the cause of-cancer; but the patient is affected with an irregularity or disappearance of the monthly discharge; and cancer frequently appears at that time of life when the month- ly discharge ceases. Cancer, however, is not confined to any period of life; and even children have suffered from it. It has also occurred in the breasts of men. There is a disease resembling cancer, which attacks different parts of a glandular structure; as, for instance, the lips and the sides of the nose. It is an eating sore which is uniformly progressive; but it dif- fers from cancer in not contaminating the neighbouring parts, nor affecting the ab- sorbent glands and skin at a distance from it. Unlike cancer, it in various instances admits of a cure, by several modes of treat- ment. The diseased skin covering a cancerous tumor, g-enerally ulcerates before the tu- mor is very large; a considerable opening ensues, and a discharge of a sharp ichorous matter takes place, with great rapidity. Sometimes it appears as if this diseased ac- tion were disposed to stop, and there is a growth of" flesh, which in some cases is even skinned over; but though there may be occasionally a little mitigation, and the dis- ease may for a time appear stationary, yet it never altogether ceases; nor do the parts show any tendency to put on a healthy ac- tion. In the mean time, the absorbent vessels take up the poisonous matter, and convey it to their glands. These become affected in the same manner as the original sore; and if the patient were not to be cut off, we should see in various parts of the body, numerous centres of malignant dis- ease. The pain and irritation are now ex- treme, the sufferings wearing out and dis- tressing, chains of glands are hard, painful, and lancinating; and by their swelling, they obstruct the passage of the fluids through them, and cause the limb to become drop- sical. A leaden lividness appears in the countenance, the sleep is impaired, emacia- 2 E tion follows, and the long-continued suffer- ■ng impresses on the face the living picture of anguish and despair. Towards the end of the disease, there is often a cough and difficulty of breathing. The edges of a cancerous ulcer are hard, ragged, and un- equal; very painful, turned in various di- rections, sometimes upwards, and at other times towards the sore itself. The surface of the sore is uneven, sometimes there are risings, sometimes there are deep hollows.*, The discharge is commonly thin, dark- coloured, and ill-smelled, and so acrimoni- ous as even to corrode the neighbouring parts. Sometimes, from the sheath of the blood-vessels and their coats being corro- ded, a great deal of blood is lost. The dart- ing pains which were present at the begin- ning of the disease, are now still more dis- tressing; and one of the most painful symp- toms is the burning heat felt all over the ulcerated part. A disease accompanied with such lament- able circumstances, occurring so frequently in the female sex, and so frequently baf- fling all attempts for its cure, has necessa- rily called forth many anxious inquiries into its nature, and the best method of treating it. Of the morbid action which takes place in cancerous swellings and ulcers, there seems to be nothing satisfactory known. It is a subject of considerable interest, whether cancer is an affection of the constitution, or if it is merely local; as on the deci- sion of this question, will depend the pro- priety of performing an operation or not. If by cutting out one tumor, we merely remove one diseased portion, and if the malady is probably only to show itself with greater fierceness in another part, then we should certainly spare our patients the ter- ror of the knife; but if the constitution be upon the whole sound, we ought surely to remove any tumor, which we have reason to think would, in a little time, put on the horrid symptoms of so destructive a disease. It would be a long and heartless task, to enumerate all the schemes, proposals, and remedies that have been suggested for can- cer: the endless list is itself a proof, that nothing has yet been discovered that is en- titled to our confidence. Supposing- a wo- man with a hard swelling of the breast, to apply to a surgeon for advice, his opinion will depend on the preceding cause of the swelling, whether it was in consequence of a blow, whether from the suppression of milk, or from cold; whether it has conti- nued long; whether it is knotty and unequal; whether the skin is puckered; whether there are acute and darting pains shooting through it. It is a safe practice, to apply to all tumors on the breast, a number of leeches, and to procure a free discharge of blood by means of them; to rub the tumor with warm oil, either simple or camphorat^ ^28 St UGICAI. DISEASES AND ACCIDENTS. ed, or with iodine ointment; to keep the bowels open, and to attend to the general health. These means should be persevered in for some time, and we shall find some tumors at first very unpromising, disappear at last under this treatment. If we find, after continuing our trial a reasonable time, of which the attending practitioner in every individual case must judge, that no progress towards'amendment is made, but that there is every reason to fear, that a scirrhous tu- mor and open cancer will ultimately be the result, there is no resource left, but to submit to the removal of the part, before the latent mischief has spread, and become irrepressible. As to the method of remov- ing the tumor, two have been proposed, either by the knife or by caustic. The operation by caustic, though it may be agreeable to the timidity and prejudices of some, is in reality a far more formidable way of removing the tumor, than the knife. The pain is indeed much greater; and the probability is, that it will excite an in- flammatory action, which will quickly bring the tumor into the state of ulceration. It often requires repetition, and the great length of time necessary in some cases, for the separation of the dead parts, renders it very tedious. Mr. Pott describes, with great indignation, another bad effect from the at- tempt at removing by caustic, viz. the plausible pretences it gives to quacks for saying, that they have removed the cancer by their applications. He says, that "the ragged appearance which the bottom and sides of the parts make, after having been removed by the application of caustic, is so unlike the smoothness of that which has been removed by incision, that ignorant people are easily induced to believe, what the designing always tell them, viz. that the medicine has taken their disease out by the roots, and that the ragged parts which they see, are such roots. When nurses and quacks talk of the fibrous roots of a cancer, and of cancerous fermentations, they are excusable, the one from their ignorance, the other from the nature of their trade; but when they who pretend to some kind of medical knowledge by using this kind of lan- guage, it is shameful." If we have decided to remove a cancerous tumor, the knife is, of all means, the simplest, the safest, and the best; and though we can not always secure the patient against a return of the complaint, yet if the operation be timely performed, there is reason to hope, that except in very bad constitutions indeed, the patient may get rid of this very deplorable malady. When it does recur, it is too often in consequence of some of the diseased parts having been left behind, or the too long delay of the operation. Some deny altogether the existence of any general dis- ease which may be termed cancerous; yet it certainly does happen, that the disease re- curs in cases where we have every reason to believe, that the injured parts have been freely and completely removed. When cancer affects any other part than the breast, its removal must be attempted by the methods proper for operating on that part. Though little good is to be done by any external application, it may not be useless to mention shortly, what has been proposed, and to state what things ought not to be done. Hemlock has been a good deal cm- ployed, on the recommendation of Dr. Stoerk, of Vienna. He had great confidence in it, but other practitioners have not found it to give even a temporary relief. It may do some little good as a narcotic, in allaying pain, and procuring a slight suspension of the irritation; but as to any power it has of an ultimate cure, it is utterly worthless. The way of using it has been, to begin with a small dose, and gradually to increase it, till giddiness is produced. Two grains of the extract, now called the inspissated juice, or three grains of the powder taken twice a day, is the dose to begin with; and at last, some patients have been able to take an ounce of the extract daily, but with no good effect. Belladonna, or the deadly nightshade, has also been used with equally bad success. The dose at first is a grain of the dried leaves, night and morning. Hyos- cyamus, or henbane, beginning with two grains of the extract, is another remedy, but equally inefficacious. Digitalis, or foxglove, by diminishing vascular action, has some slight effect, merely as bleeding or spare diet has; but has no peculiar power at all over cancer. Opium, in this irritating com- plaint, is frequently used to allay pain; though no more capable than any thing else, of effecting a cure. All the articles just mentioned are of a narcotic quality, and it is probably from their giving some slight alleviation, that remedies of this class have obtained any notice in this untractable disease. Mercury, so efficacious in a great variety of diseases, has also been tried in cancer; but so far from doing good, it is sure to aggravate the symptoms, especially in the ulcerated state. Arsenic was at one time thought to have, great and specific powers in cancer; and many practitioners yet have hopes, that if a remedy is to be found, it is to be in some preparation of this mineral. The mode of administering this dangerous substance will be found under arsenic ; and the precautions necessary even in its application in the form of plas- ters, &c. Iron, in various forms, has been used and much extolled by Mr. Carmichael of Dublin, for the cure of cancer. He has made much use of the carbonate of iron, what is well known by the name of rust, in the quantity of thirty grains in the course SURGICAL DISEASES AND ACCIDENTS. 229 of a day, in divided doses. He has also used the tartrate and phosphate of iron. In many constitutions, the preparations of-iron are apt to bring on costiveness, with head- ache and affection of the breathing: these symptoms are to be obviated by the exhibi- tion of aloes or other purgatives, by with- drawing the iron, and by giving camphor or other anti-spasmodics. But iron has shared the fate of other anti-cancerous medicines, and has not supported its claims to confi- dence. Some good has apparently been done, by keeping cancerous patients on a very spare diet, or on one consisting prin- cipally of milk. Cancerous ulcers have been dressed with a great variety of appli- cations, principally of the narcotic kind; and some of these have abated the pain, and corrected the bad smell; but the carrot poultice has been found as efficacious as any other. A weak solution of the chlorate of soda has been found a useful wash.. It is now time to bring this long and un- satisfactory article to a close, by repeating, that for true cancer, no remedy whatever has yet been found but extirpation; and that in every case, the earlier this is done, the better. It is improper to waste time by the fruitless exhibition of a variety of remedies, which former experience has shown to be quite unworthy of confidence. In the early stages, bleeding by leeches, and even in some constitutions, a general bleeding or two, and a low diet may be tried; and a prudent attempt may for a little be made by arsenic, hemlock, and iron; but these should not be long persisted in, as the disease may in the mean time be insidiously extending itself, and rendering even the operation un- likely to effect a cure. When the operation is resolved upon, let it be done effectually, and with the knife; let no timidity prefer the apparently milder but'really more cruel means by caustic; which, without removing the disease, will only aggravate it, and rouse into action that mischief which would perhaps have long been latent. Finally and especially, let the unhappy patients and their friends be on their guard against the false pretences of interested quacks, who, without the slightest portion of medical skill, promise a safe and speedy cure of cancer: who, though scarcely able to read or write, boast of having succeeded where learning and skill have failed; and who, pretending to be in possession of a secret by which the acutest sufferings of humanity can be alleviated, mysteriously conceal their nostrums from the candid practitioner, and deal only with hopeless misery, credulity, and ig-norance. CARBUNCLE. This is a very common symptom-in the plague; but comes on also sometimes as a primary disease. The first symptoms are great heat and violent pain in some part of the body, on which arises a kind of pimple, attended with great itching; below which a circumscribed, but very deep-seated, and extremely hard tumor may be felt with the fingers. This tumor soon assumes a dark red, or purple colour, about the centre, but is considerably paler about the edges. A little blister frequently appears on the apex, which, as it occasions an intolerable itching, is often scratched by the patient. The blister being thus broken, a brown sanies is discharged, and an eschar makes its ap- pearance. Many such pimples are some- times produced upon one tumor, in conse- quence of the patient's scratching the part. The progress of carbuncles to the gan- grenous state is generally quick. Their size is very various; they have been known to be as large as a plate. Considerable lo- cal pain and induration always attend the disease. The skin, indeed, has a peculiar feel, like that of brawn. As the complaint advances, several apertures generally form in the tumor. Through these openings, there is discharged a greenish, bloody, fetid, irritating matter. The internal slough- ing' is often very extensive, even when no sign of mortification can be outwardly dis- covered. The carbuncle is most frequent in old persons, whose constitutions have been in- jured by voluptuous living; and, hence, we can not be surprised, that the local disease, influenced by the general disorder of the system, should assume a dangerous aspect. The degree of peril may generally be es- timated by the magnitude and situation of the tumor, the number of such swellings at the same time, the age of the patient, and the state of his constitution. The duty of a surgeon, in cases of car- buncle, may be described in a very few words. With regard to the local treatment of a carbuncle, the grand thing is to make an early and free incision into the tumor, so as to allow the sloughs and matter to es- cape readily. As much of the contents as possible is to be at once pressed out, and then the part is to be covered with an emol- lient poultice. Fomentations will also be found to afford considerable relief, both be- fore and after an opening has been made. As the discharge is exceedingly fetid and irritating, it will be necessary to put on a fresh poultice two or three times a day, The use of the poultice is to be continued, till all the sloughs have separated, and the surface of the cavity appears red, and in a granulating state, when soft lint and a pledget of some unirritating ointment should be applied, together with a tow compress and a bandage. The dreadful manner in which the disease is protracted, by not making a proper opening in due time, can 230 SURGICAL DISEASES AND ACCIDENTS. not be too strongly impressed upon the mind of every practitioner, and it may justly be regarded as a frequent reason of the fatal termination of numerous cases. With respect to the constitutional treat- ment, we should remember, that the disease is for the most part met with in bad consti- tutions, and in persons who are weak and irritable. Hence, it is only where there is a full strong pulse, and the complaint is just beginning, that bleeding is allowable- Bark and camphor are the internal medi- cines most commonly needed. The vitriolic acid is also very proper, as well as wine and aromatics. As the pain is very severe, opium is generally an essential remedy. The constitutional treatment is very anala- gous to that of mortifications. From repeated experience the applica- tion of a blister over the affected part is confidently recommended as the best local remedy for carbuncle. CHANCRE. A local disease generally arising from im- pure connexion, presenting the following appearances: it begins with an itching in the part; this is gradually converted into pain; in some cases, the surface is excori- ated, and afterwards ulcerated; or a small abscess appears and turns into an ulcer. The parts are affected with a thickening, which terminates abruptly, and does not gradually lose itself, like some other swell- ings, in the surrounding parts. Its base is hard, and the edges a little prominent. In parts where the skin is somewhat thick, the chancre commonly makes its appearance in the form of a pimple, which forms a scab in consequence of evaporation. The first scab is generally rubbed off, after which a second, still larger, is produced. From chancres, the poisonous matter finds its way into the system, and infects it with many distressing symptoms. Chancres at first are mere local complaints; and in their treat- ment, our object is to heal the local injury, and if possible to prevent the morbid mat- ter from getting into the constitution. The local treatment consists in applying caustic to the sore, dressing it with mercurial or red precipitate ointment, and keeping it free from any accumulation of matter. In this manner the sore will probably be heal- ed, and the constitution secured from any further danger. CHILBLAINS. The chilblain is a painful swelling, of a florid, deep purple, or leaden colour, ap- pearing on the fingers, toes, heels, and other extreme parts of the body. The pain is sometimes intermittent and pungent, but the patient is more frequently annoyed by an obstinate itching, and sense of ting- ling. The part often swells, and ulceration not unfrequently follows; in which case a simple separation of the skin is first ob- served, and below this there appears a foul, irregular, and painful ulcer. It is most frequently found in children, and older persons of relaxed fibres; and the common exciting cause is exposure to se- vere degrees of cold, or incautiously ap- proaching the fire when the hands and feet are chilled. When the chilblain is not ulcerated, the topical application of a stimulating liniment, or lotion, is generally sufficient for a cure, if it be used early, and with perseverance, the part being defended, at the same time, from the contact of the external air. Equal parts of olive oil and turpentine, volatile or soap liniment, or alcohol are the most effi- cacious. Sir Astley Cooper is said to be partial to the following liniment: take of camphorated spirit of wine, one ounce; Goulard's extract, (pure), half an ounce; mix, and apply to the part. In the ulcerated state, warm and irritating dressings, as the common basilicon oint- ment, with or without the addition of tur- pentine, will alone succeed in effecting a cure. If fungous flesh should appear, we may apply the citrine, or white precipitate ointment, till it has been removed; then dress with one of the former ointments till well. The following application is much esteemed in the ulcerated state: take of honey, common turpentine, of each, four ounces; mix these together, and then stir in a sufficient quantity of the finest wheat flour to give it the consistency of a cerate. Dress the part with it twice daily, in the usual way. Many persons subject to chilblains might prevent their occurrence, or very much lessen their severity, if, upon the approach of winter, they were to defend the parts from external cold, by wearing leather socks, or a warm diachylon or Burgundy pitch plaster, spread upon leather. Daily friction with a flesh brush should also be resorted to, and the parts fomented with a wash composed of two drachms of sal am- moniac, five ounces of water, and an ounce of spirits of wine; or the soap liniment may be occasionally rubbed in, which will harden the skin, and effectually promote the cir- culation of the parts. No person troubled with chilblains ought ever to allow the employment of any means which tend to weaken either the part af- fected, or the general system. Sometimes the chilblains will swell to a considerable size, and appear very red and inflamed, but these symptoms will never fail to be much increased by poultices, confinement, and every other measure that has not the effect of giving tone and strength to the local and general circulation. SURGICAL DISEASES AND ACCIDENTS. 231 CHORDEE. A painful spasmodic erection of the penis. It occurs most frequently in the second stage of gonorrhoea, and takes place chiefly when the patient is warm in bed. For this affection, opiates are the most useful reme- dy; forty drops of laudanum are to be given at bed-time, and the parts affected are to be rubbed with laudanum, or a strong solution of opium in water. In some cases, leeches may be applied, or it may even be neces- sary to employ general blood-letting. CIRCOCELE. An enlargement and distension of the spermatic veins. It occasions considerable pain; and in some cases, is attended "-with wasting of the testicle. The pain, which is of a dull kind, and felt in the back, is re- lieved by suspending the scrotum. When this disease is mistaken for a rupture, and a truss is applied, bad effects may follow, such as great enlargement of the vessels, and shrinking of the testicle. The method of distinguishing circocele from rupture is the following: place the patient in a recum- bent posture, return the swelling into the abdomen by the abdominal ring; make pres- sure at the ring, and desire the patient to rise; if it be rupture, the swelling will not appear, being kept in by the pressure at the ring; but if it be a distended state of the vessels, the blood will not get into the ab- domen, owing to the pressure, and, there- fore, the swelling will rapidly increase. This complaint is seldom cured; and is to be palliated by cold lotions applied to the tes- ticle and spermatic cord, when there is much pain; and by supporting the parts with a bag-truss. When the symptoms are severe, leeches should be frequently ap- plied, the bowels should be kept open, and the patient should remain in the horizontal posture. CLUB-FEET. Children are sometimes born with the feet distorted either outwards or inwards. This deformity is both disagreeable to be- hold, and inconvenient for walking; and parents are naturally very anxious for its removal. The bones being in a soft and grisly state, renders this very often practi- cable, if the cure be begun very soon after birth. In most large towns, there are ar- tists who form various kinds of machinery for this purpose; and very simple means will do to restore the parts to their natural position, and to keep them there. An ex- perienced surgeon should always oversee the operations of the artist. CONTUSION, OR BRUISE. Slight bruises seldom meet with much attention; but when they are severe, very bad consequences may ensue, and these are the more likely to occur, when such cases are not taken proper care of. In all severe bruises, besides the inflam- mation which the violence necessarily oc^- sions, there is an instantaneous extravasation of blood, in consequence of the rupture of many of the small vessels of the part. Even large vessels are frequently burst in this manner, and very considerable collections of blood are the consequence. Blows on the head very often cause a large effusion of blood under the scalp. Besides the rupture of an infinite number of small vessels and extravasation, which at- tend all bruises, in a greater or less degree,. the tone of the fibres and vessels which have suffered contusion, is considerably dis- . ordered. Nay, the violence may have been so great, that the parts are from the first deprived of vitality, and must slough. The bad consequences of bruises are not invariably proportioned to the force which has operated; much depends on the nature and situation of the part. When a contu- sion takes place on a bone, which is thinly covered with soft parts, the latter always suffer very severely, in consequence of be- ing pressed, at the time of the accident, between two hard bodies. Hence, bruises of the shin, so frequently cause sloughing and troublesome sores. Contusions affect- ing the large joints are always serious cases; the inflammation occasioned is generally obstinate, and abscesses and other diseases which may follow, are consequences suffi- cient to excite serious alarm. In the treatment of bruises, the practi- tioner has three indications, which ought successively to claim his attention, in the progress of such cases. The first is to prevent and diminish the inflammation, which, from the violence done, must be expected to arise. The bruised parts should be kept perfectly at rest, and be covered with linen, constantly wet with cold water, or lead water. When there are muscles bruised, they are to be kept in a relaxed position, and never used. If the bruise should have been very vio- lent, it will be proper to apply leeches, and this repeatedly, and even, in some cases, particularly when joints are contused, to take blood from the arm. In every instance, the bowels should be kept well open with saline purgatives. A second object in the cure of contu- sions, is to promote the absorption of the extravasated fluid by discutient applica- tions. These may at once be employed in all ordinary contusions, not attended with too much violence; for then nothing is so beneficial as maintaining a continual evapo- ration from the bruised part, by means of cold applications, and, at the same time, re- 2.12 SURGICAL DISEASES AND ACCIDENTS. peatedly applying leeches. In common bruises, however, a solution of sal ammoniac in water, is an excellent discutient applica- tion; but most surgeons are in the habit of ordering liniments for all ordinary contu- sions, and certainly they do so much good' in accelerating the absorption of the extra- vasated blood, that the practice is highly praiseworthy. The soap and camphorated liniments, are as good as any that can be employed. In many cases, unattended with any threatening appearances of inflammation, but in which there is a good deal of blood and fluid extravasated, bandages act very beneficially, by the remarkable power which they have of exciting the action of the lymphatics, by means of the pressure which they produce. A third object in the treatment of contu- sions, is to restore the parts to their proper tone. Rubbing the parts with liniments has a good deal of effect in this way. But, notwithstanding such applications, it is often observed, that bruised parts continue for a long while weak, and swell, when the pa- tient takes exercise, or allows them to hang down. Pumping cold water two or three times a day, on a part thus circumstanced, is the very best measure which can be adopted. A bandage should also be worn, if the situation of the part will permit. These steps, together with perseverance in the use of liniments, and in exercise gradu- ally increased, will soon bring every thing into its natural state again. By a corn, is meant a hardened part of the |skin, with a root, sometimes extending deeply into the cellular substance. Corns are owing to long continued or repeated pressure, and occur principally on the toes and soles of the feet. Tight shoes are one of the most frequent causes of corns; and hence, they are often troublesome to fe- males and others, who are particularly at- tentive to appearance, and who wish to exhibit a neat and small foot. Happily the mutability of fashion has occasioned the dis- use of high-heeled shoes; a most perni- cious custom, by which very injurious pres- sure was made on the anterior parts of the foot, and corns very frequently produced. Corns sometimes exist without giving much pain or trouble; but in other cases, they give so much uneasiness, as absolutely to incapacitate for walking. They are made more particularly intolerable, by every thing that quickens the circulation, or which heats the feet, or causes the corn to press on the neighbouring parts. Hence, tight shoes, much walking, warm weather, heating li- quors, all tend to render the uneasiness of corns very great, and they are.generally worse in summer than in winter; and per- sons are frequently obliged to sit down to take off their shoes, and rest the foot in a horizontal posture. Corns may often be readily cured, by avoiding the above exciting causes, by wearing large soft shoes, and by continuing for some time at rest. Hence, ladies fre- quently get rid of corns during a lying-in. It is useful to take a considerable number of folds of linen, covered with some soften- ing ointment, cut a hole in the middle for the corn to lie in, and to apply them to the foot; and if it be on the sole of the foot, it may be useful to have an additional move- able sole, with a hole cut in like manner. If, along with this mechanical and palliative treatment, we use the following method, a corn will be easily and quickly eradicated: it is to be touched with lunar caustic, and wrapped round with adhesive plaster; and, generally, at the end of a fortnight, the dead cuticle will be removed with the corn adherent to it. If the corn does not come away, the operation is to be repeated. Se- veral other remedies of the same kind are recommended, of which the principal are, soap plasters, or mercurial plasters, or blis- tering ointment. The following plan may also be tried: every night and morning the foot is to be put into warm water for half an hour, and while there, the corn is to be well rubbed with soap. All the soft white outside of the corn is afterwards to be scraped off with a blunt knife; but we must not persist in this scraping, if the person complains of pain in any part of it. This treatment is to be continued without inter- ruption till the corn is totally eradicated, which it will be in about a fortnight. It is generally a difficult and painful operation to cut out a corn. Unless it be completely taken out, it is apt to grow again, and this it does faster than if it had been let alone. In old people, it is highly dangerous to cut a corn, as this too frequently excites an in- flammation, and consequent mortification, which carry off the patient. It is much better to be content with the plasters above described, with bathing, and other palliative means. When a person has once got rid of corns, they are very ready to recur, unless he take particular care to avoid pressure, to wear wide and soft shoes, and not to walk too much, especially in warm weather. EMPHYSEMA. Signifies a swelling from the presence of air, and is generally applied to the dif- fused swelling which happens front air get- ting into the cellular substance. Emphy- sema is known by a soft puffy swelling; the skin is glossy; the tumor yields to pressure, but returns as soon as the pressure is with- drawn, and a crackling noise is heard when SURGICAL DISEASES AND ACCIDENTS. 233 any part of the swelling is pressed. Em- physema most commonly arises in conse- quence of injuries to the pleura investing the lungs, as by a sharp-pointed instrument, or by a fractured rib. It is sometimes brought on by the strong exertions of res- piration during labour. When the lungs are wounded, there is troublesome cough, and the expectoration is sometimes mixed with blood; and when air escapes into the cavity of the chest, forming the disease now ■ called pneumothorax, there is great diffi- culty of breathing, anxiety, a sense of suf- focation, lividness of the countenance; and death ensues, unless relief is speedily ob- tained. If a wound be the cause of emphysema, it must be closed up, and healed in the usual way; and it may be necessary to les- sen inflammatory action by blood-letting, which will require to be repeated if there is much pain, or if the breathing is quick and laborious. The air is to be evacuated from the cellular substance, by a number of small incisions or punctures; and this is also to be done in those cases where emphysema oc- curs, in consequence of the efforts of la- bour, if the breathing be much affected; but, in g-eneral, emphysema disappears with- out much trouble. When air has got into the cavity of the thorax, as well as into the cellular substance, and occasions great diffi- culty of breathing, an opening is to be made into the cavity of the chest to give it vent. The best place for performing the operation, if the disease is on the right side, will be on the fore part of the chest, between the fifth and sixth ribs, for there the integuments are thin; and in the case of air, no depend- ing drain is required. But if the disease is on the left side, it will be more advisable to - make the opening between the seventh and eighth, or eighth and ninth ribs, that we may be sure of avoiding the pericardium. As large penetrating wounds are inconve- nient on account of the air entering by the aperture in such a quantity as to prevent the expansion of the lungs, a small wound will be proper, especially as air does not require a large one for its escape. It is bet- ter to dissect cautiously with a knife, than to employ the coarse and hazardous method of thrusting in a trocar. EMPYEMA. Signifies a collection of purulent matter within the cavity of the chest. This sup- puration is generally the consequence of pleurisy, and is suspected to be present, when there is an abatement of the previous pain, with continuing difficulty of breath- ing, cough, and hectic fever; while the pa- tient, in general, cannot lie easily, except on the side on which the collection of mat- ter is. Sometimes the chest on that side is expanded, the ribs are a little elevated, and a fluctuation of a fluid can be perceived. When we are satisfied of the existence of matter in the cavity in the chest, it is almost always proper to discharge it by an open- ing. The safest and most convenient situ- ation for making an opening into the chest, is between the sixth and seventh true ribs, on either side, as circumstances may render necessary. If there be a collection of mat- ter on both sides, the two operations should not be done at the same time. The opera- tion consists in making an incision about two inches long, through the integuments which cover the space between the sixth and seventh ribs. The patient is to be so placed that the opening may be in a depen- dent position. The surgeon is to avoid the lower edge of the upper rib, as the inter- costal artery lies in a groove running along that part. He is then cautiously to divide the layers of the intercostal muscles, till he brings the investing membrane of the lungs into view, which membrane is to be very carefully divided with a lancet. The in- strument should never be introduced at all deeply, lest the lungs should be injured; and the size of the opening should never be larger than necessary. If requisite, a little tube may be introduced into the wound for facilitating the evacuation of the fluid. This tube should not be too long, and should have a broad rim to prevent it from slipping into the chest, and may be kept in its place with sticking plaster. It may be stopped with a cork, if it should be thought con- venient to let the matter run off at inter- vals. EYE. DISEASES OP THE Cataract, a species of blindness, arising from an opacity of the crystalline lens, or of its capsule, the effect of which is to pre- vent the rays of light from passing through the different coats and humours of the eye, to form an image on the retina, which cir- cumstance is necessary for perfect vision. The cataract appears as a spot or speck on the pupil of the eye, sometimes occupying the whole, sometimes only a part of it. It is commonly of a gray or whitish colour, sometimes of a very pure white. The dis- ease at first shows itself by a weakness or imperfection of the sight, and it almost al- ways terminates in the total loss of that sense. While the disorder is in progress, the patient sees better in a moderate light than in a strong one, as the greater expan- sion of the pupil allows a few rays of light to enter. A mist seems to cover objects, and to confuse small ones. This affection often comes on without any assignable cause; and some imperfection of vision is perceptible by the patient himself, before any thing wrong is visible to another per- SURGICAL DISEASES AND ACCIDENTS. son. Without repeating the general de- scription of the eye in this place, we shall satisfy ourselves with stating, that the lens is a round crystalline body, clear and viscid, and contained in a little case or capsule, and cataract is produced by a thickening or dimness, either of the containing membrane or of the lens itself. When the contents are hard and solid, it is called a hard cata- ract; when fluid or milky, a fluid cataract; and when the contents are like a jelly, or curd, it is called caseous, or cheese-like. It is believed to occur most frequently to persons who are much exposed to strong fires, as glass-workers and blacksmiths. Cataract rarely appears before the age of forty; but children are sometimes affected by it, and some are even born with it. In general, cataract arises spontaneously, and no cause can be assigned for it. Sometimes it arises from external violence, from blows on the eye or neighbouring parts, and these cases are, in general, more likely to get well than those which begin without any evident cause. No cure is to be expected till the obstruc- tion to the passage of the rays of light is removed. This is the purpose to be ef- fected, and the means are either constitu- tional remedies, and external applications, or the removal of the opaque body from the sphere of vision by an operation. Various remedies have been recommend- ed, of which the principal are bleeding, cupping, and scarifying, as also issues, sc- tons, and blisters. The juices of some plants have also boen in vogue. Cataracts from external violence have sometimes dis- persed spontaneously; and, in other cases, a blow on the eye has been followed by the sudden disappearance of cataracts. Mr. Ware prefers to other remedies the appli- cation to the eye, itself, of one or two drops of ether, and the occasional rubbing of the eye over the lid with the point of the finger, first moistened with a weak volatile or mer- curial liniment. The best oculists place very little reliance on any of the above means in a fully formed cataract; and consider the only successful method of removing the opaque lens or capsule to be by an operation. But there are certain cases in which the completest removal of the obstruction would not re- store sight, and in which, therefore, it would be improper to have recourse to an opera- tion. The retina, the expansion of the op- tic nerve, may be quite insensible, and, of course, the freest passage for the rays of light would contribute nothing to the resto- ration of vision. We have reason to fear this insensible state of the retina when there has been a long continued inflammation of the eye, particularly affecting the inner parts of it; when there has been head-ache, with great pain of the eye and eye-brow, and when the patient is quite unable to distin< guish a bright light from total darkness. In such cases, the removal of the cataract would be of no service, and the operation is unadvisable. The operation is not to be hastily advised in cases of cataract arising from external violence, as these often dis- appear spontaneously; and some general and internal remedies may be employed, as blood-letting and mercurials. Some have advised that there should be no operation, where only one eye is affected with cata- ract, on the ground that one eye is sufficient for the purposes of life, and that there is a danger of the sight being imperfect from the two eyes not performing their functions correctly alike. This last objec- tion is disproved by numerous cases where the vision was perfect, when one of the eyes had been operated upon: and the first might be a good reason for letting the ca- taract alone, were we certain that the other eye would keep well; but, from the won- derful sympathy between the two eyes, there is reason to fear that some morbid ac tion may take place in the other; whereas it is not uncommon for a diseased action to be checked in one eye, where the opera- tion for cataract has been performed in the other. When there is a cataract on both eyes, it is not advantageous to operate on one immediately after the other, as the in- flammation excited even by the operation on one eye is apt to be too great both in the eye operated upon, and also to cause inflammation in the other by sympathy; and an operation performed nearly at the same time on both eyes is likely to increase great- ly the chance of hurtful excitement. It is a question of considerable importance, whether it is proper to operate for a cata- ract on children of a very early age, that is, before they have discretion to understand the propriety of an operation, and firmness to submit to it. There are many arguments conclusive of the propriety of an early ope- ration, as arising both from the nature of cataract, and from the important collateral questions connected with the subject. Chil- dren must be subjected to many restraints, and must have many things done to them very disagreeable to their feelings, and even inflicting much present pain; but when we consider that the purpose of the operation is to give the exercise of a sense so neces- sary, both for enjoyment and education, it must at once appear a cruel conduct, to de- prive them of the use of it for so many of the early years of life. All that is required is to keep the little patient's body, and es- pecially the eye, steady. Besides, in the lapse of years, there is no knowing what untoward circumstances may take place in the cataract; it may contract adhesions to the neighbouring parts, and so be difficult or impossible to be removed by any opera- 4 SURGICAL DISEASES AND ACCIDENTS. ,235 tion whatever. The state of the cataract in infants is generally more favourable for an operation than at any future period. The cataract is generally fluid, and requires merely the free rupture of the capsule; and this capsule, though opaque, is tender, and easily removed; and the milky fluid is soon removed by absorption. If the cataract should be soft, it is commonly of that pulpy softness that is easily dissolved by the aqueous humour, after the capsule has been lacerated. Even if the cataract should be hard, it is as easily depressed as in an adult. Mr. Gibson, of Manchester, who strongly urges the propriety of couching, even in very young subjects, thinks that & even if a surgeon had difficulties to encoun- 'l ter which do not occur in adults, the in- valuable benefit conferred by enabling, an infant to become an intelligent being, like | other children, instead of remaining in a state approaching to idiotism, would incline him to run some risk of failure, and to make more than common exertion, especially as there is little chance of injuring the eye when proper precautions are used. As ad- ditional arguments for couching infants, it I has been urged, that in all probability the eye, when long allowed to.lie passive, with- out any exercise of its powers, is apt to lose I them, so that the patient is little benefited ... by an operation; and also, that the eye of & those born blind is apt to acquire a restless %',. and rolling motion, and the patient loses m all control over it. It is not thought advi- K' sable to use any instrument for fixing the F eye, as the pressure occasioned by all such %. contrivances, is apt to cause a sudden pro- || trusion and loss of what is called the vitreous humour of the eye. Closure of the pupil. The operations of depression or extraction of the lens for the cure of cataract, are sometimes followed by ► a vehement inflammation of the membranes %.*■ of the eye, especially of the iris, termina- ting in adhesion; which occasions the pupil j$. to be almost or entirely shut, of which the f- necessary consequence is a diminution, and afterwards a total loss of sight. There is no remedy for this, but making an artificial | opening in the iris, as a substitute for the » pupil, either by a simple division of the fibres of the iris, or by cutting out a portion ! of that membrane, or by detaching the iris from the ciliary processes. The cases in which operations are advisable, and the modes of performing them, are subjects for the consideration of the most skilful ocu- lists, and by far too subtle to be treated of in a popular work. Opacity of the cornea, is a consequence of obstinate chronic ophthalmia. The pupil and iris are discernible through a kind of cloudiness, and the patient is not quite de- prived of sight, but sees things as it were through a mist. The veins of the anterior 2F part of the eye being relaxed by the long continuance of the inflammation, become turgid and prominent; they afterwards be- come irregular and knotty. Soon after, some reddish streaks are perceived, and in the spaces between these, a thin milky fluid is effused. The whitish superficial speck which results, is called a nebula. There may be either one speck, or several distinct ones. Though this opacity may at first oc- cupy only a small part of the cornea, yet, if left to itself, it advances towards the centre of it, and a dense opaque membrane is form- ed, which obstructs the sight partially or totally. Our first object is to make the turgid veins contract, by the use of astringent oint- ments or washes. There is an ointment called Janin's ophthalmic ointment, which has been found effectual when the opacity is recent, and not very extensive. This ointment is made by mixing thoroughly to- gether two drachms of prepared tutty, two drachms of Armenian bole, one drachm of the gray oxide of mercury, and half an ounce of hog's lard. When first used, the quan- tity of hog's lard must be doubled. A simi- lar purpose is served by the diluted citrine ointment. If these applications fail, the enlarged veins which run to the opaque part must be cut across; they should be al- lowed to bleed freely, and fomentations should be used to encourage this. The eye should not be opened for twenty-four hours. A tepid wash of rose-water and milk should be applied two or three times a day. The nebula often disappears very quickly after this operation. But the use of astringents and ophthalmic ointments for some time, will be proper for preventing the recur- rence »f the complaint. Leucoma, denotes a white opacity of the cornea, not superficial like the nebula, but owing to a dense coagulating lymph poured out from the arteries into the substance of the cornea, in consequence of violent acute inflammation. When recent, this opacity is of a clear milky colour, but when of older date, it becomes pearl-coloured. If the organization of the cornea be not destroyed, the leucoma may be expected to disperse by the means employed for the cure of the inflammation; by general and local blood- letting, with other antiphlogistic remedies, and emollient applications to the eye in the first stage of ophthalmia, and slightly astrin- gent washes in the second: these astringent applications cause the absorbents to remove the deposited lymph, and thus restore the transparency of the cornea. In cases of longer standing, our hopes of a cure are not at all sanguine; stimulating applications may be tried, and must be preserved in for ten or twelve weeks. Operations on the part for the cure of leucoma are generally unavailing. 236 SURGICAL DISEASES AND ACCIDENTS. Staphyloma. A disease of the eye-ball, in which the clear part of the eye, loses its transparency, rises above the level of the eye, and sometimes even projects beyond the eye-lids. It is attended with complete loss of sight, and is very often the conse- quence of that species of ophthalmy which occurs in very young children, accompanied with a profuse discharge of purulent mat- ter, and called by the common people the gum. It is also produced by the small-pox, and then chiefly when the pustules are dry, and the scabs fall off. As this disease of sight is incurable, it is best to let it alone, unless it grows so fast as to come out be- tween the eye-lids, and occasion great pain and deformity to the patient. When this takes place, it is one of the most alarming maladies that can happen to the eye-ball, for which it can no longer be covered by the eye-lids, it is exposed to the air, and to the friction of the eye-lashes; the eye be- comes painful and inflamed, the tears flow down the cheeks; the other eye is affected by sympathy, and the diseased one ulcer- ates. It has been attempted to reduce the size of the staphyloma by an issue, or artifi- cial ulcer at the bottom of the swelled part, but this has not been found to answer, and it is rather recommended to cut off the top of the projecting part, by which some of the humours of the eye are evacuated, and the swelling subsides, so as to allow the eye-lids to cover the ball. A degree of in- flammation follows, on which the eye is to be covered with a poultice of bread and milk. Purulent matter is formed; the edge of the surface from which the projection was cut becomes red, contracts and daily diminishes; so that at last the wound is en- tirely closed, and an opportunity is given for the insertion of an artificial eye. Exophthalmia signifies the protrusion of the eye from its socket, while the globe is of the natural size, and free from disease. It lies towards the temple, or on the cheek, and vision is quite lost. This occurrence may arise from violent concussion of the head, from a thrust with a stick or instru- ment passing between the orbit and the eye-ball, or from tumors within the orbit, which, as they gradually enlarge, push the eye-ball from its socket. There is gene- rally no great difficulty in replacing the eye, when the protruding body is removed; and when the eye is replaced, inflammation is to be kept down by cooling topical ap- plications, and by general or local blood- letting. If there should be any suppura- tion, care must be taken to procure a free and early vent for the matter. When a gradually increasing tumor has occasioned the displacement of the eye, the tumor must be removed by the proper surgical means, before the eye can be put back into its place. Whatever be the cause of the injuiy, its cure is always the easier the more recent it is. Dropsy of the eye. In some cases, the vitreous humour of the eye is disorganized and broken down, and the aqueous humour is increased in quantity, causing the eye- ball to assume an oval shape, ending at the point of the cornea; it then enlarges to such an extent, that it projects from the orbit, and cannot be covered by the eye-lids. This disease is sometimes produced by blows on the eye, or on the adjoining tem- ple, sometimes by an obstinate internal ophthalmia. Professor Beer, of Vienna, has seen the dropsy of the eye brought on by too long continuance of the use of mer- cury in the ophthalmia of gouty subjects. The cure consists in evacuating the fluid contents of the eye by a puncture, removing a small portion of the cornea, and exciting a slight degree of inflammation and suppu- ration; taking care that the inflammation does not go too far. When the operation is successful, the eye-ball diminishes in size, and gradually returns into the orbit. It is hardly necessary to mention, that vi- sion has, long before this, been irrecov«|-t ably gone. Cancer of the eye. There is an affection of the eye which is thought to be of a can- cerous nature, which is productive of great pain, and, at last, of death, unless the eye is completely extirpated. This complaint sometimes occurs after obstinate ophthal- my, sometimes after a blow on the eye, or after wounds, or staphyloma; and often af- ter fungous excrescences, which form on the surface, or in the interior parts of the, eye. The disease is said to be sometimes] caused by irritating applications; but very often the causes are constitutional. It is most frequent in childhood. This disorder of the eye is commonly preceded by head- aches, and an unusual heat in the organ, with an itching about it and the nighbour- ing parts. There is a considerable flow of tears; light is borne with difficulty at first; and soon becomes quite intolerable. T« the itching succeeds a pricking sensation, and afterwards pains which are acute and lancinating. The eye enlarges, and assumes a dull and livid hue, and its surface is rough and irregular. The cornea at length ulcer- ates and bursts; fungous growths project from the opening, which discharge a puru- lent fetid matter. As the disease advances, the fungous growths increase, and become livid. There are frequent discharges of blood. The pains are now incessant; the neighbouring bones and other parts become carious or ulcerated; and a miserable death ensues. As we have stated above, there is no way of saving the life, but by extirpating the eye. For the method of doing this, we refer to books on surgery. The extirpation should be complete; and the lacrymal gland SURGICAL DISEASES AND ACCIDENTS. 237 should also be removed. The antiphlogis- tic plan is to be continued for some days after the operation. Amaurosis, called also gutta serena, or black cataract. This signifies a decay or loss of sight, when no defect is visible in the eye, except an enlargement of the pupil, and its being insensible to the stimulus of light. The approach of amaurosis is gene- rally attended with pain in the head, which troubles the patient for a considerable length of time; there are various deprava- tions of sight, as the appearances of stars or bright spots dancing before him; or he is sensible of something wrong about the sight when the candles are lighted. The patient feels as if some dirt or dust were upon his eyes, and is frequently wiping them. Some- times he complains of a tension of the eye- ball, which is particularly troublesome. Whenever this sensation is experienced, the eye-sight becomes weak, and when it goes off, the patient is again able to see better. Amaurosis commonly attacks both eyes at once, and in those cases where the one is affected before the other, the inter- _ val is but short. Before the blindness is quite complete, patients can sometimes see, when an object is presented, at the side of the eye. Amaurosis is owing to a palsy of the re- tina, or injuiy of the optic nerve in some part of its course, from a tumor, or from a fulness of the adjacent blood-vessels. It may arise from external injuries done to the head, from the suppression of periodical habitual evacuations, from the effects of deadly night-shade, and other sedative poi- sons, from the absorption of the venereal virus, from great exertions of strength when the body is plethoric; and is some- times a sequel of certain fevers. In many cases, no cause can be assigned. When amaurosis has been preceded by frequent head-aches, with much pain in some part of the eye; when it occurs after fevers, or when it happens to the aged and infirm, a cure is hardly to be expected. If it occurs in connexion with pregnancy or hysteria, or in young subjects, our hopes are somewhat better. If a patient makes known his ailments early, he is to be treated, if at all plethoric, by evacuants, by leeching and cupping about the temples, and by an issue in the neck. Some cases have been treated by electricity or galvanism, and some by a course of mercury; others seem to have de- rived some advantage from frequent emet- ics, or from acrid powders, which occasioned a discharge from the nose; but in the greater number of cases, the gutta serena has proved incurable. Weeping eye, or fistula lacrymalis. An involuntary and constant flow of tears over the cheek. At the upper part of the orbit of the eye is situated the lacrymal gland, which secretes the tears. In the healthy state, these are diffused over the surface of the eye-ball by the motion of the lids. The quantity above what is necessary for keep- ing the eye clean and moist, is taken up at two little points, which may be seen in the living subject, one on each lid, near the in- ner corner of the eye. These points are the commencement of a little sac and ca- nal, through which the superfluous tears are carried into the nose, where they mois- ten the lining membrane, or are evaporated by the air we breathe. A disease, or ob- struction in any part of this canal, hinders the passage of the tears into the nose; and they, therefore, accumulate on the lids, or fall over upon the cheek. Mr. Pott, who wrote with great accuracy on the fistula lacrymalis, divides the disease into four stages. 1. A simple dilatation of the sac, and obstruction of the passage to the nose, which, upon pressure, dis- charges-a mucus, either quite clean, or a little cloudy; the skin covering the bag be- ing entire, and perfectly free from inflam- mation. 2. In the second stage, the tumor is somewhat larger, the skin is inflamed, but entire; and the discharge is of a pale yel- low, or purulent colour. 3. In the third stage, the skin covering the sac has be- come sloughy, and burst, by which the swelling is lessened; but the mucus which used to discharge itself through the lacry- mal points, now comes through the new opening; the passage to the nose is yet not otherwise diseased, than by the thickening of its lining. 4. The passage is totally ob- literated, its inside being either ulcerated or filled up with a fungus, and attended sometimes with a caries of the bone under- neath. In the first stage of fistula lacrymalis, we attempt to remove the obstruction of the passage by introducing a probe, or by in- jecting a fluid through a very fine syringe, into the inferior lacrymal points. Warm water is best at first; and if this does not succeed, a solution of sulphate of zinc, or wine of ppium may be tried. The healthy state of the neighbouring parts is to be at- tended to, and to be restored by leeches, and the ointments recommended in diseases of the eye or eye-lids. In the second and third stages, when the parts are inflamed and swelled, a proper opening should be made with a lancet; or if the skin has broke, the opening, if necessary, should be dilated. A silver probe is to be pushed into the na- sal duct, vvith force sufficient to overcome the obstruction; and afterwards a silver style, a little smaller than the probe, having a head like a nail, but placed obliquely, is to be left in the passage. It is to be re- moved for cleaning, once every day for about a week, and afterwards every second 238 SURGICAL DISEASES AND ACCIDENTS, or third day. A little warm water should be injected each time into the nose. In many cases, the watering of the eye ceases as soon as the style is introduced. Some wear this style for years, others leave it off in a month or six weeks, and the parts con- tinue well. In the worst cases of the dis- ease, or the fourth stage, an opening must be made through the bones of the nose; and by wearing a style, as above, an artificial passage will be formed. EVE-LIDS. DISEASES OF THE These are subject to various diseases, wdiich are commonly mentioned along with the diseases of the eye, &c. The habitual redness of the eye-lids so prevalent in scro- fulous habits, is to be cured by astringent ointments, and general strengthening re- medies. Sometimes a hard warty substance ' grows under the skin of the upper eye-lid, which is hardly to be removed but by being cut out. A troublesome and painful growth, known commonly by the name of stye, very frequently attacks the eye-lids; it is a kind of boil, in which is slowly formed a thick yellow matter; it may be hastened forward by bread and milk poultices, and discharged by a small puncture when it is ripe. Those who have once had a stye, are very liable to frequent returns of it. Ectropium signi- fies a turning out of one or both of the eye- lids. It may arise from elongation or swell- ing of the membranous lining of the eye- lids, or from a contraction of the outer skin of the eye-lids. The first kind may be the consequence of obstinate chronic ophthal- mia, in scrofulous and relaxed constitutions; or it may happen after small-pox. The second species, or that turning out of the eye-lids which is owing to a contraction of the skin, may arise from the pits and scars left by small-pox, or by burns; or from the cutting out of a tumor when sufficient skin has not been left. The effects of this turn- ing out of the eye-lids are very troublesome. There is a continual discharge of tears over the cheek, a dryness of the eye-ball, fre- quent attacks of ophthalmia, intolerance of light, and opacity or ulceration of the cor- nea. When the first species is slight and recent, the best method is to destroy the elongated and relaxed skin on the inner surface of the eye-lid, by completely turn- ing it out and rubbing it with lunar caustic, taking care to prevent the eye from suffer- ing by the caustic, by washing the eye with new milk. It will be necessary to use the caustic for several days, till there be a suffi- cient destruction of the internal membrane of the eye-lid, and of its inner surface. In favourable cases, this treatment is followed by the gradual return of the eye-lid to its natural position. The cure of the second species is more difficult. As it sometimes happens from the contraction occasioned by a cicatrix, it has been proposed to cut this through; but no great success has attended this operation. The cutting out of a por- tion of the membrane lining the eye-lid is the method most likely to succeed in reme- dying the eversion of that part. Entropium is the reverse of the former case, and is a turning in of the eye-lids; it is also called trichiasis, from a Greek word signifying a hair, on account of the irritation produced by the eye-lashes fretting the ball of the eye. This turning in of the eye-lids is a frequent consequence of ulcers and scars of their margin, which is called the tarsus; or of ophthalmia arising from scrofula or small- pox. The cure consists in removing a cer- tain portion of the skin of the affected eye- lid, near the tarsus. The lips of the wound are to be brought together by slips of ad- hesive plaster. A cicatrix forms, and the lid is turned out to its natural position. There is another kind of trichiasis, in which one or more hairs are turned in, without any alteration in the position of the eye-lid. It is difficult to accomplish a cure, as it is found that neither the pulling out of the hairs, nor burning the situation of the roots* can be at all depended on. Sometimes the upper eye-lid falls down, and can not be raised or kept up by the action of the vo- luntary muscles. This may arise from a redundancy of the skin, or from palsy of the^ muscles destined to raise the eye-lid. When it proceeds from the first cause, a portion of the redundant skin is to be removed; and when palsy is the cause, the eye and surrounding parts are to be bathed fre- quently with very cold water; and the eye», brow and eye-lid are to be rubbed with th<| camphor liniment, or with a liniment cotP taining a little of the tincture of cantharides. The shower bath, and bark, as correctors of debility, may be conjoined with the other methods employed. EAR. DISEASES OF THE 1. The external ear may be lost by vio- lence, as by cutting, or the bite of an ani- mal. If we see it soon after an accident, and find it much lacerated, we are to at- tempt its re-union by plasters, and even by sutures, if necessary. When a bandage is applied, it should be moderately tight, as pressure in this place gives considerable uneasiness. Wounds, and loss of a part, or even the whole, of the external ear, do not not always occasion deafness. If this oc- curs from such a cause, an car-trumpet or similar contrivance must be used. 2. Some- times the external ear is not perforated, and deafness is the consequence, at least in general. This is to be remedied by a sur- gical operation, varying according to the nature of the obstruction. If it be merely SURGICAL DISEASES AND ACCIDENTS. . 239 a membrane stretching across the passage, it is enough simply to remove the obstruc- tion; but if the cartilaginous or bony sides cohere, the cure is of much greater diffi- culty. When the obstruction is not quite close to the membrane of the drum, it has been proposed to touch it with caustic, and to introduce a little tent to keep the passage open for some time afterwards. 3. Foreign bodies, as pease, bits of glass, or cherry- stones, may get into the ear, and occasion great pain of the part, as well as impaired hearing. Such bodies have been known to occasion for many years excruciating pain of the head, palsy, convulsions, and other distressing symptoms; all which have ceased when a skilful hand has extracted the of- fending body. Such bodies should be forced out, if possible, by the injection of warm water, and the application of a small scoop or bent probe. Worms have been known to produce very violent symptoms by being hatched in the ear. When there is disease, as ulceration or suppuration in the ear, insects are attracted by it, and de- posit their eggs, which in time produce worms. Patients so affected should take care to stop the ear when they go to sleep in summer and autumn, as Morgagni ad- vises. A slight infusion of tobacco in oil of almonds may be dropped into the ear; and this proves fatal to worms. 4. A very fre- quent cause of deafness or impaired hear- ing, is the obstruction of the passage by thickened or hardened wax. The symp- toms arising from this cause are deafness, a sensation as of a noise or clash when eating, or of heavy sounds as of a hammer. This kind of deafness is not very difficult of cure. A little olive oil, or oil of almonds is to be dropped into the ear, and retained there by a piece of cotton; and when the wax is softened, it is to be taken out with a small scooped instrument. Injecting warm water with a little soap by a syringe, is a method of getting rid of the hardened wax, equally simple and efficacious. 5. A defi- ciency of the wax may occasion a degree of deafness. When this is the case, we are to drop in two drops every night of the fol- lowing mixture: pyroligneous acid, sul- phuric ether, oil of turpentine, equal parts; three drachms of the tincture of meadow saffron in six ounces of distilled water are to be taken at the time. The bowels must be kept easy. When the wax is of Tsad quality, which is known by its deviation from the healthy colour and consistence, it may be improved by frequently washing the passage; and giving, once or twice a day, a wine-glassful of the infusion of quas- sia, with a tea-spoonful of equal parts of rhubarb and magnesia. 6. Discharges of matter take place from the passage, in con- sequence of inflammation -going on to sup- puration, from scrofulous ulcers, from ab- scesses after fevers, from small-pox, mea- sles, and other causes. These discharges, not unfrequently, are attended with the loss of the small bones; and in general, total deafness is the consequence. Exposure to cold frequently produces inflammation about the ear, attended with very acute pain, (commonly termed ear-ache) which continues very troublesome and even alarm- ing, till the patient is relieved by the dis- charge of matter. This inflammatory state is to be treated by local bleeding, the in- jection of tepid water, and by fomentations; and the passage should be protected from cold air, by the introduction of wool or cot- ton. 7. Sometimes there is disease in the drum, attended with fetid, purulent dis- charge, which, making its appearance at the internal opening, shows that the mem- brane of the drum is destroyed; and so much disease is in the internal parts, that the small bones are discharged externally. In time, a continual discharge from the ear takes place, and the disorganization is so complete, that a total loss of hearing is the consequence. If this disease be noticed in its early stage; if there is acute pain, fol- lowed by a discharge of matter, we know it is from inflammation, and we are to palliate or remove this by topical bleedings, and other antiphlogistic means; and are on no_ account to inject stimulating spirituous fluids. When the disease threatens to be more chronic, we are to use blisters and setons as auxiliaries to our cure; to employ laxative medicines, and to foment the part; and when there is httle active inflammation, to throw in astringent injections, as of sul- phate of zinc. If there are fungous growths, they are to be touched with caustic. 8. Sometimes there is deafness from insensibi- lity of the nerves of hearing, though the structure of the parts may be perfect. If we can' ascertain this to be the case, we are advised to put the patient on low diet, and to give saline purgatives once or twice a week, applying blisters occasionally behind the ears. The application of electricity may be tried. EXCORIATION. A loss of the cuticle or scarf skin. Ex- coriation or chafing of the skin is very liable to happen, especially in infants, at those places of the skin that are often in contact with each other, as the ears, neck, arm- pits, and groins. The best way to prevent this tendency, is to dust the parts with pre- pared tutty or chalk finely powdered. If there be a discharge of matter from the ex- coriated parts, great care and attention are requisite in the healing of them. If the running has continued long, there is some danger in checking it too suddenly; but if proper precautions are taken to prevent 240 SURGICAL DISEASES AND ACCIDENTS. this, and to relieve the system by purging, there is no reason why they should not be healed up quickly, as there is always risk of the inflammation spreading to some in- ternal part. When chafing appears worse than can be checked by the tutty, a wash of white vitriol is to be used; eight grains of the vitriol to four ounces of rose water. If this does not prevent the excoriations, the parts are to be washed pretty frequently with some weak stimulant lotion, as lime wa- ter and milk, and they are to be covered with brown cerate or spermaceti ointment, or a liniment made of equal parts of hog's lard and beeswax. GANGRENE OR MORTIFICATION. The death of a portion of the body, while the rest continues alive, often in a sound state. When any part of the body loses all motion, sensibility, and natural heat, and becomes of a brown, livid, or black colour, it is said to be affected with sphacelus, that is, complete mortification. As long as any sensibility, motion, and warmth continue, the state of the disorder is termed gangrene. Mortification is the sequel of diseases both of excitement and of debility. In in- flammations of the external parts, which terminate in mortification, the process ob- served is as follows: the pain ceases, the purulent matter becomes acrid and sanious; air-bubbles are set at liberty, collecting in small vesications under the skin, or dis- tending the whole organ by an emphysema- tous swelling. The blood is coagulated in the vessels of the gangrened part, and the circulation can not be restored. A slight delirium comes on, followed either by de- jection of spirits or calmness of mind; but in each case attended with a peculiarly wild expression of countenance; though some- times with a very peculiar expression of serenity, with a blackness under the eyes. The pulse is usually quick, low, and often intermitting. In the earliest stages, deep incisions are attended with a discharge of blood, still florid; but the skin, the muscles, and the cellular membrane, soon melt down into a brownish offensive mass. We con- clude that similar processes take place in the internal parts when they become morti- fied. When this occurs in strangulated hernia, or in inflammation of the bowels, a remission of the violent pain takes place, and the patient and his friends are deluded with the hope of complete relief; but the experienced physician knows the treacher- ous symptom, and must not deceive them with false hopes. There is a peculiar kind of mortification called dry gangrene, where the disease begins in one of the toes, and very often after a person has been paring a corn or toe-nail. It sometimes stops spon- taneously, and deprives the patient of some of his toes, or even of his foot and leg, as cleanly as if it had been amputated by a surgical operation: at other times it has been successfully treated by giving large doses of opium. The causes of mortification are general or local. Those which affect the general sys- tem, are the violent inflammatory fevers, or the jail and hospital fever; as also scurvy and dropsy, long continued or intense cold, and some internal changes, which we can not trace or explain. The local causes of mortification are numerous. Some of them are, burns, excessive cold, the application of caustics, the strangulation of a part, as in hernia, or the tying of tumors; severe contusions, as gun-shot wounds, bad frac- tures, violent inflammation, urine effused in the cellular substance, pressure on large blood-vessels, by a ligature or by tumors, wounds of large vessels. Long continuance in one posture, as when a person is confined to bed, gives occasion to gangrene of the parts where the bones have least flesh upon them, and which are therefore much exposed to pressure; as the shoulder-blades, the haunch-bones, and the lower part of the spine. -The hospital gangrene is produced by some indescribable state of the air in hospitals, jails, and ships. During its pre- valence, the smallest scratch or ulcer is apt to turn to a fatal gangrene. In drops}', which occurs in broken down and debilita- ted constitutions, if a few punctures be made to let out the effused fluid, these are too apt to run into gangrene, and a prudent sur- geon will therefore not risk the experiment; although it is not unusual for spontaneous vesications to form and break on such drop- sical limbs, and to go on to gangrene. The local mortifications which happen in old people, are generally owing to ossification of the arteries. When mortification arises from great de- bility, from ossification of the arteries, or obstructions that we can not remove, a cure is not to be expected. Internal mortifica- tions are generally beyond the reach of medicine; but as very threatening symp- toms have sometimes disappeared, we "must attempt all that art can suggest. When inflammation is so violent and strong as to give reason to fear that it will end in mortification, it is a call for us to use with great diligence bleeding, purging, low diet, cold applications, and the other means for abating it; taking care that we do not continue them too long, lest we add to the debility and exhaustion which are to follow. When the mortification has fairly begun, our remedies must be very different from those which counteract inflammation. We arc now to prevent debility by giving a nourishing diet and tonics. Of the class of tonics, the most efficacious is the bark; and in a great variety of cases, the good effects SURGICAL DISEASES AND ACCIDENTS. 24 i of the Peruvian bark are very remarkable. Small quantities of opium and calomel com- bined, may be given at frequent intervals. When the weakness is very great, the use 'of wine may occasionally be required, as also ammonia and other diffusible stimulants. We must be careful not to give these re- medies when there is any strength of pulse and inflammatory symptoms remaining. When our remedies are successful, and the mortification is about to cease, a separation takes place at the verge of the sound part, by means of a slight degree of inflamma- tion. But, on the contrary, it very often happens that the disease spreads, and death ensues. Local applications. Some have advised cold lotions near the verge of the mortified part, to check the further progress of in- flammation; but fomentations and emollient poultices are commonly preferred. To the common poultices, in some cases are "added powdered charcoal, or yeast, to correct the fetor, and to counteract putrefaction. Stale beer grounds, or port wine, with linseed meal, make a good poultice. Stimulating balsams, hot oils, and the actual cautery, are now disused in the dressing of mortified parts. It is necessary to give vent to putrid matter, and for this purpose pretty deep incisions are required. With a view of allowing dressings to reach the sound part, and to excite inflammation, which commonly takes place at the verge of the mortified part wdien it terminates favourably, and separates from the sound, scarifications have been recommended; but they are always attended with risk of increased inflammation, and we never can be sure how much the disease extends below the surface. We may, there- fore, be cutting a superficial part, while the evil is extending close to the bone. When a part is frost-bitten, it is a very dangerous practice to bring it suddenly into a higher temperature; and in winter cam- paigns of armies, it has been found, that soldiers who have been exposed to intense cold, have not complained of being frost- bitten, till a thaw came on. The proper treatment is by frictions with camphorated spirit of wine. GLEET. A continued running or discharge, after the inflammatory symptoms of a clap have ceased. The discharge is commonly thin and clear, and is not accompanied with pain or scalding in making water. It pro- ceeds from relaxation or debility of the parts, and is best cured by some astringent or stimulant application to them; and at the same time, the general health is to be pro- moted by the use of bark, iron, and warm bathing. The best local applications are those made of the sulphate of zinc, in the proportion of two grains to the ounce, or one grain of corrosive sublimate to six ounces of water; and they require to be pretty frequently thrown up. They ought to excite a little pain on their first being used. If we do not succeed by astringent injections, we may be obliged to use bou- gies, either clean, or lightly touched with a little basilicon ointment. Balsam of co- paiba in the dose of a drachm three or four times a day, or the tincture of cantharides, ten drops, as often, may be given internally. If we find no benefit from the treatment above recommended,- we judge that the gleet does not arise from mere relaxation of the parts or from habit, but from un- healthy action of the glands in the urinary' passage, and we attempt the cure of this by bougies, and by blisters to the perineum. If the constitution is scrofulous, the reme- dies for that disease must be conjoined with our local applications. Another cause of gleet is strictures in the urethra. In such cases our attention is to be directed to the cure of the strictures, for which we refer to that article. GONORRHOEA. Clap, or Gonorrhoea, is a discharge of yellow fluid from the urethra, in conse- quence of the application of morbid matter, generally following an impure connection. The time that elapses between the applica- tion of the matter and the commencement of the running, varies in different cases, from two days to three or four weeks; but the most usual time is from six to twelve days. It begins with an itching and sore- ness about the private parts, with a soreness along the course of the urethra; soon after which, a slight discharge of whitish matter takes place, and there is heat and pain in making water. In the course of a few days, the matter discharged is increased in quantity, and becomes of a greenish or yel- lowish colour; there, is redness and inflam- mation about the parts, the stream of urine becomes smaller, and the attempt to pass it is attended with much pain and scalding. It sometimes happens, that when the in- flammation is considerable, there is a slight discharge of blood. The prepuce swells so much that it can not be drawn back, which symptom is called a phymosis,- or, being drawn back, it can not be brought forward again, which occurrence is-termed para- -phymosis. The neighbouring parts suffer. The bladder becomes irritable, and there is frequent call to make water; also uneasi- ness about the rectum. One, or both, of the testicles swell, occasioning great pain, and some degree of fever. Chordee also is not an unusual symptom. The time for which a clap will continue, depends much on the conduct of the patient himself; on 242 SURGICAL DISEASES AND ACCIDENTS. the timely or late use of remedies; and in some cases, on the acrimony of the infect- ing matter. If the proper means are used, and if the patient is guilty of no excesses, sensuality, or irregular living, the matter will, in the course of a fortnight or three weeks, become thick, and somewhat viscid; it will then gradually diminish; and at last cease entirely; but if the same riotous liv- ing be continued which brought it on, if indulgence in wine and other stimulants be persisted in, the symptoms will increase in severity, continue for a long time, and be followed by very unpleasant consequences; as g'leet, warts, and strictures in the ure- thra. If there be much inflammatory action when the patient is first seen, if the pulse be quick and strong, if there be very great heat, pain, and difficulty of making water, it may be proper to employ bleeding, both general and local. The body is to be kept open by the milder purgatives, which do not irritate the rectum and neighbouring parts, such as castor oil, and the neutral salts, dissolved in a considerable quantity of water; the patient is to drink plentifully of mild diluent drinks, as barley water or lin- seed tea, adding to them some dissolved gum arabic; all irritation is to be avoided, the diet is to be spare, no spirituous or fer- mented liquors are to be used, and quiet- ness and rest are to be enjoined. If the symptoms are more moderate, we may dis- pense with the bleeding, taking care to observe the other directions given above. When the running has continued for a week or ten days, if there be no other bad symp- toms present, it is to be checked by the prudent use of astringent washes, which are to be thrown by a syringe into the urethra. Such washes may be made by dissolving twenty grains of white vitriol in eight ounces •of rose water, or eight grains of blue vitriol in eight ounces of water. It is to be parti- cularly noted, that it is very dangerous to use astringent injections on the first appear- ance of gonorrhoea, or to use them strong at any time; there is great risk of inducing in- flammation and swelling of the testicle. If this happens, cooling lotions are to be ap- plied to the part, and it may be necessary to use even general and local bleeding. A Tetum of the running is to be solicited by warm fomentations, and injections of warm milk into the urethra. Without entering into the controversy about the identity or difference of the matter of syphilis and gonorrhoea, we may state, that it is not in general necessary to make use of mercury in gonorrhoea. Swellings of the groin are to be prevented, if possible, from coming to a suppuration, by the use of cold lotions made of a solution of sugar of lead, by a spare diet, and by giving cooling purga- tives. We are to attempt the removal of phy- mosis or paraphymosis by the ap plication of cold, or by diminishing the swelling by means of leeches; and it may be necessary, if the tightness can not be removed by other means, to cut through the prepuce. Dur- ing the whole of the disease, it will be ne- cessary to pay great attention to keep the parts clean, and to prevent excoriation and ulceration from the lodgement of acrid mat- ter. The distressing symptom called chor- dee, is to be obviated by washing the parts with a solution of opium, or the tincture, and keeping cloths wet with them to the parts: a large ppiate is to be taken at bed- time. The disease in women requires the same general plan of treatment; but it is less obstinate in them, from the greater shortness of the urinary passages. It much resembles what is commonly known by the name of whites. GULLET. AFFECTIONS OF THE Gullet, called in anatomy oesophagus. At the back part of the mouth there are two passages downwards; the anterior is that which leads into the wind-pipe; and the posterior is the pharynx or commencement Jj of the gullet, by which the food and other jl substances pass into the stomach. ™ Strictures of the gullet. Stricture is a contraction of part of the tube or canal. The } most remarkable symptom of such contrac- tion in the gullet is the difficulty of swal- lowing, which is greater or less in propor- j tion to the obstruction. Sometimes no solid J food can pass down, and fluids only with "m great difficulty, and in very small quantities. \ Sometimes there is pain extending to the ear, returning at intervals, and continuing for a considerable time, even where there is no effort made to swallow. If the stric- ture be from a permanent cause, a bougie passed downwards is stopped; and such strictures sometimes occasion ulceration at a distance from themselves and nearer the orifice.of the stomach. Sometimes strictures are so complete, that it is impossible for the patient to swallow any thing whatever; -n nourishment can be conveyed only by clys- p; ter; and in general he soon dies emaciated ' Jj for want of food. The only treatment pos- sible is the passing of a bougie through the stricture, if it will admit of this, and em- ploying one of larger size in proportion as the dilatation of the stricture will allow. Some surgeons venture on the introduction of a bougie armed with some caustic sub- stance. Liquid nourishment may be con- veyed by a hollow bougie. " Strictures from spasm. This is a very ] common symptom of hysterics; and when violent, must be relieved by antispasmodics and anodynes, applied both internally and externally. Mustard poultices, ammonia, or other rubefacients are to be employed, and SURGICAL DISEASES AND ACCIDENTS. 243 a blister may be required; but if the threat- ening symptoms of apoplexy or of violent pain be present, it will not be prudent to wait for its pperation, and we must open the jugular vein or temporal artery. If the spasm be occasioned by acrid or poisonous substances having been swallowed, the parts must be sheathed by mucilages, oil, or milk, and we must guard against inflamma- tion. The bowels must be kept very open. Foreign bodies in- the gullet. It is not at all an uncommon occurrence for foreign bodies to stick in the gullet, as pieces of crust, or meat not completely chewed, or small bones, beans, stones, pins, or pieces of money. Some of these would produce a very bad effect if not quickly removed from the gullet; and perhaps still worse, if pushed down into the stomach; but some- times pretty large bodies have passed down- wards into the stomach, and have been dis- charged by stool in a few days, without any inconvenience. v The contrivances for re- moving bodies which have stuck in the gul- let, must be left to the ingenuity of the medical man who sees the case. Pins and other sharp bodies, when they have stuck in the throat, have been returned by swal- lowing a piece of tough meat tied to a strong thread, and then pulled up again. If the detained body may be more safely pushed down, the probang, a flexible piece of whalebone, with a piece of sponge se- cured to its end, is a safe instrument. If the bodies can not be easily moved up or down, endeavours should not be continued long, lest inflammation come on. When endeavours fail, the patient must be treated as if labouring under an inflammatory dis- ease, and the same treatment will be re- quired if an inflammation take place in the part, after the obstructing body is removed, A proper degree of agitation has sometimes succeeded in removing the obstructing bo- dy, better than instruments. Thus, a blow on the back has often forced up a substance that stuck in the gullet or wind-pipe. Pins which have stuck in the gullet have been discharged by riding on a horse or in a car- riage. In the London Medical Transactions, is an account of a crown-piece which a man swallowed. An emetic was given, but without discharging the piece, which, after twenty months, was brought up by sponta- neous vomiting. If the respiration is dan- gerously impeded, it will be necessary to make an opening into the wind-pipe. GRAVEL AND STONE. The urine, in a state of health, is one of the most compound fluids of the animal sys- tem, consisting of various acids, alkalies, calcareous earth, and other materials; and it is, therefore, not surprising that, under the injurious, and often contrary influence 2G of the many deteriorating causes to which man is incessantly exposed, the natural af- finity between these various elements should frequently be subverted, and give rise to a deposition of one or other of them, thus producing the complaint called gravel. The urinary sand or gravel deposited on the sides or bottom of a receiving vessel is of two kinds, red and white,- and it is of great importance to distinguish the one from the other, as they proceed from different causes, and require a different mode of treatment. The symptoms of red gravel are well known. The shade of colour may vary from a reddish brown, or pink, to a perfect red. Here the urinary secretion is generally small in quantity, and high co- loured, and the disease inflammatory: the nearer the deposite approaches to a per- fect red, the more severe in general are the symptoms. White gravel is less common, but has long been observed to be attended by very distressing symptoms. They consist in great irritability of the system, and de- rangement of the digestive organs in gene- ral. There is often a sallow, haggard ex- pression of countenance; and as the disease proceeds, symptoms somewhat analogous to those of diabetes begin to appear, such as great languor and depression of spirits, coldness of the legs, and other symptoms of extreme debility. The urine is invariably pale, and voided in greater quantity than usual; and after standing, for a greater or less time, always deposits a most copious precipitate of white impalpable powder. In all such cases, the urine is extremely prone to decomposition, and emits a most disgust- ing smell. In many persons, there is an hereditary tendency to this complaint; general indo- lence, or a sedentary life, or an excessive indulgence in fermented liquors, and the luxuries of the table, become predisposing causes in others. But the chief cause seems to be a want of constitutional vigour, and especially in the digestive organs; and hence, the periods of life in which this dis- ease occurs most frequently, are from in- fancy to the age of puberty, and in declining years: while it is rarely found during the busy and restless term of the prime of life. A cold and variable climate often becomes a cause; calculous complaints being seldom met with in warm climates. The drink- ing of hard water often influences very sen- sibly the state of the complaint. White gravel may often be very distinctly traced to an injuiy of the back. The urine, in a healthy state, is always an acid secretion, and it is the excess of its acid that holds the earthy salts in solution. If, from any cause, it be deprived of this excess, or, in other words, the secretion of its acid be unduly diminished, the earthy 244 SURGICAL DISEASES AND ACCIDENTS. parts are no longer held in solution, and a tendency to form white sand or gravel im- mediately commences. If, on the contrary, the acid be in greater excess than usual, in- stead of deficient, or if the natural secre- tion of earth be deficient, while the acid retains its usual measure, the acid itself has a tendency to form a deposit, and hence, the modification of red sand or gravel that is so frequently found coating the bottom of chamber utensils. The red gravel is by far the most fre- quent kind of deposit, and the most effec- tual remedies for it, are the alkalies, and the alkaline carbonates, such as lime-water, Brandish's alkaline solution, the carbonate of potash, or soda, and magnesia. But to be really useful, they must be conjoined with a proper diet and regimen, alteratives and aperients; for it ought never to be for- gotten, in the treatment of gravel and stone, that they owe their formation chiefly to a weakened and vitiated action of the diges- tive organs, which will invariably require this conjunction, in order to the accom- plishment of a permanently beneficial effect. Half a drachm, or a drachm of carbonate of potass, or soda, may be given in water two or three times a day, with an alterative pill of blue mass five grains, ipecacuanha one grain, rhubarb three grains; or four grains of the compound calomel pill every night; the following draught being taken every morning, or every other morning, as a gentle and suitable aperient: take of Ro- chelle salts two or three drachms; carbo- nate of soda one scruple; water, three table- spoonfuls—mix, and after adding a table- spoonful of lemon juice, or thirty grains of tartaric acid, let it be drank directly. Sir Everard Home, and Mr. Brande, have strongly recommended magnesia in this species of gravel, and it is of con- siderable use. Mr. Brande has related a case which yielded to it after the alkalies previously given had failed. It may be taken either alone, in doses of ten-grains twice a day, or combined with the carbonate of soda, in the proportion of six or eight grains of the former, to ten grains of the latter, twice or thrice a day. Or ten grains of magnesia may be dissolved in a draught of soda water, which is an excellent way of administering it. Ten or fifteen grains of the carbonate of ammonia, twice a day, is likewise a useful medicine, especially in cases where great languor, or weakness and coldness of the stomach is present. It is a powerful cor- rector of acidity, and a most valuable cor- dial. A very convenient and valuable mode of combining an alkali with an aperient, and gentle bitter tonic, is the following; it is wor- thy of particular regard when weakness of the stomach, costiveness and red gravel are combined. Take of carboqjrte of soda ten grains; Epsom salt half a drachm, or a drachm; compound infusion of gentian three table-spoonfuls; compound tincture of car- damoms a tea-spoonful—mix for a draught, to be taken three times a day. The bowels should be kept gently open by it,, and, therefore, the Epsom salt may be either in- creased or diminished, according to cir- cumstances. The powder of uva ursi is both tonic and astringent, and has been spoken well of, for its virtues in gravel and stone, by physi- cians of high authority. It may be alterna- ted with the alkalies; and where general debility exists, or there is a discharge of pus-like matter from the bladder, denoting ulceration, or a very faulty condition of its secreting vessels, it is at once an appropriate and excellent medicine. The dose is from a scruple to a drachm of the powder, twice or thrice a day: or a strong tea may be made by pouring hot water upon the leaves of the plant; to three table-spoonfuls of which may be added ten grains of carbonate of soda, or a tea-spoonful of Brandish's alka- line solution, and drank thrice a day. In white gravel it may be given with the nitric or muriatic acid. The diet of persons troubled with red gravel should be moderate in quantity, and of a nutritious and wholesome quality, con- sisting principally of fresh animal food, and farinaceous vegetables. All acids, and acescent food, must be carefully avoided, and likewise heavy bread, fat, and hard- boiled puddings, and soups. Ardent spi- rits and red wine are altogether objection- able, and but a very small quantity of white wine should be allowed. Soda water should be the common beverage. Jelly or jam made of the common bramble berry will be found useful, taken as an article of diet, and spread on bread instead of butter. This appears to have been highly esteemed by Mr. Pott, a surgeon of great and deserved celebrity in the last centuiy. Constant and active exercise is of great importance in all gravelly disorders; and flannel should be constantly worn. Sailors and other persons accustomed to constant and laborious exertion in the open air, are very rarely affected with these complaints. M. Magendie, a celebrated physician, has given a striking example of the advantages to be derived from exercise and abstinence, and the mischievous effects of luxury, in the case of a merchant of one of the Han- seatic towns. " In the year 1814, this gen- tleman," says he "was possessed of a con- siderable fortune, lived in an appropriate style, and kept a very good table, of which he himself made no very sparing use. He was at this time troubled with the gravel. Some political measures unexpectedly took place which caused him the loss of his whole SURGICAL DISEASES AND ACCIDENTS. 245 fortune, and obliged him to take refuge in England, where he passed nearly a year in a state bordering upon extreme distress, which obliged him to submit to numberless privations; but his gravel disappeared. By degrees he succeeded in re-establishing his affair*; he resumed his old habits, and the gravel very shortly began to return. A se- cond reverse occasioned him once more the loss of all he had acquired. He went to France almost without the means of subsis- tence, when his diet being in proportion to his exhausted resources, the gravel again a second time vanished. Again his industry restored him to comfortable circumstances; again he indulged in the pleasures of the table, and had to pay the tax of his old com- plaint." In the cases of white sand or gravel, an acid is the best medicine, and all the acids seem to answer the purpose, though the muriatic, nitric, and citric acids, have been in the greatest repute. The citric acid, or lemon juice, is preferable for children, as being the pleasantest, and that-which may be persevered in for a considerable time: it may be mixed with water in any proportion that is agreeable. The muriatic acid may be given in doses of from five to twenty drops, twice or thrice a day, in four table- spoonfuls of water; and the nitric acid in doses of from five to twelve drops, in the same proportion of fluid. In general, the diet should be nutritious, easy of digestion, and moderate in quantity, and be as largely as possible intermixed with acids, salads, fruits, and especially oranges and lemons. "Ardent spirits and malt liquor must be abstained from; and if the habit of the patient absolutely require that he should continue the use of wine, Champagne, Claret, or Hock, in very mo- derate quantity, will be preferable to Ma- deira or Port. Water, saturated with car- bonic acid, is the best common beverage in this kind of gravel, and, attention being paid to diet and exercise, will sometimes be alone a sufficient remedy. If pain attend the gravel, opium or ex- tract of henbane should be occasionally ad- ministered, according to the urgency of that symptom. Thirty or forty drops of laudanum, or of rthe solution of acetate of morphia, or from five to ten grains of the extract of henbane may be given alone, or in any draught which the patient may be taking, and repeated until the pain is re- lieved. Opium seems generally preferable in the white gravel; and henbane in the red. In white gravel, the solution of acetate of morphia, is particularly indicated as an ano- dyne, since the acid it contains is an appro- priate and efficient remedy for the com- plaint, and, at the same time, counteracts the injurious effects likely to result from the frequent use of opium, when taken in any of its common forms. In case of great pain and irritation about the urinary organs, an opiate injection will be proper, and often of much service; or two or three grains of opium may be made into a pill, and inserted within the rectum, as a suppository. A burgundy pitch or galbanum plaster may be applied over the loins with advan- tage. If the symptoms are unusually se- vere, and connected with manifest injury of the bladder or kidneys, a seton or issue should be instituted in the back. Whether the gravel be white or red, when a small stone passes from the kidneys into the bladder, there is generally a fit of pain and irritation; to relieve which, bleed- ing, the warm bath, or hot fomentations, to- gether with forty or fifty drops of lauda- num every three hours, will be the most proper and effectual remedies. The pas- sing of a small stone from the kidneys to the bladder, is denoted by a fixed pain in the region of the affected kidney, with a numbness of the thigh on the same side. The pain is sometimes very acute, and ac- companied with nausea and fainting, but the pulse is rarely accelerated. During the whole of the passage from the kidneys, the urine is usually high coloured, and fre- quently mixed with blood. Stones, or calculi in the bladder. These differ greatly in their composition, form, size, and colour; but by far the most fre- quent is the uric acid calculus; while the mulberry calculus is productive of the greatest suffering. Their magnitude is generally in an inverse ratio to their num- ber: the average size may be compared with that of a chesnut, walnut, or a small hen's egg. A stone was taken from the bladder of the late Sir David Ogilvie, of England, which weighed forty-four ounces, and was of an oval shape, its long axis mea- suring sixteen inches, and the shorter four- teen. The symptoms of a stone in the bladder are, a sort of itching along the urethra, par- ticularly at the extremity of the glans, from which the patient often acquires a habit of pulling the prepuce, which becomes very much elongated; frequent propensities to make water, and go to stool; great pain in voiding the urine, and difficulty in retaining it; the stream of urine being liable to stop suddenly, while flowing in a full current, although the bladder is not empty, so that the fluid is expelled by fits as it were; and the pain being greatest towards the end of, and just after, the evacuation. There is a dull pain about the neck of the bladder, to- gether with a sense of weight, or pressure, at the lower part of the belly; and a large quantity of mucus is mixed with the urine, and sometimes the latter is tinged with blood, especially after exercise. But all these symptoms are so equivocal, and bear 246 SURGICAL DISEASES AND ACCIDENTS. so great a resemblance to the effects of several other disorders, that they cannot be depended upon, and, consequently, no well informed surgeon will venture to pronounce positively that there is a stone in the blad- der, unless he can distinctly feel it with a sound. The causes of calculi are the same as those which give rise to gravel. Stone in the bladder is much more frequent in some countries than in others. It has been con- jectured that women are less liable to the stone than men, but it is a question not yet completely settled. Infants, and children to the age of twelve, or fourteen, are par- ticularly subject to it. The treatment of stone is precisely the same as that of gravel, both in regard to medicines and diet: if the urine deposits a red sand, the alkalies, and other remedies just mentioned, must be taken; if white sand, the acids. There is this difference between gravel and stone, that, in the for- mer, active exercise is highly advisable; whereas, during the presence of an actual stone in the bladder, the patient's exercise ought, for obvious reasons, to be less active and constant. Dr. Morris, of Canada, has lately found that an injection of castor oil, has great ef- fect in relieving the sufferings occasioned by a stone in the bladder. Different con- siderations had inclined him to the opinion, that the introduction of a lubricating fluid intajthe bladder would, under such circum- stances, be productive of ease and advan- tage, and, being afflicted with the stone, he soon had an opportunity of trying the ex- periment on his own person. " I first took care," says he, " to rid myself of the con- tents of my bladder; this I had no sooner accomplished than, with a large syringe, I injected, through a small leaden tube reach- ing to the sphincter, about two ounces of cold-drawn castor oil, and I cannot express to you my feelings occasioned by the change which took place upon the moment of its introduction, for it seemed as if a new lower- half had been given me. The absence of former painful symptoms still continuing, I went to bed, and can safely say, that I had not known, for some time previous, the pleasure of a sound and uninterrupted sleep. Latterly, I never awoke without a wish to make water, and the morning fol- lowing was the first exception to it. When I did obey the call, I took care, finding that the oil came last, to leave as much within the bladder as I could. This I had little difficulty in effecting, as it does not dispose the bladder to contract as other fluids do." After this, the bladder was constantly sup- plied with two or three ounces of castor oil, and under this treatment every symptom of irritation vanished, and during two months no one symptom re-appeared to remind him of the existence of the cqjkmlous concre- tion. When all the foregoing means of relief fail, and the general health is worn out by a long succession of pain and anxiety, nothing remains but the operation of extraction. In females, stones, even of a large size^may frequently, perhaps generally, be extracted by dilating the urethra, by means of sponge tents, to a size sufficient to allow the cal- culus to pass, without the use of a knife at all. HARE-LIP. A division in the upper lip, with which some children are born. The division is sometimes confined to the skin and muscles of the lip, but in other cases, it extends to the palate bone and soft parts of the mouth. It is a deformity which parents are very anxious to get rid of, and it is done without a great deal of pain or difficulty; but it is proper to wait till the child is a few years old, and able to give a little assistance by its own steadiness. The operation consists in removing the skin from the two surfaces, and bringing and keeping the two raw edges in contact; when the opposite sides grow together perfectly, and hardly a scar remains. Adhesive plaster will not do to keep them in contact, but it must be done by two or three gold pins pushed from one side to the other, and kept firm by thread or silk twisted round them in the figure of 8. In three days they may be removed, and the cure will be complete. This is the course of things in favourable circumstan- ces; but sometimes there are two or more clefts which require separate operations, and one should be healed before the cure of the other is attempted. When the palate bone is divided, the cure cannot be accom- plished, and the voice is defective from the wrong conformation of the roof of the mouth, and swallowing is difficult, on ac- count of the food getting up into the nose. HERNIA OR RUPTURE. Rupture, called in surgical language her- nia, signifies the displacement of one of the internal organs from their natural situation; but it is more commonly applied to that disease, which arises from the bowels get- ting through some of the apertures designed. for the transmission of other organs. When the parts of the bowels or omentum which have protruded can be replaced by change of posture or by the hand, the hernia is said to be reducible; when it is not, it is called irreducible hernia,- and when dangerous or painful symptoms are brought on by its being constricted, it is said to be strangu- lated. Ruptures are inconvenient and, dangerous SURGICAL DISEASES AND ACCIDENTS. 247 in proportion to their bulk, to the place where they occur, and to the stricture or pressure they undergo; and without enter- ing upon the discussion of the more uncom- mon and obscure kinds, we shall mention those which are generally met with, and which, by their frequent occurrence, de- mand attention. 1. Inguinal hernia, or that which occurs in the groin. There is, at the lower part of the belly, and towards the middle line, a passage through the muscles of the belly for the transmission of certain organs, which in the male sex are lodged in the scrotum, and in the female are distri- buted among the skin at the sides of the labia. Through these openings, the bowels are sometimes protruded, either by the apertures being unusually large, or by some stress or violent exertion of the body. Some portion of the bowels is thus forced down- wards in the direction of the scrotum, oc- casioning a greater or less swelling in that part; or the bowels may be pushed out so very little, as to form merely a small and hardly perceptible swelling in the groin. 2. Femoral hernia is that which appears at the upper part of the thigh, or at the open- ing by which the great blood-vessels enter into and pass out of the abdomen. 3. Um- bilical hernias signify those ruptures which occur at the navel. Ruptures also occur at various other parts, but much more rarely than at those above mentioned. When a rupture comes on suddenly, in consequence of any violent exertion, the patient has the sensation as if something had given way, and the pain is considerable. But many persons are afflicted with rup- ture, in whom it has come on gradually, and in whom there are large swellings, giving no inconvenience but what arises from their bulk. But a person who is ruptured, can never be sure that things will remain in a quiet state; because from external violence, from unusual exertion, or from causes un- known, dangerous symptoms may speedily come on. Sometimes ruptures return into the cavity of the belly when the patient is in the horizontal posture, or they can be replaced with a little manual assistance; but in other cases, from the great quantity of intestine that is down, from adhesions hav- ing been formed between it and the neigh- bouring parts, its reduction is impractica- ble. When a rupture can be replaced, it is proper for the patient to wear a truss, which, when well made, gives the neces- sary support to the bowels, and prevents their being pushed out of the cavity: the wearing of it is attended with no inconve- nience; and even very young children may wear a truss if it be properly fitted. When a truss can not be worn, or when the rup- ture can not be put up, all that remains is for the patient to take as much care as pos- sible, that no injury or blow be inflicted on the tumor; to guard against costiveness, and to avoid violent exertions of every kind; and in children, care must be taken to pre- vent crying, and all such motions as are apt to increase or occasion rupture. There are some persons in whom rupture takes place more easily than in others, and in whom it is constant. The reason seems to be, that the parietes of the abdomen, or the neighbourhood of the openings in it, are more lax and yielding in them than in others. It is common in warm climates, in old people after long illness or debilitating fevers, and in the poor who have laboured hard and been ill fed. The circumstance which immediately occasions ruptures, is generally some violent exertion, which im- plies a strong action of many muscles, espe- cially those of respiration; hence ruptures are brought on by lifting or carrying heavy weights, jumping, running, vomiting, strain- ing at stool, the efforts of women in child- bed ; or by coughing, sneezing, crying, laughing. . As the whole of the human race are continually exposed to some one or other of these exertions, and as ruptures are comparatively rare, we infer that those to whom they occur, have some peculiar laxness in the structure of the parts through which the bowels protrude. Rupture, symptoms of, when it is reducible and not strangulated. A swelling in some part of the belly; this diminishes a little on pressure, but returns when the pressure is withdrawn; it goes off when the patient lies down, and is increased by coughing. Patients with rupture are sometimes troubled with indigestion; but frequently, all the functions of the alimentary canal are quite regular. When we succeed in getting up the bowels, there is commonly heard what is called a guggling noise. Rupture, strangulated, symptoms of. When either an' old rupture from some cause has become strangulated, or when some sudden exertion has at once produced rupture and strangulation, the following symptoms occur: there is a swelling at the place of the rupture, painful to the touch, and increased by coughing, sneezing, or by the upright posture. These symptoms are followed by sickness, retching, costive- ness, with a frequent hard pulse, and other attendants of fever. The cause of these symptoms is the stricture made on the bowel, by the part through which it pro- trudes. The object of cure, is therefore to relieve the bowel from this pressure, which is to be effected either by returning the intestine into the belly, by the same aper- ture through which it came out, or by en- larging the aperture by an operation. We are first to endeavour to replace the bowel by the hand, if possible; and various methods are to be put in practice, to pro- duce the x*elaxation necessary for that pur- 248 SURGICAL DISEASES AND ACCIDENTS. pose. The surgeon is to place the patient with the thighs bent; and he is to make pressure on the tumor in a direction up- wards and outwards. In a young and strong person, bleeding is very proper, both to induce relaxation, and to prevent inflamma- tory symptoms. The warm bath may be tried also to induce relaxation. With a view to diminish the bulk of the. swelling, and so to render it more easily replaced, cold has been applied to the external parts, by means of ice or of ether. An injection of the infusion of tobacco produces an ex- treme relaxation of the whole system, and so has conduced to the replacement of pro- truded bowels. The strength of the infusion is a drachm of the leaves to an English pint of boiling water; this is infused for ten minutes; one half is injected at first, and the other a little afterwards, if no proper effect is produced by the first. The tobacco injection is a remedy of the greatest danger, and must never be administered, except by an experienced practitioner. These at- tempts to reduce the bowel, may be made for a longer or shorter period, according to the symptoms of each case. Much handling will add to the danger of inflammation which is already so great; and too long de- lay will allow the bowels to get into a state of mortification. When we have decided that an operation is necessary, it is to be performed by making an incision through the skin and other coverings, till we reach the sac containing the gut; we are then to ascertain the situation of the part that causes the stricture, and, guided by the finger, or by an instrument called a director, we are to divide with a bistoury in the proper di- rection. It is unnecessary to trouble the general reader with more than the plan and outline of the operation, and what is in- tended by it. If the bowels are in a fit state to be replaced, and the operation is suc- cessful, the first favourable symptoms will be a cessation of the vomiting, and a free discharge by stool; and after the wound is dressed, we are to watch lest inflammation come on. Rest and quiet are to be enjoined, and occasional mild laxatives are to be given. After the cure is completed, the patient should wear a truss, probably for life; and ever after be cautious not to use any violent exertion. Ruptures in infants. Ruptures in different parts, especially at the navel, are not unfre- quent occurrences in infancy; fortunately, they are not attended with so much danger as similar disorders in grown people. When the disease is confined to the navel, a broad piece of flannel, in the form of a roller, together with pieces of adhesive plaster applied over the part with a ball of cotton, forming what has been termed by surgeons a graduated compress, by affording a safe and firm support, prove so useful, that as the infant acquires strength, the rupture commonly disappears. The other varieties of rupture are often cured by the natural increase of size and strength in the body, and require chiefly attention to the due re- gulation of the bowels, and the daily use of the cold bath. No truss ought to be employed for at least the first two years of life. HYDROCELE. A collection of water in the scrotum, or in the membranes investing the testicle and its vessels. Hydrocele is to be distinguished from the watery swelling which takes place in the cellular substance of the scrotum in general dropsy, and which ought not to be considered as hydrocele at all, but to be treated as part of a more general affection, by the remedies appropriate to that parti- cular disease. Water may be collected in the cells of the spermatic vessels; and while this collection is not very large, the scrotal bag has little or no appearance of disease. If the water accumulates, there is a knotted appearance along the course of the sperma- tic cord; and the size may become so large and inconvenient as to require the water to be evacuated by an incision. Sometimes, instead of several cells being thus filled with water, it collects in a large one, and requires similar treatment. The more com- mon form of the disease is, when there is an accumulation of water in the common coat of the testicle. The gradual collection of this fluid dis- tinguishes the disease from rupture, which forms suddenly; the swelling in rupture disappears on pressure and change of pos- ture, that of hydrocele does not; the swell- ing begins at the upper part in rupture, but from the lower part in hydrocele; besides, if a candle be held behind the swelling, there is a degree of transparency visible. The cure of hydrocele is temporary or permanent. The water may be easily eva- cuated, but it will readily accumulate again, and means must be taken to prevent this. The means most effectual, were it always in our power to execute them, is to excite such a degree of inflammation in the parts, as will cause the outer covering of the tes- ticle to grow to the inner surface of the bag; thus to obliterate the cavity altogether, and leave no space for the accumulation of fluid. Such inflammation is excited by introducing through a syringe, port wine diluted with water to a proper strength, generally two parts of wine to one part of water; but if the liquor be too strong, it may excite so much inflammation as to give rise to gene- ral fever, which will require to be treated by blood-letting, both general and local, with purgatives, and cooling lotions. SURGICAL DISEASES AND ACCIDENTS. 249 JOINTS. .INFECTIONS OF THE Inflammation of the joints. This com- plaint ordinarily originates in consequence of a contusion, sprain, wound, or some other kind of injuiy, done to the part af- fected. The inflamed joint shows the common Bymptoms of inflammation, viz. preternatu- ral redness, increased heat, throbbing pain, and swelling, while the constitution is also disturbed by the usual symptoms of inflammatory fever. It is highly deserving notice, however, that in these cases, such symptoms are often exceedingly severe, and the pulse is more frequent, and less full and strong, than when parts more disposed to return to a state of health, are affected. The inflammation first attacks some part of the capsular ligaments, and very quickly diffuses itself universally over their whole extent, as usually happens in all inflamma- tions of smooth membranes. The complaint is accompanied with an increased secretion of the synovia, which becomes of a more aqueous, and of a less albuminous quality, than it is in the healthy state. The capsular ligaments, like other parts, are frequently thickened by inflammation, and, sometimes, coagulating lymph, being effused~ou their internal surfaces, organized cartilaginous, or osseous bodies, are formed in their cavities. When the inflammation attains a higher pitch, an abscess may occur in the capsular ligament. This part at length ulcerates, and the pus makes its way beneath the skin, and is sooner or later discharged through ulcerated openings. An abscess rarely takes place in an im- portant articulation, in consequence of acute inflammation, without the system being, also, so deranged, that life itself is immi- nently endangered. In the violent stage of the inflammation, just before the abscess forms, very severe symptoms of inflamma- tory fever afflict the patient, and occasion- ally, delirium and coma taking place, death itself ensues. When the abscess has taken place in a large joint, hectic symptoms almost imme- diately begin to show themselves, and the strong symptoms of the common inflamma- tory fever suddenly subside. Local consequences, even worse than those above described, may follow inflam- mation of a joint. As the layer of the cap- sular ligament, reflected over the cartilages of the articulation is often inflamed, the cartilages themselves are very apt to have the inflammation communicated to them. Parts partaking of a cartilaginous structure, being very incapable of bearing the irrita- tion of disease, often ulcerate, or, in other words, are absorbed, so as to leave a por- tion, or the whole, of the articular surface of the bones, completely denuded of its na- tural covering. At length, the heads of the bones themselves inflame, and become carious; or the consequence may be an an- chylosis. When a joint is inflamed, how mild soever the affection may be, we ought never to forget, that, when there is a tendency to scrofula in the system, the original case of simple inflammation is very apt to be the exciting cause of the white swelling, one of the most severe and intractable diseases, which increase the catalogue of human miseries. It will considerably shorten what we have to say concerning the treatment of inflamed joints, to observe, that the antiphlogistic plan, in the full sense of the expression, is to be strictly adopted. There are few other surgical cases, in which general, and, especially topical bleeding is more strongly indicated. The violence of the inflammation, and the strength, age, and pulse of the patient, must determine, with regard to the use of the lancet; but, the topical application of leeches may be said to be invariably pro- per. When the leeches fall off, the bleed- ing is to be promoted by fomenting the part. The surgeon should daily persist in this practice, until the acute stage of the inflammation has subsided. But, in con- junction with this treatment, we are to keep the joint continually surrounded with linen rags, wet with cold lead water. In a few instances, however, the patient seems to derive more ease and benefit from the employment of fomentations and emol- lient poultices, and the feelings of the af- flicted should always be consulted; for, if the pain be materially alleviated by this, or that application, its employment will hardly ever be wrong. Nothing more need be said, concerning the rest of the treatment, proper during the vehemence of the inflammation, as it is not materially different from what it is in other inflammatory cases. As soon as the acute stage of the affection has subsided, the grand object is to remove the effects which have been left. These are a thickened state of the capsular liga- ment, and parts surrounding the articula- tions ; a stiffness of the. joint, and pain when it is moved; a collection of fluid in the capsule, &c. This state of the com- plaint, when neglected, and there is a tendency to scrofula, may prove exceed- ingly obstinate; and even terminate in an irremediable distemper of the joint. When this second stage of the disorder seems tardy in going off, the application of a blister is proper, and it should be kept open for a few days, by means of the savin cerate. 250 SURGICAL DISEASES AND ACCIDENTS. In other cases, in which the inflammation has been more trivial, and the effects which it has left are slight, lotions, composed of vinegar and sal ammoniac, suffice for the removal of the chronic complaints, continu- ing after the abatement of the acute stage of the disorder. Dropsy of the joints. This signifies a col- lection of serous fluid in the capsular liga- ment of a joint. The complaint is attended with more or less swelling, and a fluctua- tion; but there is, in general, but little pain. The affection is sometimes situated in the bursae mucosae. The knee is more subject, than other joints, to dropsical dis- ease. The complaint is frequently preceded by severe rheumatic affections, and a local injuiy of the part. When the fluid is not so copious as to produce very great disten- tion of the capsule, a fluctuation is easily distinguishable. Also, if the limb be ex- tended, so as to relax the ligament of the patella, pressing the collection of fluid causes a rising of that bone, and a fulness on each side of it. The disease, though unattended with much pain, produces a degree of rigidity in the joints. Dropsy of a joint sometimes follows fevers. The cure of the above described dropsi- cal affection of the joints, depends upon the absorption of the effused fluid. Such ab- sorption is sometimes altogether spontane- ous, and the event may always be excited, and promoted, by mere friction, by rubbing the joint with camphorated mercurial oint- ment, by repeatedly applying leeches, and particularly, by the employment of a per- petual blister. The operation of a blister may always be very materially assisted by a bandage, ap- plied with moderate tightness. Among other effectual means of cure, we may enu- merate frictions with flannel impregnated with the fumes of vinegar, electricity, and the exhibition of mercurial medicines to open the bowels. When dropsy of a joint occurs subsequent to typhoid, and other fevers, the complaint can hardly be expect- ed to get well before the patient has re- gained some degree of strength. Circumstances do not often justify making an opening into the joint; but, excessive distention, in some neglected cases, might certainly be an urgent reason for performing such an operation. Also, if the complaint should resist all other plans of treatment, and the irritation of the tumor greatly im- pair a weak constitution, the practice would be justifiable. Dislocation. When the articular surfaces of bones are forced out of their proper place, the accident is termed a dislocation or luxation. The loose joints which admit of motion in every direction, as the shoul- der-joint, and the hip-joint, are those which are most frequently dislocated; while those which move like a hinge, as the knee-joint and elbow, are more rarely dislocated, and require an unusual degree of violence to accomplish it. Dislocation may be com- plete, as when the articulating surfaces are quite separated; or incomplete, when a part i still remains in contact with its neighbouring J bone. The dislocation of the round-headed I bones may take place in every direction, J that is, they may be pushed backward, for- ■ ward, upward," downward, or in any part i| of the circumference. The other kinds of 'Jl joints are capable of dislocation only back- jj ward, forward, and to either side. When ^ a dislocated bone has been restored to its « place, it is said to be reduced; and the ease | with which this is accomplished depends much on the short period which has Ik elapsed since the accident. When bones | have been out of their place for a few days, their reduction becomes very difficult; and |; when the time is very long, it is impossible. *g| The soft parts and the bone accommodate themselves to the altered position. In se- ■ veral cases, the opening in the capsular M ligament becomes closed, and will not al- H low the bone to return into its place; or adhesions may be formed between the H bone and the place to which it has come. JH For this reason, when a person has had the S misfortune to dislocate a joint, he should ■ immediately apply for assistance to have it « reduced if possible, before swelling and in- flammation of the parts, or any other un- fl toward consequence, render reduction dif- 1 ficult or impossible. In cases of very great " external violence, it sometimes happens that not only is the joint luxated, but an external wound is inflicted, by which the 'I danger and severity of the symptoms are \ exceedingly increased; and in some cases, i so great is the danger of a wounded joint, 9 and of the air getting admission into its cavity, that immediate amputation of the <] limb is advisable. 1 A bone is known to be dislocated by q there being a loss of the usual motion in the joint, by the limb being altered in its length, or distorted; by there being great I pain in the sorrounding parts, and this pain * increased on motion or pressure. The head > of the dislocated bone is sometimes dis- tinctly felt in a wrong place, and a vacuity ,j I or depression is perceived where there T ought to be a fulness. t The causes of dislocation are either inter- | nal or external. The internal causes are, diseases of the joint or its appendages, re- laxation of the ligaments, palsy of the mus- cles, any morbid affection that destroys the cartilages, the ligaments, or articular cavi- ties. A white swelling sometimes partially dislocates the knee; and scrofulous disease of the hip-joint is the cause of dislocation there. External causes of dislocation are such as blows, falls, violent wrenches or SURGICAL DISEASES AND ACCIDENTS. 251 twists, and the like. Dislocations from the last set of causes are more easily reduced than others. The treatment of dislocations, though a branch of surgery requiring great skill and dexterity, as well as anatomical science, has very frequently been in the hands of those who had no pretensions to either, and who were possessed only of brute strength, or of a certain knack empirically acquired, of which they knew not the mechanism nor the reason. Many people regard bone- setting, as it is called, as no matter of sci- ence, as a thing which the most ignorant farrier may, with the utmost ease, become soon and perfectly master of; nay, that he may receive it from his father and family as a kind of heritage. In the former practice of surgery, too much was expected from mere force, either of the human arm alone, or assisted by machinery, and too little was allowed to the powers of nature, which might be brought into action by a proper knowledge of the muscles which favour or oppose the reduction. The muscles which move the joints in a sound state, do not lose their power when the joint is luxated, but, on the contrary, are often spasmodically affected, and draw the bone out of the di- rection most favourable for its reduction. It becomes, therefore, a matter of accurate consideration, what muscles are likely to oppose the reduction of a joint; and these muscles will vary according to the direction in which the bone is luxated. Although a joint may have been luxated by means of considerable violence, it can by no means follow that the same degree of violence is necessary for its reduction. When a joint has been luxated, at least one of the bones is kept in that unnatural situation by the action of some of the muscular parts in con- nexion with it. We can not know whether the ligaments of the joints are broken or not, and this circumstance need not influ- ence our methods of reduction. All the force used in reducing a luxated bone, be it more or less, be it by hands, towels, liga- tures, or machines, ought always to be ap- plied to the other extremity of the said bone, and as much as possible to that only. In the reduction of the shoulder and hip-joint, the whole body should be kept as steady as possible. In order to make use of an ex- tending force with all possible advantage, and to excite thereby the least pain and inconvenience, it is necessary that all parts serving to the motion of the dislocated joint, or in any degree connected with it, be put into such a state as to give the smallest possible degree of resistance. In the reduction of such joints as consist of a round head, moving in a socket, no attempt ought to be made for replacing the head, until it has by extension been brought forth from the place where it is, and nearly to a 2H level with the socket. All that the surgeon has to do, is to bring it to such level; the muscles attached to the bone will do the rest for him, and that whether he will or not. Whatever kind or degree of force may be found necessary for the reduction of a luxated joint, that force must be em- ployed gradually; the lesser degree must always be first tried, and it must be in- creased gradually. They who have not made the experiment, will not believe to how great a degree a gradually increased extension may be carried without any in- juiy to the parts acted upon, whereas great force exerted hastily, is productive of very terrible and lasting mischief. Extension may either be made by means of assistants, who are to take hold of napkins or sheets, put round the part at which it is judged proper to make the extension, or else a multiplied pulley may be used. The first is the preferable method. The extension should always be first made in the same direction into which the dislocated bone is thrown; but in proportion as the muscles yield, the bone is to be gradually brought back into its natural position. The exten- sion will prove quite unavailing, unless the bone, with which the dislocated head is naturally articulated, be kept motionless by counter-extension, or a force at least equal to the other, but made in a contrary direc- tion. When the attempts at reduction fail, the want of success is sometimes owing to the extension not being powerful enough, and to the great muscular strength of the patient, whose muscles counteract all the efforts to replace the bone. In the latter case, the warm bath, bleeding, and other means of relaxation are to be employed; and some have even recommended intoxica- tion; but though a drunken man is some- times quit,e incapable of resisting any force applied to him, the propriety of this is very questionable, as the* same effect may be produced by more scientific and less immo- ral means. Long continued, unremitting, gradual extension, will at last weary out - the most powerful muscles; and this prac- tice is the most to be recommended. A dislocation is known to be reduced by the limb recovering its natural length, shape, and direction, and by the patient being able to perform certain motions, which he could not do when the bone was out of its place. There is a great and sudden diminution of pain; and sometimes the bone is heard to give a loud crack when going into its natu- ral position. After the reduction of a dislocated bone is effected, care must be taken to prevent a recurrence of the accident, by retaining the limb steady by appropriate bandages, which should be put as far as possible from the centre of motion. To the ankle and the wrist, splints may sometimes be necet. 252 SURGICAL DISEASES AND ACCIDENTS. sary. After luxations of the shoulder-joint, the arm is to be kept in a sling. If there is any appearance of inflammation or swell- ing taking place after the accident, or from the force applied in reduction, a cold lotion is to be kept to the place, and even leeches may be necessary, with a saline purgative. The patient must for some time be cautious in using the limb. Compound luxations are those which are attended with a wound communicating with the cavities of the injured joints. These injuries are often attended with very great danger, and much skill and judgment are required to decide upon the treatment im- mediately after the accident. So much in- jury may be done, that any attempt to cure it would soon be frustrated by violent fever, gangrene, and death; all of which may be prevented by the amputation of the limb. At the same time, it is to be remarked, that by proper care and judicious treatment, many apparently untoward cases may do well. The reduction of compound disloca- tions must be effected as gently and as quickly as possible. The wound is to be cleared from dirt or any extraneous matter, and its lips are to be brought together by adhesive plaster. The limb is to be bound with the proper splints and bandages, and to be kept cool by cooling lotions; and if there is much constitutional excitement, bleeding, large and general, is to be put in practice; and internal means are to be used for the diminution and cure of feverish symptoms, should any such present them- selves. S: line draughts and antimonial me- dicines must be resorted to, and purgatives also, provided they do not subject the pa- tient to too much motion of the injured part. If the febrile symptoms abate, and the local inflammation does not run to anv great extent, we may hope that the injury is to pass over without bad consequences; but the reverse may happen, violent inflam- mation may attack the joint, and be follow- ed by suppuration, and all the dangers and debilitating symptoms of hectic fever. While these continue it would be dangerous to attempt amputation; but we must wait till these symptoms abate, and then give the patient the only chance of saving his life. Having made these general observations on dislocations, and shown the principles on which they should be treated, it can hardly be considered necessary or proper, in a popular work, to enter on the minute de- tails of the symptoms and cure of every particular dislocation. For these we must refer to books of surgery. Dislocations or fractures of the limbs of infants sometimes happen in delivery. They ought never to be concealed or neglected, but the proper measures should be taken for their replacement and cure. Anchylosis. A stiff joint, most frequently owing to the smooth gristlfP covering which tips the ends of bones destined to move on each other, being eroded by disease, and the bones in consequence growing together This may arise from inflammation, and other diseased actions, by which the cartilages at the ends of contiguous bones are destroyed; and the bony parts grow together. A stiff joint may also be produced by the thicken- ing and adhesion of tendinous parts, but this is not the true anchylosis. When this affec- tion is complete, it is hardly possible to cure it; but it is to be prevented by remo- ving inflammation and other exciting causes; and in some cases, it is to be considered as a favourable termination of what would otherwise have produced a wasting dis- charge, or have required amputation, as in white swellings of the knee-joint. Stiff joints very frequently occur in old rheumat- ic and gouty cases. When the stiffness is not complete, attempts may be made by friction with oily and stimulant matters, as camphorated oil, oil of turpentine, a strong brine, or neat-foot's oil. Water, either warm or cold, poured from a height upon the affected joint is sometimes successful. When anchylosis cannot be prevented, it is important to place the limb in such a situ- ation as to be of most use to the patient, or at least to give him the least inconvenience after the joint is destroyed. Hence, the lower limbs should be kept extended, and the upper, especially the elbow, flexed. The joint of the wrist, when affected, should have the hand extended. White swelling. This is a very formida- ble disease, to which joints, but more espe- cially the knee-joint, are liable. It is called white swelling, from the circumstance of the colour of the skin not being altered, notwithstanding the increased-size of the joint. It occurs most frequently in scrofu- lous constitutions. At the commencement of the disease, the swelling is inconsider- able, and there is merely a fulness at the depression on each side of the knee-pan, which gradually spreads over the joint. Pain soon begins, and increases till the pa- tient is unable to bear the weight of the body on the diseased joint; he, therefore, gets into the habit of touching the ground only with his toes, keeping the knee-joint bent, so that it at last becomes incapable of being straightened. The joint, in time, ac- quires a great size, but the skin retains its natural colour, distinguished only by. its shining appearance, and by the large veins running through it. As the disease advan- ces, collections of matter form round the joint, and burst. Sometimes the ulcers heal, but more commonly other collections succeed. The constitutional disturbance is now great. The health is impaired, the appetite and sleep are bad, the pulse is small and frequent, there is obstinate diar- SURGICAL DISEASES AND ACCIDENTS. 253 rha«a, and profusf night sweats. Death, in no long time, happens, unless some means be taken to free the constitution from all this disease and irritation. If the swelling should be seen by the sur- geon when there is a degree of inflamma- tion present, it is to be treated by topical bleeding, and cooling lotions, accompanied by the antiphlogistic regimen, and saline purgatives. Cupping is a very good way of abstracting blood in this state of the dis- ease; but when the inflammation and ten- sion are very great, probably thirty or forty leeches are preferable. These measures are to be considered as applicable only to the inflammatory condition of the joint; but when that state is not present, such practice has no beneficial tendency, and no influence on the principal disease. A method of dis- cussing white swellings has been in many cases very successfully practised, viz: fric- tion with the hand, using no other medium than dry flour. This is to be done with considerable force, and for one or two hours at a time. Another essential measure, is to keep up a discharge from the surface of the joint by blisters, or by issues. It is advisa- ble to begin with a very large blister, com- pletely enveloping the whole circumference of the joint; when the blister heals, the part is to be strongly rubbed with some stimulating liniment, three or four times a day. If we prefer the employment of is- sues, one about the size of half-a-crown is to be made with caustic, on each side of the joint, and kept running by the application of stimulating ointments. Pressure also by adhesive plaster, and by oiled silk, has been recommended. During all our local treat- ment, much attention is to be directed to the constitutional symptoms, especially to the hectic fever, which is so commonly pre- sent. When the disorder of the constitu- tion is so great as to threaten life, or to pro- duce long and tedious ill health, it becomes necessary to amputate the limb; and the good effect of this operation is in many cases very wonderful. The irritation from the diseased joint is no sooner removed, than the constitution rallies; and the patient, who but lately seemed within a few days of his death, recovers his health completely, and has every prospect of a long life. Loose cartilages in the joints. Sometimes one or two pieces of cartilage, or of bone covered by cartilage, are found in the cavity of the knee-joint. They are generally flat and oblong, and have their edges rounded. They are commonly about the size of a horse-bean, often much smaller, and some- times considerably larger; when very large, they do not give so much trouble to the pa- tient as the smaller kind. From the irrita- tion of these bodies, the fluid which lubri- cates the joint is secreted in greater quanti- ty, the capsular ligament is distended, a degree of stiffness of the joint takes place, with more or less of external inflammation. Sometimes the symptoms are so mild as not to need an operation; but often, that is the only means of relief. Sometimes the ope- ration succeeds; but in other cases, severe inflammation and lameness ensue. As the danger of inflammation to the joint is very great, some have proposed to try a laced knee-cap, or a roller and compress, when the loose cartilage is so situated as not to occasion pain. In one case, this method was tried for ten years with complete suc- cess. Hip-disease. This affection is attended with considerable suffering; and, in many cases, it ends either in death or lameness. It most frequently attacks children under the age of fourteen; and generally, though not always, seems connected with scrofula. It comes on in a very insidious manner, be- ginning with a slight weakness and limping of the affected limb. These symptoms for a time attract but little attention; and are passed by as growing pains, or rheumatic affections, and as there is often an uneasi- ness at the knee, it is supposed that the principal complaint is there, and remedies are applied to it accordingly. These re- medies, though in themselves they do little harm, are bad, as they lead to the neglect of those measures which would be of service in the first stage of the hip-disease, but which would do little good at a more ad- vanced period. Besides this pain in the knee, there is often a pain in the groin, and this contributes to mislead the inexperien- ced practitioner still further from the real state of the disease. The symptoms which characterize the disease of the hip-joint when fairly present, are, a degree of ema- ciation of the leg and thigh, great pain when pressure is made on the front of the joint; the patient limps in walking, and there is a remarkable lengthening of the limb. The buttocks loose their natural ful- ness, and appear somewhat flattened.— Though the patient complains of pain about the knee, he can bear to have it moved about, but cannot suffer the same motion of the thigh without very great pain. The patient instinctively finds out the pos- ture which gives him least pain, and this is by leaning the weight of the body chiefly upon the opposite limb, while the thigh of the affected side is bent a little forward. The symptoms above detailed indicate the presence of inflammation; and if this is not checked, the next stage, or the formation of matter comes on. Sometimes there is swelling and redness of the skin, and a de- gree of inflammatory fever; at other times, matter forms without any very evident in- flammatory symptoms, and without showing itself by any fulness externally. The limb after some time i3 not longer, but shorter 254 SURGICAL DISEASES AND ACCIDENTS. than the other; the toes are turned inwards, and the leg is bent; while the thigh-bone is pushed upwards and outwards, in conse- quence of the destruction of the cartilages and ligaments, which should keep it in its proper cavity. When the disease of the hip-joint has existed for some time, it very generally brings on hectic fever; though, in some cases, the health remains unaffected for a considerable period. The disease of the hip-joint may be occa- sioned by external violence, as blows or falls; by exposure to cold or damp, or by lying on the damp ground; it occurs in scrofulous constitutions, but often appears without its being possible to assign any cause for it. In the early part of the disease, we are to enjoin complete rest, fomentations to the part, topical bleedings, especially cupping. Such treatment is more particularly proper, when the symptoms of active inflammation are present; but when these have abated, the best treatment is to form an issue with caustic, behind and below the part of the thigh-bone which is felt to project at its up- per part. The issue should be of the size of a half crown-piece, and will require to be kept open a very long time. Attention is to be paid to the general health; bark, and a nourishing diet are to be given as the strength requires, and the digestive or- gans and bowels are to be carefully regula- ted. Sometimes, after long and tedious confinement, the disease is removed; but at other times, either death, from wasting hec- tic fever, and destructive ulceration, takes place, or the joint becomes stiff and con- tracted, and the patient is lame for life, though the constitution, in general, may be in a healthy state. NOLI ME TANGERE. Touch me not. A species of disease af- fecting the skin and cartilages of the nose; very difficult of cure, as most applications seem to make it worse. It generally begins by small ulcerations on the side of the nose, which spread, and sometimes destroy a great part of it. A similar disease has been seen on the pectoral muscle; and in a few cases of long duration, without much in- flammation, the internal use of arsenic has seemed to be of some slight advantage. PHYMOSIS. Phymosis is a disease of the penis, in which the prepuce can not be draw n back, so as to uncover the glans. A chancre is the most frequent cause; but a mere inflam- mation and discharge from the glans and prepuce, and also a gonorrhoea, may bring on the disease. This state is frequently productive of bad consequences, especially when there are chancres behind the glans; for, the glans being between the orifice of the prepuce and the sores, the matter some- times can not get a passage forward, between the glans and prepuce, and, consequently, it accumulates, so as to form a kind of ab- scess, which produces ulceration on the inside of the prepuce. This abscess bursts externally, and, the glans often protruding through the opening, the whole prepuce becomes thrown towards the opposite side, and the penis seems to have two termina- tions. A phymosis should be prevented, if pos- sible ; therefore, upon the least signs of a thickening of the prepuce, which is known by its being retracted with difficulty and pain, the patient should be kept quiet; if in bed, so much the better, as in a horizontal position, the end of the penis will not be so depending. As when there are sores, they cannot be dressed in the common way, injections must frequently be thrown under the prepuce, or the operation for phymosis performed. Mr. Hunter advises mercurial injections; either crude mercury rubbed down with a thick solution of gum arabic; or calomel with the same, and a proportion of opium; or else a solution of one grain of corro- sive sublimate in one ounce of water. Mr. Hunter also recommends the application of emollient poultices, with laudanum in them, and, before putting them on the part, to let it hang over the steam of hot water, with a little vinegar and spirits of wine in it. When the inflammation has abated, he advises moving the prepuce occasionally to prevent its becoming adherent to the glans. He savs, he has seen the opening of the prepuce, so much contracted from the in- ternal ulcers healing and uniting, that there was hardly any passage for the water. If the passage in the prepuce, so contracted, be in a direct line with the orifice of the urethra, a bougie must be used. If other- wise, the operation of slitting up, or re- moving part of the prepuce, becomes ne- cessary. poLtrus. An excrescence growing in certain cavi- ties of the body, most commonly in the nose, or the uterus and vagina. They are often very troublesome and painful, alter- ing the shape, and impeding the functions of the part in which they are found. They are sometimes with a broad base or attach- ment, at other times they arise by a narrow- neck, and are very subject to bleeding. When cut, unless it be done very complete- ly, and even a portion of the healthy struc- ture taken along with it, they are apt to grow faster than before. They are often in such a situation that they can not safely SURGICAL DISEASES AND ACCIDENTS. 255 be cut, or have cJtostic applied to them; and the polypi most likely to be safely removed, are those which, having narrow bases or necks, allow of a ligature being put upon them, by which the influx of nourishment being prevented, they drop off. The clots of blood found in the cavities of the heart, after death, are called polypi. SARCOCELE. A scirrhous disease of the testicle, of which the first appearance is an enlarge- ment and hardness of the body of the testi- cle, without pain or inequality of surface, and occasioning little uneasiness, except by its weight. Sometimes, very soon after its ^ appearance, it becomes unequal and knot- ty, with acute pains darting to the loins and % back, but the skin still remains entire. Sometimes the disease produces a large foul ulcer with hard edges. r, Though the disease in some cases remains I quiet for a length of time, yet, in many jj| others, it becomes suddenly worse, and even fatal. It is now pretty generally admitted, that as soon as a patient is ascertained , to have a scirrhous testicle, the only safe plan is to have it removed. This, in gene- ral, relieves the patient; though, in some cases, the same disease may seize on other parts, and render the operation unavailing. SPINE. AFFECTIONS OF THE Curved spine. Distortion of the spine has of late years become very frequent, es- pecially in young females. Correctly speak- ing, it is oftwo kinds: 1. Lateral distortion, arising from weakness or rickets; 2. Dis- tortion forwards, arising from caries of the bones of the spine, or ulceration of the in- ter-vertebral substance. The lateral distortion is usually to the right side, and is the kind of curvature now K* most commonly met with. The first cir- I cumstance that attracts attention in a be- \ ginning curvature of the spine is, one breast JK appearing larger than the other, or so un- f equal as to lead to a suspicion that it is m growing out of its place; or the patient's m friends are struck by the right shoulder ap- K pearing enlarged, and farther removed from K the spine than the left. At the same time, there is generally an apparent enlargement of the left hip; so that the ordinary visible s effects of the lateral distortion are, such a ? change in the appearance of the right shoul- der, and hip on the opposite side, that mo- thers, in describing the state of their child, when the spine begins to be distorted, ex- plain it as a growing out of the right shoul- der, and of the left hip. In this condition, the patient, when in certain positions, ap- pears to have one leg shorter than the other; and in walking, there is a constrain- ed position of the head and neck, an incli- nation to one side, and also an inequality in the step. If, when these appearances present them- selves, the spine be examined, it will be found nearly in the form of an italic /, and perhaps with a slight bend outwards; and the whole of the right side will be of a rounded or barrel-like form, while the left is diminished and contracted, the ribs be- ing closer together than is natural. In the distortion forwards, the spine is bent forward, that is, from within outwards, (not laterally,) so as to form an angle pos- teriorly. In most cases of this kind of dis- ease in the spine, the lower limbs are soon- er or later affected with some loss of the power of voluntary motion, and ultimately with complete paralysis. The immediate cause of the lateral cur- vature is debility, however induced, and af- fecting more especially the muscles and ligaments of the back. This debility may be induced by the want of sufficient gene- ral exercise, and especially of that which acts more immediately on the muscles of the back,—by sitting long at work, or in practising on a musical instrument without artificial support,—by a habit of lounging on one leg,—by indulging much in sleep on a soft bed with a high pillow,—by the fash- ionable but pernicious attempts that are made to correct the figure, or to model it into a certain form, by corsets and other braces. The true cause of the distortion forwards, is a morbid state of the spine, or of some of the soft parts connected with it. The majority of those who labour under this kind of distortion are young children, and particularly those of a scrophulous habit; while the lateral curvature occurs most com- monly in young females of from fifteen to one and twenty years of age. The lateral curvature, arising from weak- ness, is always curable, if attended to in time. The indications of treatment are, to give due strength to the back, and whole constitution, by a proper and continued use of exercise and rest, nutritious food, and strengthening medicine. Gymnastic exer- cises are found to be of the highest value in this complaint. The exercise must be of that kind which will restore tone to a debi- litated frame, and, therefore, it must be re- sorted to daily, the' modes and degrees of it being varied and gradually increased, always stopping short of any particular fa- tigue. Friction and shampooing are species of exercise, and well adapted to this disease, since they have the power of giving tone to the back and general system, without occa- sioning fatigue to the patient. Therefore, in addition to the gymnastic exercises, gen- tle friction over the chest, spine, and limbs, should be practised once or twice a day. 256 SURGICAL DISEASES AND ACCIDENTS. Proper rest is of much consequence, be- cause the patient being weak and easily fa- tigued, if a state of comfortable rest were not observed at those times when the ne- cessary exercise is not resorted to, the weakest part would be likely to suffer from the effects of exhaustion and languor, and the spine, in consequence, to become more distorted. Occasional ease and rest should, consequently, be given to the muscles of the spine by the patient's lying down, either on an inclined plane or on a couch, and this she should do whenever she feels fatigued, or a want of such rest. It has been a very common practice of late years, to confine young ladies to the inclined plane, or to the couch, for months together, often without their being allowed to rise during any part of the day, and this wearisome rest alone has been considered sufficient to cure the distortion; but the practice is extremely ir- rational and injurious, and should never be followed in lateral curvature. It invariably injures the general health, and by augment- ing the debility of the muscles of the back and whole constitution, increases the curva- ture, and sometimes induces additional com- plaints of a serious nature. Sir Astley Coop- er relates the case of a lady who submitted to this vile practice for many months, and in the end rose without any favourable al- teration in the state of the spine, but with a disease in the bladder, which afterwards spread to the womb, and proved fatal. Mr. Abernethy also objects to a state of constant recumbency, and to laying down in any constrained attitude. He savs, "I would by no means deprive the patient from ta- king that degree of active exercise which is conducive to health." Patients afflicted with the present complaint should have rest, but it should be only occasional rest, taken at any time in the day that they find a need of it, and not continued so long as to interfere with the necessary exercises, or to injure the general health. The best thing for the patient to repose upon is a moder- ately hard hair mattress, which may be pla- ced on an inclined plane, if preferred. The food should be of a mild nutritive quality, consisting chiefly of broiled mut- ton, or lamb chops, tender roast beef, fowl, venison, eggs, biscuit, tea, cocoa, or thin chocolate, the most digestible vegetables, but neither spirits, wine, nor malt liquor. Salubrious countiy air is highly advisable. Sometimes the administering of steel, or vegetable bitters will assist the foregoing means. The bowels must be carefully re- gulated by the occasional use of a gentle laxative. Whenever there is an appearance of scrophula or rickets in the constitution, tonics, especially steel tonics, will be clear- ly indicated; and sometimes a tepid bath, of about ninety degrees, may be taken twice a week with great advantage. Caries of the spine. T^pis is a very com- mon complaint in early y-outh. It arises sometimes from scrofula, or rickets, some- times from blows or other accidents, and frequently from sedentary employments, or being too much confined to one posture, as frequentjy happens to children whose edu- cation is forced on with to^ great rapidity. It is also a consequence of too rapid growth of the trunk of the body. The patient at first has listlessness, lan- guor, and want of appetite; no complaint is made of any particular part; but, in a short time the legs begin to fail. On stand- ing, the knees involuntarily bend forward, and in walking, the legs cross each other. There are now cramps or pains in the thighs and legs, and afterwards the power of feeling and motion are lost. These symp- toms, at first, are supposed to arise from debility; but when more particular examina- tion is made, the spine is found to be in some degree distorted. The curvature is most commonly from within outwards, but sometimes on one side. In the latter case, however, there is generally a double curva- ture: for, if the first deviation is unnoticed, the patient, to relieve himself from an un- easy position, rests chiefly on the opposite side, and this posture produces the second $ curvature. The complaint originates from | a disease of the cartilages and ligaments, communicated to the bones; it appears to be the languid inflammation of scrofulous ha* J bits, and to terminate in caries. The start- £ ing of the vertebrae from their proper line seems to be owing to the unequal erosion, and, of course, to the want of a uniform support. *_ While the state of the general health is |fl attended to by general remedies, not only | with a view to the debility, but to the scro- -^ fulous habit, the particular care of the sur- geon must be directed to the curvature; and the best means of relieving it is the plan suggested by Mr. Pott, in procuring a M considerable local discharge on each side, l| as near the curvature as possible, but be- 't™ yond the spinal processes of the protruded bone. Tenderness in this case is cruelty; and the issue made either with the knife or the caustic, should be large enough to con- tain a horse-bean. If the curvature be considerable, the size of the issue should %£ he increased. The discharge should be continued till the complaint is in a great , measure relieved, and the degree of amend-- 'M ment may be judged of by that of the gene- M ral health. During the continuance of the J| discharge, the complexion becomes clearer, the appetite is improved, the general strength is increased; sensation and motion \ are gradually restored. It has been sup- } posed that the curvature may be reduced f by this measure; we dare not deny that it * will be lessened, but we have never found / SURGICAL DISEASES AND ACCIDENTS. 257 it so in any considerable degree. The chief effect is to relieve the inflammation of the bones and cartilages. The curvature may be prevented from increasing during the action of the drains, and possibly, at last diminished by the use of machines, con- structed by artists on proper principles. After the inflammation is checked, sea- bathing may be ordered; during which the issues are to be covered with leather, se- cured by a margin of sticking plaster. Divided spine. A swelling on the spine of new-born children, at the lower part of the loins, at first of a bluish colour, but at length becoming paler, and then transpa- rent. It is generally attended with a weak- ness or palsy of the lower extremities. Some have opened the tumor, but with very bad success, as the infants have died imme- diately. Whether the tumor be opened or not, it is a very fatal disease, few children affected with it living above three years. The only method that appears to have been at all serviceable, is pressure gradually and permanently employed; or evacuating the fluid by small punctures, and afterwards inducing such a degree of inflammation as to obliterate the cavity. SPRAIN. A sprain is an injury done to the neigh- bourhood of a joint, generally the wrists, knees, or ankles, and usually occasioned by a slip or some sudden and violent exertion. Sprains are commonly productive of a pain- ful and inflammatory swelling. There is generally an effusion of serous fluid, from the rupture of exhalant vessels; but some- times the swelling is discoloured, from blood being effused. In sprains, we are to en- deavour to prevent the parts from swelling much, and to check the inflammatory tend- ency. Both of these ends may be in a great degree obtained, by the application of cold and astringent lotions, such as vinegar and water, spirits and water, solution of muriate of ammonia, or of sugar of lead, cold water, &c. We are also to apply leeches to the part; and to give cooling laxatives. If the injury has been very severe, and has induced general fever, we may take blood from the arm, and employ active purgatives; continuing the cold applications. When the inflammatory symptoms of sprain have gone off, the part is to be rubbed with some liniment, as camphorated oil or vola- tile liniment; and it is in many cases useful to pour cold water in a stream from a height on the joint which remains stiff. ULCERS. A chasm or vacancy formed on the sur- face of a part, whether external or internal, by the absorbent vessels removing a part of the solids. Ulceration takes place more readily in the cellular and fatty substance, than in muscles, tendons, blood-vessels, and nerves. There are many varieties of ul- cers, requiring a corresponding variety of treatment. Simple purulent ulcer. Some ulcers are covered with matter of a white colour, of a thick consistence, and~which readily sepa- rates from the surface of the sore. There is a number of little eminences called gra- nulations, which are small, florid, and point- ed at the top. As soon as they have risen to the level of the surrounding skin, those next the old skin become smooth, and are covered with a thin film, which afterwards becomes opaque, and forms skin. The principal thing to be done in the treatment of this kind of ulcer, is to keep the surface clean, by putting on a little dry lint, and a pledget over it, covered with very simple ointment. In some patients, ointment irri- tates and inflames the neighbouring skin. Bandages sometimes irritate the sore, and disturb the healing process; but when they do not, they are useful in giving a moderate support to the parts, and in defending those that are newly formed. Ulcers in weakened parts. Other ulcers are in parts which are too weak to carry on the actions necessary to their recovery. In them, the granulations are larger, more round, and less compact than those formed on ulcers in healthy parts. When they have come up to the level of the healthy parts, they do not readily form skin, but rising still higher, lose altogether the power of forming it. When the parts are still weaker, the granulations sometimes fill up the hollow of the ulcer, and then are sud- denly absorbed, leaving the sore as deep as ever. Ulcers are very much under the in- fluence of whatever affects the constitution; and change of weather, emotions of the mind, and some other agents, quickly occa- sion a change in their condition. Such ul- cers as we have been describing; require general as well as local treatment; bark, nutritious diet, and tonics are to be given; and the granulations are to be kept from rising too much, by the pru- dent application of blue vitriol, lunar caus- tic, and the like, weakened sufficiently by proper admixture of ointment to act as stimulants, and not as caustics. This will give a proper and healthy action to the granulating surface; whereas the destroying of the rising parts by escharotics seems ra- ther to encourage the growth. Bandages and proper support to the parts, are highly useful. These ulcers, in weak parts, do not seem to be the better of poultices, or other relaxing applications; powders rarely do good, and perhaps the best dressing is the citrine ointment, more or less diluted. Irritable ulcers. There are certain ulcers, 258 SURGICAL DISEASES AND ACCIDENTS. which may be called irritable ulcers. The margin of the surrounding skin is jagged, and terminating in an edge which is sharp and undermined. There is no distinct ap- pearance of granulations, but a whitish spongy substance, covered with a thin ichorous discharge. Every thing that touches the surface gives pain, and com- monly makes the ulcer bleed. The pain sometimes comes on in paroxysms, and causes convulsive motions of the limb. Such ulcers seldom do well, without a frequent change*of treatment. Fomentations with poppy heads, chamomile flowers, or hem- lock leaves, are sometimes of use in irritable ulcers. When poultices are prescribed, they should never be allowed to rest or bear weight on the sore limb. Powdered applications are generally too stimulating for irritable ulcers, and bandages also prove hurtful. Indolent ulcers are those which have the edges of the surrounding skin thick, pro- minent, smooth, and rounded. The surface of the granulations is smooth and glossy; the matter is thin and watery, and the bot- tom of the ulcer is nearly level. A great proportion of the ulcers in hospitals are of the most indolent kind. Indolent ulcers form granulations, but frequently they are all of a sudden absorbed, and in four and twenty hours, the sore becomes as much increased in size as it had been diminished for many weeks. The principal applica- tions required for indolent ulcers are those of a stimulating nature, as the basilicon ointment, and occasionally sprinkling with red precipitate. Pressure is to be made by a roller, and by slips of adhesive plaster. Scrofulous, syphilitic, and cancerous ulcers are to be treated according to the methods laid down under these various diseases. URETHRA. STRICTURES OF THE The membranous canal continuous to the neck of the bladder, by which the urine is evacuated from the body. It is very short in women. In men, it passes through the prostate gland which surrounds the neck of the bladder; there are openings into it from the prostate gland, and the receptacles of the seminal fluid. The passage is lined with a smooth and sensible membrane. The urethra is liable to various diseases. It is affected with pain and scalding during the acute stage of gonorrhoea; and there is a considerable discharge of thick yellow mat- ter from it. This, in many cases, afterwards degenerates into gleet, which is best re- moved by astringent injections. Stridures in the urethra. These are of three kinds. 1. That which arises from an alteration of the structure of the passage. 2. That arising partly figpm altered struc- ture, partly from spasm. 3. That arising from spasm. In all these cases, the stream of water becomes small, in proportion to the obstruction. As the disease advances, the urine is voided more frequently, with considerable effort, with pain, and a strain- ing sensation after the bladder is emptied. Cold is very apt to increase the symptoms which occur when a part is strictured, and to obstruct the flow of urine altogether for a time. If the stricture be not relieved, a swelling may take place from the lodging of the* water behind it; and this, by the pressure and acrimony, may give rise to-in- flammation and ulceration, and the forma- tion of fistulous openings in the perineum. Various methods have been proposed for the cure of strictures. The one most pro- per to begin with is, to attempt to dilate the passage by the insertion of bougies, or cylindrical waxed rolls of linen, beginning with one of a small size, and gradually coming to use one of a larger size. These bougies either dilate the stricture, or make it ulcerate. Their use must be persevered in for a considerable time. But it may hap- pen that the urethra is contracted at differ- ent parts of the passage, in which case the cure is, of course, more difficult and uncer- tain. Another method of destroying stric- tures has been, to introduce a small portion of some kind of caustic, in order to act as an escharotic. Different caustics have been proposed, but none of them should be employed, except under the superintends ence of a skilful surgeon. In the pain of passing water which accompanies stricture, as well as some other affections of the uri- nary organs, the tincture of muriate of iron, given in doses of ten drops every ten mi- nutes, till some sensible effect is produced, has seemed to act beneficially. A stone striking in the urethra, is attend- ed with very painful symptoms; inflamma- tion, swelling, and a suppression of urine, more or less complete. If the stone does not pass, or if it is not extracted, there is ulceration of the urethra, the urine escapes into the cellular substance, and great swel- ling or gangrene of the parts may be the consequence. The removal of a stone from the urethra is to be attempted by relaxing the parts, and the whole body, by the use of the warm bath, or by general or topical bleeding, and by opium applied externally, or taken by the mouth. In this way, a stone may be sometimes made to pass, when aided by skilful pressure from behind. If these methods do not succeed, it is neces- sary to cut down upon the stone, and so re- move it. The female urethra is very dila- table, and large stones have been known to be brought through it, SURGICAL DISEASES AND ACCIDENTS. 259 TBflg VENEREAL. This formidable and loathsome disease is generally the consequence of impure sexual intercourse; but in the various and compli- cated relations of society, it may be in many cases received Very innocently. This dis- ease is owing to a poisonous matter intro- duced into the system by absorption, and thus producing more poisonous matter, which, in time, corrupts the fluids, and oc- casions many disorders in the various parts of the body. The symptoms of syphilis are either primary or secondary. I. Primary symptoms. The primary are those which appear in the near vicinity of the place to which the matter has been ap- plied, and which appear not long after its application: the secondary are those which occur in distant parts, and which, in some instances, do not show themselves for a very long- period. As the infectious matter is commonly received by impure connex- ion, the first symptoms generally show themselves on the genital organs, in the form of chancre; by which is meant, an ul- cer considerably inflamed and painful, un- equal at the bottom, with prominent edges of an ash colour, having-little tendency to heal, but rather continuing to spread, if left to itself. The matter being taken up by the absorbents, is carried by them to the nearest glands; these glands are irritated, become inflamed, swelled and painful, and go on to suppuration: when in the groin, these swellings are termed buboes. If the syphilitic matter be applied to the hand, as may happen when a surgeon having a slight cut or scratch, gets some of it from dressing a venereal sore; or to a patient, from being bled with a lancet which has opened a bu- bo, or to those who wash the clothes of in- fected patients; in all those cases, the same symptoms ensue, and the glands in the arm- pit are the seat of swelling and suppuration. Sometimes, nurses get the syphilitic infec- tion from suckling children who have been born with the disease, and in them it ap- pears on the nipples; and the glands of the arm-pits swell. If the matter be applied to the lips, the glands of the neck swell. The symptoms, above mentioned, viz: chancre and bubo, are to be regarded as the primary and local symptoms of the venereal disease, and the constitution may be still unaffected; but unless these are checked by the proper remedies, the poison may pervade the sys- tem, and produce other bad effects. II. Secondary symptoms. In whatever way the matter has entered, it is particularly ready to attack the throat. In this kind of sore throat, some uneasiness is felt in swal- lowing, and there is a sensation of fulness and tenderness, without much pain When the throat is examined, an ulcer is in most 21 cases observed, generally on one of the ton- sils or almonds of the ear, but sometimes on the uvula. These ulcers are small at first, but sometimes quickly spread, and destroy a portion of the contiguous parts; from the first, they are foul, and have a degree of fulness and swelling, with an erysipelatous redness of the neighbouring parts. Some- times these are dark copper-coloured spots on the throat, continuing for weeks-. A troublesome attendant of the sore throat is the constant heat and irritation of the parts,. with the formation of acrid tough mucus, which gives the patient much trouble to get it thrown off'. Deafness is not an unfrequent accompaniment of the sore throat. Some- times, when the disease has been neglected, or when the remedies do not succeed, the ulceration spreads beyond the soft parts, and destroys the bones of the p.date, and back parts of the nose. Next to the throat, the nose is most liable to be attacked by the venereal disease. The patient complains of a stoppage in one of the nostrils, with tenderness and pain at a particular point. When this point can be seen, it is found to be covered with a slough or crust, with a foul sore beneath. There is a discharge, which increases, as it con- tinues, and is thin and ill smelled. If the thin spongy bones of the nose become af- fected, the matter becomes blackish, and the smell is very offensive. Portions of the bones come away, and, in time, the figure of the nose is changed; at first, by the exter- nal parts becoming red and swelled, over the ulcerations; and then by the bones coming away, it loses its prominency, to the great disfiguring of the patient. Ulcers also take place on the palate and other parts of the mouth; and the destruction occasioned by their progress in the parts necessary for the formation of the voice, occasions a total loss of the power of modulating it. The skin is the part next most liable to be affected by the venereal. On the skin, there appear eruptions or blotches, chiefly on those parts which are generally kept co- vered, as the breast and arms; and succes- sively, on the shoulders, thighs, legs, feet, and hands. These blotches are not painful at first, but have a slig-ht degree of itchiness. They are of a pale red colour; and some- times disappear for a time, and again either attack the same parts, or g'o to others. The skin is now inflamed and tender, and a scab or crust forms on the parts. When ulcers attack a person who is tainted with the ve- nereal poison, they are generally of abad and eating nature, destroying a great deal of the surrounding- parts. In advanced stages of the disease, the bones of the extremities and of the forehead are liable to be affected with swelling, and hard unequal knotted appear- ances. The hair fails off, blindness attacks 260 SURGICAL DISEASES AND ACCIDENTS. the patient, and a variety of maladies assail him, which destroy life in misery and putre- faction. Cure of the venereal. Nothing could ex- ceed the alarm and dismay occasioned in Europe, by the wide-spreading ravages oc- casioned by this disease, shortly after its appearance in 1493; and it was not till a considerable number of years afterwards, that the casual coincidence of its occurring in certain persons, who were treated by mercury for diseases of the, skin, and who were cured of both complains by that mine- ral, led to the discovery that it was capable of safely and completely curing lues vene- rea. From that time, this dreadful scourge was divested of the terrors excited on its first appearance; and physicians, till within these few years, have been quite confident of safely curing the vast majority of vene- real cases by the prudent use of mercury; but of late, it has been suggested, that the dreadful havoc made on the constitution is not the effect of the venereal poison, but of the combination of it with mercury. It has been proposed in consequence, and very many cases have done well, to cure the venereal without mercury at all. It is not easy to get rid of the conviction impressed on the mind, by the recorded experience of able and upright physicians during three hundred years; nor to forget what we have observed in our own practice; we can not, therefore, as yet, discard mercury as unne- cessary, or condemn it in all cases as perni- cious. We must here premise, that there are some constitutions to which mercury is pe- culiarly adverse, and in which syphilis ap- pears to gain ground under almost every manner of administering it; and also, that the rapid, violent, and long continued sali- vations, at one time too common, were ex- ceedingly likely to inflict irreparable injury on the constitution. But the skilful and prudent exhibition of that active and impor- tant mineral is calculated with ease and safe- ty to cure the disease in every stage, both primary and secondary; and to guard the constitution from all those hateful effects, of which the early writers give such just and affecting details, in works which were writ- ten before mercury was employed in its cure. 1. Chancre. If a chancre has been seen by the surgeon when recent, it is to be treated by local applications; it is to be dressed with simple cerate, and if it be touched with lunar caustic, it will the sooner put on a healthy action. It may happen, that the application of the caustic will cause a swelling in the groin, which may be mistaken for true bubo; but this will go off when the irritation from the caustic subsides, or it may be kept back by cooling lotions. Nearly the same treatment will answer even somewhat later; but it will be a matter of precaution jo bring the sys- tem in a slight degree under the influence of mercury, until after the chancres have healed. 2. Bubo. When we find that we cannot prevent the formation of a bubo, by leeches and cooling applications, our best plan is to bring it forward to a kindly suppuration by emollient poultices; and when it is ripe, to open it with a lancet, like a common ab- scess. It will be still more necessary now to put the system under the influence of mercury; though there is no occasion to use it with the rapidity and violence for- merly too common. In scrofulous consti- tutions, buboes are sometimes the com- mencement of extensive ulcerations, which are very^painful, and discharge a very acrid matter. The pain is to be alleviated by washing the parts with a decoction of poppy heads, and afterwards applying some emol- lient plaster. If there be a tendency to fungous growth, it may be proper to sprin- kle a little red precipitate of mercury, and to dress with basilicon or other stimulating ointment, till a better action is put on by the parts. Internal medicines are neces- sary, as sarsaparilla, or the nitric acid; and unless there are urgent symptoms of the original disease threatening the destruction of important parts, it will be prudent to sus- pend the use of mercury by the mouth, or rubbing in. If the constitution be feeble, bark and wine, and other tonics are to be given; and irritation is to be allayed by the use of opium or hemlock. 3. Constitutional symptoms. These are so many and so various, that it is needless to enumerate them again, since for each of them, mercury is the principal remedy; and the skilful exhibition of it, and the applica- tion of appropriate remedies to local symp- toms, are the great instruments we employ. Gargles and washes are to be used for the throat, dressings for ulcerations, and sudo- rifics for the skin; all in addition to the mercurial course, which, in different cases, will require to be continued for various lengths of time. Under the article mercury, we have men- tioned the symptoms occasioned by its use, and the proper method of conducting a mer- curial course; and it is one mark and evi- dence of the improved condition of medical science and practice, that the tedious, de- bilitating, and dangerous courses of mer- cury formerly in use, are now altogether laid aside. The unpleasant consequences arising from mercury improperly adminis- tered, naturally excited many a wish that some other medicine might be discovered, free from the inconveniences of mercury; and accordingly many articles of the Mate- ria Medica have been successively brought forward, and many virtues ascribed to them in the cure of the venereal. Some of them may, SURGICAL DISEASES AND ACCIDENTS. 261 no doubt, be useful auxiliaries, and some of them may give relief in certain symp- toms, as opium, sarsaparilla, the nitric acid, and some others; but for real curative pow- ers, nothing can be compared with mercury. Whether the modern method of curing the disease without mercury at all, will be found to answer, in all cases, must be left to time. WARTS Are excrescences from the skin, having their surface pointed or granulated, some- times being very painful when rubbed, and liable to bleed when touched. Young peo- ple are sometimes much infested with them, and as they appear in great numbers about the hands, they are very anxious to get rid of them. Sometimes they go off of them- selves, and leave the skin quite clean; but it is generally necessary to adopt some means for their speedier removal. This is not very difficult; some stimulant application, as "avine ointment, or blue vitriol, or lunar caustic, or potash, will answer the purpose; and it is proper first to pare off the tops of them, to let the stimulant reach the sensi- ble surface. When they are removed by the knife, it is necessary to apply caustic to destroy their roots completely. When warts have a narrow neck, a silk thread or horse-hair may be tied round them, and they will drop off in a few days. Warts are of- ten a sequel of venereal complaints. They are to be cured by the remedies suited to the original disease; and they may be rubbed with red precipitate ointment, or some other stimulant application. WASP STING. These insects seldom sting unless irrita- ted; but when they do, the injury they in- flict is accompanied with a sharp pain, fol- lowed by inflammatory swelling in the neighbourhood, which occasionally extends over the whole limb. It generally ceases of itself, but may be relieved by the appli- cation of hartshorn, or spirits of wine, or other cooling lotion. If a person has been stung by a great many wasps, as sometimes happens when they are irritated by the de- struction of their nest, a considerable de- gree of fever may be excited, and this will require some cooling medicine, and the application of oil to the inflamed parts of the body. WEN, Is the common popular name for any ex- crescence or tumor, growing on any part of the body, most frequently applied to tu- mors about the throat and neck. Tumors are distinguished by surgeons, according to the nature of their contents; and they re- quire treatment varied according to circum- stances. Sometimes wens are attached by a narrow neck, and may be removed by the knife, or by ligature; at other times, they have a broad base, and are so supplied with large blood-vessels, that they cannot be re- moved at all, or cut without the utmost risk. Sometimes tumors are filled with a curdy or cheese-looking matter, and are contained in a cyst, or bag, which may be dissected out along with its contents, and the cut'skin will heal, and leave very little deformity; in other cases, the tumor is fungus hcema- todes, or bloody cancer, which pretty cer tainly destroys the patient. The broncho cele, or goitre, is to be treated with iodine ointment, and the tincture of iodine internal- ly ; the vessels that go into it are so large and numerous, that an operation can rarely be performed there. Sometimes very large wens contain a mixed substance resembling fat or marrow; they have a firm fleshy feel, and sometimes attain an enormous size. Sir * Astley Cooper removed from the abdomen of a man, a fatty swelling, which weighed, independently of the blood in it, thirty-se- ven pounds, ten ounces. WHITLOW. An inflammation or suppuration at the last joint of the fingers; but the toes may also be the seat of whitlow. There are se- veral kinds of whitlow, the peculiarities of which are oy/ing to the different depths of the parts which are the subjects of the dis- ease. 1. The suppuration may take place merely beneath the outer skin, in which case the disease spreads a considerable way round the joint. If the abscess takes place under the nail, the pain is very severe. Emollient poultices, and giving vent to the matter, seem to be alone required in this kind of whitlow. 2. The inflammation may occur in the cellular substance of the point of the finger; in this case, the pain is con- siderable, and the swelling advances more slowly. The pain may extend a consider- able way up the arm. Sometimes consti- tutional symptoms arise in this kind of whit- low; and it is necessary to use bleeding, and the other parts of the antiphlogistic regi- men. Bleeding by leeches, and dividing the skin over the pained part by a crucial incision, may sometimes relieve the pain, and prevent the suppurationi If we find that we are not likely to do this, we must promote it by emollient poultices and fo- mentations, and open the abscess as soon as it is ripe. 3. A third kind of whitlow is marked by the most acute pain, which ex- tends to the hand, the wrist, the elbow, and even the shoulder. With all this severe pain, there is little swelling in the affected finger; and even when matter is formed, the 262 SURGICAL DISEASES AND ACCIDENTS. fluctuation of it cannot be perceived at the finger, though it may sometimes be felt at other parts of the hand'and arm. This is owing to the inflammation of the finger be- ing seated in the sheath of the tendons, Which, being strong and unyielding, are painfully stretched, but do not allow the matter to be felt under them. In this case, we must not wait till we can feel the fluc- tuation of matter; but we must cut deeply down through the sheaths of the tendons; and also in other parts of the hand and arm, we must make incisions, if the pain in those parts is not relieved by the opening we first made. 4. The fourth species of whitlow is that in which the periosteum, or the mem- brane covering the bone, is inflamed. The pain is here very acute; and as the disease advances, the bone itself is affected with caries. Here early incisions, quite down to the bone, are necessary; and when these have not availed to prevent the caries of the bone, it will be necessary to amputate one or two joints of the finger. Vror/ffDS. Are divided into various classes, accord- ing to the nature of the instrument with which they are inflicted, and the effect pro- duced. They may be all included under the head of gun-shot wounds, simple incised wounds, lacerated or contused wounds, and punctured wounds. . 1. Gun-shot wounds. These include not only the injury inflicted by bullets, balls, and the like, but those also which are occa- sioned by the bursting of bombs, shells, and the flying about of splinters, fragments of stone, &c. It is now acknowledged, that the violent injuries inflicted by fire-arms, depend solely on the weight, bulk, and ve- locity of the substance impelled, and have no connexion whatever with burning or poisoning from the explosion of the pow- der. A shot may occasion merely a contu- sion, or it may penetrate the surface, and lodge in a part; or it may pierce through and through, or a very large shot may tear off a limb. These different effects may be combined with the shattering- of bones, or the wounding of vessels, or the lodgment of foreign bodies. When a shot has been received on any of the extremities, the first thing for the surgeon to consider is, whether he will at- tempt to save the limb, or whether it be necessary to amputate. He is then to con- sider the propriety of immediate amputa- tion, or if it should be delayed; and the skill and too ample experience of modern sur- geons has ascertained, that in a great ma- jority of cases, if amputation is necessary at all, immediate amputation gives the patient the best chance for his life. The following are some of the cases in which immediate amputation is necessary. 1. When a limb is torn off. 2. When the bone and other parts are much shattered. 3. When much of the flesh and soft parts are torn away, or when the large artery of the limb is wound- ed t 4. When the muscles and nerves arc much injured. There are* other circum- stances to be taken into consideration, as whether the patient is likely to be taken with proper care to an hospital, whether the wounded must be left on the field, &c. When amputation is not to be performed, the wound is to be treated on general prin- ciples; foreign bodies are to be extracted, and incisions made where necessary, to get either at the ball, or at any foreign body. It was at one time recommended, uniformly to make incisions to dilate gun-shot wounds; but this is found not to be at all necessary as a general rule, as these incisions must add to the pain and irritation which are al- ready very great. We must not even be too anxious about getting out every foreign body, or even the ball, when to da this is very difficult; as it is probable that a Ttfp- puration will come on, and contribute to their discharge. The course and contents of the wound, when it is large enough to admit the finger, are better examined by it than with a probe or other instrument. When extraneous substances do not bring on suppuration, so as to bring them into view, and render them easily extracted, they often give rise to a fisuilou :ulcer. Sometimes balls and other bodies get into a place where they do no injury, and re- main during the patient's life. It is an im- proper practice to put tents into gun-shot wounds. The first dressings should be mild, unirritating, and superficial; and to promote the separation of the bruised-and dead parts, and to assist in removing the tension and swelling, emollient poultices and fomenta- tions are to be employed ; the application of leeches is also very proper, and for the general system, we must observe.the anti- phlogistic regimen. From the bruising and compression of the parts, there is often but little bleeding at the first, and we are to watch for a more sudden bleeding when the sloughs drop off; and, therefore, when the v/ound is near the tract of any large vessel, we should be prepared for this event, and have every thing in readiness for stopping bleeding. Care should always be taken not to remove the dressings teo has- tily. If the wound does not heal, but con- tinues long to discharge matter, occasioning a wasting of the body, with hectic fever, and other dangerous symptoms, amputation then becomes necessary to save the life of the patient. The following remarks on gun-shot wounds, from the lectures of Mr. Aberne- thy, are judicious and sufficiently charac- teristic: SURGICAL DISEASES AND ACCIDENTS. 263, " I now come to^eak of gun-shot wounds, and this is a kind of wound attended with the greatest possible contusion. The prac- tice in France, in Louis the Fourteenth's time, was to slit open the wound in its whole length, in order to give exit to any blood or matter—nay, they put setons through the wound. Mr. Hunter very much simplified the surgical practice in gun-shot wounds, and used, as well as recommended in his lectures, a soothing plan of treatment. Of course they are to be treated upon the com- mon principles of surgery. In speaking of gun-shot wounds, the question is whether the ball has gone through or not, and this creates considerable anxiety to the relatives —rif with a probe you can feel wadding, clothes, or the ball, why common sense would tell you to take it away; but common sense will equally tell you, not to be poking about, and being over curious, for you can not tell where the ball is gone to. It is re- ally curious the course which balls will sometimes take; and it is founded on the laws of projectiles—a ball may strike on the abdominal muscles, and go out through the other side. It is within the compass of ^ possibility that the ball may pass in at the .$ belly, and by passing quite round, may p come out at the same wound. When 1 was an apprentice, I recollect a case which made some impression on me. My master j was gone out of town, and I was called up from my bed one night to a man who had shot himself through the temple. When I arrived, there was a hole in the right tem- ple, where the ball had gone in, and one on the opposite side, where, I took it for granted, it had come out. I, of course; thought the man was shot clean through the brain; but he retained his senses, and had all his faculties about him. This was puz- zling enough in all conscience; but as I wished to be doing what I thought right and proper, I bled him, and ordered his head to be shaved—the course which the bullet had taken was then apparent enough, for it had travelled under the scalp, and had passed out at the opposite side, and the track of the bullet was indicated by a red line running all over the scalp. One of the strangest cases of bullet-travelling was rela- ted by Sir James Eaiie—the bullet went in under the blade-bone, and came out at the loins on the opposite side. Great stress is always laid on the necessity of extracting the ball. Nay, in almost every novel, where a duel is often the consequence of rivalry in love, do we not read that ' Sir Harry has been wounded, but the ball was extracted, and that Sir Harry was expected to recover.' "All gun-shot wounds being very likely to produce sloughing, you should guard yourself by a double prognostic; for al- though no injury may be apparent at first, yet sloughing of an artery may happen, and destroy the patient by sudden hemorrhage. A sailor was found dead in his bed one night, and the bed half full of blood—the femoral artery had been slightly grazed, and had sloughed—at first, however, the case, to all appearance, was going on fa- vourably, being a slight and trivial gun-shot wound. " Poultices are good in gun-shot wounds —and great care is to be taken that the di- gestive organs are tranquillized. In super- ficial gun-shot wounds, as a line of demar- cation is set up, it will not be so difficult to trace out the bullet; but in deep-seated wounds of this nature, I again caution you not to be poking for bullets, as great irrita- tion is brought on thereby." II. Simple incised wounds, or cuts, are those which are inflicted with a clean cut- ting instrument, and they are to be con- sidered as the most favourable kind of wound. When the bleeding has stopped, the edges of the wound are to be brought together, and kept so by straps of adhesive plaster, or, in some situations, by one or two stitches; and when this apposition has been carefully made, such wounds gene- rally heal very quickly, without any suppu- ration taking place. HI. Lacerated and contused wounds, are those where thereTias been much tearing and bruising of the soft parts; they heal less kindly, and suppuration is almost always a stage of the process. When a part is torn, we are to place it in its natural situation, and retain it there if possible; but if there- appears little likelihood of its uniting again to the neighbouring parts, it is better to re- motive it; and we are to diminish the swel- ling and inflammatory symptoms which commonly attend contused wounds, by cooling lotions, or by emollient poultices. IV. Punctured vjounds, are such as are inflicted with a pointed instrument, as a thrust from a bayonet, a short sword, a gra- ver's tool, or the like.. The first thing to be guarded against in such wounds, is the coining on of inflammation. If there has not been much bleeding from the wound, we may take blood both generally and lo- cally, and we are to employ the'antiphlo- gistic regimen. Punctured wounds on the scalp, over tendinous places, or parts which are thinly covered, as the bones of the leg, are apt to be followed by an erysipelatous inflammation of the skin. It may sometimes be necessary to enlarge the wound a little, in order to remove the stretching of the parts; and to lessen the inflammation, leech- es and fomentations are proper. WRY NECK. A long continued or permanent turning of the head to one side. It is different from 264 SURGICAL DISEASES AND ACCIDENTS. the pain and stiffness which occur from cold and rheumatism, and which prevent the free motion of the head; and arises from various morbid conditions of the part, either from distortions of the vertebrx, from palsy of some of the nerves going to the muscles that move the head, or from some altered structure of the muscles themselves. The removal of this affection, when possible, is accomplished by treatment adapted to the particular cause inducing it. The bones of the neck may be aided by machinery, if the subject is young; blistering, friction and shampooing, long persevered in, have been of service in the paralytic affections of the nerves and muscles; and at one time, it was a favourite practice to cut across the large muscle, extending from the ear to the breast-bone, which was generally supposed to be in fault. This severe measure very often was unsuccessful, and is hardly ever to be recommended. PART V. DISEASES. THEIR SYMPTOMS, CAUSES, AND TREAT MENT. INTERMITTING FEVER. Intermitting fever, or as it is more po- pularly called, fever and ague, or chills and fever, is a fever composed of several distinct paroxysms, with a perfect intermission, or period when no fever is present, interposed between each. Each paroxysm of an intermittent is com- posed of three stages, which successively follow each other with considerable regu- larity—namely, a cold stage; a hot stage; and, finally, a sweating stage, which terminates the paroxysm. Previously to the attack of this, as well as of every other form of fever, provided it does not come on during sleep, or when the attention is strongly directed to some en- grossing object or pursuit, a feeling of lan- guor and debility is experienced, with a sluggishness in motion, and some uneasiness in attempting it. The face and extremities soon become pale; the nails of a leaden or livid colour; the features shrink; the bulk of the body is diminished; and the skin ap- pears as if constricted by cold. A feeling of coldness now comes on in the back, re- sembling a stream of cold water running down it, and soon extends over the whole body, though, at this time, the skin of the patient will often feel warm to another per- son. The sensation of cold soon increases to a tremor, and this to rigors and shiver- ings, almost convulsive, with an indescriba- ble feeling of distress. The mind is more or less unsteady and confused, attention and recollection are difficult, and complete stu- por is, sometimes, an early symptom. The pulse becomes weaker, and sometimes slow- er than before the attack; but as the cold increases, it is always smaller, and veiy generally quicker. The respiration is small, frequent, and laborious; the appetite ceases; a nausea and sometimes vomiting come on; the matter discharged being very generally -bilious. The secretions are, in general, diminished, many of them entirely suspend- ed. The urine discharged is watery; the mouth is dry and clammy, and the tongue covered with a thick white or yellow crust; ulcers no longer discharge; and tumors di- minish in bulk, or disappear. Sometimes in this stage, but more frequently in the en- suing, head-ache comes on ; but a constant symptom, but little noticed by the generality of writers, is wandering pains over the whole body. Pain in the back is generally men- tioned, but pain is likewise felt in every joint, seldom continuing fixed, but disap- pearing and returning; they are not sharp and pungent, but tensive and dull. A stri- king change takes place in the features of the patient, in general, they appear to be sunk; but their real appearance is difficult to be described. The above symptoms, which are those of the cold stage, vary in different individuals, being slight, almost imperceptible in some, in others, very severe. They are more se- vere in the old and debilitated, than in the young and strong, and last from a few minutes to many hours. The duration of 266 DISEASES. the cold regulates that of the succeeding stage; if itbeshort, the feveris, in general,of long continuance, and vice versa. After a time, differing as we have just re- marked, in almost every case, the chilliness seems to abate, or to alternate with slight flushes of heat. These soon give place to continued and increased heat of the skin. The surface of the body becomes smooth and red, and the countenance of a deep rose tint. The mind is now more or less confused, and sometimes delirium is pre- sent. The pulse becomes more regular, hard, and full; the respiration more free, but still frequent and anxious; the thirst in- creases; the urine becomes of a deep red, and often occasions pain when passed; ex- ternal .tumors again enlarge; and ulcers pro- duce their discharges. The sensibility, di- minished in the cold stage, is recovered, often greatly increased; the head-ache is frequently extremely violent, and accompa- nied with a throbbing of the temples; and often there are pains in the back and limbs. After an uncertain period these symp- toms abate. A sweat now gradually breaks out and soon becomes profuse. The urine deposits a sediment; all the painful symp- toms disappear; the skin becomes cool, as well as soft and moist; the pulse abates in frequency, is less full and hard, and "the pa- tient is restored to a state of comparative health. Still, however, many of the func- tions of the body are disturbed; the appetite is, in general, deficient; the individual feels weak, irritable, and very sensible to slight degrees of cold. He is pale; easily fatigued; the tongue is coated with slime; and a sen- sation of weight, or fulness is experienced at the stomach. According to the duration of the inter- missions, intermittent fevers are divided into the quotidian, or every day fever; the ter- tian, or every other day fever; and the quar- tan, or every third day fever. In the quo- tidian, the paroxysm occurs every day, with an interval of twenty-four hours. The ague generally commences in the morning, and with the fever, usually lasts about eighteen hours. In the tertian, the paroxysm oc- curs every second day, with an interval of forty-eight hours. The ague commences at noon, and with the fever, usually lasts twelve hours. In the quartan, the pa- roxysm occurs every third day, With an in- terval of seventy-two hours. The ague commences in the afternoon, and with the fever, lasts about nine hours. These forms of intermittents frequently change into one another; thus, both tertians arid quartans change into quotidians; quo- tidians, on the other hand, are apt to change into remittents. Besides the above forms of intermittent fever, there are many others which writers on the disease have described with great minuteness. Thus, we hgfe double, triple and duplicate tertians, with as many varie- ties of the quartan form. Into the peculiari- ties of these, it is unnecessary for us to en- ter on the present occasion. All that the reader has to recollect is, that all fevers marked by a distinct chill, followed by fe- ver and sweating, and terminating in a more or less perfect remission of all the symp- toms, the ague occurring at tolerably regu- lar intervals, are included in the class of intermittents. The duration of an intermittent is very variable. Those which occur in the spring, frequently disappear with the advance of summer. Those which attack in the au- tumn, are more obstinate, especially when of the quartan form, being very frequently complicated with chronic affections of the spleen, liver, and other abdominal viscera. A very great deal, however, will depend upon the nature of the treatment had re- course to, and the habits of the patient. In persons of robust habits, the symp- toms, during the hot stage of intermittents, are occasionally very violent, and demand active depletion for their removal. In those of a weak, relaxed, or broken down consti- tution, or where the disease has continued long, or has frequently recurred, the symp- toms of fever, and of inflammation, are sel- dom so decided, and active blood-letting is less admissable. <• The most common consequences of inter- mittents, when of long continuance, *or when they attack frequently the same indi- vidual, and especially when they have been neglected, or their cUre has been attempted by improper remedies, are chronic inflam- mation and enlargement of the liver; jaun- dice, indigestion, emaciation, livid colour of the skin, dropsies, either general or local; induration of the pancreas; enlarged spleen, Sec. The usual cause of intermittent fever is unquestionably, exposure to the exhalations from low marshy grounds, the low banks of rivers or inundated plains. The disease may, however, be produced by a variety of other causes, the most frequent of which is, cold, united with dampness, in whatever manned applied to the body. They are more liabl* to have the fever induced by any the above causes, whose systems are in a state of ex- haustion, or morbid irritability, whether produced by excessive fatigue, exposure to extreme heat, intemperance, deficiency of food or that which is of a bad quality, long watching, the depressing passions "of the mind, preceding disease, &c. In. those who are predisposed to its attacks, exposure to the cold and moist air of the night, will more frequently produce an attack, than almost any other cause, especially if the exposure take place during sleep. In the cure of intermittent fever, the two DISEASES. 267 leading indications are, 1st. To shorten the paroxysm, and render the intermission per- fect, and 2dly. To prevent the recurrence of the paroxysm in future. Our remedies must, of course, differ according to the dif- ferent periods of the disease. During the cold stage, or just before its commencement, the patient should be put to bed, under a sufficient quantity of bed clothes, to excite and keep up the heat of the skin; at the same time, bottles filled with hot water may be applied to his arm pits, sides, feet and groins; taking care, how- eyer, that the water be not so hot as to pro- duce an injurious effect upon the skin. This being done, there should be administered to the patient a large draught of some sim- ple warm drink. A great variety present themselves for the choice of the practition- er; thus, warm lemonade, a weak infusion of common tea, of balm, or of snake root, will answer every purpose. In conjunction with any of these warm beverages, the ef- fervescing mixture, taken at intervals, will often be beneficial, especially towards the close of the chill. In young and robust habits, where the chill is but moderate, and the attack of the disease recent, we must be extremely cau- tious not to attempt to snorten the cold fit, by the use of any article of a stimulating na- ture ; as this would have a tendency rather to prolong the chill, or at least to increase the symptoms of the succeeding or hot stage. In the cases here described, proba- bly one of the very best means of cutting short the chill, and curing the disease, is the abstraction of blood from the arm, when used with great caution and judgment. The bleeding should be performed at the very commencement of the cold stage; after, however, the shivering has come on; later than this it is of more doubtful propriety. From twelve to eighteen ounces may be taken away, according to cirpumstances; after which, the patient should be allowed to lie perfectly quiet for an hour or two; but not covered with too many bed clothes; Tie should be supplied, immediately after the arm is tied up, with a cup of warm tea, or gruel, or thin panado. When the patient is of an infirm habit, or has been greatly exhausted by the disease, particularly where the chill is obstinate and violent, he may often take, with advantage, a tea-spoonful of a solution of ammonia, in a tea-cup full of warm tea or whey; or the acetate of ammonia may be used in the same way; the same dose of either being repeated, if the first should produce no good effect. In many cases where the paroxysms have recurred regularly for a long time, one of the most powerful means we possess of shortening the chill, is undoubtedly the ope- ration of an emetic, given just as the ague is about to occur, and followed by immer- 2K sion in a warm bath, or by bathing the feet in warm water, the administration of thirty drops of laudanum, and the application of sinapisms to the feet and ancles. The emetic will frequently, not only shorten the cold stage, but will influence beneficially those which succeed, rendering the symptoms of the hot stage milder, causing a more speedy appearance of perspiration, and a more complete remission. It has even been known not unfrequently to prevent entirely the expected paroxysm. In this case, as the skin begins to regain its heat, and be- comes softer and moister, the effervescing mixture, or some mild drink, milk warm, and rendered slightly sour with lemon juice, should be administered, and the patient must remain in bed during the whole of the time that would have been occupied by the expected paroxysm, or if sweating occur, until this ceases. When the hot stage does occur, a very different treatment is demanded. What- ever increase of bed clothes had been added, during the chill, is now to be removed; and if the heat of the patient's skin is very great, he should be entirely uncovered, and the bed curtains raised, so as to allow of a free ac- cess of the cool externa] air. All the drinks given should now be cold, and whenever the patient is young or robust, his pulse, hard, full and rapid, and he complains of pain of the head, back, or extremities, bleed- ing either from the arm, or by cups or leeches from the head and over the stomach, or both will be required. The quantity of blood to be drawn off can only be deter- mined by the circumstances of each case, and the effects produced during its flow. In recent cases it should seldom be omitted; and whenever the fever runs high, upon its judicious employment, the speedy and ef- fectual cure of the patient will mainly de- pend. After bleeding, in most cases, it will be proper to administer a dose of calomel and jalap, followed by a solution of salts or senna tea. The calomel is especially re- quired where there is an indication of a loaded state of the stomach and bowels. Whenever the heat of the skin is con- siderable, if at the same time it be perfectly free from perspiration, the application of cold, by spunging the surface with either cold water or vinegar, will tend greatly to reduce the fever, and, at the same time, shorten the paroxysm. When there is great pain of the head, with flushed face, and throbbing at the temples, or any degree of delirium, cups to the head, followed by cloths wet with cold water to the scalp, and renewed as they become warm, will give great relief. Pain, or burning at the region of the stomach, with frequent nausea or vomiting, will best be relieved by cups to the epigastrium, and cold mucilaginous drinks, slightly acid; as apple water, barley 268 DISEASES. water with the addition of lemon juice, so- lution of currant jelly in water, &c. The diet of the patient, during the hot stage, should be very spare; indeed, nothing should be allowed, in the majority of cases, excepting some bland fluid for drink; any of those mentioned in the last paragraph may be given. All stimulating- drinks, and solid, or animal food, are to be strictly pro- hibited. During the sweating stage, little is re- quired, excepting to avoid every thing that may have a tendency to check the perspi- ration. The drinks, as soon as the skin be- comes moist, should be about milk-warm. The patient should be lightly covered with bed clothes, and it is important that he re- main in bed until the perspiration has en- tire!}" ceased, and the skin has regained its natural temperature and dryness. The second indication, in the cure of in- termitting fever, is to prevent the occurrence of subsequent paroxysms. For this purpose, no remedy can be placed in competition with the Peruvian bark, or some one of its pre- parations. The bark, when unadulterated and judiciously administered, is confessedly the most efficacious medicine we possess for preventing the return of the chills, and as such, has for many years enjoyed the confi- dence of a majority of the profession. Of late years, the bark in substance has, in a great measure, been superceded by the sul- phate of quinia. Although we are not pre- pared to say that it possesses all the virtues of the former, yet, under certain circum- stances, it is an invaluable remedy. The smallness of its dose renders it more rea- dily taken than the bark itself, and it is more easily retained upon the stomach; it is likewise less apt to be adulterated, and in cases of the disease affecting children, may be given when it would be impossible to give the bark itself in any form. Neither the bark nor quinine should be given, excepting when a perfect intermis- sion has been obtained, and the stomach and bowels are entirely free from irritation. If then there be any degree of heat of the skin, or feverishness; pain of the stomach, side or back; a hard, full or active pulse; a loaded state of the tongue; a feeling of weight or uneasiness about the abdomen; a bitter taste in the mouth, bilious vomiting, or disordered bowels, the use of the bark should not be commenced with until these are removed. Those symptoms which in- dicate fever, or local irritation, must be re- moved by bleeding, a spare diet, and leech- es to the seat of pain or uneasiness; and those which denote a foul state of the sto- mach, or an irregular condition of the bow- els by mercurial purgatives, of which a very excellent one is, five grains of blue mass, the same quantity of rhubarb, one of ipeca- cuanha, and three of soap, to be made into three pills for a dose, and itpeated if neces^ sary. The warm bath and frictions to the surface, and occasionally cups over the re- gion of the stomach, will be found highly beneficial. The dose of the powdered bark for a grown person is a drachm or two every two or three hours, according to circumstances. AYhen the bark alone will not stay on the stomach, fifteen grains of powdered snake root added to each dose will often cause it to be retained, or ten grains of powdered cinnamon, or twenty of Seville orange peel powdered may be added. The fol- lowing is an excellent prescription in many cases: one ounce of powdered bark, two drachms of snake root powdered, and two scruples of the bicarbonate of soda for eight powders. Where the bark in sub- stance is rejected, a decoction or infusion may be tried; one ounce of the bark may be boiled or infused in a pint of water, in a close vessel, and a wine-glass full taken every three hours, when cold; or we may add to the bark the same quantity of snake root, or cinnamon, or Seville orange peel, which, to some stomachs, renders it more agreeable. The dose of the sulphate of quinia is from one to two grains every three hours. It may be given in a pill or solution. The best mode of giving it in solution, is to take fifteen grains of the quinine, one drachm of elixir of vitriol, five ounces of cinnamon water, and three drachms of sugar; the dose flr'jj is a tea-spoonful every hour. » Several extracts of bark are employed in the cure of intermittent fever. When of a good quality the extract will often prove an effectual remedy—dose, one grain every one, two or three hours. Sometimes the bark, when given in sub- stance, will act upon the bowels, producing considerable purging. When this is the case, it is proper to add to it a small quan- tity of opium, or some astringent, as kino, or extract of logwood. If, on the contrary, the bark occasions costiveness, to each dose a portion of rhubarb should be added. Many articles have been proposed as sub- stitutes for the bark arid its preparations in the cure of intermittents. A few of these we shall notice; premising, however, that when the bark or the quinine can be pro; cured of a good quality, it is always to be"1 preferred. The most common substitute for the bark is Fowler's solution of arsenic. It will ge- nerally, when properly administered, cure the disease very promptly. Its use, how- ever, requires great caution, as it is very apt, when given in an over dose, or in de- bilitated or broken down constitutions, or when too long continued, to produce very unpleasant and even dangerous effects. Dose for an adult, from 10 to 20 drops three DISEASES. 269 times a day. For a child, from two to five years old, 5 drops; from six to eight years, 6 or 8 drops; from eight to twelve years, 10 drops, and from the latter, to eighteen years, about 12 or 13 drops. The medicine should always be dropped from a half ounce vial on a lump of sugar, or in a little sugar and water. The bark of the dogwood is strongly re- commended for its efficacy in intermittents. It may be given in the same dose, and un- der the same circumstances as the bark. The bark of the tulip tree (liriodendron tu- lipifera) has likewise been employed with good effect in the same manner as the bark. The wild cherry tree bark has also been found occasionally successful, even when other remedies have failed. The common spider's web, rolled up into pills, and given to the extent of from 3 to 5 grains every three or four hours, has cured the disease in numerous instances, when given in the intermission. Its effects upon the system are those of a slight narcotic. The sulphate of copper, in the dose of a quarter of a grain, combined with one of extract of bark, repeated every three hours, is employed by many practitioners in cases of long standing, and their report is deci- dedly in its favour. The same remark may be made in reference to the prussiate of iron, given in the dose of from 4 to 6 grains every four hours. The diet and regimen of the patient during the intermission, should be carefully attended to. The diet should be light, plainly cooked, and composed of articles easy of digestion. Rice, plain bread and butter pudding, bread and milk, weak chicken or mutton broth, or when the sto inach is perfectly free from disease, a very small quantity of chicken or beef may be allowed. All high-seasoned, stimulating, indigestible, or flatulent food should be cautiously avoided. The patient's drink should be water, toast and water, whey, or weak lemonade. Such active exercise should be used as the strength will admit of. Frictions of the surface of the bod}', and the occasional use of the warm bath, are highly beneficial. The exercise, when the strength of the patient and the weather will permit, should be taken in the open air, but never pushed so far as to induce much fatigue. Exposure to cold and damp should be cautiously guarded against. The patient should be warmly clothed, and wear flannel next his skin. It is to be recollected that relapses are very easily induced in this disease, and hence the necessity of great caution for a long period after a cure has been effected. In many situations, fever and ague is a disease which prevails extensively every year; and all who reside in such places are subject, more or less, to its influence. Under such circumstances, the only effec- tual preventive is a removal, without delay, to a more healthy district. bilious FEVER. Bilious fever constitutes, in the middle and southern states, the principal form of eur summer and autumnal epidemics. It may occur in different situations and sea- sons, or in different individuals, under the various types of a remittent, continued, or highly malignant fever, and attended by various degrees of arterial excitement. Though thus diversified in its features by peculiarity of constitution, climate, season, and modes of life, yet it is very generally attended in all cases by great irritability of the stomach, pain, burning heat or uneasi- ness at the epigastrium, and more or less affection of the head; rarely will all, or any of these symptoms be absent. The most simple form of bilious fever is usually preceded for some days, by listless- ness, languor, bitter taste in the mouth, nausea,- aversion from food, sometimes costiveness, and more or less pain and heaviness over the eyes. These symptoms are followed by a chill or merely a sense of coldness, particularly about the back, which after a short time is followed by increased heat of the skin, flushed face, suffusion of the eyes, a quick, hurried, and somewhat tense pulse, prostration of strength, intense pain of the head and back, with sometimes a feeling of soreness in the limbs. '1 he stomach is more or less irritable; being sometimes affected with nausea only; at others, rejecting every thing swallowed. The bowels are generally costive, and the tongue, during the paroxysm of the fever, after the disease has continued for some time, becomes dry and covered with a whitish or light brown fur. There is at the same time considerable thirst, and some- times delirium. The fever generally con- tinues from eight to twelve hours, when a slight moisture may be observed on the surface, but more generally the skin conti- nues dry after the heat has declined. A paroxysm of fever generally occurs once every day, sometimes twice in the same day. All the preceding symptoms, in an aggravated degree, with less distinct re- missions, mark what has been termed the continued or inflammatory form of the dis- ease. In this form, the tongue soon be- comes dry, and covered with a dark or brown coating; the eyes are suffused, and of a yellowish hue, languid and dull; the breathing is laborious; the head and back intensely painful, with aversion from light and sound, and generally delirium. The pulse is corded and quick, sometimes irre- gular. There is loss of appetite, nausea, and vomiting, the stomach frequently dis* 270 DISEASES. charging* a thick ropy fluid, of a yellow or green colour; the skin is intensely hot and dry, and often of a brownish or yellow co- lour, particularly about the face; the bow- els are costive, or, if open, discharge a thin watery fluid, with griping and tenesmus. When evacuations are p ocured by the operation of purgatives, they are copious, dark coloured, slimy and tenacious, and very offensive; the urine is scanty and high coloured. More or less tenderness always exists over the region of the stomach: sometimes this is only evinced when pres- sure is applied; in other cases it amounts to an intolerable sensation of soreness and pain, accompanied by fruitless efforts to vomit. There is also great oppression at the breast, with anxiety and difficulty of breathing. The remissions in bilious fever are often so imperfect as scarcely to be no- ticed; in other instances they are very dis- tinct, and continue for many hours. All the prominent symptoms increase in violence during the ensuing paroxysm, par- ticularly the tenderness at the epigastrium, disturbance of the stomach, pain of the head, and delirium; the pulse becomes more full, frequent, and tense; the temples throb; the eyes assume a red and fiery ap- pearance; and there is great restlessness and entire loss of sleep. This state of things may continue for many days, when, if not removed, they are followed by deep stupor; the tongue becomes parched, and nearly black, the skin cool, and covered by a clammy moisture; the pulse small and weak; the respiration short, quick, and la- borious; low muttering delirium comes on, accompanied with involuntary discharges from the bowels, and finally death ensues. When, however, the case is mild and judi- ciously treated, all the more violent symp- toms gradually decline, the paroxysms of fever are shorter and less intense, the re- missions more distinct and longer, until. finally a complete state of convalescence is established. The causes of bilious fever are almost the same as those productive of intermittents; hence, in warm or tropical climates, or during the warm season of more temperate climates, in all situations where extensive marshes exist, or indeed, any extensive collection of putrefying materials, the dis- ease prevails extensively. A greater de- gree of heat would appear, however, to be necessary, to produce the bilious than the common intermittent type of fever; hence the former is "the chief form of fever oc- curring in hot climates and seasons, and its prevalence and violence are generally in proportion to the rise of the temperature of the atmosphere above the medium degree. Intermittent fevers, on the contrary, pre- vail in more temperate climates, and are most prevalent during a chilly and damp state of the atmosphere. limbs are unable to support the body with ' their usual firmness; the head is confused and affected with vertigo; sometimes with deep seated pain, or a sense of heaviness. The eves are dull, suffused, and often glassy; the face has a peculiarly dirty and pale appearance; the skin is occasionally contracted and clammy, and it is either re- duced in temperature, or warm only at par- ; ticular parts; the pulse is weak and indo- lent; or oppressed, readily compressible and variable; the voice is slow and drawl- ing, or imperfect and stammering; the countenance is haggard and distressed; the tongue, at first little changed, soon becomes dark brown or black; the lips are dry and livid; the stomach occasionally irritable; the epigastrium sore to the touch and .;,! swelled; the bowels costive; when stools J are obtained, they are dark and fetid. The *$$M mind is generally confused, and soon sinks ^1 into a state of stupor, or is affected with a :. ■ low species of delirium. The respiration is I anxious and labouring, with frequent sigh- I ing. When death occurs, it is frequently I preceded by purple spots on the skin, and • I discharges of dark coloured blood from the y.d nostrils, mouth or bowels. This form of fever occasionally attacks with great suddenness, and runs rapidly its course. Under a judicious treatment, the violence of the symptoms may gradually.-{J$jJ abate, the fever assume a milder and more regular form, and finally, every symptom of the disease entirely disappear. In the treatment of this form of fever, the lancet, early and judiciously employed, is one of our most efficacious remedies. On f the first onset of the disease, a vein should be opened, and the effects of the bleeding ' upon the pulse carefully watched; if the - pulse sinks rapidly, the flow should be at once suspended; but if on the contrary, the pulse rises, becoming more full and re- 5' gular in its action, then the bleeding should r be continued. In judging of the quantity W± of blood to be taken, the amount of relief e&X& obtained can be our only guide. Some- times, on the first opening of the vein, the blood will not flow, but after issuing for some time, drop by drop, frequently the circulation will become more free, and a large and full stream of blood will gush forth with manifest advantage to the patient. In many cases it will be judicious, parti- cularly if the pulse is much depressed, previously to bleeding, to immerse the pa- tient in a warm bath, and at the same time apply brisk friction with a soft brush or DISEASES. 27$ flannel rag over, his whole surface; after coming out of the bath, the patient is to be put to bed between blankets, and the ef- fects of bleeding tried. Often an emetic exhibited in the early or forming stage of congestive fever, will be productive of the most decided benefit. Whenever symptoms are present indi- cating an oppressed state of the brain or lungs, cups to the head, or to the chest, will be found advantageous, and should not be omitted. Subsequently to their use, general bleeding will be found to act with great certainty in relieving the remaining symptoms of the case. Cathartics are useful, also, in congestive fever, to unload the bowels of the vitiated contents; to render the circulation of the blood more regular and uniform, and to re- lieve those organs which are oppressed by a morbid distension of the blood vessels. Calomel alone, or combined with other purgatives, in the same manner, exhibited as in ordinaiy cases of bilious fever, is the purgative to be preferred. It should be given immediately after the first bleeding, and continued until regular natural dis- charges from the bowels take place. The action of the purgative given by the mouth may be increased by injections frequently repeated. With the view of equalizing the circula- tion and unloading- the internal organs, ir- ritants to the surface are almost always beneficial; the warm bath, followed by frictions of the skin, or mustard poultices to the feet, wrists, and over the stomach, and when the lungs are much oppressed, blisters over the chest should, in the majo- rity of cases, be resorted to, in conjunction with bleeding and purgatives. Stimulating frictions along the spine will occasionally be found useful; they may be made with the volatile liniment, a decoction of can- tharides in turpentine, or dry mustard. In- ternal stimulants should not be resorted to; however much they may seem to be de- manded by the apparent prostration of the patient, they never fail to increase the stu- por, oppression, and all the more promi- nent symptoms of the case. A little light nourishment, moderately warm, as panado, gruel, tapioca, or chicken broth, given im- mediately after blood has been drawn, will, however, often do good. In many cases, after the use of the lancet, and the evacua- tion of the bowels by purgatives, the good effects of our other remedies will be consi- derably increased by the use of some dia- phoretic; either, opium, two to four grains; ipecacuanha, six to eight grains, and calo- mel four grains, mixed together, and made into eight powders, one of which is to be taken every three hours; or, camphor, four to eight grains, the same quantity of ipeca- cuanha and calomel, and one drachm of nitre, for twelve powders; one to be given every three hours, may be employed. The effects of these will often be increased by the occasional use of the acetate of ammo- nia, the effervescing mixture, or a weak in- fusion of snake root, boneset, or similar dia- phoretic drinks, aided by the occasional use of the warm bath. By the foregoing treatment, early resort- ed to, and judiciously managed, the skin of the patient will become warmer, softer, and disposed to a gentle perspiration; the pulse will increase in fulness and regulari- ty; the delirium or stupor under which the patient laboured will be removed; the bow- els will become more regular, and a state of convalescence will be established. Under the use of proper remedies, it sometimes happens that the congestive form of bilious fever, will become changed, within the first twenty-four hours, into a mild remittent, or inflammatory fever; the treatment is then precisely the same as in the common forms of bilious fever. VELLOW FEVER. It is not our intention to enter into an examination of all the endless discussions and contrary opinions to which the subject of yellow fever has given rise; but rather to present, in a few words, the general conclusions in relation to its origin, causes, nature, and treatment, which the present state of our knowledge in regard to it, per- mit us to draw with some degree of confi- dence. Yellow fever is a disease peculiar to warm and tropical climates, and is more prevalent and malignant in proportion to the greater heat of the season. In Philadelphia, the yellow fever has never made its appearance, excepting during those months of the year, the medium temperature of which has been above 75° of Fahrenheit's thermometer; and the average mortality of-the disease was always in proportion as the heat of the sea- son rose above this point. The same gene- ral statement is true also of the occurrences of the disease in the other cities of the union. Heat alone, however, is not suffi- cient for the production of yellow fever. The disease has never occurred in this, nor in any other country, excepting from a lo- cal cause, consisting in the emanations from large collections of filth in a state of decom- position. The dependence of the disease upon a vitiated state of the atmosphere is so notorious, that even they who believe it communicable by contagion, acknowledge that the contagion is inert in a pure state of the atmosphere, and that by domestic clean- liness and ventilation, we are able to extin- guish the cause of the fever, after it has been introduced amongst us. Yellow fever is especially liable to occur in hot climates, 274 DISEASES. and during hot weather, in the neighbour- hood of extensive marshes, along the low muddy banks of rivers, and in sea-port towns and large commercial cities, where a strict attention to cleanliness and ventilation are neglected. In sea-port towns, and places bordering upon navigable streams, vessels arriving from foreign ports with un- clean holds, or damaged cargoes of vegeta- ble substances, become often the cause of yellow fever among those who visit such ships. The crews themselves may remain perfectly healthy, so long as the poisonous effluvium is confined to the hold; but the mo- ment the hatches are unclosed, and the un- loading of the cargo commenced, nearly all who come within the influence of the dele- terious gas which issues from the vessel, will be attacked with the fever. The cir- cumstance of a poisonous gas being so liable to be generated by heat and filth on ship- board, is one of the fruitful sources of mis- take, by which many have been led to believe that the yellow fever is produced by a contagious matter contracted in foreign ports, and subsequently communicated from the sick to the well. From what has now been said, it will be perceived that we are not believers in the contagious nature of yellow fever. The fact is, that while we can in every case, point out local causes fully adequate to the production of the disease, in no instance has the fever been satisfactorily traced to any single point of infection, if the first ten or twenty cases which occur among a popula- tion be strictly investigated, most of them will be found to have originated independ- ently of each other. Instead of pervading families, or creeping slowly from one neigh- bourhood to another, as is always the case with contagious diseases, cases of yellow fever will generally be found to occur, at one and the same time, in distant and un- connected spots, and in situations where contagion can not be traced nor suspected. Contagious diseases spread whenever the sick are brougiit in full contact with the well; but a case of yellow fever has never, or at least very rarely, been known to oc- cur beyond certain limits; hence the well known term of infected district, and the fact that, by enclosing such district, so as to prevent persons from entering it, the in- habitants being previously removed, a com- plete stop has been put to the further in- crease of the disease. Contagious diseases, also, are slow in their progress; the yellow fever spreads rapidly over a certain space, whenever it occurs. The latter will in two or three weeks overrun an extent of city, which the small pox would not pervade in twice as many months; proving that the one arises from a general cause, and that the other is propagated from one person to another. Yellow fever is confined to par- ticular seasons and climat^. To say that a disease is contagious which'«an not be pro- pagated excepting in certain climates, and in such climates only at certain seasons, and even at such seasons, only during a certain state and temperature of the air, is merely saying in other words, that the disease is not contagious, but depends upon certain local causes. Yellow fever does not spread when the sick are removed from out the impure air where the disease was gene- rated; by breathing this impure air, without contact with the sick, persons, during the ' prevalence of the disease, are every day attacked; while, on the contrary, without breathing it, no attack will take place. The conclusion is therefore irresistible, that the impure air is the cause of the disease. The medical attendants, nurses, and servants, in well regulated yellow fever hospitals, are not more liable to the disease than individu- als who never come in contact with the sick. The disease may, and often is, produced by certain circumstances, without previous j contact or intercourse with those affected j with it. Thus it has occurred at sea, on I board of vessels coming from a perfectly 1 healthy port; in inland situations, where ya no intercourse has taken place for many *wfl weeks between the inhabitants and persons <|4J from any other part, sick or well. It has occurred among the prisoners in a jail, I when no person has been admitted labour- 1 ing under the disease, or who has had con- M tact, directly or indirectly, with persons M labouring under the disease. The yellow fever is invariably extinguished by th« oc- i currence of cold weather; if it really de- J pended on contagion, in place of ceasing I with the setting in of colder weather, it should, like all diseases known to be conta- m gious, become then more prevalent and de- I. structive. Persons labouring under the * disease, when removed to a healthy part of the country, do not communicate infection j. to the well; this is a conclusive argument '..$ against disease, some difference of opinion exists Is among physicians. During the acute stage '', jf of the disease, we should advise the bowels to be kept regular by occasional doses of t castor oil, and purgative injections. After .1 the free use of blood-letting, however, a ™ full dose of calomel may be administered, B' and followed after a short interval by castor p. oil, or a solution of the sulphate of magne- Jm sia. A very good prescription in these cases, after the use of calomel, is sulphate \ of magnesia, one ounce and a half; lemon | juice, two drachms; sugar, four drachms, V and boiling water, twelve ounces; the dose of which is a table-spoonful every two hours. The warm bath is an admirable remedy in many cases of peritoneal inflammation. At the period of the disease when we have £;.' directed a resort to blisters, previous to F their application, it will often be found pe- ls, culiarly beneficial, or in mild cases, attend- ■r ed with a decreased temperature of the m' skin, it may be resorted to in the first pe- m riod of the attack, and it is then an excel- E lent preparative for the other remedies. I. When the disease appears to be rapidly K verging to a chronic form, in conjunction f with the warm bath and blisters, the Do- f ver's powders, or small doses of calomel, ipecacuanha and opium, with or without the addition of nitre, may be administered, and often theyjwill be found to produce a r rapid abatement of all the remaining symp- toms. We may give one grain of "calomel and ipecacuanha, and a quarter of a grain of opium, with, if thought proper, five or six grains of nitre, every three hours. The spirits of turpentine, in doses of from half a drachm to a drachm, has been strongly recommended as a remedy in puerperal fever; it appears to us, however, to be of very doubtful propriety in this dis- ease; at any rate, it should not be given until after copious depletion by the lancet and leeches. Throughout the whole disease, the pa- tient should be kept in a state of as perfect rest as possible; he should be debarred from every species of food, and to quench his thirst, should.be allowed only small quantities of toast, barley or gum water. In regard to the treatment of chronic peritonitis, the remedies are, leeches to the abdomen, in numbers proportionate to the extent of the local symptoms; the warm or vapour bath; repeated blisters to the sur- face of the belly; calomel purgatives, fol- lowed by injections; and^ the prescription of ipecacuanha, opium and calomel, as di- rected above. The diet of the patient should be moderate, light and unirritating, and a state of complete rest should be enjoined upon him. INFLAMMATION OF" THE KIDNEYS. Inflammation of the kidneys is marked by heat, uneasiness, and a dull or acute pain about the loins, with often a dull pain in the thigh of one or other side, and some-. times considerable stupor. The urine is at first clear, and afterwards of a reddish co- lour, often bloody, and voided frequently, and in small quantities at a time. The urine is generally coagulable by heat. The dis- ease is often attended with vomiting, cos- tiveness, difficulty of breathing, and cold extremities. There is a painful sense of uneasiness when the patient is sitting up- right, or standing; the easiest position being that of lying on the side affected. If the inflammation of the kidney be severe, or occur in a broken down constitution, it most commonly gives rise to more or less dropsy, either externally, or of the abdo- men. In some cases, apoplexy is suddenly induced, and terminates rapidly the life of the patient. The disease may be induced by cold; by habits of intemperance; by the use of pow- erful diuretics, as spirits of turpentine, can- tharides, &c.; by contusions or sprains of the back or loins; gravel; violent or long continued riding, &c. It is all important to detect the inflamed condition of the kidneys, and apply the proper remedies for its removal at as early, a period as possible; for if neglected or mismanaged, an incurable disorganization of the kidneys, terminating sooner or later in death, may be induced. When the local symptoms are, severe, the patient young, and possessed of a considerable degree of strength, a copious bleeding from the arm, 298 DISEASES. followed by cups or leeches over the kid- neys, should be at once resorted to, and repeated until the disease is removed. When the symptoms are less intense, and the patient debilitated, local bleeding alone should be resorted to. The warm bath, or fomentations to the loins, constitute an im- portant remedy, after blood-letting, and should be resorted to daily. A mild laxa- tive, as an ounce of castor oil, or a solution of one ounce of Glauber's salts in eight ounces of warm water, with the addition of one drachm of lemon juice, in the dose of a table-spoonful every two hours, should be given, so as to keep the bowels regularly open, with frequent emollient injections of flaxseed tea, infusion of slippery elm or thin starch. The patient should make use plentifully of thin gum or barley water, or flaxseed tea, and abstain from all solid and irritating food, and stimulating drinks. In case of violent pain after the bleeding, a grain of opium may be administered at bed time. A decoction of the dried leaves of the peach tree has been said, when taken to the amount of a pint a day, in many cases, to produce considerable relief. If the disease become chronic, the inser- tion of an issue or seton at the loins, and internally twenty to thirty drops of balsam copaiba, or half a drachm to a drachm of uva ursi, three times a day, will be advisable. INFLAMMATION OF THE URINARY BLADDER. Inflammation of the bladder is indicated by a sense of tension and pain in the situa- tion of that organ. There is a frequent desire and great difficulty in discharging the urine, often a total suppression, with frequent efforts to expel the feces, occa- sioned by the irritation extending to the rectum. These symptoms are generally accompanied with fever, sickness and vo- miting; great anxiety and restlessness; sometimes delirium, coldness of the extre- mities, and clammy perspiration ensue. The mucous or lining membrane of the bladder, is likewise occasionally affected with a chronic inflammation; in these cases, there is a dull, uneasy sensation in the part, frequent desire to pass urine, which is gene- rally thick, from being loaded with mucus; sometimes bloody, or, if ulceration of the bladder has taken place, mixed with mat- ter. The coats of the bladder from chronic inflammation become often thickened, in- durated, and otherwise disorganized, giving to the patient great uneasjness referable to these parts, and causing a constant inclina- tion to urinate, or a total suppression of the urine. In the acute variety of the disease, the early employment of the lartcet, with leeches over the region of the bladder, followed by the warm bath and fomentations, will be required. The bowels should be kept gently open by mild laxatives and emollient injections, as in inflammation of the kid- neys. The bleeding and leeching should be repeated until the pain and uneasiness of the bladder are subdued. During the disease, the patient should observe a very low, unirritating diet, and make use of some mucilaginous fluid for drink. Any of those mentioned in the preceding article may be employed. If the urine be retained so as to cause distension of the bladder, it should be drawn off by means of an appro- priate instrument. During the treatment, the patient should remain at rest. In cases of chronic inflammation of the bladder, leeches will occasionally be re- quired. The bowels should be kept lax by castor oil, or mild injections. The warm bath should be used daily, and warm water, or infusion of the pith of sassafras thrown into the bladder by means of a syringe, two or three times a day. If much pain attend the disease, a dose of the Dover's powders , may be given at bed time. In many cases, great benefit will be derived from the bal- sam copaiba and uva ursi, as directed in in- flamed kidneys. The diet should be the same as in the acute variety of the disease. In both, fermented and distilled liquors are to be avoided. INFLAMMATION OF THE WOMB. Inflammation of the womb seldom hap- pens, except in lying-in women. It may occur at different periods, from delivery to the fifth or sixth day, but it sometimes hap- pens later. Like other inflammations, it is ushered in by shivering, followed by great heat, thirst, quick hard pulse. Pain is felt in the womb from the beginning, with a sensation of fulness and weight; also a burning heat, and throbbing. The exact spot where the pain is felt, varies according to the part of the womb that is inflamed; it may be towards the navel, or over the share-bones, or shooting backwards, or down the thighs; or it may affect the blad- der with pain and suppression of the urine* or difficulty of passing it. The disease is distinguished from after- pains by the constancy of the pain, by the heat and throbbing of the part, and by the pain being much increased on pressure over the region of the womb. Inflammation of the womb is induced by difficult or tedious labour, by officious interference during la- bour, or by wrong methods of forcing the expulsion of the child and after-birth; by too much strong food or heating drinks; or by exposure to cold. This inflammation requires very prompt and active interfer- ence, as its progress is very rapid, and ita event uncertain and dangerous. If assist- DISEASES. 299 fcnce is procured in time, it may be stopped by blood-letting, both general and local, by leeches over the region of the womb, a very low diet, diluent drinks, slightly acidulated; with laxative medicines or clysters, and fo- mentations to the belly. A copious sweat, and a flow of the lochia, with relief from pain, mark the success of this plan of treat- ment. But we are not always so successful, for the pain sometimes becomes more acute, with throbbing, and an increase of fever, sickness, delirium and restlessness. In these cases there is risk of mortification; and this is shown to have come on by a languid pulse, low delirium, and cold clammy sweat. Such termination happens chiefly in bad constitutions, or in those who are much debilitated. When suppuration is to take place, the pulse continues firm, and the throbbing is more violent. The matter is discharged by various outlets; the most favourable of which is the mouth of the womb; but sometimes it is discharged by the rectum, or by an opening in the groin. When the discharge is going on, the strength of the patient is to be support- ed by nourishing diet; the bowels are to be kept open, and bark is to be given. Much attention must be paid to cleanliness. DROPSY OF THE BRAIN. A frequent disease in young subjects, of a very fatal and melancholy termination; or rather, the concluding symptoms of a pre- vious disease, which symptoms, from their frequency, from the severity of suffering which they occasion, and from the hopeless state into which they bring the patient, con- stitute one of the most dangerous diseases to which children are liable. The com- mencement of the disease is marked by a considerable degree of fever, by thirst, restlessness and vomiting; and when the *patient is old enough to give an account of his sensations, by very severe pain of the head. He utters frequent piercing screams; he appears flushed in the face; there is red- ness of the eyes, but delirium is less fre- quent than we might expect. If these symptoms are not relieved by the remedies employed, they are succeeded by those which more decisively show the presence of water in the ventricles of the brain. The patient is now dull and heavy, has a con- stant desire to keep the head in a reclining posture, or rolls it about from side to side, or frequently puts up the hand to the head; the breathing is heavy, the pulse intermit- ting and very slow, the eyes squint and are insensible to the impression of light, the bowels are costive, the urine scanty, and the discharges are made involuntarily; the patient lies in a dozing state, interrupted only by occasional lamentable shrieks. This distressing hopeless state may continue for 20 several weeks. Towards the fatal termina- tion, the pulse becomes again exceedingly frequent, feverish heat of the skin again prevails; while convulsions of the whole body or of some particular muscles, or palsy of one half of the body, give notice of the near approach of death. From the pre- ceding description of symptoms, it appears that the commencement of the disease is of an inflammatory nature; and the subsequent symptoms, combined with the knowledge acquired by examination of the bodies of those who have died of the disease, show that there is pressure on the brain, from fliiid accumulating in certain parts of it, which, in the healthy state, are free from such accumulation. The delicacy of the constitution in child- hood, renders it liable to be affected by a very great variety of causes, which grown up people are exposed to with impunity; and certain circumstances peculiar to early life increase the number of these hurtful agents. The extreme readiness with which the stomach and bowels of children are put out of order, their susceptibility to all men- tal emotions, and the relative largeness of their heads, with the quantity of blood sent to the head in order to its speedy growth, all give a tendency to disease in the brain, and its appendages. There are certain temperaments and hereditary peculiarities which seem to predispose to dropsy in the head. Children of a delicate make, of in- genious talents and amiable character, whose early advances in knowledge and in virtue give the fairest hopes of mature and distinguished excellence, are too often those, who, from this fatal disorder, disap- point the fondest hopes of their friends. An eruption behind the ears too suddenly dried up, an occasional irregularity in diet, neglect of the bowels, a fall or blow upon the head, teething, and many other circum- stances are exciting causes of the disease. A scrofulous habit seems more especially liable to dropsy in the head. In the acute or commencing stage, we are to use with great diligence the means for lessening inflammatory action. Leeches are to be applied to the head, purging is to be actively employed; and cold water, or vinegar and water, to wash the head and temples. If there is any appearance of stupor or palsy coming on, the head must be shaved and a large blister applied. When the disease has got to the stage where there is reason to fear that the effu- sion of water has taken place, many reme- dies have been applied, but unhappily they are in general attended with very bad suc- cess. Mercury has been pushed to a great extent, both by rubbing in, and in the form of calomel. A succession of blisters, or an issue has also been tried. To relieve the pain and restlessness, opiates may be can- 300 DISEASES. tiously given, remembering the danger that there is, of increasing the costiveness and inclination to stupor. We must not be induced, by the supposed incurable nature of dropsy in the brain, to be negligent in the use of remedies, when the symptoms of that disease appear. It is an undoubted fact, that children have been affected with head-ache, with stupor, dilated pupils, squinting, and every bad symptom, and yet, by very active treatment, especially by repeated strong purging, they have re- covered. All our knowledge of the brain, both in its healthy and morbid state, forbids us to suppose, that when water is effused in such quantity as to press upon the brain, and produce the foregoing symptoms, it will ever be carried away by absorption; and, therefore, though we can not say that water in the head has been cured, we may say, that symptoms very like it may be got the better of. In such cases, our most ra- tional hope is in blistering and purging; and the quantity and strength of medicine necessaiy in such cases is truly astonishing. From three to five grains of aloes may be given night and morning for two or three days; this is to be worked off by a full dose of senna, or tamarinds and senna, or by a dose of Epsom salts. When one or two children of a family have died of dropsy in the brain, it naturally begets a very anxious solicitude about the rest; and it is found to be a very useful precaution, to begin at a very early age, to make an issue in the neck or other conve- nient place. Many families have brought safely up to manhood, numerous children, who in all probability would have died in infancy, had not this expedient been re- sorted to. Great care should be taken of the health of ingenious, delicate, and sensi- ble children. If their parents' fortune ad- mit of it/no expense should be spared in procuring for them the most virtuous, well- informed, and sensible persons that can be procured, for directing their education, and watching over their minds; their treatment should be tender, yet firm and consistent; no harsh usage, and especially no blows about the head, should be permitted; and every indulgence that will not injure the health, the temper, or the character, should be freely allowed them. CONVULSIONS IN INFANTS. The greater degree of irritability of the infantile constitution, renders the muscular system at that period of life peculiarly liable to be thrown into irregular or morbid ac- tion from the impression of a variety of irritating causes, which at a later period would produce little or no disturbance in the system. The period of infancy at which convul- sions are most liable to occu*, is previously to the completion of the first dentition, that is to say, from birth until between the se- cond and third year. The causes productive of convulsions in the infantile state are extremely numerous; we shall, therefore, confine ourselves to the most common, and those which render most generally a modification of the treat- ment necessary. These are, retention of the meconium during the first days after birth; an unhealthy condition of the milk of the mother or nurse; overloading the stomach of the infant; improper food; va- rious irritations of the bowels; costiveness; worms; the impression of cold and damp upon the surface; a vitiated condition of the air; want of cleanliness; the sudden repul- sion of certain eruptions of the skin; diffi- cult dentition; fright, and various emotions suddenly excited; every circumstance pro- ducing an increased determination of biood to, or an irritated state of the vessels of the brain, &c. Convulsions among children are said, at certain periods, to have occurred epidemically. The following symptoms are enumerated as sometimes preceding the attack of con- vulsions. The child is in a state interme- diate between sleeping and waking; he scarcely enjoys, for one hour out of the twenty-four, a true sleep; his eyes remain either constantly open or are but half clos- ed, the pupil being turned upwards, and concealed under the upper eye-lid; the respiration is unequal; he moans frequent- ly, or as it occasionally happens, cries al- most continually; frequently he is agitated by momentary starts, which occur without any manifest cause, or from a very slight one; in these moments the limbs become stiff and the fingers are separated from each other. The above state of things, which is occa- sionally succeeded by vomiting and purg- ing, has been denominated internal con- vulsions, or inward fits; it may endure for a longer or shorter period, and is not invaria- bly followed by true convulsions. Symptoms like those we have now re- cited, have been supposed to constitute a particular variety of convulsions, of a very formidable character. Dr. Armstrong has written very elaborately upon their nature and treatment, but has certainly attached to them much more importance than the nature of the complaint demands; they ap- pear, in every instance, to be the effect of a deranged or overloaded condition of the digestive organs, and will seldom occur where proper attention is paid to the na- ture and regulation of the diet of the in- fant. Though the above symptoms do fre- quently occur in young children, and are occasionally the prelude to convulsions, yet, in general, it will be found that the iatter DISEASES. 301 occur suddenly, without any premonitory symptoms. Convulsions vary much in their degree and duration; generally, the child is sud- denly seized with spasm of the muscles of the limbs, which are violently agitated to and fro; the fists are clenched; the body bent back; the features distorted; the eye- lids open, the pupils dilated; the eyes ei- ther fixed in the socket, or rolled about in every direction; the face is either pale or livid. The spasms sometimes, in place of being general, are confined to one particu- lar set of muscles, as those of the face, or limbs; sometimes one side of the body only is affected; frequently, when the convul- sions are universal, one side is more strong- ly affected than the other. Convulsions may prove very suddenly fatal; sometimes, after the fit has continued for a few minutes, it ceases, and does not again return. In other cases, after a greater or less inter- val, they return frequently during the day, and they may continue thus to recur for many days, or even weeks. The duration of the paroxysms, as well as the interval of their recurrence, varies from a few minutes to an hour or more. In gene- ral, the danger of convulsions is in propor- tion to the obstinacy of the paroxysms and the shortness of the interval between their repetition. When the convulsions are light, of short duration, and the infant returns, im- mediately after they have they have ceased, to his ordinary state of health, is cheerful and playful, we may conclude that the dis- ease has been produced by some slight ir- ritation, and is without danger; but when, on the contrary, the paroxysms are of some length, or increase in violence; when they succeed each other with rapidity, or when they commence at first with extreme vio- lence, without the most prompt, active and judicious treatment, we have reason to fear for the life of the little patient. Even though the convulsions themselves may not cut short his days, yet when they are misma- naged, violent, or allowed frequently to re- turn, the brain finally becomes permanently - affected, and the child is seized with para- lysis; becomes affected with fatuity, drop- sy, or other disease of the brain; which, after prolonging his sufferings, finally ter- minates his life. We do not wish it to be understood, howTever, that these effects are produced by the convulsions them- selves; they invariably depend upon the continuance of the same cause by which the convulsions are produced. Convulsions are always, however, a disease of sufficient magnitude to demand the close attention of the practitioner, that he may be enabled to put as speedy a stop as possible to the pa- roxysm which is present, and to prevent the possibility of their future recurrence. In the cure of every kind of convulsions, the first thing to be attended to is the re- moval of the cause producing the disease. This must be ascertained by a close investi- gation of the state of the circulation, and of the brain; the age of the patient; the condi- tion of the skin, gums, tongue, discharges, and all the circumstances connected with the attack; and an interrogation of the nurse or parents in relation to the diet, clothing, &c. of the infant. If, from the result of this examination, we have cause to believe that the dis_ease has originated from a retention of the meconi- um in very young infants, or from costive- ness or a morbid condition of the contents of the bowels, or from worms, of course the offending substances must be removed by purgatives or injections, according to circumstances. If from repelled eruptions, these must be solicited to reappear by the warm bath and stimulants to the surface; if from difficult dentition, the irritation produced by the protruding tooth must be removed by a free incision of the gums; if from an undue determination to, or an excited state of the vessels of the brain, by the abstraction of blood from the arm, leeches and cold ap- plications to the head, purgatives, and all the means which have a tendency to un- load the vessels of that organ. There are many pases, however, where it is impossible to determine the exact na- ture of the cause by which the convulsions have been produced, or by which they are kept up, and others, where the mere re- moval of the original irritating cause is not sufficient to suspend the disease, and hence some general remarks will now be made on certain remedies, many of which are more or less adapted to every case of convul- sions. Bleeding. In those instances in which the face is tumid and flushed; where the action of the arteries, particularly about the head, is increased; the eyes red and swol- len; and the head hot, indicating a deter- mination of blood to, and an irritation of the brain; from whatever cause the con- vulsions may have been primarily caused, we should immediately open a vein and re- move a quantity of blood, proportionate to the symptoms of the case. The lancet will, in these cases, whenever blood can be ob- tained from a vein of sufficient size, be pre- ferable to leeches, because producing a more prompt effect; where, however, as is sometimes the case, a vein of sufficient size can not be opened, and in cases in which the symptoms are less violent, or subsequent to general bleeding, when this has failed in subduing the disease, leeches may be resorted to. They should be ap- plied about the head and neck; or perhaps 302 DISEASES. what is better, one or both temporal arteries may be divided under the same circum- stances as are above referred to; shaving the hair, or applying cold to the head will be productive of benefit, and aid the effects of the other remedies. It is not merely, however, in those in- stances where increased arterial action is to be reduced, or extensive congestion to be removed, that bleeding is beneficial; we are to recollect, that in all spasmodic and convulsive diseases arising from irrita- tion, or where there is nothing present to forbid its use, the lancet is one of our best, most certain and most manageable antispas- modics. Caution and judgment, however, are necessary in its employment, as well in regard to the particular circumstances un- der which it is proper, as to the extent to which it is necessary to carry it. Purgatives. We have already stated, that wherever there exists any offending sub- stance in the bowels, this must as quickly as possible be removed. Purgatives are the best means for effecting this, and there are few cases of the disease in which they are not indicated; there being few in which convulsions, if not produced, are not at least kept up by intestinal irritation. In mild cases, or in very young children, castor oil and mild injections should be preferred; but in every instance, occurring in older patients, and where the discharges from the bowels are vitiated, as well as in all cases in which the disease is of considerable vio- lence, a dose of calomel, proportioned to the age of the child, should be administer- ed and followed by caster oil, or by purga- tive injections. The repetition of the pur- gative is to be determined by the effects produced by the previous dose. Not only with the view of removing irri- tating substances from the bowels, but where the disease has been produced or kept up by cerebral determination, purga- tives are also important and even indis- pensable remedies. The warm bath. There are but few cases of convulsions to which this remedy, when properly managed, is not applicable. Where there is any determination to the brain or much arterial excitement, it must always be preceded by the evacuation of blood. The child should be immersed into the bath to the neck and retained there for five or ten minutes; after which he should be taken out of the water and enveloped in a soft dry flannel. This remedy acts by equalizing excitement, relaxing spasmodic action; and if the complaint has been pro- duced by any impression upon the skin, the bath operates by renewing the healthy functions of that organ. Mustard poultices. After the patient is removed from the warm bath, mustard poultices to the extremities have a consider- able tendency, by the irritation they there create, to lessen that of the brain, and thus to weaken or suspend the convulsive action of the muscles; they should seldom be neglected; in violent cases, never. They may be applied to the wrists as well as the ankles, and often they will be found more efficacious when applied over the stomach. They should be kept on for a half hour or even longer. They are preferable to blis- ters, because their operation is more prompt and they do not leave behind them a raw surface, which in infants is sometimes found troublesome and difficult to heal. A variety of stimulating liniments to the surface and along the spine are also recommended by various writers; they no doubt, in many cases, are very beneficial; and where mus- tard poultices are not thought necessary, or even in addition to these, they may be em- ployed. Where a considerable tendency to cere- bral irritation exists, giving us cause to fear a repetition of the convulsions, a blister to the nape of the neck will be a proper ap- plication, and under these circumstances should invariably be directed. When the convulsions have succeeded to the disap- pearance of eruptions behind the ears of children, applying small blisters or the tartar emetic ointment to this part will be proper. Emetics. When the cause producing the convulsions is ascertained to be some irritating substance contained in the sto- mach, or where they have arisen from re- pelled eruptions, emetics will be called for. Ipecacuanha will be the most proper artir cle. But where there exists any considera- ">. ble affection of the brain, they are not to be employed, or at least not until after the free use of the lancet. Opium and antispasmodics. These arti- cles, but more especially the former, are not merely improper, but absolutely injuri- ous, in every instance where there is much determination to the brain, or considerable arterial excitement; but where this is not the • case, and the paroxysms of the disease ap- pear to be kept up by continued irritation of the gums, after the free division of the latter, the use of bleeding, active purga- tives and the warm bath, an anodyne injec- tion, composed of thin starch and a few drops of laudanum, will have occasionally a very excellent effect in quieting the irrita- tion and suspending the convulsions. Even in cases where the symptoms call for pretty active bleeding, after the evacuation of blood and active purging have been carried to a proper extent, the convulsions still continuing, an anodyne injection may ba resorted to; this practice, however, it is to be recollected, is only proper in violent cases, and where the other remedies have been previously fully tried without com- plete success. Under the same circum- DISEASES. 303 stances in which anodyne injections are proper, a watery solution of assafoetida by injection or by the mouth may be adminis- tered. Turpentine. Dr. Copland of London, states, that, in several cases, he has witnessed the beneficial effects of turpentine, when given as a remedy in the convulsions of children; especially when the disease is connected with a deranged condition of the digestive organs. In such cases, the doctor gives it so as to produce by it a purgative effect. When given by the mouth, the turpentine should be combined with an equal quantity of castor oil, a tea-spoonful of which mixture may be given for a dose. In very violent cases of convulsions, an in- jection of one drachm of turpentine, one ounce of sweet oil, and five or six ounces of thin starch, will often be found beneficial. Subsequently to an attack of convulsions, measures should be taken to prevent their return in future. If the infant has been placed under the care of a nurse, it is ne- cessary to ascertain that her milk is per- fectly good, that she is strictly temperate, and cleanly in her person, not given to vio- lent paroxysms of passion, nor suffering under some corroding care or deep depres- sion of mind, and that she pays all proper attention to the diet, clothing, cleanliness and exercise of the infant. If such be not the case, she should be at once deprived of her charge. It is all important that the diet of the child be perfectly wholesome, and of a qua- lity adapted to the state of the digestive or- gans. The breast milk of a healthy nurse, or if it be weaned, cow's milk, diluted with water and sweetened with loaf sugar; pre- parations of stale bread, rice, arrow root or tapioca; thin chicken or mutton broth, or beef tea, will all be proper under different circumstances. Cleanliness of the infant's person should be carefully attended to; hence the daily use of the warm bath is an important measure. The child should be allowed to breath constantly a pure and free air; indeed, all the rules laid down in a former part of this work for the treatment of infants and young children, should be cautiously attended to. APOPLEXY. Apoplexy, or an apoplectic fit, is a sud- den suspension of the powers of sense and motion, from some diseased affection of the brain and nervous system, the respiration being generally laborious, and frequently attended with a stertorous noise. We are sometimes warned of the ap- proach of apoplexy by a dull pain in the head, accompanied by a sense of heaviness; giddiness; drowsiness; frequent fits of nightmare; fulness and redness of the face and eyes; obscurity of sight; bleeding from the nose; faltering in the speech; ringing in the ears, and loss of memory: but its at- tack is more frequently sudden, and the patient falls to the ground with scarcely any warning, and lies as if in a deep sleep, from which he can not be roused. In this state, his breathing is laborious, and gene- rally accompanied by stertor; the face is red and tumid; the veins of the head and neck are distended; the head is hot, and often in a copious perspiration; the eyes are prominent, bloodshot, sometimes half open, but more frequently quite closed, the pupils dilated, and a frothy saliva is often excreted from the mouth. The pulse is at first regular, strong, full, and slow, but soon becomes weaker, frequent, irregular, and intermitting. The pupils of the eyes are commonly dilated, but they are now and then much contracted. The duration of a fit of apoplexy is various; but it generally lasts from eight to twenty-four hours, and occasionally to thirty-six hours, or even longer. There are two varieties of apoplexy, which are in general clearly marked, the one attended with a hard, full pulse, flush- ed countenance, and stertorous breathing; the other with a feeble pulse, and pale countenance. The former usually occurs in persons of a full plethoric habit, and con- siderable energy and strength; the latter, for the most part, in the old, phlegmatic, and feeble. The most common immediate cause of apoplexy is pressure on the brain, either from an effusion of blood or serum, or from a distention of the vessels of the brain, by an accumulation of blood in them, inde- pendently of effusion. Whatever operates in determining a great quantity of blood to the head, or in imped- ing a free return from it, may produce ex- cessive distention or effusion within the cranium, and is, therefore, to be considered as an exciting cause: such as violent passions of the mind, immoderate exercise, intense study, fits of intemperance, excessive strain- ing, ligatures about the neck, the suppres- sion of accustomed evacuations, as piles, &.c, unrestrained indulgence of the appe- tite, and exposure to sudden and great heat, or to excessive cold. The disease may happen at any age, but is most frequent about the middle, or towards the decline of life, especially in persons of a plethoric habit, who have short necks, and who are indolent, and indulge much in eat- ing and drinking. Apoplexy is distinguished from epilepsy, or falling fits, by the presence of convul- sions and contortions of the limbs in the lat- ter, by the comparative shortness of the fit, and the greater facility with which the pa- tient is roused. In deep intoxication, the 304 DISEASES. breath is in general tainted with the intoxi- cating liquor, and the patient may be in some degree roused by shouting in his ear, or by applying a strong stimulant to the nostrils. Although, in systems of physic, it has been usual to divide this disease into the two varieties of sanguineous and serous; the former arising from the extravasation of blood, the latter from the effusion of serum; yet it is very doubtful whether these dis- tinctions have any real foundation in expe- rience, or observation. But, in treating this disease, it is unquestionably proper and ne- cessary to attend to the following modifica- tions, namely: 1. Apoplexy occurring in the vigorous and plethoric. 2. Apoplexy attacking a constitution infirm by nature, or enfeebled by age, intemperance, or exces- sive exertion. In the former case, copious blood-letting, both general and local, active purgatives by the mouth and in-clysters, and the free application of cold to the head, form the best remedies; but in the apoplexy of the infirm, or enfeebled, we must be cautious and sparing in-the employment of the lan- cet, and all other very active depleting measures. In all cases of the disease, the patient should, if possible, be immediately carried into a spacious apartment, into which cool air may be freely admitted; his head and shoulders should be placed in an upright position; all ligatures, especially those about the neck, must be speedily removed; and the legs and feet should be placed in warm water, and rubbed with some stimulating liniment, as the volatile liniment, and after- wards mustard poultices should be put on the ankles. When the disease occurs in a full habit, or has been preceded by marks of strong action in the vessels of the brain, a pint or two of blood should be immediately drawn from the arm or jugular vein, and a do- zen leeches applied to the temples, or what is preferable, the patient may be cupped on the back of the neck. Immedi- ately subsequent to these operations, a co- pious purgative clyster, composed of one ounce of Glauber salts dissolved in a pint of water, with the addition of a spoonful of sweet oil, should be given; this injection may be quickened by the addition of four ounces of infusion of senna. A very excel- lent injection is a solution of soap in water, with the addition of common salt. The in- jection should be followed by active purga- tives, administered by the mouth as soon as the patient is able to swallow. The best will be calomel and jalap, or calomel and gamboge, aided by strong senna tea. The head may, at the same time, be shaved and then covered with linen rags wet with cold water, vinegar and water, or powdered ice. Unless the first clyster ^operate well, it ought to be quickly repeated, which should likewise be observed with regard to the purgative powder. In the commencement, the purgative medicine should be repeated every day, and afterwards every second or third day, for some time. Dr. Baillie, after recommending the treatment above laid down, says, "if the patient should recover by these means, the best plan of management, in order to escape from another attack, is to live almost en- tirely throughout future life upon vegetable food, and to abstain from wine, spirits, and malt liquor. It will be of considerable ad- vantage to avoid any strong- or long-conti- nued exertion of the mind. In a few in- stances, when the full state of the vessels of the brain had for some time subsided, 1 have derived considerable advantage from the moderate use of tonic medicines, and more especially of steel." But in the second variety of apoplexy, which is the same disease occurring in an enfeebled constitution, free local bleeding by cupping and leeches, will be preferable to that by the lancet. Purgatives are here always of much service. The forms above recommended are proper, though the pa- tient need not take them in so large doses as is advisable in the apoplexy of full ha- bits. Blisters may also be applied, first to the back, and then to the arms or thighs; and when the patient is recovering, a change of air and scene, with the use of mild laxa- tives and a well regulated, very abstemious, chiefly vegetable diet, and daily gentle ex- ercise, may be resorted to with the prospect of considerable advantage. Much of the treatment recommended for indigestion, will be useful here. They, who from their constitutional make, are disposed to the present malady, ought to be very attentive in observing a mild, spare vegetable diet, and regular habits; they should rise and retire early, take no strong drink, especially avoiding malt li- quors, keep an open state of tlie bowels, and use a great deal of active exercise in the open air. A seton in the nape of the neck, or between the shoulders, is often a valuable preventive, and highly merits the attention of those who have had one attack of apoplexy. The same may be said also of daily frictions of the skin with a flesh brush. In recovering from an attack of apo- plexy, strict attention to diet and regimen is of the utmost moment, and we shall, therefore, conclude this article with some of the most important rules relating to these points. It has been correctly re- marked, that the recovery of health and strength after the disorder has been in a measure subdued, requires (and often for a long period of time) unceasing attention to minutiae. DISEASES. 305 1. Having the head shaved frequently, and washing it daily with cold water, are practices worthy of attention. Frequently rubbing the head with a flesh brush, dip- ped in cold water, is very beneficial. The scurf on the skin is thus got rid of, a proper perspiration promoted, and the head can be kept much cooler. 2. As soon as it is practicable, it is highly expedient to use the shower bath, with cold or tepid water, at least occasionally, as the means of propelling the blood from the- head. 3. A strong flesh brush ought to be ap- plied for ten minutes, night and morning, to the feet and arms, with the view of giv- ing tone to the skin and muscles, and aug- menting the quantum of daily exercise. Rubbing the limbs, and patting them by 1 the hands of a servant, in particular the > feet and legs with the stockings on, greatly tends to the acquisition of strength, and brings what is so much wanted, the blood to the extremities. 4. The breathing of pure air is of the ut- most importance to health; and for that purpose, the improved mode of ventilation, *$ by pulling down the upper sashes, and having a wooden conductor, by which the air is made to strike against the ceiling, can ^ not be too strongly recommended. By this * means, the room occupied by the patient f may be kept constantly cool in the summer, and in the winter an occasional recourse to it will prevent any stagnation of air in the apartment, and carry off superfluous heat. 5. The body clothes should be kept loose, especially about 'the neck, the wrists, and the knees, and light, for the sake of easy conveyance. It is not difficult, by using flannel, to combine warmth with lightness. 6. In regard to diet, at breakfast a mode- rate quantity of milk may be taken, if it agrees with the patient, with biscuit, or rusks, or stale or toasted bread, which are |, both more agreeable to the stomach, and excite its digestive powers better, than common bread. If costive, toasted brown bread, especially with a little uye flour in its composition, will be preferable. Oat meal gruel, might also be occasionally taken; or weak tea for a change. No but- ter nor cheese is on any account to be taken. Luncheons ought to be entirely given up. For dinner, (about two o'clock,) take a single plateful of light soup or broth, and then a moderate quantity of pudding, made of pearl barley or rice. Rice or barley af- fords excellent nourishment; when ground into meal, it may be made into cakes pre- pared with milk, which are more whole- some than fermented bread. A little fowl or mutton, is allowable once or twice a week for a change. The more wholesome fruits, as strawberries, gooseberries, grapes, cur- rants, peaches, and oranges, may be taken, but never after the stomach is filled. Stone fruits are to be avoided, excepting peaches. Remember to eat slowly, and to masticate well what is eaten. For drink, whey or toast and water, carefully made, is to be preferred. Arti- ficial mineral water, likewise may be occa- sionally taken: but no malt liquor, nor wine, nor spirits, even with water. A late tea may be taken, to prevent the necessity of supper, which ought to be en- tirely given up. 7. With respect to sleeping, a mattress is to be preferred: the head should be rais- ed, and very lightly or not at all covered; the pillow to be stuffed with horse hair in- stead of feathers. A habit of retiring to bed early, and rising very early, out to be studi- ously cultivated. 8. Daily exercise is of the first import- ance, more particularly if the patient be of a full habit. Walking much on level ground, surveying the beauties of nature, or directing the operations in the labours of gardening, are practices highly advi- sable. The management of a green-house, and attention to the culture of plants, are excellent means of occupation. These should be alternated with gentle horse ex- ercise. In regard to " in-door amusements," no game of chance is to be recommended, from the anxiety it occasions, &c. Books of a light and amusing description are pro- per, and the company of the young and lively ought to be cultivated. Daily friction and percussion must not be forgotten. 9. Quit large towns and cities for the open elevated countiy. On the whole, it is hardly possible, where the constitution is not gone, or the frame in a state of decay, that a careful attention to all these particulars, will not be productive of the most essential benefit. PALSY. Palsy is a diminution, or total loss of the power of motion and sensibility in certain parts of the body, but without that oppres- sive sleep witnessed in apoplexy. Some- times the powers of voluntary motion alone are affected in any considerable degree, while those of sensation are only rendered a little more obtuse; at other times, how- ever, both kinds are equally torpid, and sometimes several of the faculties of the mind participate in the debility, though they are never so completely lost as in apoplexy. There are three varieties of the disease, the hemiplegic palsy; the paraplegic palsy; and the local palsy. In the first, the disease affects only one side of the body; in the se- 300 DISEASES. cond, it is confined to the lower part of the body on both sides; and in the third, to particular limbs. Palsy usually comes on with a sudden though slight loss of the power of motion in the parts affected, which is frequently preceded by a numbness, coldness, and paleness, and sometimes by convulsive twitches. In some cases, this ioss of motive power continues to increase till it becomes complete; in others, it is stationary and partial. When the head is much affected, the eye and mouth are drawn on one side, the memory and judgment are impaired, and the speech is indistinct and incoherent. If the disease affects the limbs, and has been of long duration, it not only produces a loss of motion and sensibility, but like- wise a considerable flaccidity and wasting away in the muscles of the parts affected. The progress of the disease is uncertain; and depends very much upon the state of the nervous system at the time of the at- tack. If there be no chronic debility, or other morbid condition of the. brain, the patient will sometimes recover entirely in a week, or even less; but if his system, or some particular part of it be in an infirm state, he recovers only imperfectly; and obtains, perhaps, a thorough or a limited use of the lower limb, while the upper re- mains immoveable; or he is compelled to pass through the remainder of a painful ex- istence with only one half of his body sub- servient to his will. The paralytic state of the lower limbs generally depends upon a diseased affection of the spine, in its bones, ligaments, or in- terior. In such examples, there is at first nothing more than a slight numbness in the lower limbs, with an appearance of stiffness or awkwardness in the motion of the muscles; these symptoms increase by degrees; there is a great difficulty in walk- ing, and an inability in preserving a balance; the aid of a staff, or the arm of an assistant, is next demanded; and the urine is often found to flow in a feeble stream, or perhaps involuntary. The bowels are at first always costive; but as the sphincter of the anus loses its power of contraction, the stools at length pass off involuntarily. The dis- ease may continue for years, and either ter- minate in recovery, or the patient may at last sink from general exhaustion. Palsy is frequently the consequence of a fit of apoplexy; and all the causes of apoplexy may give rise to this disease, though no apoplectic fit actually precede it. These causes are compression or rupture of the brain from the effusion of blood, tu mors, or induration of the membranes. The circumstances predisposing to this disease are, advanced age, corpulency, fulness and grossness of habit, an inordinate in- dulgence in wines and fermented liquors, excessive heat, and whatever tends to un« duly excite the nervous system. All its varieties more generally appear in the aged and infirm, than in the young and robust; and the left side is, perhaps, more frequently affected than the right. As in all other complaints, the treatment proper for this disease will depend on the age of the patient, and the state of the con- stitution. If the age of the patient is not far advanced, and the habit full, active bleeding and purging are generally proper in the commencement, and they are parti- cularly indicated when the head is much affected. In such a state, fourteen or six- teen ounces of blood should be directly taken from the jugular vein, or temporal artery; a purgative of Epsom salts or senna tea being given so as to act freely on the bowels; then quietness should be enjoined, and as little exercise of body as possible. Plain light vegetable food should be given, and but very little of it. If the first bleed- ing and purging afford only partial relief, they may be repeated, in robust habits, to the same extent without delay, or the first bleeding may be followed by cups to the back of the neck, and cold applications to the scalp, and a large blister between the shoulders; the quantity of blood drawn be- ing always regulated by the strength of the patient, and the degree in which the symp- toms approach those of apoplexy. But if the age be considerable, the habit debilitated, and the pulse feeble and inter- mitting, with little or no stupor, or giddi- ness, we shall in general do better to ab- stain from the use of the lancet, and give the purgative, as above advised, or a pill composed of blue mass five grains, and aloes three grains. The purgative should be re- peated once or twice a day, according to its effects, for the first four or five days. If this course be persisted in for a proper length of time, the patient will very fre- quently entirely recover; but should it not succeed, and the disease proves obstinate, we may try the effects of certain other re- medies. Numerous cases have been cured, or greatly benefited, by the judicious use of electricity and galvanism, and unless there are symptoms which contra-indicate their employment, they should never be neglect- ed, when other remedies fail. They are more likely to be useful in palsy connected with general debility, than when it occurs in full habits. Some physicians recommend galvanism as superior to electricity in pal- sy. Dr. Bardsley, of Manchester, says, that he has found it succeed, when the latter has failed. In weakly habits, warm bathing is some- times useful, especially the natural warm DISEASES. 307 Waters; but in persons who are full of blood, of mind, sickness at the stomach, palpita- they are much less useful, and should be tion of the heart, and sudden bursts of tears, used with caution. without any assignable cause. The pa- The leopard's-bane (arnica montana) has roxysm soon succeeds, with a coldness and been a good deal praised by some conffhen- shivering over the whole body, and fre- tal physicians, and is worthy of trial. But quently with an acute pain on the left side, the sumach (rhus toxicodendron) is, perhaps, and a sense of distention, giving the idea of much more beneficial. Dr. Alderson, of a ball or globe rolling about in the abdo- Hull, employed it with success in twenty- men, and gradually advancing upwards till four cases. He began with half a grain it gets into the stomach; thence removing or a grain of the powdered leaves three to the throat, it occasions the sensation of times a day, and gradually increased it to an extraneous body lodged there. The five or six grains, or till he found a sense of disease having arrived at its height, the pa- tingling produced in the paralytic part, ac- tient appears threatened with suffocation, companied with some degree of twitching she becomes faint, and is affected with stu- or convulsive motion. por and insensibility; whilst, at the same The nux vomica isanother medicine which time, the trunk of the body is twisted back- has been found useful in some instances, ward and forward, the limbs are variously Four grains of the powder may be taken agitated, and the fists are closed so firmly, three or four times a day, and increased to that it is difficult, if not impossible, to open sixteen or twenty grains, its effects being the fingers: wild and irregular actions fol- carefully watched. It seems of most ser- low, in alternate fits of laughter, crying, vice in sanguine habits, where there has and screaming; incoherent expressions are been a good deal of general strength, and uttered, and sometimes a most obstinate energetic health; after irritation has been and distressing fit of hiccup takes place. allayed, and the pulse brought down to a The spasms at length abating, a quantity of subdued and temperate state, by means of wind is evacuated upwards, with frequent blood-letting, purgatives, and a mild spare sighing and sobbing; and the patient, after diet. When the head is soon affected by appearing for some time quite spent, reco- small doses, it is rarely of much use. vers the exercise of sense and motion, The leopard's-bane, sumach, and nux without any other feeling than a general vomica, are very active medicines, and, soreness, and a pain in the head. It is therefore, must be employed with the great- rarely that an hysteric fit has become dan- est caution. gerous; though it has, notwithstanding, in a Turpentine, guaiacum, camphor, mus- in a few instances, terminated in epilepsy or tard, horse-radish, garlic, and other stimu- insanity. lating medicines of the same kind, have Hysteric affections occur much more fre- commonly been employed in palsy, but are quently in the unmarried than in the mar- all of very doubtful propriety. ried, and most commonly between the age In palsy of the lower limbs arising from of puberty and that of thirty-five years; and a disease in the spine, the most effectual they make their attack oftener about the remedy is a large issue, made as near as period of menstruation than at any other possible to the diseased part of the spine, time. Women of a delicate habit, and which must be kept open for a great length whose nervous system is extremely sensi- of time. tive, are those most subject to hysterics. If the palsy arises from the use of lead, The habit which predisposes to their at- or exposure to its fumes, the means pointed tacks is acquired by inactivity and a seden- out under Painter's colic must be resorted tary life, grief, anxiety of mind, late hours, to, and the palsied arms Supported in splints dissipation, a suppression or obstruction of and a sling. the menstrual flux, excessive evacuations, In debilitated subjects, especially after intemperance, an unchaste life, and the con- the disease has lasted some time, the diet stant use of a too stimulating or an innutri- should be nutritious, but mild, and very tious diet. They are readily excited, in moderate in quantity. those who are subject to them, by passions of the mind, and by every considerable hysterics. emotion, especially when the effect of sur- Hysterics consist in a convulsive strug- prise; hence sudden joy, grief, or fear, are gling, alternately remitting and increasing, very apt to occasion them. They have with 'a sense of a suffocating ball in the also been known to arise from an accidental tnroat, drowsiness, copious discharge of irritation of the stomach, bowels or other pale urine, rumbling in the bowels, and internal organ, affecting the nervous system fickleness of temper. sympathetically. The hysteric fit often takes place without In regard to the treatment of hysterics, any previous warning, though generally this may be divided into that which is pro- there are some precursive signs, as yawn- per during the fit, and that demanded in the ing stretching, dejection of spirits, anxiety intervals, to prevent their return. During 2P 308 DISEASES. the fit, it will be the safest practice to rouse the patient by applying burnt feathers, as- safoetida, or smelling salts, to the nose; by rubbing the temples with ether, and by putting the feet into warm water. In ob- stinate cases, cold water may be dashed over the face and limbs, and a purgative in- jection administered. A clyster of cold wa- ter alone has been effectual in putting an end to the fit. If the patient be young, robust and full of blood, and the attack of a recent nature, from ten to sixteen ounces of blood may be taken from the arm; but in very weak and delicate constitutions, or where the disease has been of long standing, taking blood from the arm would be often improper. In these cases, however, cups to the temples and back of the neck, and along the back bone, will be found advantageous. When- ever the hysteric fit is very violent, the ap- plication of cups to the head, followed by cloths wrung out of cold water, and mustard poultices to the extremities, are not to be neglected. In the intervals of the paroxysms, the object is to restore the healthy action of the stomach and bowels, and to strengthen the whole constitution. Every remote or ex- citing cause is to be sedulously avoided. Active exercise is to be taken daily in the open air. The diet should consist of light nourishing food. These, with early rising, and cheerful company, are the principal means of invigorating the body and mind, and thus effecting a radical cure of hysterics. The warm bath, with frictions over the whole surface of the body, will in all cases be useful; a visit to the mineral springs and the cautious use of the waters, are often advantageous. "When hysteric affections are connected with a suppression or obstruction of the menses, the means recommended when speaking of these affections should be adopted. Anodynes and antispasmodics, as opium, musk, castor, and valerian, together with a long list of tonics, are often had recourse to in this complaint, but they are all of very doubtful advantage, and often injurious. The tincture of meadow saffron has occa- sionally succeeded in curing obstinate at- tacks of hysterics; and from its acknowledg- ed power of allaying pain and nervous ir- ritation, it may be considered a valuable remedy in many cases. Used as a palliative to put an end to the actual fit, a tea-spoon- ful may be given, in water, and repeated to the second or third time, if necessary: and when employed, in the intervals, with the view of obtaining a radical cure, thirty drops may be given twice a day. In its power of affording present relief, it seems to be superior to assafoetida, or any of the antispasmodics in common use, and much safer than opium. It should not be conti- nued for any length of time; in general, not longer that three or four weeks at one time. Cups along the spine, or rubbing this part with an ointment composed of simple ce- rate and tartar emetic, are often attended with the very best effects. Regular exercise on horseback, with va- riety of scene, and early rising, are particu- larly desirable. The diet should be nou- rishing, light and such as is recommended in dyspepsia. HYPOCHONDRIASIS. Hypochondriasis, low spirits, or vapours, is a certain state of the mind accompanied with indigestion, wherein the greatest evils are apprehended upon the slightest grounds, and the worst consequences imagined from any unusual feeling even of the slightest kind; and in respect to such apprehensions and feelings, there is always the most obsti- nate belief and persuasion. Ancient medical writers supposed this disease to be confined to those particular regions of the abdomen technically called hypochondria, which are situated on the right and left side of that cavity, whence j comes the name of hypochondriasis. The common symptoms are, loss of appe- tite, atroublesome flatulency in the stomach or bowels, acrid eructations, costiveness, a copious discharge of pale urine, spasmodic pains in various parts of the body, giddi- ness, dimness of sight, palpitations, general sleeplessness, and often an utter inability of fixing the attention upon any subject of importance, or engaging in any thing that demands vigour or courage. The mental feelings, and peculiar train of ideas that haunt the imagination and overwhelm the judgment, exhibit an infinite diversity: sometimes the hypochondriac is tormented with a visionary or exaggerated sense of pain, or some concealed disease; a whim- sical dislike of particular persons, places, or things; groundless apprehensions of per- sonal danger or poverty; a general listless- ness and disgust; or an irksomeness and '■< weariness of life. In other instances, the disease is strikingly accompanied with ; peevishness, and general malevolence; the patients are soon tired with all things; dis- contented; disquieted; upon every light oc- casion, or no occasion; often tempted to make way with themselves; they can not die, t. they will not live; they complain, weep, la- ment, and think they lead a most miserable life: never was any one so bad. The whims that are sometimes seriously entertained under this complaint are of the most ludicrous description. A foreign writer makes mention of a baker of Ferrara who thought himself a lump of butter, and durst not sit iuthe sun or come near the DISEASES. 309 fire, for fear of being melted. The wisest and best of mankind are as open to this affliction as the weakest. The excellent Pascal was at one time so hallucinated with hyppchondriacism, as to believe that he was always on the verge of an abyss, into which he was in danger of falling; and un- der the influence of this terror, he would never sit down till a chair was placed on that side of him on which he thought he saw it, and thus proved the floor to be sub- , stantial. Rousseau was a perfect hypochon- driac. The chief cause may be a strong consti- tutional predisposition, or the disease may be the consequence of a sedentary life of any kind, especially severe study protracted to a late hour in the night, and rarely re- lieved by social intercourse or exercise; a debauched and dissolute habit; great ex- cesses in eating and drinking; the immode- rate use of mercury; violent purgatives; the suppression of some habitual discharge, or long-continued eruption. The poet, Cowper, who was deeply impressed by hy- pochondriasis for the greater part of his life, was thus afflicted after having had a cutaneous eruption repelled, to which he had been for some time subject. Congestion, or some peculiar affection (by whatever produced) of one or more of the important organs within the abdomen, ■ ¥ is a frequent cause. M. Pinel, a French writer on this disease, of considerable re- putation, regards the displacement of the transverse arch of the colon as a powerful and ready cause of hypochondriasis; and M. Esquirol, another distinguished French physician of the present day, has found it as frequently as M. Pinel. This displace- ment sometimes consists in an oblique, and sometimes in a perpendicular direction of the intestine; but no disease of the organiza- tion has been found in any instance, and hence the change of place seems to proceed from relaxation and debility alone. The principal objects of treatment are, to remove the indigestion, to strengthen the body, and to enliven the spirits; and one of the best plans with which we are acquainted, for the fulfilment of these in- tentions, is, constant exercise and change of place, with a warm bath about thrice a week; early hours, regular meals, and plea- sant conversation; the bowels being at the same time carefully regulated by the occa- sional use of gentle purgatives, and the sto- mach strengthened by some appropriate to- nic medicine. The exercise should be very considerable daily; and of all common modes, that in an open carriage, or on horseback, is the best; this should be com- bined, if possible, with constant change of air and scene. Indeed, travelling is a powerful remedy in this disease, since it is often one of the most effectual means in removing indigestion, of strengthening the body, and exhilarating the spirits; and where the patient's circumstances will per- mit, it ought invariably to be one of the first measures resorted to, as it will un- doubtedly be found one of the best. At the same time, a warm bath at 95° or 96° should be taken every other morning; the patient accustoming himself to early rising, and regular meals of nourishing and easily digested food. The bowels are almost al- ways torpid in hypochondriasis, and will, therefore, require constant attention in se- lecting articles of diet which are of an opening quality, with the occasional em- ployment of medicine Either of the fol- lowing pills are very suitable, one or two of which maybe taken thrice a week: blue mass, three grains; soap, three grains, and aloes, two grains: or, compound extract of colocynth, three grains; rhubarb, three grains; soap, one grain. The bitter and metallic tonics are generally prescribed in this complaint, but we anticipate from them very little service. The ipecacu- anha, however, is often beneficial; it at once invigorates the stomach, relaxes the skin, and favours the natural action of the bowels. It may be taken in the following manner: ipecacuanha, in powder, twenty grains; Castile soap, one drachm; extract of chamomile, one drachm; mix, and divide into forty pills. Take two, twice or thrice a day. Regular daily friction over the limbs and bowels, with the flesh brush, is very advisa- ble; and the general diet and regimen should be governed by the same rules as in indigestion. The sulphate of quinine, in doses of a grain or two, two or three times a day, may prove a useful tonic medicine in a few in- stances. It is certainly the best way in which bark can be administered. The wa- ters of certain chalybeate springs have also been productive of service in many cases. For local pain in the head or stomach, the most efficacious means are blisters, ap- plied to the neighbourhood of the part affected, or friction with camphorated lini- ment; or five or ten grains of extract of hemlock, with one grain of ipecacuanha, may be administered as occasion requires, or a few drops of the solution of acetate of morphia. In regard to the moral management, assi- duous kindness and consoling conversation produce a deeper-effect than they seem to do. The patient should rarely be opposed in the expression of his sentiments, and never with ridicule. A very grand object is to gain the patient's confidence, and in order to effect this, we must humour his foibles, and seem to fall in with his views. When he is dwelling upon some imaginary disease, it must be prescribed for, and 310 DISEASES. should his anxiety pass, in succession from one complaint to another, they ought all to be prescribed for in their turn, for there is seldom any other way of removing the groundless fears associated with hypochon- driacism. NERVE PANG OR TIC DOULOUREUX. This is a dreadfully painful affection of the nerves of a part. It occurs most fre- quently in the face, although other parts of the body may be attacked with it. The pain experienced by those afflicted with this malady is of the most acute, distressing, and indescribable kind; it is not continual, but occurs in violent paroxysms, which often make their attack like the sudden and painful shocks of electricity, and vary in duration in different instances. When tic douloureux occurs in the face, its most common seats are the forehead and temple, or the fore part of the cheek. In the former case, the agonizing pain darts into the inner angle and ball of the eye, and in its progress affects the whole side of the head; in the latter, it strikes towards the mouth and angles of the nose, then back- ward to the ear, and sometimes spreads up- ward to the forehead. Its causes are often involved in great ob- scurity; but, frequently, they are sufficient- ly clear, and are found to consist in a great derangement of the digestive organs, and general health. We are persuaded this derangement is by far the most frequent cause of tic douloureux; no one will assert that it is not equal to the effect, and the evidences of its existence are very often, perhaps, generally, equally apparent. This disease is distinguished from rheu- matism, and tooth-ache, by the agonizing violence of the pain, the shortness of its duration, and the absence of all swelling or inflammation: it is also sometimes excited by the slightest touch. Believing, as we do, that the majority of cases of tic douloureux originate in severe disorder of the digestive organs, we have no doubt, that the best and most successful plan of treatment consists in correcting that disorder, and invigorating the general habit, by the administration of suitable aperients, alteratives, and tonics, combined with a perpetual blister or an issue, change of air and scene, and a correct diet and regimen. From the accounts which have been pub- lished, of cases of the disease successfully treated, it clearly appears, that a very con- siderable majority of them were cured by the preceding means alone. Costiveness, or an irregular arid disorder- ed condition of the bowels, with furred tongue, and other symptoms of abdominal derangement, very generally prevail in cases of this disease; hence, particular care should be taken to regelate the bow- els, by means of attention to diet, and the use of mild aperients, and to restore healthy secretions from all the digestive viscera, by having recourse to mercurial and other alteratives, in conjunction with tonics, daily active exercise, the warm bath, frictions of the skin, and a mild un- irritating diet. The patient should take either of the following pills: blue mass, five grains; rhubarb, three grains; ipecacuanha, one grain: or, blue mass, two grains; com- pound extract of colocynth, two grains: or, blue mass, three grains; soap, five grains; aloes, one grain; at first every night, and then on alternate nights, and a grain of sulphate of quinine, and half a grain of ipe- cacuanha powder, made into a pill with ex- tract of gentian, three times a day. On this plan, the dose of sulphate of quinine may be gradually increased to two or three grains, or more, thrice a day, if it be found to agree; and if the above pills be not suffi- cient to move and clear the bowels gently, two may be taken, or they may be occa- sionally dropped for three or four days, and the senna tea, or magnesia and rhubarb substituted. Delicate persons will, for the most part, find the pills agree with them best, and will find an increasing advantage from continuing them regularly, as above directed; but stronger patients will some- times be greatly benefited by an occasional resort to the saline purgatives. In this, as well as in many other points, the patient must be guided, in some measure, by his own feelings; while he constantly remem- bers, that the chief objects are, to preserve the bowels in rather a lax condition without teazing and irritating them, to allay internal irritation arising from other causes, and to invigorate the general habit. Together with the preceding remedies, a warm bath at 95°, may be advantageously taken, thrice a week, and the painful part freely rubbed occasionally with the camphorated liniment. In most instances, a perpetual blister, or an issue, between the shoulders, or a seton in the nape of the neck, will be found a valua- ble auxiliary. The carbonate of iron has lately been strongly recommended as a tonic in this complaint, and if the sulphate of quinine fail to afford the patient satisfactory relief, it may be changed for the iron, eight or ten grains of which may be taken thrice a day, and gradually increased to one, two, or even three scruples at a dose. It will sit better on the stomach if two or three grains of aromatic powder are taken with each quantity; and, if it confine the bowels, a small proportion of powdered aloes should also be added. , The arsenical solution appears to have been useful in some cases, and may be tried when other medicines fail. The extract of DISEASES. 311 belladonna is also another article which has occasionally succeeded. It is a very active substance, and if the patient wishes to try it, he may begin with a pill containing half a grain, repeated thrice a day, and gradually increased to one or two grains, at a dose. Belladonna is unquestionably a valuable anodyne in this malady, and in many in- stances it may be advisable to employ it simply as such, to mitigate the violence of the pain, while we trust to the administra- tion of a direct tonic medicine, and a suita- ble diet and regimen, to effect a perfect and lasting cure. But the sufferer must be impressed with the necessity of constant attention to a cor- rect diet and regimen, and to the regulation of the bowels, whatever medicine be re- sorted to. Whether, therefore, he take the carbonate of iron, sulphate of quinine, arsenic, or belladonna, he should daily re- sort to active exercise, in the country, on foot, or horseback; he should retire and rise early; should, if practicable, change the air and scene, and make use of mild, nourishing and digestible food; abandoning at the same time all stimulating drinks. Every medical man, who has seen this dis- ease frequently, must acknowledge, that instances continually occur in which steel, quinine, and arsenic, fail of any curative, or even satisfactory effect, if the patient trusts to either of them alone. The operation of dividing the trunk of the affected nerve is sometimes resorted to, and if the complaint originate in local causes, as from some source of irritation fixed in or near the affected part, and di- rectly irritating the nerve, may frequently be effectual, and the best mode of treat- ment. But if it arise from derangement of the digestive functions, the operation will generally fall short in affording much relief, and the little advantage gained will not be permanent; sometimes, under such circum- stances, it fails altogether. The application of leeches to the seat of the pain will fre- quently be attended with benefit. TETANUS. Tetanus is a violent and extensive con- traction of the muscles, attended with ten- sion and rigidity of the parts affected. The excessive contraction of the muscles is kept up, without any intervals of complete re- laxation, mostly without any relaxation whatever; but the powers of sensation and intellect are unimpaired. Either the whole or a part of the body may be attacked with this malady. Sometimes only the flexor muscles are affected, when the body is ri- gidly bent forwards; sometimes only the extensor muscles, when it is as rigidly bent backwards; at other times both sets of mus- cles are involved, and the body is rigidly erect. When its effects are confined to the muscles of the jaw or throat, it is called locked-jaw. This disease differs greatly, in different cases, in the intensity of its symptoms, and in the mode in which it makes its attack. Generally speaking, the commencement of the disorder is announced by a sensation of stiffness about the neck, which increasing, the motion of the head becomes painful, and there is a difficulty and pain in swal- lowing; there is also a severe pain at the bottom of the breast-bone, darting back- wards to the spine; the spasms of all the muscles of the neck become exceedingly violent, and, together with the spasm at the pit of the stomach, recur every ten, fifteen, or twenty minutes. At the same time that the spasms increase, the retraction and ri- gidity of the muscles affected become stronger, the belly feels as hard and tense as a board, and the body is drawn forward, backward, or to one side, according to the muscles chiefly affected. In the extreme period of the disease, one set of muscles contract so powerfully as to counterbalance the force of the opposite set, and hold the head and trunk in a straight, fixed, and im- moveable position. The muscular contrac- tions in tetanus are always accompanied with the most excruciating pain, and when the disease arrives at its height, a violent convulsion usually puts an end to the pa- tient's misery. The most common causes are, scratches, punctures, lacerations, or other mechanical injuries. Considerable irritation in the di- gestive organs seems also sometimes to give rise to this disease. It may likewise be produced by exposure to cold and moisture. It is much more frequent in warm than in temperate climates, and in marshy situa- tions. The male sex more frequently suffer than the female; and the robust and vigor- ous more frequently than the weak. Tetanus is a dangerous malady, and me- dical men are not yet agreed respecting the most effectual plan of treating it. It is clear, however, that a principal point is to remove all sources of irritation; and the ex- hibition of calomel and opium; opium, camphor, and nitre; opium and ipecacuan- ha, as in Dover's powder; and mild purga- tives of calomel, jalap, and rhubarb, seem to have, been the most useful means, when used in conjunction with the warm or cold bath, and blood-letting, as the circumstances of the case point out. A proper plan in most cases is, to give from one to two grains of opium, and a grain of calomel, made into a pill, with a little mucilage of gum arabic, eveiy three or four hours; with a mild purgative, as castor oil, senna tea, or a solution of Epsom salts, with purgative injections, every morn- ing, or every other morning, allowing, at 312 DISEASES. the same time, a nourishing but unirritating diet. In addition to these means, the cold bath is generally safe when the disease oc- curs in a hot climate, and is sometimes of great service, especially when it arises from other causes than a wound. It has not ap- peared applicable to tetanus arising from wounds, and, in all cases, is most proper when the heat of the body is above the na- tural standard. It may be repeated, if ne- cessary, every three or four hours. In other cases, the warm bath will be found more beneficial. The French surgeon-general, Larrey, states, that he found a combination of ex- tract of opium, camphor, nitre, and almond emulsion, the most useful medicine in this disease; and it may, therefore, be taken if preferred, instead of the calomel and opium recommended above.' A grain of extract of opium, ten grains of camphor, and five grains of nitre, may be mixed in a mortar, with an ounce and a half of almond emul- sion, and given four or five times a day. Dover's powder is also said to have been useful; it is, no doubt, a valuable medi- cine in allaying great irritation, and maybe taken in this complaint in doses of ten grains, every three or four hours. Instead of the calomel and opium above advised, some practitioners recommend large doses of opium alone, for example, five or ten grains of the substance in its crude state, every three or four hours, and this practice appears to have been sometimes attended with success; but in general, free doses of Dover's powder, or moderate doses of ca- lomel combined with opium should be pre- ferred. It is said that an injection of tobac- co infusion has been found of great service in several cases. If the patient be young or of a full habit, especially if he has a wound which is in- flamed, swelled, and painful, twelve, four- teen or sixteen ounces of blood may be ad- vantageously taken from the arm, and the bleeding may be subsequently repeated. Frequently the patient is unable to swal- low, and then the medicines used must be injected into the rectum. If tetanus originates from a puncture, or any other kind of wound, it is advisable to sooth the irritation existing in it by the use of mild anodyne applications, and, perhaps, there is nothing superior, if equal, to a watery solution of opium. A sufficient quantity of solid opium to cover the wound should be liquefied with a little w-ater, and laid over the surface with a feather or ca- mel's hair pencil., This is the application made use of by Sir Astley Cooper. In some cases, the use of lunar caustic will be useful. The treatment proper for locked-jaw is the same as above described, and mild ape- rients, with Dover's powder, or calomel and opium, with a generous«tiiet, and the warm or cold bath, will be found the best remedies. The locked-jaw of infants and very young children, almost invariably arises from irritation in the stomach and bowels, and is most successfully treated by the fre- quent exhibition of mild aperients, as castor oil, calomel and rhubarb, or rhubarb and magnesia, with an occasional purgative clyster. A mixture of small doses of cam- phor, ipecacuanha and mucilage of gum arabic, may also be given. Some physi- cians advise opium to be given, but this medicine so generally and greatly disagrees with infants, that if ever employed, it should be in combination with ipecacuanha, as in Dover's powder, a grain or two of which might be administered to a very young child, every three hours, in extreme cases. HYDROPHOBIA. The dread of water. A remarkable symp- tom, which gives its name to a train of painful affections, which arise ordinarily from the bite of a mad animal. All the symptoms of hydrophobia may, however, be produced from other causes. The irrita- tion arising in very excitable constitutions from punctured wounds or contusions; vio- lent affections of the mind; sudden alterna- tions of heat and cold; the sudden suppres- sion of the perspiration of the feet, by washing those parts in cold water, may all produce a train of phenomena identical with those of hydrophobia. The animals whose bite most commonly occasions hy- drophobia, are the dog and cat; and they can impart the disease both to man and other animals. It is in the warm season of the year, that hydrophobia most commonly appears; and though nothing should be said to make people negligent of what may prevent the horrid effects of canine mad- ness, yet it may be right to spare unneces- sary alarm to any, by remarking, that out of many persons who are bit by dogs, but very few are affected with the disease. The bite of a mad dog may not pierce the skin, or the teeth may be dried and cleaned in passing through the clothes, or the saliva may have been entirely expended by at- tempts at biting other men or animals; or from some peculiarity of constitution, even a person who has really been bitten, may not take the disease; of which a remarkable instance is given by Mr. Hunter, who re- lates, that of twenty persons who were bit- ten by the same dog, only one was seized with hydrophobia. When the popular ter- ror is excited, every dog, whether mad or not, is supposed to be so, when he shows any signs of anger; but although such dogs bite, they do not inflict a poisonous wound. The time which elapses between the inflic- DISEASES. 313 tion of the wound and the appearance of the disease is various, and is in some cases astonishingly long; instances, though very rare, have been recorded where a year has elapsed; but from six weeks to two months is a period by no means uncommon. The symptoms of hydrophobia are the following; the bitten part begins to be pain- ful, then there ensue uneasiness, restless- ness, heaviness, a desire to be alone, sudden starting, pain, spasms, disturbed sleep, and frightful dreams. These symptoms in- crease, pains dart from the wounded place to the throat, with a sensation of choking, and a horror and dread at the sight of li- quids. The person can swallow solids, but any thing in a fluid form causes him to start back with horror; and the most painful convulsions are excited by any application of it to his throat or lips. In the course of the disease, vomiting comes on, with much fever, great thirst, dryness and roughness of the tongue, hoarseness, and a continual discharge of saliva. There is great watch- fulness, a dislike of light and air, difficult breathing; in some cases, delirium, but in others the judgment is unimpaired. The pulse becomes tremulous and irregular, convulsions arise, and the patient sinks ex- hausted, about the third or fourth day from the first appearance of the symptoms. Hydrophobia is one of those diseases in which the resources of the medical art al- most universally fail. ' To enumerate all the remedies that have been tried, would be to give a list of the most various and contra- dictory articles. Cases have got well under several plans, which when applied to others have altogether failed. Large bleedings, cold bathing, warm bathing, wine, opium, musk, and other antispasmodics, ipecacuan- ha, turpentine, potash, vinegar, and a copi- ous assortment of quack medicines, have all been tried in vain. From this view of the case, it must be obvious, that our most anxious care should be directed to the pre- vention of the disease, since, in the present state of our knowledge, it is hopeless of cure. For this purpose, nothing is so effec- tual as completely cutting out the bitten part, and some portion of the surrounding substance, as soon as possible after the in- jurv, whenever the situation of the part will allow of it—dressing the wound thus made with stimulating salves, or freely applying to its surface the lunar caustic. If this be freely and properly done, we have every reason to hope that no bad effects will fol- low from the bite of the animal. If, not- withstanding, hydrophobia should come on, however hopeless, something should be done; and we must attempt, in the best way we can, to palliate the distressing symptoms. If the patient be furious, care must be taken to prevent him from injuring himself or others; and for this purpose, the best restraint is the strait waistcoat; as the struggle with other men is always hurtful. Nourishment of a light kind must be given as long as he can swallow, and when this power fails, animal broths must be given by clyster. Costiveness is to be obviated by laxative injections, or by purgative me- dicines in the form of pills. Bleeding from the arm, cups along the spine, when freely and early employed, have been found beneficial. When active depletion has in this manner been employ- ed, we may try the effects of opium in re- peated doses, and frequent immersion in the warm bath. Placing the system as speedily as possible under a mercurial im- pression, is said, in a few cases, to have ar- rested the progress of the disease. . As it may sometimes be of consequence, in connexion with this disease, to know whether the dog be really mad, we shall subjoin a few of the marks of the rabid state. There is an alteration in the usual habits of the dog; his appetite is depraved; he is very irritable and treacherous, allow- ing himself to be fondled, but suddenly snaps or bites without any provocation. The eyes become inflamed, and matter is discharged from the eye-lids. His bark is changed into a howl; he becomes very rest- less, and desirous to gnaw every thing around him. If he gets loose, he bites all animals that come in his way, especially his own species. He often appears palsied behind, he becomes feeble, his jaws drop, saliva runs from his mouth, and he dies ex- hausted on the fourth or fifth day. EPILEPSY. A disease of frequent occurrence, and arising from various causes. It occurs in paroxysms, marked by convulsions of more or fevver of the muscles of voluntary mo- tion, accompanied with a loss of sense, and ending in a state resembling deep sleep. Epilepsy suddenly attacks persons seem- ingly in perfect health; and going off, after a certain time, the patients are left in their usual state. In some patients, there is a very curious warning of the approach of an epileptic fit. From some point on the sur- face of the body, perhaps one of the fingers or toes, a sensation begins, as of a cold wind, or the creeping of an insect, which appears to proceed to the head, and when \ it reaches that part, the patient is convuls- ed. In other cases, the patient fancies he sees a spectre approaching him, and the contact of this figure is the commencement of the convulsions. Whether there be any warning or not, a person thus attacked loses all power of sense and motion, and either falls, or is thrown, with convulsions, to the ground. In that situation, violent con- vulsions variously move the limbs and the 314 DISEASES. trunk of the body, and frequently with more violence on one side than the other. In almost all cases, the muscles of the face and eyes are much affected, giving a very dis- tressing and alarming distortion of the countenance. The tongue is often affected, and thrust out of the mouth; and by the convulsive action of the muscles which shut the jaw, the tongue is not unfrequently se- verely wounded, and has been known to be almost bitten through. During the continu- ance of the convulsions, as the patient has not the power of swallowing, the spittle issues from the mouth, worked into a frothy state by the action of respiration. This is always an unseemly appearance, though by itself it is not to be greatly regarded. The convulsions remit for a few minutes, and are then renewed, perhaps with in- creased violence. In a little time, the con- vulsions cease altogether, and the person is in a state of complete insensibility, which remains for a considerable time. Gradually he recovers his senses, but has no distinct remembrance of what has passed from the first attack of the paroxysm. The pulse and breathing are somewhat irregular and hurried during the fit, but soon return to their natural state. Every thing that irritates tbe brain, or unduly excites the mental faculties, has been known to produce epilepsy; thus an injury done to the skull, the growth of tu- mors in the internal parts of that cavity, splinters of bone scaling off in consequence of disease, and various alterations of struc- ture which have been discovered after death in patients afflicted with epilepsy, give us just grounds for reckoning mecha- nical irritation among the causes of epilep- sy. Violent emotions of the mind, as joy, fear, anger, are well known to produce epilepsy. Hence the propriety in all cases, of being very cautious in communicating intelligence likely to produce a strong im- pression; as even the most joyful tidings, suddenly and rashly imparted, have been known to produce convulsions, madness, or death. It is a singular fact, that the sight of a person in convulsions affects bystand- ers with similar symptoms; and medical men express the fact, though they can not explain the cause, by ascribing it to the principle of imitation; by which great num- bers of persons are affected in the same way as one begins to be, whether by en- thusiasm, fear, rage, or the more corporeal affections of hysterics and epilepsy. An- other cause which is referable to the brain, is over fulness or determination of blood to that organ; of this we are convinced by the frequent occurrence of apoplexy and genuine convulsions in the same person, and the interchange and alternation of these Bymptoms with each other. Acute pain in distant parts of the body, as from a stone passing through the ureter, gives rise to epilepsy; and irritations of the bowels, by acrid matters lodging in them, by costive- ness, or by worms, occasion convulsions, though no great uneasiness is felt in the bowels themselves. Children, when teeth- ing, are very frequently affected with con- vulsions, and also when their stomach and bowels are out of order. Many causes, the opposite of excitement, produce epilepsy. Thus, a person when weakened by a large bleeding, is sometimes seized with epilepsy; and debilitating causes, which in some pro- duce fainting, in others cause convulsions. The depressing passion of terror sometimes produces epilepsy. Several of the vegeta- ble poisons produce convulsions before they prove fatal. A tendency to epileptic convulsions exists in persons of a delicate and irritable habit, who are easily suscepti- ble of impressions on their nervous system; and hence it so frequently occurs in chil- dren, in young persons of both sexes, and in the natives of warm climates. Convul- sions of the most violent kind not unfre- quently attack women when pregnant. The affections which epilepsy most re- sembles, are apoplexy, and hysteria. It resembles apoplexy in the suddenness of the attack, and sometimes in the preceding symptoms; but is distinguished by the want of the stertorous breathing, and of the slow and laborious pulse which occur in apo- plexy. Epilepsy is distinguished from hys- teria, by this last occurring chiefly in fe- males, and being attended with much flatu- lence and other disorders of the bowels, and with variable and irregular emotions of the mind. Epilepsy seldom destroys the life of the patient by a single fit; but it is a matter of much anxiety to judge whether the disease is likely to be cured; that is, to cease from recurring upon the patient. It is seldom cured when it is hereditary; and the longer it has been habitual, the less is the probabi- lity of a cure. In young persons subject to epilepsy, we hope that some of the great changes which take place in the constitu- tion, the approach of puberty, the appear- ance of the monthly discharge, or the deli- very of the first child, will operate a per- manent cure; but if those events pass over without this favourable result, we are com- pelled to think badly of the case. Epilepsy which is owing to mental emotions, and especially to frights, is rarely cured. In the treatment of epileptic patients, we have three very distinct indications to fulfil: to prevent a fit, to shorten its duration, and to hinder its recurrence; but unhappily our resources are often inadequate to our wishes. In cases where any warning is given of the fit for some time previous, as by head-ache, flushing of the face, or ring- ing of the ears, in persons of a full habit, we DISEASES. 315 are to resort to purges and bleeding, either general or local, taking care to avoid all sources of irritation. In epileptic cases, accompanied with the aura, it has been proposed to stop the fit by applying a tight ligature in some part of its course between the extremity and the head; and to effect a permanent cure by cutting the nerve across which is believed to transmit the nervous energy to the part; but neither of these plans have succeeded often enough to war- rant our confidence in the practice. Our second indication is to shorten the fit, if possible. But, however distressing to friends and bystanders may be the ap- pearance of a person in a fit of epilepsy, it is not often that the most skilful attendant can do much to shorten its duration; often all that can be done is to take care that the patient does not injure himself by the vio- lence of the convulsions. A roll of silk, or some such soft substance, should be put into the mouth, to protect the tongue from being bitten; and the arms or legs are to be held firmly, to prevent them from being dashed about with violence. The patient should be placed on a bed or couch, or have some soft things put under him; he should have the head and temples rubbed with vinegar, or some other cold applica- tion; and ammonia or other stimulants are to be applied to the nostrils. It is in gene- ral impossible to give any thing by the mouth; and the choice of any thing, when it can be swallowed, must be determined by the peculiar symptoms of each case. If there is flushing of the face, heat of the skin, and evident marks of increased deter- mination of blood to the head, it is proper to bleed, and even largely too, during the fit, which will often be shortened by the practice; but if there is a feeble pulse, with clammy sweats, and other marks of debili- ty, it would be the height of imprudence to detract blood; and we should rather, if possible, restore the heat of the skin by gentle rubbing with warm dry flannel, im- mersing the patient's feet and legs in hot water, and subsequently applying mustard poultices to the ankles; the bowels being opened by an injection of one pint of warm water, half an ounce of Epsom salts, and twenty grains of assafoetida. In the con- vulsions of children from teething, it is ne- cessary, along with the other remedies, to scarify the gums; and in many cases this should be done to prevent a fit from taking place. Our last indication is, when a fit of epi- lepsy is over, to do what we ca'i to prevent another. Tliis is not always practicable, but it is to be attempted by correcting the system in general, and the nervous system in particular. If the person shows marks of fulness and determination to the head, we are to diminish these dangerous tenden- 2 Q cies by purgative medicines, by a low diet, and by avoiding all excesses. An issue in the neck is a prudent measure. Few me- dicines can be trusted to, as having any power to prevent the return of epilepsy. Such as have had any reputation at all are some metallic preparations, and some strong smelling vegetable productions, as valerian, assafoetida, and other antispasmodics. It was the opinion of Dr. Fothergill, that the good effect apparent from the preparations of copper and some other metals used in epilepsy, was merely from their deranging the stomach in some degree, and thus pre- venting people from eating too much, by which the fulness of the system was dimi- nished, and the irritability lessened, which brought on the fits of epilepsy. The am- moniuret of copper, in the dose of half a grain twice a day, increasing it gradually to three grains, or the oxide of zinc, in the dose of from three to six grains, or the ni- trate of silver, in the dose of an eighth or a quarter of a grain, have been frequently used, but in too many cases without any great success. When there is reason to con- sider debility as the cause of epilepsy, such measures are to be adopted as strengthen the constitution; and for this purpose we employ bark, chalybeates, and tepid bath- ing, with regular exercise, frictions to the skin, and attention to the stomach and bowels. CHOREA. Saint Vitus' Dance, called by medical writers Chorea Sancti Viti, or simply Chorea, is a disease attended with convulsive mo- tions, attacking bot 1 sexes, chiefly between the years of seven and fourteen, and rarely occurring after the age of puberty. The origin of this name is said to be as follows. Some women who were disordered in mind, once every year paid a visit to the chapel of St. Vitus near Uhn, and there exercised themselves day and night in danc- ing, till they were completely exhausted. Thus they were restored, till the return of the following May, when they were again seized with a restlessness and disorderly motion of their limbs, in so great a degree as to be obliged, at the anniversary feast of St. Vitus, to repair again to the same cha- pel for the sake of dancing. Chorea attacks boys and girls indiscrimi- nately; and those chiefly who are of a weak constitution, or whose health and vigour have been impaired by confinement, or by the use of scanty or improper nourishment. It appears most commonly from the eighth to the fourteenth year. The approaches of chorea are slow. A variable and often a ravenous appetite, loss of usual vivacity and playfulness, a swelling and hardness of the belly in most cases, in 316 DISEASES. some a lank and soft belly, and in general a constipated state of the bowels, aggravated as the disease advances; and slight irregular involuntary motions of different muscles, particularly of those of the face, which are thought to be the effect of irritation, pre- cede the more violent convulsive motions, which now attract the attention of the friends of the patient. These convulsive motions vary. The muscles of the limbs, and of the face, those moving the lower jaw, the head, and the trunk of the body, are at different times, and in different instances, affected by it. In this state the patient does not walk stea- dily; his gait resembles-a jumping or start- ing; he sometimes can not walk, and seems palsied; he can not perform the common and necessary motions with the affected arms. This convulsive motion is more or less violent, and is constant, except during sleep, when in most instances it ceases alto- gether. Articulation is impeded, and frequently completely suspended. Swallowing also is occasionally performed with difficulty. The eye loses its lustre and intelligence; the countenance is pale, and expressive of va- cancy and languor. These circumstances give the patient an idiotic appearance. Fever is not a necessary attendant on chorea. In the advanced periods of the disease, flaccidity and wasting of the flesh take place, the consequence of constant irritation and impaired digestion, the com- mon attendants of protracted chorea. The fits are sometimes preceded by a coldness of the feet and limbs, or with a sensation as of cold air rising along the spine, flatulence, pain of the bowels, and obstinate costiveness. At other times, nau- sea, yawning, stretching, and giddiness, with pains about the teeth and ears, usher in the convulsive motions. These motions assume the form of a sort of lameness and unsteadiness of one of the legs, which the patient draws after him in a ridiculous manner. The arm of the same side can not be held still, but if it be laid on the breast, it is drawn from it by a convulsive jerk; if he is desired to thread a needle, it is at- tempted with many deviations, but rarely accomplished; if he endeavours to carry any drink to the mouth, it is only after many unsuccessful efforts that he hastily throws the liquor down the throat, as if for the amusement of the bystanders. There are often hysterical symptoms, laughing and crying, or passing from one of these to the other, on very slight occasions. Chorea arises from various irritations, as teething, worms, disordered stomach and bowels, &c. Violent affections of the mind, as fear and anger, have been known to bring it on; in many cases, it arises from weakness; and sometimes, it first begins from seeing the disease in others. They who have once suffered under this disease, are veiy subject to a relapse. However violent the symptoms, they are never suddenly destructive. When recent in a young person, there is hope of a speedy cure. If the menses are obstructed, their return will mitigate, if not cure the disease. If the temperament is one of great sensibi- lity, or if the disease is hereditary or habi- tual, the cure is difficult. Though this disease is rarely attended with danger to life, unless when conjoined with epilepsy, or passing into it, still it is a very disagreeable disease, and parents are naturally very anxious for their children to get rid of it. Various plans have been pro- posed. By those who consider it a disease of debility, the cure of it has been attempt- ed on the tonic or strengthening plan, by giving preparations of iron, bark, and a nourishing diet; by others, opium, ether, camphor, musk, and antispasmodics gene- rally, have been given, to allay the inordi- nate muscular motions; while many, and especially Dr. Hamilton, of Edinburgh, are confident of effecting the cure by purga- tives. Many interesting cases of success by this method have been brought forward by Dr. Hamilton; and Dr. Parr, of Exeter, treated more than sixty cases with purga- tives, in one of which only he may have been styled unsuccessful. He says, that the choice of the purgative appears of little importance; but it must be active, for no other will produce the necessary discharge, and the saline purgatives are apparently less adapted to the complaint. The author knows no distinction, but in their power; the most active are the most useful. He had no reason to follow the purgatives by tonics. After the disease was removed, the general health was always restored with rapidity. It is to be particularly attended to, that the purgative plan requires to be persevered in for a considerable lime, and that the bowels often show themselves to be exceedingly loaded. The plan of treatment by purgatives is also decidedly approved of by Professor Hamilton, in his work on the Management of Children. We have no doubt whatever of the bene- ficial effects resulting from purgatives in this disease. We would recommend that chorea be treated precisely as a case of epi- lepsy; that is, in the young and robust, and where the disease is accompanied with evi- dent marks of an over excited state of the blood-vessels of the brain, the lancet, and cups or leeches to the head, warm baths to the feet, followed by mustard poultices, a low vegetable diet, and blisters or setons along the course of the spine; at the same time, purgatives being administered daily, DISEASES. 317 so as to produce a free evacuation from the bowels. This practice being persevered in for a sufficient length of time, without the disease being removed, then may be tried the effects of tonics, particularly the pre- parations of iron, sulphate of quinia, oxide of zinc, or nitrate of silver. The arsenical solution has occasionally been found useful, in the same doses as it was directed in in- termitting fever. When the irritation of worms is suspected to keep up the disease, spirits of turpentine may be administered. The tincture of meadow saffron is said to be occasionally very effectual in removing the disease, in the dose of from thirty to forty drops, three times a day. Opium, ether and other stimulants, should be entirely prohi- bited. INSANITY. Menial disease, mania or madness. It is difficult to give a definition of mental disor- ders that will be alike satisfactory to all. The metaphysician, the medical practitioner and the moralist, would probably differ as to the degree of vice, folly, absurdity or fury that they would consider as constituting the state of madness; while the infinitely diversified characters of men, and the changing intellect and views of the same person at different periods, tend still fur- ther to perplex the subject, and require a great latitude to be allowed in all our dis- cussions on the derangements of the under- standing. In a plain and practical work like this, we shall not attempt the strictness of metaphysical accuracy, but shall state some of the more remarkable symptoms of madness, which are expected to be taken care of by the medical attendant. Medical writers, in treating on this subject, com- monly adopt the following distinctions:— I. Mania, or Madness, as it occurs either in the sanguine or melancholic temperament. II. Fatuity, or Idiotism. III. Melancholia, by which is meant, not what we commonly understand in English by the word melan- choly, but the condition of the mind of those who, on all subjects but one, reason and act like other men. I. Mania. Madness is distinguished by the patient having false and incorrect views of things, especially shown by the wrong opinions he entertains of his nearest friends; suspecting them of the most malignant in- tentions towards him, and treating them with the bitterest abuse and hatred; he talks incoherently and ravingly, and often with prodigious rapidity, and for a long continuous period; the passions are not un- der the control of the will, and there is, for the most part, great violence of action, and furious impatience of restraint. Insanity in the melancholic temperament has some variety in the symptoms. Such patients are sad, dejected and dull, without any apparent cause; gloomy and fond of solitude. They are cowardly, prone to an- ger, and changeable in their tempers; when the disease is at its height, they are very furious, and some tear and mangle their own bodies. Their countenance is pale, and their pulse is slow; their bowels are generally costive. As the paroxysm goes off, they are stupid, calm, and mournful; and much grieved on account of their un- happy situation. Patients of this description are often lamentably prone to suicide. A striking circumstance in maniacal pa- tients is their power of resisting impressions from external things, which persons in health feel so acutely. A maniac will en- dure, for instance, an intensity of cold, which would destroy a person in health; the ordinary doses of medicine have little or no effect upon them, and they are capa- ble of enduring hunger for a very long time. The muscular strength of maniacal persons is prodigiously increased; and it is a difficult matter to restrain them by the strength of other men in the violence of their paroxysms. Persons of every different temperament are subject to madness, but it principally attacks the exquisitely sanguine, or the ex- quisitely melancholic. In many cases of mania, it is not a permanent affection, but there are what are called lucid intervals, during which the patient is in good health of mind and body. Mania comes on at dif- ferent periods of life. It is not at all certain that the moon, in any part of its course, has any influence on madness. Sometimes ma- nia lasts during the whole of the life of the patient, or degenerates into idiotism. The immediate accession of a paroxysm of mad- ness does not show itself by the same symp- toms in different patients. Not unfrequent- ly they complain of uneasiness about the stomach, costiveness, heat, and want of sleep. Soon after, the language and con- duct become incoherent, and the motions and gestures wild and irregular; some are gloomy and sullen, while others are good- humoured and disposed to laughter. In some cases the conduct is violent and furi- ous; there is grinding of the teeth, rolling of the eyes, loud roarings, great exertion of muscular strength, a desire of hurting those around them, and especially those who were formerly most dear to them. Though the examination of the bodies of maniacs has as yet thrown little light on the causes of madness, not enabling us to say what part of the brain or nervous system is principally interested, yet we can not doubt, but in our present state of being, there is the most intimate connexion between mind and body, and that the disordered intellect is always connected with some remarkable changes in the bodily organs. 318 DISEASES. It is very often a hereditary disease, and there can be surely none of a more afflict- ing nature. It is brought on by sudden and violent emotions of the mind; jealousy, anger, love, pride, joy, disappointment; though it is remarkable, that an unexpected flow of prosperity, or a sudden communica- tion of joyful intelligence, is more frequent- ly known to upset the mind than the recep- tion of disastrous news. Madness is often the sequel of frequent intoxication, of vio- lent exercise, of the sudden drying up of accustomed drains or evacuation from the body. The injudicious use of mercury, and the occurrence of some febrile disease, has been known to excite madness; and some circumstances in parturition, though we can not say in what constitutions these circum- stances occur, seem to give rise to madness; but sometimes this last species, though it lasts very long, is at last got the better of. In the early and furious stage of mad- ness, something is to be attempted by me- dical means, to allay the violent excite- ■ment. The head is to be shaved, and cold applied, either by pouring on cold water and vinegar, by laying on wet cloths, or, as has been sometimes done, a clay cap. Blood should be drawn from the arm, and from the head by cups or leeches, and purgative medicines of great activity given, as gam- boge, jalap, and scammony. The remark- able resistance of the system to the powers of medicine, renders it necessary to increase the doses given, and to persist in them for some time. To prevent the maniac from injuring himself or others, the best expedi- ent is the strait waistcoat; and it is always distressing and hurtful to make the patient contend with the strength of other men. However painful to the feelings of friends it may be to have recourse to the strait waistcoat, it is in reality the most lenient method we can employ; it gives no pain to the patient; and very commonly, when he finds that his exertions are unavailing, he gives them over, and continues quiet. The first period of the attack, when the body is much disordered, is soon over; and then comes the difficult part, the manage- ment of the mind. This has too often been left to persons of rude habits and unfeeling hearts, who have thought to govern their unhappy charge by brute force, to restrain their violence by bolts and chains, or to quell their passions by blows and stripes. Of late years, a more humane and rational practice has prevailed. Persons of educa- tion, of principle, and of humanity, have undertaken the management of the insane; and though they must necessarily employ meaner hands in the details of their duty, their superintendence has been faithfully exerted to prevent any improper conduct in their subordinate agents. When a per- son becomes decidedly insane, it is unques- tionably the most prudent tnd humane mer»ure, to put him under the care of per- sons who have devoted themselves to this occupation; and to remove them from their usual homes, to places where security is combined with as much comfort as their situation will admit of. It is of great con- sequence to acquire an influence over the minds of maniacs, and this is to be done by the exercise of prudence and firmness; by showing them that their violent and out- rageous conduct does not lead them to the attainment of their purposes. Coercion is in very many cases absolutely necessaiy, and this should be employed in the most peremptory and effectual manner. It should be remembered that the muscular strength of maniacs is great, and therefore the force employed in securing them should be amply sufficient, and such as not only to prevent the patient from being successful in his re- sistance, but such as to show him instantly that resistance is vain. When the keeper has established in the mind of the maniac, the awe and respect necessary for his ma- nagement, the patient is to be treated with all possible lenity and attention, conforma- ble to his station in life, and to his former habits; and every indulgence consistent with his health and security should be al- lowed. It is of great moment to keep ma- niacs employed; and many establishments engage their patients in constant and regu- lar field-work or exercise. This may be repugnant to the former habits, and to the rank of some patients, who are therefore deprived of a resource and a means of cure, possessed by their more humble fellow- sufferers. Females are to be allowed their usual occupations, drawing, music, sewing, knitting, or the like. There is frequently a degree of cunning about maniacs which is very apt to deceive the ignorant and in- experienced. They appear to conduct themselves with great propriety when in confinement, but whenever they return to their families, their disorder returns. Their relations should therefore be very cautious about removing them. The diet of insane persons should be light, nourishing, and easy of digestion, and in proper proportion to their bodily strength, and the exercise they are accustomed to take. With respect to medicine and all its auxiliaries, drugs, warm and cold bathing, and other appliances, insanity seems to be quite beyond their reach; and the utmost we should attempt in this way, should be to obviate costiveness, and occasionally to administer the warm bath. Some have thought a blister or issue to the back or neck may be useful, but the dressing of such sores would be so difficult that such expedients are better let alone. In the melancholy or depressed kind of madness, a little variation of the treatment is to be DISEASES. 319 adopted. Instead of withdrawing stimuli altogether, we are to admit light and free air, to suffer the patient to look out on green fields and cheerful objects, and to permit every healthful and safe amusement of which they are capable. Every instru- ment of destruction must be carefully kept out of their way. Insane patients, when confined in cold weather, are subject to a mortification of the toes and feet, and when helpless and bed-ridden, are liable to ulcer- ations of different parts of the body. To prevent these melancholy accidents, the apartments of asylums should be warmed by heated air; and the parts likely to be- come affected are to be rubbed with emol- lient or stimulating liniments, and soft sub- stances should be put under them to lessen the effects of pressure. II. Fatuity or Idiotism is a very hopeless kind of mental disease. It often arises from original imperfection of the faculties of me- mory and judgment, and sometimes forms one of the sad train of evils that beset the path of closing life. It sometimes arises from epilepsy or organic diseases within the skull; or it is the consequence of dis- orders in which the mind and body have been long debilitated. In the last cases only, is there the smallest encouragement to attempt a cure; and this is to be tried by cheerful company, gentle exercise in the open air, change of scene, a generous diet, and attention to the bowels. HI. Melancholia is the technical term adopted by Cullen and other writers, for that species of insanity in which, on all sub- jects but one, the patient thinks and acts correctly. No better example can be given of this disorder, than one with which all Europe is familiar, the case of the hero of La Mancha, the champion and flower of chivalry. On all subjects but one, Don Quixote displays good sense and virtue of the highest order; but when knight-errantry and romance come across his disordered imagination, he is betrayed into the most absurd reasoning, wild adventures, and lu- dicrous distresses. The treatment of pa- tients affected with this partial insanity, scarcely belongs to the physician, unless when there is considerable derangement of the health, or when he is consulted as to the propriety of putting them under re- straint. He can only recommend attention to what is likely to promote the general health, especially the diet, and the regula- rity of the alvin'e discharge; and it is right to comply with the more harmless fancies of the patient, and mildly and unobtrusively to combat those which are more dangerous. Precautions should of course be taken, that they who labour under partial insanity neither injure their own persons, nor those of others. Much of the treatment is appli- cable here, which we have detailed under hypochondriasis. In a late work on the Intellectual Powers, by Dr. Abercrombie, he has some observa- tions on the subject of insanity, which he discusses like a Christian moralist as well as a physician; and we are happy to add to the foregoing imperfect sketch of the dif- ferent kinds of insanity, and their treatment, a large quotation from his useful and judi- cious pages. The principal distinction he makes of mental diseases, is into insanity in its various kinds and degrees, and idiotism. " There is a peculiar power which is possessed by the mind in a healthy state, of arresting or changing the train of its thoughts at plea- sure,—of fixing the attention upon one or transferring it to another,—of changing the train into something which is analagous to it, or of dismissing it altogether. This power is, to a greater or less degree, lost in insanity, and the result is one of two conditions. Either the mind is entirely under the influence of a single impression, without the power of varying or dismissing it, and comparing it with other impressions; or it is left at the mercy of a train of im- pressions which have been set in motion, and which succeed one another according to some principle of connexion, over which the individual has no control. In both cases, the mental impression is believed to have a real and present existence in the ex- ternal world; and this false belief is not corrected by the actual state of things as they present themselves to the senses, or by any facts or considerations which can be communicated by other sentient beings. It appears, then, that there is a remarka- ble analogy between the mental phenomena in insanity and in dreaming; and that the leading peculiarities of both these condi- tions, are referable to two heads. 1. The impressions which arise in the mind are believed to be real and present existences, and this belief is not corrected by comparing the conception with the ac- tual state of things in the external world. 2. The chain of ideas or images which arise, follow one another according to cer- tain associations, over which the individual has no control: he can not, as in a healthy state, vary the series or stop it at his will. In the numerous forms of insanity, we shall see these characters exhibited in va- rious degrees; but we shall be able to trace their influence in one degree or another through all the modifications; and, in the higher states, or what we call perfect ma- nia, we see them exemplified in the same complete manner as in dreaming. The maniac fancies himself a king,' possessed of boundless power, and surrounded by every form of earthly splendour; and, with all his 320 DISEASES. bodily senses in their perfect exercise, this hallucination is in no degree corrected by the sight of his bed of straw and all the horrors of his cell. From this state of perfect mania, thema- lady is traced through numerous gradations, to forms which exhibit slight deviations from the state of a sound mind. But they all show, in one degree or another, the same leading characters, namely, that some impression has taken possession of the mind, and influences the conduct in a manner in which it would not affect a sound under- standing; and that this is not corrected by facts and considerations which are calculated immediately to remove the erroneous im- pression. The lower degrees of this condi- tion we call eccentricity; and, in common language, we often talk of a man being crazed upon a particular subject. This con- sists in giving to an impression or a fancy, undue and extravagant importance, without taking into account other facts and conside- rations which ought to be viewed in con- nexion with it. The man of this character acts with promptitude upon a single idea, and seems to percieve nothing that inter- feres with it; he forms plans, and sees only important advantages which would arise from the accomplishment of them, without perceiving difficulties or objections. The impression itself may be correct, but an im- portance is attached to it disproportioned to its true tendency; or consequences are deduced from, and actions founded upon it, which would not be warranted in the esti- mate of a sound understanding. It is often difficult to draw the line between certain degrees of this condition and insanity; and in fact they very often pass into each other. It is incorrect to say of insanity, as has been said, that the maniac reasons correctly upon unsound data. His data may be un- sound, that is, they may consist of a mental image which is purely visionary; but this is by no means necessary to constitute the dis- ease; for his premises may be sound, though he distorts them in the results which he de- duces from them. A remarkable peculiarity, in many cases of insanity, is a great activity of mind, and rapidity of conception,—a tendency to seize rapidly upon incidental or partial relations of things,—and often a fertility of imagina- tion, which changes the character of the mind, sometimes without remarkably dis- torting it. The memory, in such cases, is entire, and even appears more ready than in health; and old associations are called up with a rapidity quite unknown to the individual in his sound state of mind. It is this activity of thought, and readi- ness of association, that gives to maniacs of a particular class an appearance of great ingenuity and acuteness. The peculiar character of-insanity, in all its modifications, appears to be, that a cer- tain impression has fixed itself upon the mind, in such a manner as to exclude all others; or to exclude them from that influ- ence which they ought to have on the mind in its estimate of the relation of things. This impression may be entirely visionary and unfounded; or it may be in itself true, but distorted in the applications which the unsound mind makes of it, and the conse- quences which are deduced from it. Thus, a man of wealth fancies himself a beggar, and in danger of dying of hunger. Another takes up the same impression, who has, in fact, sustained some considerable loss. In the one, the impression is entirely visiona- ry, like that which might occur in a dream. In the other, it is a real and true impression, carried to consequences which it does not warrant. There is great variety in the degree to which the mind is influenced by the erro- neous impression. In some cases, it is such as entirely excludes all others, even those immediately arising from the evidence of the senses, as in the state of perfect mania formerly referred to. In many others, though in a less degree than this, it is such as to change the whole character. The particular manner in which this more im- mediately appears, will depend of course upon the nature of the erroneous impres- sion. A person, formerly most correct in his conduct and habits, may become obscene and blasphemous; accustomed occupations become odious to him; the nearest and most beloved friends become objects of his aver- sion and abhorrence. The uniformity of the impressions of ma- niacs is indeed so remarkable, that it has been proposed by Pinel, as a test for dis- tinguishing real from feigned insanity. He has seen melancholies confined in the Bice- tre, for twelve, fifteen, twenty, and even thirty years; and, through the whole of that period, their hallucination has been limited to one subject. Others, after a course of years, have changed from one hallucination to another. The sudden revival of old impressions, after having been long entirely suspended by mental hallucinations, presents some of the most singular phenomena connected with this subject. Dr. Prichard mentions an interesting case of this kind from the American Journal of Science. A man had been employed for a day with a beetle and wedges in splitting pieces of wood for erecting a fence. At night, before going home, he put the beetle and wedges into the hollow of an old tree, and directed his sons, who had been at work in an adjoining field, to accompany him next morning to assist in making the fence. In the night he DISEASES. 321 became maniacal, and continued in a state of insanity for several years, during which time his mind was not occupied with anv of the subjects with which he had been con- versant when in health. After several years his reason returned suddenly, and the first question he asked was, whether his sons had brought home the beetle and wedges. They, being afraid of entering upon any explanation, only said, that they could not find them; on which he rose from his bed, went to the field where he had been at work so many years before, and found, where he had left them, the wedges, and the iron rings of the beetle, the wooden part being entirely mouldered away. A lady, mentioned in the same journal, had been intensely engaged for some time in a piece of needle-work. Before she had com- pleted it, she became insane, and continued in that state for seven years, after which her reason returned suddenly. One of the first questions she asked related to her needle-work, though she had never alluded to it, so far as was recollected, during her illness. I have formerly alluded to the re- markable case of a lady, who was liable to periodical paroxysms of delirium, which often attacked her so suddenly, that, in conversation, she would stop in the middle of a story, or even of a sentence, and branch off into the subject of her hallucination. On the return of her reason, she would resume the conversation in which she was engaged at the time of the attack, beginning exactly where she had left off, though she had never alluded to it during the delirium; and, on the next attack of delirium, she would resume the subject of hallucination, with which she had been occupied at the conclusion of the former paroxysm. Among the most singular phenomena connected with insanity, we must reckon those cases in which the hallucination is confined to a single point, while, on every other subject, the patient speaks and acts like a rational man; and he often shows the most astonishing power of avoiding the sub- ject of his disordered impression, when cir- cumstances make it advisable for him to do so. Lord Erskine gives a very remarkable history of a man, who indicted Dr. Munro for confining him without cause in a mad- house. He underwent the most rigid examination by the counsel of the defendant, without discovering any appearance of in- sanity, until a gentleman came into court, who desired a question to be put to him respecting a princess with whom he had corresponded in cherry juice. He imme- diately talked about the princess in the most insane manner, and the cause was at an end. But this having taken place in Westminster, he commenced another action in the city of London, and, on this occasion, no effort eould induce him to expose his insanity; so that the cause was dismissed only by bring- ing against him the evidence taken at West- minster. Several years ago, a gentleman in Edinburgh, who was brought before a jury, defeated every attempt of the opposite counsel to discover any trace of insanity, until a gentleman came into court, who ought to have been present at the begin- ning of the case, but had been accidentally detained. He immediately addressed the patient by asking him what were his latest accounts from the planet Saturn, and speed- ily elicited ample proofs of insanity. When the mental impression is of a de- pressing character, that modification of the disease is produced which is called melan- cholia. It seems to differ from mania merely in the subject of hallucination, and accord- ingly we find the two modifications pass into each other,—the same patient being, at one time, in a state of melancholic depression, and at another, of maniacal excitement. It is, however, more common for the melan- cholic to continue in the state of depression, and generally in reference to one subject; and the difference between him and the exalted maniac does not appear to depend upon the occasional cause. For we some- times find persons who have become de- ranged, in connexion with overwhelming calamities, show no depression, nor even a recollection of their distresses, but the highest state of exalted mania. The differ- ence appears to depend chiefly upon con- stitutional peculiarities of character. The most striking peculiarity of melan- cholia is the prevailing propensity to suicide; and there are facts connected with this sub- ject, which remarkably illustrate what may be called the philosophy of insanity. When the melancholic hallucination has fully taken possession of the mind, it becomes the sole object of attention,—without the power of varying the impression, or of directing the thoughts to any facts or considerations cal- culated to remove or palliate it. The evil seems overwhelming and irremediable, admitting neither of palliation, consolation, nor hope. For the process of mind calcu- lated to diminish such an impression, or even to produce the hope of a palliation of the evil, is precisely that exercise of mind which, in this singular condition, is lost or suspended;—namely, a power of changing the subject of thought, of transferring the attention to other facts and considerations, and of comparing the mental impression with these, and with the actual stale of ex- ternal things. Under such a conviction of overwhelming and hopeless misery, the feeling naturally arises of life being a bur- den, and this is succeeded by a determina- tion to quit it. When such an association has once been formed, it also fixes itself upon the mind, and fails to be corrected by 322 DISEASES. those considerations which ought to remove it. That it is in this manner the impression arises, and not from any process analagous to the determination of a sound mind, ap- pears, among other circumstances, from the singular manner in which it is often dissipa- ted; namely, by the accidental production of some new impression, not ca culated, in any degree, to influence the subject of thought, but simply to give a momentary direction of the mind to some other feeling. Thus a man mentioned by Pinel, had left his house in the night, with the determined resolution of drowning himself, when he wa-3 attacked by robbers. He did his best to escape from them, and, having done so, returned home, the resolution of suicide being entirely dissipated. A woman, men- tioned, I believe, by Dr. Burrows, had her resolution changed in the same manner, by something falling on her head, after she had gone out for a similar purpose. Insanity is, in a large proportion of cases, to be traced to hereditary predisposition; and this is often so strong, that no prominent moral cause is necessary for the production of the disease, and probably no moral treat- ment would'have any effect in preventing it; we must, however, suppose, that, where a tendency to insanity exists, there may be, in many cases, circumstances in mental habits or mental discipline, calculated either to favour or to counteract the tendency. The higher degrees of insanity are in general so distinctly defined in their charac- ters, as to leave no room for doubt in deci- ding upon the nature of the affection. But it is otherwise in regard to many of the lower modifications; and great discretion is often required; in judging whether the conduct of an individual, in particular instances, is to be considered indicative of insanity. This arises from the principle, which must never be lost sight of, that, in such cases, we are not to decide simply from the facts themselves, but from their relation to other circumstances, and to the previous habits and character of the individual. There are many peculiarities and eccentricities of character which do not constitute insanity; and the same peculiarities may afford reason for suspecting insanity in one person and not in another;—namely, when in the for- mer, they have appeared suddenly, and are much opposed to his previous uniform char- acter; while, to the latter they have been loi g known to be habitual and natural. T! us, acts of thoughtless prodigality and extravagance, may, in one person, be con- sidered entirely in accordance with his uni- form character; while the same acts, com- mitted by a person formerly distinguished by sedate and prudent conduct, may give good ground for suspecting insanity;—and in fact constitute a form in which the affec- tion very often appears. In ordinary cases of insanity, a man's conduct »to be tried by a comparison with the average conduct of other men; but, in many of the cases now referred to, he must be compared with his former self. Another caution is to be kept in mind, respecting the mental impressions of the individual in these or suspected cases of insanity;—that an impression, which gives reason for suspecting insanity in one case, because we know it to be entirely unfounded and imaginary, may allow of no such conclu- sion in another, in which it has some reason- able or plausible foundation. Insane persons indeed often relate stories which hang to- gether so plausibly and consistently, that we cannot say whether we are to consider them as indicative of insanity, until we have ascertained whether they have any founda- tion, or are entirely imaginary. The same principle applies to the antipathies against intimate friends which are often so remarka- ble in the insane. They may be of such a nature as decidedly to mark the hallucina- tion of insanity,—as when a person expresses a dislike to a child, formerly beloved, on the ground that he is not really his child, but an evil spirit which has assumed his form. This is clearly insanity; but if the antipa- thy be against a friend or relative, without anj- such reason assigned for it, we require to keep in view the inquiry, whether the impression be the result of hallucination, or whether the relative has really given any ground for it. In all slight or doubtful cases, much discretion should be used in putting an individual under restraint, and still more in immediately subjecting him to confine- ment in an asylum for lunatics. But there is one modification in which all such delicacv must be dispensed with,—namely, in those melancholic cases which have shown any tendency to suicide. Whenever this pro- pensity has appeared, no time is to be lost in taking the most effectual precautions; and the most painful consequences have very often resulted, in cases of this descrip- tion, from misplaced delicacy and delay. Some of the points which have been briefly alluded to, seem to bear on the practical part of this important subject,— the moral treatment of insanity. Without entering on any lengthened discussion, some leading principles may be referred to the following heads:— 1. It will be generally admitted, that every attempt to reason with' a maniac is not only fruitless, but rather tends to fix more deeply his erroneous impression. An important rule, in the moral management of the insane, will therefore probably be, to avoid every allusion to the subject of their hallucination, to remove from them every thing calculated by association to lead to it, and to remove them from scenes and persons likely to re- call or keep up the erroneous impression. DISEASES. 323 Hence, probably, in a great measure, arises the remarkable benefit of removing the insane from their usual residence, friends and attendants, and placing them in new scenes, and entirely under the care of stran- gers. The actual effect of this measure is familiar to every one, who is in any degree conversant with the management of the in- sane. That the measure may have its full effect, it appears to be of importance that the patient should not, for a considerable time, be visited by any friend or acquaint- ance; but should be separated from every thing connected with his late erroneous associations. The danger also is well known which attends a premature return to home and common associates;—immediate relapse having often followed this, in cases which had been going on for some time in the most favourable manner. II. Occupation. This is referable to two kinds, namely, bodily and mental. The higher states of mania, in general, admit of no occupation; but, on the contrary, often require coercion. A degree below this may admit of bodily occupation, and, when this can be accomplished in such a degree as fully to occupy the attention, and produce fatigue, there is reason to believe that much benefit may result from it. On a similar principle it is probable, that in many cases much benefit might result from moral management calculated to revive associations of a pleasing kind, in regard to circumstances anterior to the occurrence of the malady. III. Careful classification of the insane, so that the mild and peaceful melancholic may not be harrassed by the ravings of the maniac. The importance of this is obvious; but of still greater importance it will proba- bly be, to watch the first davvnings of reason, and instantly to remove the patient from all associates by whom his mind might be again bewildered. Cases of decided insanity in general admit of little moral treatment, until the force of the disease has been broken in some con- siderable degree. But among the numerous modifications which come under the view of the physician, there are various forms in which, by judicious moral management, a great deal is to be accomplished. Some of these affections are of a temporary nature, and have so little influence on a man's gene- ral conduct in life, that they are perhaps not known beyond his own family or confi- dential friends. In some of these cases, the individual is sensible of the singular change which has-taken place in the state of his mental powers, and laments the distortion of his feelings and affections. He com- plains, perhaps, that he has lost his usual interest in his family, and his usual affection for them; and that he seems to be deprived 2 R of every feeling of which he was formerly susceptible. The truth h, that the mind has become so occupied by the erroneous impression, as to be inaccessible to any other, and incapable of applying to any pursuit, or following out a train of thought. A most interesting affection of this class often comes under the observation of the physician, consisting of deep but erroneous views of religion,—generally accompanied with disturbed sleep, and considerable de- rangement of the system, and producing a state of mind closely bordering upon insanity. It occurs most commonly in young- persons of acute and susceptible feelings, and re- quires the most delicate and cautious man- agement. Two modes of treatment are frequently adopted in regard to it, both equally erroneous. The one consists in hurrying the individual into the distraction of company, or a rapid journey; the other, in urging religious discussions, and books of profound divinity. Both are equally injudicious, especially the latter; for every attempt to discuss the important subject, to which the distorted impression refers, only serves to fix the hallucination more deeply. The mode of treatment, which I have always found most beneficial, consists of regular exercise, with attention to the general health; and in enforcing a course of reading of a nature likely to fix the mind, and carry it forward in a connected train. Light reading or mere amusement will not answer the purpose. A regular course of history, as formerly mentioned, appears to succeed best, and fixing the attention by writing out the dates and leading events in the form of a table. When the mind has been thus gradually exercised for some time in a connected train of thought, it is often astonishing to observe how it will return to the subject which had formerly overpowered it, with a complete dissipation of former erroneous impressions. A common com- plaint at the commencement of such an exercise is, that the person finds it impossi- ble to fix the attention; or to recollect the subject of even a few sentences: this is part of the disease, and, by perseverance gradual- ly disappears. This experiment I have had occasion to make many times, and it has always appeared to me one of extreme interest. I do not say that it has uniformly succeeded, for the affection frequently passes into confirmed insanity; but it has succeededina sufficient number of instances to give every encouragement for a careful repetition of it. The plan is, of course, to be assisted by regular exercise, and atten- tion to the general health, which is usually much impaired. These affections are par- ticularly connected, in a very intimate man- ner, with a disordered state of the stomach and bowels, and with derangements in the 324 DISEASES. female constitution. Means adapted to these become, therefore, an essential part of the management. In that remarkable obliteration of the mental faculties, on the other hand, which we call idiocy, fatuity, or dementia, there is none of the distortion of insanity. It is a simple torpor of the faculties, in the higher degrees amounting to total insensibility to every impression; and some remarkable facts are connected with the manner in which it arises without bodily disease. A man mentioned by Dr. Rush, was so violent- ly affected by some losses in trade, that he was deprived almost instantly of all his men- tal faculties. He did not take notice of any thing, not even expressing a desire for food, but merely taking it when it was put into his mouth. A servant dressed him in the morning, and conducted him to a seat in his parlour, where he remained the whole day, with his body bent forward, and his eyes fixed on the floor. In this state he continu- ed nearly five years, and then recovered completely and rather suddenly. The ac- count which he afterwards gave of his con- dition during this period was, that his mind was entirely lost; and that it was only about two months before his final recovery, that he began to have sensations and thoughts of any kind. These at first served only to convey fears and apprehensions, especially in the night-time. The most striking illustration of the vari- ous shades of idiocy, is derived from the modifications of intellectual condition ob- served in the Cretins of the Vallais. These singular beings are usually divided into three" classes, which receive the names of cretins, semi-cretins, and cretins of the third degree. The first of these classes, of per- fect cretins, are, in point of intellect, scarce- ly removed above mere animal life. Many of them cannot speak, and are only so far sensible of the common calls of nature, as to go, when excited by hunger, to places where they have been accustomed to receive their food. The rest of their time is spent, either in basking in the sun, or sitting by the fire, without any trace of intelligence. The next class, or semi cretins, show a higher degree of intelligence; they remember com- mon events, understand what is said to them, and express themselves in an intelligible man- ner on the most common subjects. They are taught to repeat prayers, but scarcely ap- pear to attach any meaning to the words which they employ; and they can not be taught to read or write, or even to number their fingers. The cretins of the third de- gree learn to read and write, though with very little understanding of what they read, except on the most common topics. But they are acutely alive to their own interest, and extremely litigious. They are without prudence or discretion in the direction of their affairs, and the regulation,of their con- duct; yet obstinate and unwilling to be ad- vised. Their memory is good as to what they have seen or heard, and they learn to imitate what they have observed in various arts, as machinery, painting, sculpture and architecture; but it is mere imitation with- out invention. Some of them learn music in the same manner, and others attempt poetry of the lowest kind, distinguished by mere rhyme. It is said, that none of them can be taught arithmetic, but I do not know whether this has been ascertained to be invariably true;—there is no doubt that it is a very general peculiarity. The imbecile in other situations, show characters very analogous to these. Their memory is often remarkably retentive; but it appears to be merely a power of retaining facts or words in the order and connexion in which they have been presented to them, without the capacity of tracing relations, and forming new associations. In this manner, they sometimes acquire languages, and even procure a name for a kind of scholarship; and they learn to imitate in various arts, but without invention. Their deficiency appears to be in the powers of abstracting, recombining, and tracing rela- tions; consequently they are deficient in judgment, for which these processes are necessary. The maniac, on the other hand, seizes relations acutely, rapidly, and often ingeniously,—but not soundly. They are only incidental relations, to which he is led by some train of association existing in his own mind; but they occupy his attention in such a manner, that he does not admit the consideration of other relations, or compare them with those which have fixed them- selves upon his mind. The states of idiocy and insanity, there- fore, are clearly distinguished in the more complete examples of both; but many in- stances occur in which they pass into each other, and where it is difficult to say to which of the affections the case is to be referred. I believe they may also be, to a certain ex- tent, combined; or that there may be a cer- tain diminution of the mental powers exist- ing along with that distortion which con- stitutes insanity. They likewise alternate with one another; maniacal paroxysms often leaving the patient in the intervals in a state of idiocy. A very interesting modification of another kind is mentioned by Pinel. Five young men were received into the Bicetre, whose intellectual faculties appear- ed to be really obliterated; and they con- tinued in this state for periods of from three to upwards of twelve months. They were then seized with paroxysms of considerable violence, which continued from fifteen to twenty-five days, after which they entirely recovered. Idiocy can seldom be the subject either DISEASES. 325 Of medical or moral treatment; but the pe- culiar characters of it often become the ob- ject of attention in courts of law, in relation to the competency of imbecile persons to manage their own affairs; and much diffi- culty often occurs in tracing the line be- tween competency and incompetency. Several years ago, a case occurred in Edin- burgh, which excited much discussion, and shows in a striking manner some of the peculiarities of this condition of the mental faculties. A gentleman of considerable property having died intestate, his heir-at- law was a younger brother, who had always been reckoned very deficient in intellect; and consequently his relatives now brought an action into the Court of Session, for the purpose of finding him incompetent, and obtaining the authority of the Court for put- ting him under trustees. In the investiga- tion of this case, various respectable per- sons deponed that they had long known the individual, and considered him as de- cidedly imbecile in his understanding, and incapable of managing his affairs. On the other hand, most respectable evidence wa,s produced, that he had been, when at school, an excellent scholar in the languages, and had repeatedly acted as a private tutor to boys; that he was remarkably attentive to his own interest, and very strict in making a bargain; that he had been proposed as a candidate for holy orders, and, on his first examination had acquitted himself well; but that, in the subsequent trials, in which the candidate is required to deliver a discourse, he had been found incompetent. The Court of Session, after long pleadings, de- cided that this individual was incapable of managing his affairs. The case was then appealed to the House of Lords, where, af- ter further protracted proceedings, this de- cision Was affirmed. I was well acquainted with this person, and was decidedly of opin- ion that he was imbecile irt his intellect. At my suggestion, the following experi- ment was made, in the course of the inves- tigation. A small sum of money was given him, with directions to spend it, and pre- sent an account of his disbursement, with the addition of the various articles. He soon got rid of the money, but was found totally incapable of this very simple process of arithmetic, though the sum did not ex- ceed afewshillings. This individual, then, it would appear, possessed the simple state of memory which enabled him to acquire languages, but was deficient in the capacity of combining, reflecting, or comparing. His total inability to perform the most sim- ple process of arithmetic, was a prominent character in the case, analogous to what I have already stated in regard-to the cretins. In doubtful cases of the kind, I think this might be employed as a negative test with advantage; for it probably will not be doubt- ed, that a person who is incapable of such a process, is incompetent to manage his affairs. It is a singular fact, that the imbecile are, in general, extremely attentive to their own interest, and perhaps most commonly cau- tious in their proceedings. Ruinous ex- travagance, absurd schemes, and quixotic ideas of liberality and magnificence, are more allied to insanity;—the former may become the dupes of others, but it is the latter, who are most likely to involve and ruin themselves. DELIRIUM TREMENS. Delirium tremens, or the delirium of drunkards, is a species of mental derange- ment, accompanied with a constant and universal tremor of the muscles of the body, and total loss of sleep during the entire continuance of the disease. The disease occurs most commonly in drunkards, who, after a debauch of some days or weeks continuance, suddenly abstain from intoxi- cating drinks; it may attack those, how- ever, who still continue these daily-pota- tions, and is occasionally met with in per- sons who make use of stimulating drinks in what are termed moderate quantities, that is, to such an extent as to produce an ex- citement of the brain, falling short, how- ever, of actual ebriety. The disease has by some writers been improperly termed mania-a-potu or mania from drinking, and by others, brain fever. The individual affected with delirium tremens, continues almost incessantly, night and day, in a state of excitement, constant- ly talking, and engaged in restless activity. They are not for an instant silent; their limbs never remain quiet, and they are in- cessantly changing the situation of then- bodies, or arranging their clothes, beds and the furniture of their rooms. The delirium with which they are affected, consists in a belief in the presence of imaginary objects, or of persons and things not really present. These objects, whether real or imaginary, are actually seen by the patient, and he is often seriously tormented by the presence of fictitious dogs, cats, snakes, disgusting insects, ferocious animals, or demons, crowd- ing his room, covering his person and bed, and threatening his life. Sometimes he sees, in imagination, persons whom he knows, perhaps some of his friends who have been long dead, or who are in a fo- reign country, and holds long conversations with them; occasionally, his room is the scene of some brilliant pageant, then of some deadly combat, and again of ludicrous oc- currences, the sight of which, by turns, de- lights, frightens or amuses him. In some instances the patient is pursued by robbers, or by the officers of justice, and his actions 326 DISEASES. are precisely those we should suspect in an individual exerting himself to escape from some impending evil. But it is impossible to describe all the phantasies and horrid shapes, which the disordered imagination in this disease conjures up to torment and harass the unfortunate patient. As we have already remarked, the individual labouring under delirium tremens, neither sleeps nor continues still for a single moment. His eyes are in constant motion, moving with sidelong, fearful, suspicious glances from object to object, and around every part of the room. His arms and feet are inces- santly employed, and his- tongue is never silent. The skin is seldom altered from its natu- ral condition, unless the patient be at the same time labouring under some other dis- ease. The head, however, is often hot, and the eyes blood-shot and watery. The tongue is generally coated with a thick, yellowish mucus; the bowels are usually costive, and nausea and vomiting are not unfrequent. When the disease has conti- nued for any length of time, the tempera- ture of the surface occasionally sinks, cold clammy sweats break out, the patient falls into a state of stupor, with low mutter- ing delirium, constant picking at the bed clothes, and spasmodic startings of the tendons, followed by death. In other cases, the patient gradually sinks into a state of complete exhaustion and dies suddenly, and in a few instances, violent convulsions have preceded the fatal termination. This disease is one which, unless re- moved by an appropriate treatment, very generally destroys the patient. The chief indication is to procure sleep, from which, if it continue for several hours, the patient awakes perfectly rational, and without any remains of the complaint, save a slight tre- mor of the limbs and great weakness. When the patient is young, and still pos- sesses some strength of constitution, when the attack is recent, and is accompanied by some fulness of pulse, heat of the head, a red, watery state of the eyes, and especially if there be flushing of the cheeks, it will be proper to commence the treatment by taking away a few ounces of blood from the arm, and applying cups to the temples and nape of the neck. In nearly all recent cases, local bleeding from the head, by means of cups, will be demanded. Subse- quently to bleeding, the head being shav- ed, cloths wet with cold vinegar and water should be applied to the scalp, and mustard poultices to the extremities. If the bowels be costive, a dose of some mild purgative may be administered, as calcined magnesia, twenty grains; rhubarb, five grains, and powdered ginger, three or four grains: or, senna, one ounce; cream of tartar, half an ounce; cinnamon, half an ounce, to be in- fused in a pint of boiling water; dose, when cold, a wine-glassful every two hours; or, castor oil, three drachms, turpentine, one drachm; tincture of senna, two drachms. In the use of purgatives, we must be cau- tious lest a too loose condition of the bow- els be induced, which in all cases of the disease is decidedly prejudicial. The above remedies will often, when ju- diciously employed, procure a refreshing sleep; but if this should not be the case, the following may be given towards even- ing, and repeated every three hours, until sleep occurs: powdered opium, one grain; or sulphate, of morphia, half a grain; pow- dered camphor, one grain; ipecacuanha, one grain; or tartar emetic, one sixth of a grain. In some cases, larger doses of opium will be required. The effects of the remedy must, however, be cautiously watched, lest it produce an apoplectic stupor, from which the patient, when it occurs, can seldom be recovered. The patient should be kept as quiet as possible, in a cool, darkened room; he should be used with great kindness, not unnecessarily contradicted, nor never con- fined by means of a strait jacket or ligatures, unless he attempt his own life. His food should be light and nourishing, and mode- rate in quantity, and his drink may consist either of coffee, weak ginger or hop tea, or toast water, as may be most agreeable to him. After the patient has recovered from his state of delirium, we should endeavour to restore strength to the stomach and consti- tution generally, by mild, nourishing diet, regular exercise in the open air, the use of the warm bath and frictions to the surface. The use of distilled and fermented liquors should be entirely abandoned; for a short time, however, after his recovery, the pa- tient may make use of an infusion of any light bitter, as chamomile flowers, Colombo root, or gentian, or some agreeable aromatic, as a weak infusion of ginger, orange peel, balm or mint. MUMPS. The Mumps is a painful tumor of the pa- rotid glands, appealing in the neck, often . extending to the maxillary glands. The tumor, though sometimes confined to one side of the neck, more usually ap- pears on both; it is at first moveable, but soon becomes diffused to a considerable extent. It increases till the fourth day, and often involves the maxillary glands in the inflammation; it is supposed to be conta- gious, and often prevails as an epidemic. After the fourth day it gradually declines; and, for the most part, there is but little fever, or need of medical aid. As the swelling of the throat subsides, it not un- DISEASES. 327 frequently happens, that a swelling takes place in the testicles of males, and in the breasts of females; which is by no means an unfavourable sign; for it has occasionally been found, that where this sympathy has not been manifested, or the glandular swelling has been suddenly repelled, the symptomatic fever has been greatly in- creased, and delirium has ensued. All that is in general requisite is, to keep the head and face moderately warm, to avoid exposure to cold, to observe a mild diet, and to open the bowels by a very gentle aperient, as a dose of magnesia, rhubarb, or salts. When the testicles and breasts simply enlarge, they ought not to be interfered with; but should they be very painful, and tend to suppurate or break, a saline purga- tive should be given, a few leeches be ap- plied, and afterwards a warm poultice. In case of high fever occurring, with other alarming symptoms, the usual means of reducing inordinate vascular action by bleeding, purging, &c. must be resorted to. THRUSH OR APHTHJE. A,disease very common to infants within the first month, though it may occur later. It consists in small white specks on the tongue, inside of the cheeks and fauces, with more or less derangement of the sto- mach and bowels. There are two forms of this disease; a milder one, in which the af- fection of the mouth is slight and the con- stitutional symptoms not severe; and another form, in which both the local and constitu- tional symptoms are rather violent. In the milder form, a few scattered spots appear on the tongue, in the mouth, or within the lips, like little bits of curds; these soon be- come yellowish and fall off, leaving the parts below of a red or pink colour. The spots may be renewed several times. The bowels are somewhat deranged, griping or purging occurs, the stools are greenish, ill smelled, and containing portions of undi- gested rnilk. The child is fretful, and the mouth is rather warmer than usual, but there is no general fever. The other variety of the disease begins with great oppression and feverishness, sometimes with fits and violent screaming. When the spots begin to appear, the fever- ish symptoms are mitigated a little, but do not go off entirely; and it would appear that the ulcerations are not confined to the mouth, but go through the whole alimenta- ry canal, causing severe pain, vomiting, griping, and purging; and the matter dis- charged is so acrid, as even to produce ex- coriation of the parts about the anus. The mouth is very tender, and the child sucks with pain and difficulty. The aphthae in a little time fall off, but they may be renew- ed, and the affection of the bowels often gets much worse. When the vomiting is frequent, when the stools are thin and the belly is tender, the case is very unfavourable; and drowsi- ness, spasms, and languor, with frequent pulse, are also dangerous symptoms. With respect to the mouth, if the spots are few and separate from each other; if they be- come yellowish and fall off in three or four days, leaving the parts below clean and moist, we may expect that the eruption will not be renewed. But if the aphthae turn brown or black, the prospect is not so favourable. The disease appears to depend upon an irritation of the stomach and bowels. It may be caused by improper or too much food, or by a bad state of the mother's or nurse's milk. The stomach and bowels of infants are peculiarly delicate, and the mouth sympathizes very readily with the derangements of those parts. Bad air or want of due attention to the cleanliness of the child's person or clothing frequently produces this disease. Exposure to cold and damp has also a tendency to bring it on; and aphthae occur in the adult inhabit- ants of northern climates, where there is continual moisture of the air, or where the soil is marshy. As the disease is frequently connected with considerable acidity of the stomach, a little magnesia should be given as a cor- rective, or the chalk mixture, in the dose of a tea-spoonful every two hours, to infants within the year, or larger doses to those who are farther advanced. No force must be used to displace the curd-like specks; and the patient must not get any thing too warm, salt, or otherwise pungent. Mild cooling substances may be applied to the mouth, as powdered borax mixed with a little honey, or a weak solution of alum, v/eaker than what a sound mouth could bear. The greatest attention must be paid to the food of the patient. If not weaned, it should be confined to the breast milk of a healthy nurse. If the patient be beyond one year of age, its sole diet should consist of rice or gum water, sweetened with loaf sugar; to which may be added, as the dis- ease gets better, an equal quantity of fresh cow's milk boiled. The patient should be immersed in a warm bath daily, and breathe constantly a pure dry air. In severe cases, particularly if the belly be sore or the pa- tient be affected with much griping, two, three or four leeches should be applied over the stomach. croc p. Croup may be divided into three distinct periods or stages. That of congestion or inflammation; that of effusion, and that of weakness or exhaustion. 32S DISEASES. Most frequently the disease is preceded by a catarrhal affection, which appears to be in every respect similar to an ordinaiy catarrh. The patient experiences alternate sensations of heat and cold, lassitude, and a tendency to sleep. The tongue becomes slightly furred; the appetite is diminished or entirely lost; and soon a cough is added to the above symptoms. There is scarcely any fever during the day, but an augmenta- tion of febrile symptoms takes place towards the evening. The nights are passed in a state of calmness, if we except some slight fits of coughing, which occasionally awaken the patient, particularly in the fore part of the night. The above catarrhal symptoms present numerous varieties as well in relation to their intensity as to their duration. Many times they are very slight, while in other cases they assume no little intensity; in cer- tain subjects they exhibit little tendency to run into the croup, but in others this ten- dency manifests itself from their very com- mencement. Their duration, also, is occa- sionally prolonged to six, eight, and even ten days, while most frequently it is confi- ned to one, two or three days. It is generally during the night that the symptoms proper to the croup show them- selves. The child goes to bed as on the evenings preceding, somewhat unwell and with a slight fever. He sleeps quietly, but all at once, during his sleep, his respiration becomes difficult and loud; he coughs fre- quently and with a peculiar sound; his face is red, his skin hot, his voice hoarse. He awakens suddenly, is continually agitated, and complains frequently of a kind of con- striction of the throat; many times even of pain about the larynx. These symptoms do not, however, endure for any length of time; the patient gradually becomes calm, the sleep more tranquil, the respiration more free, the sound of the cough more na- tural, and by morning the child appears to have returned to the same state in which he had gone to bed. But this calm should not lull us into security. For even during the day the pulse is found to preserve its fre- quency, the cough is hoarse, the respiration somewhat impeded; and in the evening, scarce has the infant fallen asleep, than a paroxysm, still more violent than that of the night preceding, suddenly awakens him. All at once the respiration becomes wheez- ing and hoarse, the oppression is consider- able, with frequently a sensation of suffoca- tion or of strangulation. The patient is seen occasionally to carry his hand to his neck, as though to remove some obstacle by which his breathing is constrained. His eyes have a wild look, his face is swollen, his pulse hard and frequent, his voice hoarse, his cough convulsive and extremely sonorous. There is now a trifling expectoration of a little mucus, sometimesmarked with streaks of blood. This paroxysm is at length ter- minated in the same manner as the prece- ding, but it is veiy soon followed by other paroxv"sms which are repeated with more or less violence during the night. Sleep ap- pears to favour their return; but even when the infant is awake, the slightest exertion is sufficient to excite them. It is ordinarily at this juncture that the first period of the disease terminates. The symptoms which follow announce with more or less certainty that effusion has taken place in the trachea. The paroxysms of the disease now increase in force and fre- quency, and even in their intervals we find that all the symptoms of the disease remain but in a moderate degree. The voice is always hoarse, and the cough commences to assume a more piercing and acute sound. The oppression is extreme, and the wheez- ing of the respiration is heard in every part of the house. In the heighth of the par- oxysm the infant is agitated in a frightful manner; his face and lips become livid, and his forehead is covered with sweat; his pulse, until now strong and hard, commen- ces to be small, contracted, and of an ex- treme frequency. By the cough, and also by vomiting, is thrown up an immense quantity of thick and thready mucus, mixed frequently with portions of a membranous appearance. What is very remarkable is, that in the midst of* all this tumult, and even during the whole continuance of the dis- ease, the power of swallowing remains al- ways free. The third period of the disease is cha- racterized by the presence of all the signs of approaching- death. The paroxysms have between them but a few moments of an imperfect remission. The voice is en- tirely lost. The respiration is convulsive and extremely difficult, and a frightful suf- focation every moment threatens the life of the patient; his eyes are without lustre; his face is pale and covered with a cold and clammy sweat: weak and exhausted, he no longer is agitated with violence as in the former period. There is scarcely any cough; the expectoration is almost entirely arrested; the pulse, scarcely sensible, is ir- regular and intermittent, and most of the animal functions appear to be destroyed. The intellectual faculties, however, gene- rally preserve their integrity even to the last moment. Death comes finally to termi- nate this painful scene. Sometimes the pa- tient expires without a struggle, and at others in the midst of the most rending ago- nies. In the first period of the disease we have a congestion and inflammation of the mucous membrane of the trachea and an increased secretion of the ordinary mucus of this part. In the second stage, there is a morbid se- DISEASES. 329 cretion of a peculiar character, frequently to such extent as to impede the function of respiration; and in the third stage, we have the consequences of these two—a state of general exhaustion, with an almost total sus- pension of the function of the lungs. The passage of one of these periods into the other is by degrees almost insensible. Many times they succeed each other with such rapidity that they appear to be confounded. Neverthelesss an experienced eye can al- ways distinguish the principle symptoms peculiar to each. In the progress of the disease towards a cure, the symptoms, in place of increas- ing, lose by degrees their force. The paroxysms become less frequent, and at longer intervals, or are entirely suspended. The respiration recovers its freedom, and the disease terminates. When the cure is obtained during the first period, and par- ticularly at its commencement, the disease terminates many times suddenly and with- out leaving any traces behind. If it is more advanced, and especially if it has at- tained the middle, or end of the second pe- riod, the cure is slow and gradual. The duration of croup is extremely variable. When it is early attacked by appropriate remedies, it will give way very promptly. When neglected or mismanaged, or when its violence is such as to resist for a long time all remedies, it may be prolonged to eight or ten, or even twelve days; itseldom, however, continues beyond the latter pe- riod. Such is the ordinary progress of the croup in its approach, invasion, increase and ter- mination. But there is another variety of the disease where all the periods are con- founded with each other, and where all the symptoms present themselves at the same time, in the most violent and frightful man- ner. We then no longer observe the ca- tarrhal symptoms which ordinarily precede its invasion. The disease appears suddenly, rarely in the day, but almost, invariably, in the night. And when once commenced, it increases and proceeds with the most alarming rapidity. There are no alterna- tions of paroxysms and remissions, or at least these alternations are scarcely marked, or rather there is but a single paroxysm, in the very commencement of which the op- pression is considerable, the respiration hoarse, the cough peculiar, the suffocation imminent, the pulse hard and frequent, the face red, the eyes projecting, and the state of anxiety is carried to the highest extent. All these symptoms continue in- creasing until death. This horrible scene is prolonged to from twenty four to forty- eight hours, but frequently it continues but eight or ten. The patient perishes then as though violently strangled, and in the most frightful agonies. But if the physician has been called in time, and by the aid of ener- getic means subdues the violence of the dis- ease, we see the symptoms diminish and cease almost as promptly as they were de- veloped; and it frequently occurs that in a few hours the patient appears to pass alter- nately from life to death, and again from death to life. The essential symptoms of the croup are a peculiar hoarse sound of the voice—a ringing cough—difficulty of respiration— fever and expectoration of a peculiar kind. The hoarse sound of the voice manifests itself ordinarily at the very commencement of the disease; and frequently even before the fever and difficulty of respiration. It is the symptom which, in those cases of the disease that are preceded by a cattarrh, should first awaken the attention of the parent and physician, and inspire them with a prudent suspicion. This hoarseness is at first not considerable, but it augments in proportion as the disease progresses, and it is not rare that in the second or third periods it rises even to such a height as to entirely destroy articulation. This hoarseness of the voice exists even for some time after the disease is terminated. The cough, in those cases of croup where the disease commences with a catarrh, pre- cedes the disease, and is then not distin- guishable from the cough attendant on an ordinary cold; but as soon as the disease at- tacks the larynx or trachea, the cough changes its character, becomes hoarse, deep and ringing. Th's change is one of the first symptoms of the invasion of the disease. Some have compared the peculiar sound of the cough in croup to the crowing of a young cock; or that of an irritated fowl, or to the barking of a dog; others describe it as a hoarse and hollow sound; others again as a clear and ringing exclamation of voice; and others as a wheezing more or lessacute. A just idea of the peculiarsound of the cough can only be obtained by hear- ing it, and once heard, it can never be again mistaken. The difficulty of respiration, in sudden or violent cases, shows itself from the com- * mencement, and accompanies the disease until it3 termination; but when the croup is preceded by symptoms of catarrh, it takes place later, or many times even is not very evidently marked until towards the second or third day. The hoarseness of the voice and the croupy cough are the only symptoms which point out the true character of the disease, and their union is sufficient to authorise the physician to act; for if he waits until the dif- ficulty of respiration completely manifests itself, he loses the only time when he can reasonably hope for success. The patient, tormented by the difficulty of breathing, tries every position to obtain ease. 330 DISEASES. Sometimes the difficulty is augmented in the horizontal, in others in the erect position. Most patients throw back their heads, to increase as it were the size of the larynx, and give to the air a more easy passage into it. The respiration is not only difficult, it is also extremely loud. This noise gene- rally accompanies inspiration, which be- comes wheez.ng and sonorous, while the expiration is deep and obscure. The re- verse of this occurs, however, in some cases. It is necessary, however, to observe, that in the second period, and even sometimes at the commencement of the third, the dif- ficulty of respiration is interrupted by inter- missions sufficiently observable. It may even occur, that these intermissions shall be so complete, that the infant returns to a state of apparent calm, and seems to have been suddenly recalled from death to life. Nothing, however, is more insidious than these sudden alterations, and a prudent physician should entirely distrust them, for the same child whom he believes to have suddenly escaped from danger, may in a short time be as suddenly struck with death. The croup is a disease almost entirely confined to infants. It is rare, however, in the first months of life, but very frequent from the seventh to the eighteenth; and it rarely attacksafter the latter period. Adults, however, are not entirely exempt from the disease. It will in general be found, that children of a robust habit, and apparently in the enjoyment of the most perfect health, are more liable to the disease than those under opposite circumstances. In some families there appears in all the children to be a peculiar liability to be attacked by it. In reference-to this well known fact, of the greater susceptibility to the disease in the children of some families than others, it behoves the practitioner when called in to attend a case, to press upon the parents the necessity of the strictest atten- tion to guard their remaining children against every possible cause that can either predis- pose to or excite the disease; and to be particularly on their guard on the first symp- tom of any catarrhal affection. In Royer Collard's analysis of the several reports on this disease presented to the French Government, it is remarked, that nothing predisposes to the occurrence of the croup more certainly than a previous attack of the same disease; and it is above all to prevent its recurrence in those who have already been affected by it, that the greatest precautions should be observed. The croup is said occasionally to have occurred as an epidemic; particularly at a time when certain eruptive complaints are of frequent occurrence. It is produced by cold and damp, and all the usual causes of catarrh. It is all important to commence the treat- ment of croup with the veiy onset of the disease. Let this time be lost, and all is lost! The sooner we act, the more our success is certain: the longer we wait, the less of hope remains. An error to be cautiously avoided, in the treatment of this formidable disease, is that of confining ourselves to mild and inert remedies, when in its commencement the disease appears to be slight. By a prompt and energetic treatment, we have almost always the certainty of crushing the disease in its birth; but when by a less active treat- ment, we allow the disease to develope itself, it may no longer be in our power to arrest its course. The principal remedies to be employed in ordinaiy cases of croup, are bleeding, emetics, and purgatives of calomel. We commence by an. emetic in those cases where there is but little fever, and when the hoarseness of the voice and cough are almost the only signs which announce the invasion of the disease. We may give the tartar emetic either alone or combined with ipecacuanha, in doses sufficiently pow- erful to excite frequent vomiting. If the vomiting is not produced by the aid of the antimony alone, we augment its efficacy by joining to it the sulphate of zinc or of cop- per. After the emetic, the child should be immersed in a warm bath; on being removed from which, it will be proper to administer a large dose of calomel, mixed in a little mucilage or syrup; the calomel is to be re- peated at short intervals, until very full and free evacuations from the bowels are ob- tained. Most frequently, when administered in time, these remedies cause the first symp- toms of the disease to disappear, or at least reduce their violence. We should not, however, depend upon a success so promptly obtained. Many times it is permanent, but most frequently it is but momentary; and soon a rapid developement of the disease requires that we should have recourse to a still more powerful remedy. This remedy is bleeding; in general local bleeding by leech- es, is sufficient. If, however, the child is very robust—if the suffocation is imminent— and particularly if the head is menaced with a congestion of blood, we should not hesitate to bleed from the arm. The bleeding should not be carried so far as to cause fainting; but it should be sufficient to cause a manifest abatement of the disease. The number of the leeches, or the extent of the bleeding from the arm, should always vary according to the age of the patient, his strength, and the force or violence of the disease. When the first bleeding has not reduced the symptoms, we must have re- course to a second, or to a third or fourth, according to circumstances, only we should not allow too much time to intervene be- DISEASES. 331 tween the repetitions, when they are judged necessary; otherwise we expose the patient to the occurrence of the stage of exhaustion, when bleeding in any quantity will be inju- rious. We can also, after bleeding, return with advantage to the employment of the emetic and warm bath; or we may give the tartarized antimony in small and frequently repeated doses. By this means we excite the expectoration of the mucus, which col- lects continually in the trachea; we deter- mine the circulation to the surface, and produce a free perspiration. When at the accession of the disease, the fever is considerable, the face red, the pulse hard and full, and above all, w:here there is pain of the larynx, and considerable diffi- culty of respiration, we should commence the treatment by bleeding. After general and local bleeding, single or repeated, we resort to the emetic; and then administer at intervals the antimony in small doses. When these remedies are had recourse to in the very commencement of the disease, aud carried to a sufficient extent, they in a majority of cases arrest its further progress. However, so happy an effect is not always obtained; audit happens frequently, that we are obliged to have recourse to the employ- ment of additional remedies. A large blis- ter is then the most efficacious application: the best place to apply it is around the whole of the fore part of the neck, not fearing even to cover by it the recent bites of the leeches. To the above means we join the use of frequent doses of nitre, tartar emetic, and calomel combination; the patient being sup- plied with drinks of a mild and simple na- ture, as barley water, toast water, rice wa- ter, &c. In the second stage, besides keeping down inflammatory symptoms by occasional bleed- ing, blisterii, &.C., we endeavour to excite the expectoration of the fluids effused in the trachea by vomits, combined with ex- pectorants, such as tartar emetic or ipecacu- anha, in divided doses; calomel, in small and repeated doses; the different prepara- tions of squills; the simple or compound decoction ofsenega; and where they can be had recourse to, fumigations to the throat of vinegar and water, or pure vinegar. In some cases the vigour of the patient, the intensity of the fever, and hardness of the pulse, will still require the full applica- tion of leeches. There is another means very proper to calm the inflammation and allay the spasm: this is the warm bath. We continue the patient in it during an hour, and repeat it every day, or even twice a day. We should be cauti >us that the pa- tient is not chilled on coming out of the bath, and that his bed be properly heated to receive him the moment he is removed 2S from the water. Unless this caution be at- tended to, the disease will be augmented by it rather than diminished. With the bath, the most powerful revul- sants should be by turns made use of, and continued, in proportion to the force and obstinacy of the symptoms. We can place anew blisters on the chest, between the shoulders, upon the arms, or we can apply mustard poultices on the soles of the feet and around the legs. If so powerful a remedy be not judged necessary we can bathe the feet in hot water, in which mustard has been introduced. If the cure be not obtained in the second period, it is still more rare that we obtain it in the third: the strength is now exhausted; suffocation is imminent, and nature appears no longer to be able to con- tend against the disease. The treatment here should change: antispasmodics and expectorants are the only means that we now are enabled to make use of. We may continue the use of blisters or mustard poultices, placing them in succession upon the trunk and limbs; at the same time we may apply frictions with the volatile or camphor liniment, upon those parts which are not covered with blisters or poultices. We may continue the fumigation of the throat, and the administration of a very strong decoction of senega. Emeiics should be employed with caution; but in small doses, frequently repeated, the tartarized anti- mony will be of advantage. The diet should be very light and abste- mious during the continuance of the disease. During the stage of inflammation, it should consist of toast-water alone. So long as the dis- ease continues, care is to be taken to shelter the patient from all impressions ofcold or hu- midity. A moderate and dry temperature is absolutely necessary to the success of the treatment. This caution is necessary for some time after the disease has been removed; for those children who have been once affected with croup, preserve during a long time a great susceptibility to exterior impressions, and to a relapse, in consequence of their ef- fects upon the system. In that species of croup in which all the periods are confused, and the disease seems to be reduced to a single paroxysm, equally rapid in its progress as terrible in its symp- toms, it is important that we should be prompt to act, and to act energetically: the least delay may cause the loss of the patient. If the child is robust, we should commence by bleeding from the arm, and immediately afterwards apply leeches to the throat. Im- mediately after the bleeding, either general or local, we should administer anemetic; and as soon as its operation has ceased, apply a blister, and administer a large dose of calo- mel, followed by an injection. If these 332 DISEASES. means, resorted to as speedily and with as quick succession as possible, do not stop the progress of the disease, and if the strength of the patient permit it, we can have recourse anew to bleeding; or if this be not practicable, we place the patient in a warm bath, apply mustard to the feet, and give repeated large doses df calomel and purgative injections. When the inflamma- tion appears to be weakened, we administer the antimonial powders, with the addition of small doses of calomel. When called in sufficiently early, this disease is as much under the control of the appropriate remedies as pleurisy, or any other inflammatory disease. But, as Ferriar very justly remarks, ' if the symptoms are not mitigated during the first two hours, the disease will generally prove fatal.' 1I00PING coucu. Hooping cough or pertussis, is most com- monly a disease of childhood; adults, how- ever, are by no means exempt from it. It seldom attacks the same individual more than once. It usually commences with a dry cough, hoarseness, slight fever and the other symptoms of ordinary catarrh, with which the disease is generally confounded in its forming stage. The cough becomes by degrees more harsh, and assumes the pe- culiar sound, and paroxysmal character by which hooping cough is characterized. The above symptoms may continue several days, before the cough acquires the hooping sound. Its peculiar characteristics, after the disease is fully formed, consist in the act of expiration being repeatedly inter- rupted at short intervals, each interruption being succeeded by a long effort at inspira- tion, accompanied with a sharp, hissing or wheezing sound. The fit of coughing con- tinues in the same manner, until at length a copious expectoration of glairy mucus, or vomiting takes place, by which the fit is terminated. The fits of coughing occur irregularly, and are often numerous through- out the day and night. The violence of the disease is proportionate to the duration and intensity of the paroxysms, previously to expectoration or vomiting taking place. Sometimes the fit does not continue but a few minutes, while at others it endures a much longer period. The patient is made aware of the approach of a paroxysm of coughing, by a slight irritation felt in the throat, in consequence of which he throws himself upon his knees, seizes hold on some object near him, or desires his head to be held fast by his parents or nurse. The paroxysms follow each other more fre- quently, and are more severe during the night than in the day'. The ordinary inter- val between them varies in almost every case; every sudden emotion or rapid move- ment of the body; a fit of crving or anger; the inhalation of irritating substances, &c. are so many causes capable of exciting a paroxysm. When the paroxysm of cough- ing commences, the patient is affected with great anxiety; the face swells, and becomes flushed; the eyes protrude and are filled with tears; and if the disease be violent, the face becomes of a dark red or purple hue; the eyelids swell; the eyes appeal- starting from their sockets; the neck is tu- mid, and at every accession of the cough, the child appears to be threatened with apoplexy, suffocation or strangulation. The general health of children labouring under this disease is seldom much impaired, and the little patient will rise from his knees, upon which he had thrown himself at the commencement of the fit, and return with unimpaired spirits to his play. After a vio- lent fit, also, has terminated by vomiting, he will call for food, and eat greedily and vo- raciously. In the intervals of the paroxysms, • indeed, we would scarcely suspect that he was labouring under disease. After hoop- ing cough has continued some time, it is attended with expectoration, frequently tinged with blood, which infants often swallow, and which even those who are older do not readily discharge. The dis- ease is not always accompanied with fever, excepting in its early stages; when pre- sent, the fever resembles that which ac- companies catarrhal complaints, and has a paroxysm every evening. Hooping cough is a disease of uncertain continuance; after an indefinite time, the symptoms gradually abate, until at length nothing remains ex- cepting a harassing and frequent cough, unaccompanied, however, with the peculiar marks by which it was characterized in the height of the disease. This ordinarily ceases after a few days, and the patient returns very quickly to a state of health. In some cases, however, it is kept up apparently by the force of habit, and continues for months, or even longer. The hooping cough, under ordinary cir- cumstances, is rather a troublesome than a dangerous disease. It is, however, danger- £ ous in proportion to its violence and dura- tion; to the weakness of the constitution ; of those it attacks; it is also a much more serious disease in young infants than during childhood or adult age. In warm climates or in warm seasons of the year, it attacks with less violence and is of shorter dura- tion, than under opposite circumstances. In infants, particularly those of a delicate or unhealthy constitution, it is apt to pro- duce convulsions, suffocation, apoplexy, »* inflammation or dropsy of the brain, or rup- tures; a moist skin, warm extremities, open bowels, and free vomiting, are favourable symptoms. When hooping cough is very violent or long continued, it is apt, in the DISEASES. 333 predisposed, to produce a diseased condi- tion of the lungs, attended with hectic fe- ver, and other symptoms of consumption; or a state of extreme emaciation may be in- duced, finally terminating in death. When the paroxysms are violent, it is said that death may be produced by the rupture of a blood vessel in the brain, or by suffoca- tion; we believe, however, this to be a rare occurrence. It is remarked, that seasons" in which sudden vicissitudes of temperature are the most frequent, as towards the end of autumn or the commencement of spring, are those in which the disease occurs with the great- est violence, and we know that when the symptoms have been considerably abated, and the disease is on the decline, if the pa- tient be exposed to the influence of a cold or damp atmosphere, it will recur with in- creased force. With respect to the treatment of hoop- ing cough, this differs considerably, ac- cording to the violence and nature of the symptoms, and the stage of the disease. In the very commencement, the remedies are the same as in the forming stage of ca- tarrh; and we have reason to believe, that at its very onset, by an emetic, followed by a warm bath, and an opiate combined with some diaphoretic, adapted to the age of the patient, we should in most instances be enabled greatly to diminish the violence and curtail the duration of its subsequent symptoms. When the disease is fully form- ed, if the patient be of a robust or full ha- bit; if there be much difficulty of breath- ing, or if the other symptoms of the pa- roxysm be of considerable violence, parti- cularly if there be fever, and an evident de- termination to the head, bleeding from the arm, or locally from the head and chest, by cups or leeches, will be demanded; and a quantity of blood should be thus drawn oft', graduated by the urgency of the symp- toms, and the age and strength of the pa- tient; although, in every case of pertussis, bleeding will not be demanded; yet, under circumstances similar to those we have enu- merated, its neglect would be attended with serious consequences. Emetics are the remedy from which the most advantage will be derived in this dis- ease. To do good, however, the operation of the emetic should be frequently repeat- ed; at least once in the twenty-four hours during the first stages of the disease, or as long as the paroxysms recur with violence. In cases attended, however, by the symp- toms indicating blood-letting, the use of the emetic should be preceded by the lancet, cups or leeches, according as circumstances may require. During the intervals of vo- miting, the exhibition of nauseating doses, either of tartar emetic or ipecacuanha, will generally produce decided relief. Subse- quent to the operation of the emetic, Dr. Pearson has recommended a combination of opium, ipecacuanha, and carbonate of soda, according to the following formula: tincture of opium, one drop; wine of ipeca- cuanha, five drops; carbonate of soda, three grains; water, one drachm; which is the dose for a child a year old, to be repeated every three hours. Blisters to the chest or to the back, be- tween the shoulders, are in many cases productive of the best effects. There are few cases marked with any degree of vio- lence, in which they should not be applied; but in milder cases, a warm plaster, or em- brocations to the spine, with some stimu- lating liniment, may in general supersede the use of blisters. The most common sti- mulants employed for this purpose are gar- lic, camphor, ammonia, and the spirits of turpentine and oil of amber. As the local stimulating effects of the remedies are those from which the benefit is to be derived, any of the class may be made use of. The bowels in pertussis are to be kept freely open during the whole continuance of the disease, though we are not convinced that any advantage will be derived from active purging. The castor oil, senna tea, or in older children, calomel, followed by castor oil, will in most cases fully answer our purpose. These articles are to be re- peated as occasion may require. After the disease has passed through its first stages, and appears to consist almost entirely in a spasmodic affection of the re- spiratory organs, unattended with inflamma- tion or febrile excitement, the treatment consists almost entirely in the exhibition of antispasmodics, narcotics and tonics, cer- tain articles of each of which classes have been supposed more particularly adapted to the disease before us. The best article at the stage referred to, is, perhaps, a watery solution of assafoetida; when properly timed, it will seldom be found to fail in very speedily removing the cough and other remaining symptoms. The only difficulty is that some children can not be prevailed on to take it, in consequence of its nauseating smell and taste. The dose must of course be adapted to the age of the patient. The artificial musk obtained from the ac- tion of nitric acid upon oil of amber, has been recommended by some as a very effi- cient remedy, and in obstinate cases may be tried. Almost all the narcotics have at different times been employed in pertussis. Opium, except in extremely minute doses, combin- ed with an expectorant or diaphoretic, we should consider a very doubtful if not dan- gerous remedy, especially in cases of the 334 DISEASES. disease occurring in young children. It has, however, the recommendation of many re- spectable practitioners, and Dr. Willan states that he has found a watery solution of opium more useful than any other nar- cotic. Dr. Butter extols the extract of hemlock in the highest terms, both inter- nally, and externally, in plasters and cata- plasms; but in^the hands of other practi- tioners it has by no means been attended with the same success. By most of the European practitioners, the belladonna is preferred to all other narco- tics in the disease before us. Borda consi- ders that he has saved the lives of children apparently past recovery, by the exhibition of this remedy, and several of the German practitioners consider it as little less than a specific in pertussis; and according to Ali- bert, the article has been equally successful in the practice of the French physicians. An excellent prescription in the chronic form of the disease is, magnesia, five grains; ipecacuanha, a quarter of a grain, and bel- ladonna, one sixth of a grain, for a child one or two years old. To the bark Cullen trusted almost ex- clusively. I consider, he says, the use of this medicine as the most certain means of curing the disease in its second stage, when there is but little fever present. It will seldom fail to put an end to the remaining symptoms. Floyer, Morris, and many of the German practitioners also, strongly re- commend the bark. It is proper only during the period pointed out by Cullen. Of course, the most eligible form for children will be the sulphate of quinia. The acetate of lead was first recommend- ed by Dr. Forbes of Edinburgh, in the form of solution. It is, however, a remedy from which unpleasant symptoms are so apt to result, that it should be-given to young children with a very great deal of caution. The arsenic, in the form of Fowler's so- lution, has been recommended by Mr. Sim- mons, of Manchester, Eng. He asserts that it will moderate the symptoms of the dis- ease in a few days, and generally effect a cure in a fortnight. Dr. Ferriar speaks also highly of the arsenic in the second stage of the disease; other physicians have found advantage from the use of the remedy. Besides the above, various other reme- dies have been proposed; we believe, how- ever,.that the above are those upon which our dependence should be chiefly placed. The diet in hooping cough should be light, easy of digestion, and moderate in quantity. The patient should breathe a pure air, and be carefully guarded, by ap- propriate clothing, against cold and damp. In the chronic form of the disease, warm bathing, change of air, and regular gentle exercise, will be found of great advantage. HREAST PANO. This disease is marked by an acute pain at the lower end of the breast bone, inclin- ing towards the left side, accompanied with great uneasiness. The leading symptoms are violent palpi- tations of the heart; difficulty of breathing, and a feeling of suffocation. In the first stage of the disorder, the pain is felt chiefly after some exertion, as going up stairs, or up a hill, or walking' quickly, particularly when the stomach is full; but in the more ad- vanced stages, slighter exertions are suffi- cient to cause a paroxysm of pain, as walk- ing, riding, coughing, sneezing, or speak- ing; passions of the mind also have the same tendency. In the first stage, the un- easy and threatening symptoms go off soon; but afterwards they are longer and more distressing, and give the patient the fear of immediate dissolution. During the fit, the pulse is feeble and irregular, the face pale, and covered with a cold sweat, and the pa- tient appears as if in a fit of apoplexy, with- out the power of sense or motion. The disease makes occasional attacks for years, and at last suddenly puts a period to the patient's life. The breast pang is believed by some to be chiefly owing to an ossified state of the vessels which nourish the heart, by which its powers are weakened, and it is rendered unable to empty itself properly; so that, upon any exertion of body or mind, by which the blood is sent back to the heart more quickly than usual, that organ is un- able to send it through the lungs, and hence the distressful symptoms above noted. But the symptoms of the disease and the exami- nation of bodies after death scarcely war- rant this conclusion, as this state of the ar- teries has not been found even in very severe cases; and the manner in which it attacks and goes off by paroxysms, does not seem to be dependent on so permanent a cause as ossification. It rather appears to be of a spasmodic or convulsive nature, as is shown by the manner of treatment, which is sometimes successful by stimulants and antispasmodics. It is found to attack chiefly those who are of the make which has been supposed most liable to apoplexy, viz. those with large heads and short necks, and who lead a sedentary and inactive life, who are disposed to be corpulent, or who are of gouty habits. It seldom attacks per- sons under the age of fifty. The cure and prevention consists in di- minishing the quantity of blood in the sys- tem, by small bleedings and spare diet, and avoiding every thing that would quick- en the circulation. In the fit, stimulants must be very cautiously employed, the head and temples are to be bathed with DISEASES. 335 cold water and vinegar; a slight bleeding should be used to relieve the overloaded heart, gentle pressure employed on the left side to empty the heart; and on the ap- pearance of returning respiration, ammonia is to be applied to the nose. The disease has been mitigated by forming issues in some part of the body. Also by blisters, or tartar emetic ointment applied to the chest. Sinapisms to the ancles and an ac- tive purgative injection are often bene- ficial. Those who are subject to this disease, should carefully shun all mental irritation, and every gust of passion that would hurry the circulation. Moderate exercise should be daily taken in the open air, but no vio- lent exertion should be ventured on; and all attempts at going up a rising ground should be avoided, or if made, it should be with the utmost care. The food should be plain and easily digestible; such as is not liable to occasion flatulence. Ferment- ed and distilled liquors are improper. On any approach of fulness of blood, animal food should be withdrawn from the diet; and mild saline purgatives frequently taken. A perpetual blister or other irritation in the region of the heart is useful, and warm bathing to the feet and legs may help still further to prevent the undue flow of blood to the other parts of the body. ASTHMA. This disease consists in a difficulty of breathing, for the most part temporary, and occurring at uncertain periods, accompa- nied with a wheezing sound, and a sense of constriction in the chest, with cough and expectoration. Asthma may be produced either by a diseased condition of the lungs themselves, or a sympathetic disturbance of these organs from disease of the stomach and bowels; or it may arise from organic disease of the heart and large bloodvessels, or from some contamination in the air respir- ed. In the latter case, it will of course be but of short duration. It is commonly divided into two species, the dry, spasmodic, or nervous asthma; and the humid, or habitual asthma. In the for- mer, the fit is sudden, violent, and of short duration; the constriction of the chest very hard and spasmodic; the cough slight, and the expectoration scanty, and only appear- ing towards the close of the fit. In the second species, or habitual asthma, the paroxysm is gradual and protracted; the constriction of the chest is heavy and labo- rious; the cough severe, and more or less constant; the expectoration commencing early, soon becoming copious, and afford- ing great relief. The spasmodic asthma is comparatively a rare disease, not one case occurring for, perhaps, fifty cases of habitu- al asthma. Asthmatic paroxysms are usually prece- ded by languor, flatulency, headache, drow- siness, pale urine, disturbed rest, and pain in the head. Soon a sense of tightness and stricture is felt across the breast, with dis- tressing straitness of the lungs, impeding respiration; the difficulty ofjbreathing con- tinues to increase; both inspiration and ex- piration are performed slowly, and with a wheezing noise; the speech becomes diffi- cult and uneasy; a propensity to coughing succeeds, followed by the most anxious dif- ficulty of breathing; the patient is threat- ened with immediate suffocation, and is obliged instantly to rise from an horizontal position. The face is sometimes turgid, and of a livid hue; at others it is morbidly pale and shrunk. These symptoms con- tinue for a longer or shorter period, when they gradually decline, the fit being gene- rally terminated by an expectoration of mucus. Notwithstanding the violence of the assault, it is very seldom that asthma proves fatal at the time. In spasmodic asthma, the patient soon recovers from the fit, if we except the ef- fects of weakness left behind, and when the weather is warm and favourable, may con- tinue for weeks or mowiths free from diffi- culty of breathing or cough; but in the humid or habitual asthma, although weeks may be sometimes passed without a severe fit, yet the sufferer, for the most part, la- bours under continual difficulty of breath- ing, accompanied with a wheezing noise, and more or less cough. The exciting causes are numerous, and among the chief of them we may reckon, hereditary predisposition,—a cold and moist atmosphere, — sudden changes of tempera- ture,—removal from a healthy spot in the country to a crowded and populous city,— suppression of long accustomed evacua- tions,—mechanical constriction of the chest. Yet all these may be resolved into an irrita- tion of some kind or other, existing within the cavity of the chest, and stimulating its moving powers to a convulsive constriction. In such instances, the asthma is a primary affection originating in the chest; but we have already remarked, that this disease not unfrequently occurs secondarily, and as a mere symptom, or result of some other complaint, or of a diseased state of some re- mote organ, as the stomach, bowels, or liver, when it is only to be removed by re- moving the disorder on which it is depen- dent. Hence, it is of the utmost importance that we should trace out the actual cause, so as to determine whether it has its seat within the chest, or in a mere remote part When once asthma is established, a recur- rence of the fit may be readily excited by 336 DISEASES. any excess or imprudence in diet, or any unusual exertion of body or mind. Indeed, whatever greatly deranges the functions of the stomach and bowels, will prove a pow- erful cause of exciting the fits; and though this disease is not, generally speaking, im- mediately dangerous, frequent returns of it are liable gradually to induce incurable dis- ease of the heart, or lungs, and thus to oc- casion a fatal termination. These facts evince the importance of an unceasing attention in avoiding the constitutional or occasional causes of this affection. When the fit is on, or felt to be coming on, the patient should have his feet and legs immediately immersed in warm water; he should drink frequently of some mild diluting liquor made warm, as barley-water, or very thin gruel, into a pint of which, two or three tea-spoonfuls of aromatic spirit of ammonia, may be put; and if there be much pain about the chest, the part may be fomented with hot flannels, or bladders filled with hot water. A draught, consist- ing of twenty drops of the solution of ace- tate of morphia or of laudanum, with half a drachm of ether, and an ounce and a half of mint water, will sometimes be very useful; or the acetate of morphia may be given in a breakfast-cupful of strong coffee; to be repeated three or four times in twenty-four hours, if necessary. Sir John Floyer, and Sir John Pringle, both confidently recom- mended coffee, and the latter eminent prac titioner says, that it is the best abater of the periodic asthma that he had seen. The best Mocha is to be preferred, which should be newly burnt, and made very strong im- mediately after grinding it. An emetic of twenty grains of ipecacu- anha powder, is often attended with great advantage on the accession of the fit, and may be beneficially employed afterwards, once in three or four weeks. The emetic determines to the surface of the body, pro- motes spitting, greatly relieves the chest; but if the patient is averse to it, he may take instead three grains of compound ipe- cacuanha powder, made into a pill with con- serve of roses, every second or third hour till the fit abates. The inhalation of the steam of hot water will sometimes give re- lief during the paroxysm. This may be repeated frequently if it agrees, and the severity of the disease makes it desirable. If the bowels are confined on the acces- sion of the fit, they should be relieved by the exhibition of a laxative clyster, or by ad- ministering a dose of calomel and rhubarb, or calomel and magnesia; but active purg- ing is almost invariably to be avoided. Dr. Bree, the able author of an approved work on disordered respiration, advises the following draught to be taken every three hours, during the paroxysm: extract of hen- bane, three grains; diluted- nitric acid, thirty drops; tincture of squill, fifteen drops; water, an ounce and a half. Asthma is frequently observed in middle aged and elderly persons, to take much of the character of a slow inflammation and obstruction in the lungs, being attended with a good deal of pain in the chest, fever- ishness, and hard pulse, especially in the winter and spring, and then, after cupping the chest, seneka is a very useful medicine. In such cases, while the feverishness con- tinues, it must be united with a saline medi- cine, as three drachms of the solution of acetate of ammonia, to an ounce and a half of decoction of seneka, which may be taken as a draught, three or four times a day. Blisters to the chest in these cases will also be found beneficial. When the febrile state gives way, the following may be taken, which will be found to promote spitting, perspiration, and urine, in a powerful man- ner: decoction of seneka, an ounce and a half, or two ounces; vinegar of squill, half a drachm; paregoric elixir, half a drachm— for a dose to be taken three or four times a day. This combination will often be useful in the intervals, and the dose of squill may be increased if necessary. When asthmatic paroxysms occur in young, robust, or full habits, and particu- larly when the disease is recent, a bleeding from the arm will be found to abate the vio- lence and shorten the duration of the fit. When general bleeding is not thought ad- visable, cups may be applied to the chest. During the intervals of the fits, the most valuable medicines are ammoniac, assa- foetida, squill, seneka, ipecacuanha, prepa- rations of zinc, or steel, and mercurial alter- atives, combined with such a diet and regi- men as are calculated to invigorate the digestive functions, the organs within the chest, and the constitution at large. In some cases, where no inflammatory symp- toms are present, the following pills are very serviceable: gum ammoniac, g-um as- safoetida, of each, a drachm; powder .of ipecacuanha, fifteen grains; Peruvian bal- sam, a sufficient quantity to form the whole into a mass, to be divided into thirty pills. Two or three to be taken twice or thrice a day. Or these: compound squill pill, a drachm; powder of ipecacuanha, twelve grains; purified Turkey opium, three grains; camphor, a scruple, divide into twenty pills. Take two pills three times a day. The compound tincture of benzoin, when good, is sometimes a useful medicine, and may be taken to the extent of thirty or forty drops, three times a day, on a lump of sugar. We have already adverted to the value of occasional emetics of ipecacuanha in the intervals. They are almost invaria- bly useful, especially in habitual asthma, DISEASES. 337 and may be advantageously repeated once a month, whatever medicine is taken. Twelve or fifteen grains of ipecacuanha is a proper dose. There can be no doubt, that asthma may frequently be much relieved by the skilful employment of mercurial alteratives, and particularly when it is connected with a de- ranged state of the digestive organs, and symptoms of chronic disease of the liver, spleen or other internal organs. Under such circumstances, a pill of blue mass, five grains; soap, three grains; and ipecacuanha, one grain, may be taken every night, in ad- dition to any other medicine that may be re- sorted to during the day. This pill may be advantageously persevered in for several weeks. Occasional blisters are very advisable, but a perpetual issue or seton in the side, arm, or between the shoulders, is of still greater effect, and sometimes proves a powerful remedy. It ought never to be neglected in bad cases, for if it fails to cure, it rarely falls short in relieving. Dr. Wilson Philip has.discovered, that, in hab'itual asthma, the application of gal- vanism is often of great benefit, and some- times effects a complete cure. He states, that it seldom fails to relieve the difficulty of breathing, and the symptoms of indiges- tion present. The galvanism is applied in the following manner:—Two thin plates of metal, about two or three inches in diame- ter, dipped in water, are applied, one to the nape of the neck, the other to the low- er part of the region of the stomach. The wires from the different ends of the trough are brought into contact with these plates, and as great a galvanic power maintained as the patient can bear without complaint. In this way the galvanic influence is sent through the lungs, as much as possible, in the direction of their nerves. It is proper, constantly to move the wires upon the metal plates, particularly the negative wire, other- wise the skin is injured in the places on which they rest. The relief seems much the same, whether the positive wire is ap- plied to the nape of the neck, or the pit of the stomach. The galvanism is to be discontinued as soon as the patient says the breathing is easy, which varies from five to fifteen minutes. It is remarkable, that in several who had laboured under oppressed breath- ing for from ten to twenty years, it gave relief quite as readily as in more recent cases. In all inflammatory cases of asthma, the application of galvanism would be injurious; and in cases arising from dropsy, or any other mechanical impediment, little or nothing is to be expected from it. The smoking of tobacco, or stramonium, is now and then of service, although some physicians object to the practice. It would seem to be more especially applicable to humoral asthma, or that form of the com- plaint in which the patient expectorates rather copiously, and where there is no great fulness of habit. , - A distressing pain sometimes affects the integuments of the head, and generally at the back of the head. A blister has been- known to afford perfect relief to this pain, but in general the most effectual remedies are those which are calculated to restore the healthy action of the stomach and intes- tines. The diet must uniformly be light, and easy of digestion, consisting chiefly of fresh animal food, eggs, bread, tea, cocao, &c. A waistcoat of wash leather, or flannel, worn constantly next the skin, from Sep- tember to May inclusive, is highly to be recommended. With respect to regimen, the points most worthy of attention are, to keep the bowels regular, by the occasional use of mild laxa- tives; to preserve the surface of the body warm, avoiding damp, wet, and the east and north east winds; and to take daily exer- cise in the open air, when the weather per- mits, short of fatigue. Horse and carriage exereise are by far the best. Removal to a milder climate is highly advisable. DISEASES OP THE HEART. The heart is subject to various diseases both of its structure and function. Indeed^ the alteration of its structure necessarily leads to irregularity of its action. The most severe and the most frequent diseases of the heart, are dilatation of the ventricles, thickening of their walls, and the combina- tion of these two states. The continuance of the foramen ovale after birth, perforation of the ventricular septum, ossification of the sigmoid valves of the aorta, or of the mitral valve, excrescences growing from these valves, productions of different kinds which may be formed in the heart, are af- fections much less frequent; and which generally disorder the health, only when they attain a degree of intensity sufficient to produce increased bulk or dilatation of the ventricles. Dilatation or increased bulk of the auricles is still less frequent, and is perhaps, always, consecutive affection, pro- duced by a morbid state of the valves, or of the ventricles. Of all these diseases, the general symptoms are nearly the same. Respiration habitually shortand constrained; palpitations and stiflings invariably produced by mounting an ascent, by rapid walking, by mental emotions, and returning even without known cause; frightful dreams, and interruption of the sleep by sudden start- ings; occasionally the symptoms are the same as those described under the name of 33S DISEASES. breast pang,- and, lastly, they may be at- tended by a cachectic paleness, with ten- dency to dropsical effusion, which eventually appears. All of the foregoing symptoms mav, to a greater or less extent, occur in persons affected with disease of the heart. In an extreme degree, the symptoms are still more obvious. Incapable of bearing the horizontal position, the patient seated rather than lying in bed, with his head inclined on his chest, or thrown back on the pillow, re- tains this position night and day; his face, more or less swollen, is sometimes pale, but, most generally, has a deep violet tint, diffuse, or confined to the cheeks; the lips, swelled and prominent like those of the ne- gro, are most intensely livid, even when the face is pale; the lower extremities, the scrotum, the labia in females, the integu- ments of the trunk, the arms and the .face even are successively affected with drop- sical infiltration. Great derangement of the capillary circulation is denoted by dyspnosa, or oppressed breathing, and spitting of blood, racking pains of the stomach, amounting sometimes to vomiting, and finally lethargic stupor, coma, and apoplectic seizure, which too often terminates at once the disease and the life of the patient. I. Alteration of the structure of the heart. 1. Hypertrophy, or excessive nutrition, (active aneurism of the heart,) consists in increased thickness of its muscular sub- stance, without enlargement in the capacity of the cavities. The substance of the organ is in general firmer than natural. It may exist in one ventricle only, or extend to both, and it may be general or partial. This disease very frequently induces apo- plexy. 2. Dilatation of the ventricles (passive aneurism) consists in enlargement of the cavities of the heart, with thinning of their walls. The muscular substance is at the same time unusually soft, sometimes of a violet colour, in other instances pale, and almost yellow. The most general and powerful cause of this is original conforma- tion. 3. The substance of the heart is al- tered in its texture, sometimes becoming peculiarly firm, at other times soft and flab- by. 4. Ossification of the tricuspid and semilunar valves is very rare, but that of the mitral or semilunar aortic valves is very common. It appears in general, first in the substance of the base of the valve, and then pierces the covering membrane, so as to render the surface of the valve rough and prominent. Eventually it may affect the margin of the valve, when it produces ex- treme contraction of the opening. A slight degree of this disease may occur without much derangement in the action of the heart, or serious disorder of the healtlu 5. Inflammation of the heart or pericardium. It occurs in various forms, sometimes with acute pain referred to the pit of the sto- mach, quick and short breathing, with ex- treme anxiety and restlessness, pulse very quick; sometimes cough attends. It is to be treated by active bleeding from the arm, leeches or cups to the chest, fol- lowed by blisters, an extremely low diet, perfect rest, and the use internally of anti- mony, digitalis, and other remedies which have the effect of reducing the circulation. Diseases of the heart are difficult to be distinguished, or to be cured when they are known to be present. Modern physicians consider themselves as having the means of ascertaining their presence by the steth- oscope, a wooden cylinder, which, when placed upon any part of the chest, gives a different sensation to the ear of the examin- ei', according as it is in a healthy state or affected with various diseases. By com- paring these different sounds imparted in health, with the appearances observed when there is an opportunity of examining the dead body, they hope in time to obtain a tolerably correct pathology of the diseases of the lungs and heart. II. Irregularities in the action of the heart. These are principally irregularities of pulsa- tion, intermission, and palpitation. 1. Ir- regularity of pulsation. This may consist either in variation of the frequency of the beats, or in some one or more very strong beats, in the midst of regular ones. 2. In- termission may either be owing to an actual cessation of the heart's action, or to the contractions being too feeble to communi- cate their impulse to the arteries. 3. Pal- pitation. This is an affection in which the motion of the heart is performed with great- er rapidity, and more force than usual; and the patient is affected with difficulty of breathing, with great anxiety, and various uneasy and painful sensations. It arises from various causes, as from violent exer- cise, from diseases of the heart itself, or of the great vessels; from emotions of the mind, and from all those circumstances which occa- sion fainting fits. The cure must be very much regulated by what we judge to be the cause. Many of these are quite beyond our reach; and all that we can do is to di- rect a careful avoidance of whatever tends to quicken the circulation, as violent exer- cise, or going quickly up a height, or over distension of the stomach; and also to pre- scribe occasional small bleedings, and such diet as will not occasion fulness of the ha- bit, or give any tendency to inflammatory symptoms. Something may be done by moral management; endeavouring not to let the mind be easily ruffled or harassed, by the sudden and often small accidents, that are so apt to overset the tranquillity of those who do not exert themselves to keep a well balanced mind. DISEASES. 339 CONSUMPTION. A wasting or decaying of any part, now generally used without any addition in English, to signify the wasting of the lungs. When a person spits up a great quantity of purulent matter; when he is affected with hectic fever, and becomes extremely emaciated; these are evident and almost unequivocal symptoms of consumption of the lungs. But these symptoms are only the sequel of a long train of others, of which it may be proper to give the detail; premi- sing that many of them may be parts of other diseases, and many may show them- selves without being followed by the plain and aggravated marks of confirmed and fatal consumption. There are certain habits of body, that appear more liable to consump- tion than others. Persons of a slender make, of long necks, narrow chests, and prominent shoulders; with a florid counte- nance and sanguine temperament, are those particularly referred to. Instead of general descriptions, let us take a single patient, and trace the progress of the disease in him. He is affected with a slight and short cough, which becomes habitual to him, which he does not remark in himself, nor like to hear taken notice of by others. His breathing is easily hurried by any bodily motion, he becomes languid and indisposed for exertion, and also, in some degree, emaciated. This state continues for a year, or more, without his making much complaint about it; but he' is more easily affected by cold than former- ly, his cough is increased by it, and he has some affection of the head, nose, and eyes, as if from catarrh. This may be relieved; the patient and his friends believe he has had a common cold; and little or no alarm is excited, or precautions taken. At length, a cold appears to have been taken, of more than usual severity, the cough is more troublesome than before, and continues lon^r than a common cold generally does. The cough had formerly been dry; now it becomes more constant, and there is some expectoration, which is most considerable in the morning. This becomes, by degrees, more copious, thick, and tough; at length of a greenish or yellow colour, and puts on the appearance of purulent matter. When these symptoms have come on, the breath- ing is at the same time more difficult, and the debility and wasting are increased. At this time, also, there come on the symptoms of hectic fever; of which it may be proper, in this place, to give the description, altho' hectic fever is the accompaniment of other diseases besides consumption of the lungs. A hectic fever, though the febrile symptoms are always present, has exacerbations, or an increase of their severity twice every day. The first of these occurs about noon, some- times a little sooner or later: a slight remis- 2 T sion happens about five in the afternoom This is followed by another exacerbation, generally increasing till after midnight; but after two in the morning a remission takes place, and this remission becomes more complete as the morning advances. Some- times these exacerbations are introduced by a degree of cold shivering, or a sensation of cold; though the patient's skin, if examined by the thermometer, would show an actual increase of heat. The evening exacerba- tion is the most considerable; and after no long period, it is accompanied by sweating, which continues through the whole course of the disease, and becomes more and more profuse as. it advances. The time of its most distressing and harassing flow is be- tween two and four in the morning. The appetite for food is less impaired in hectic than in some other kinds of fever; but any approach to indulgence, is apt to make the exacerbation more severe. The thirst is not great, and the mouth is commonly moist; as the disease advances, the tongue is free of fur, and even appears raw; and to- wards the very termination, the surface of the mouth, tongue, and fauces appears red and inflamed, and covered with white and curdy looking specks, like the most painful form of the thrush in children. The face is commonly pale; but at certain times, chiefly during the exacerbations, there is a flush, and a bright red spot on each cheek. There is a peculiarly blue or pearly whiteness about the white of the eye. A looseness comes on, which baffles all the attempts of art to check it. The weakness of the system is great and increasing, and the wasting is carried to an extent that is almost incredible. Patients have been seen whose countenance looked more ghastly and ca- daverous when breathing, than it did when life was extinct. Sometimes watery swel- lings occur in the feet and legs. The fever is not often attended with headache and de- lirium; and the state of the mental faculties is one of the most singular and characteris- tical features of hectic fever, and especially of that disease of which it is the unfailing attendant, pulmonary consumption. While every spectator sees the evident and resist- less approach of death, the patient himself is, in many cases, confident and full of hope; and while judicious and pious friends wish to direct the mind to what alone can make the future desirable, they often find the patient devising favorite schemes for the promotion of his recovery, and for distant visionary happiness. Sometimes the ele- gant and cultivated genius shines out with more than usual brightness, as life goes down; and bequeaths to after times, some of the most delicate effusions of the pensive muse. Sometimes, in more dignified eleva- tion, the soul, looking calmly down on the early wreck of its frail tenement, and, 340 DISEASES. triumphant amidst deploring friends, gives a glimpse of what is to be enjoyed, when its capacities of understanding and affection are satisfied to their fullest extent. With the symptoms of consumption al- ready described, the cough, expectoration and fever, are going on, and there is gene- rally a pain felt in some part of the chest. At first, this pain is felt under the breast bone, and chiefly or solely on coughing; but very often a pain is felt in some part of the side, and to such an extent as to prevent the patient's lying on that side. These symptoms, pretty nearly in the succession above described, though varying a little in their continuance and degrees of severity, occupy more or less time before they come to their fatal termination. In this climate they often take up some years, the symptoms appearing especially in the winter and spring: in the warm weather of summer, they are mitigated or nearly removed; but on the return of winter, they again appear; and after a season or two prove fatal, towards the end of spring or beginning of summer. There are several diseases of the organs contained in the cavity of the chest, which are found to terminate in consumption. A spitting of blood, a common cold, inflamma- tion of the lungs or some of their coverings, asthma, all have been thought to be the cause of that fatal ulceration of the lungs, which destroys their structure, and the life of the patient. Most of the above-mentioned diseases are frequently seen, and are fre- quently cured, without consumption taking place; but it is unquestionably true, that a spitting of blood in young persons is always to be dreaded, as it is too often the first indication of consumption. At the same time, it is also to be remembered, that a spitting of blood is a mark of inflammatory action, that it often yields to a judicious employment of bleeding and regimen, and though never to be-neglected, it need not inspire the patient or his friends with over anxiety or alarm. It is the same with the other diseases mentioned; the most prudent methods are to be taken for their removal, remembering the insidious nature of the first symptoms of consumption, and the fatal progress which it makes when once it is begun. It is generally agreed by medi- cal men, that by far the most frequent sub- jects of consumption are those who have tubercles in the lungs. By tubercles we mean certain hard swellings in the lungs: which are inactive at first, but at length become inflamed, and change into little abscesses, which break and pour out their matter, and give occasion to purulent ex- pectoration. It may now be asked, Who have tuberculous lungs; and how are we to know or suspect the presence of tubercles' It is admitted that persons of a scrofulous habit are those who are most frequently attacked with consumption from tubercles; or that it occurs most in those who are affected with swellings of the external glands, viz. persons of a sanguine tempera- ment, or of a temperament compounded of flie sanguine and melancholic, who have smooth fine skins, ruddy complexion, large veins, and soft flesh. Another question of great anxiety is, Are we able to distinguish, by the matter spit up, whether the lungs are in an ulcerated state or not? Different tests have been proposed to ascertain the differ- ence between mucus and pus, but few of these tests can be depended upon; and very accurate chemists and physiologists have confessed, that the matter expectorated in a common cold is, is in some of its stages, precisely the same as from wasting lungs; and that the most formidable looking matter has in a few days been exchanged for an improving expectoration, and at last perfect health has been restored. It is from other circumstances than the expectoration, that we are to judge whether the patient is af- fected with consumption or not. This is a subject attended with very great difficulty indeed, as several diseases of organs within the chest, and foreign bodies getting into the lungs may give rise to all the symptoms of incurable ulceration of the lungs, which symptoms may yet get well. In a case of diagnosis, which baffles the most skilful and experienced physicians themselves to under- stand, or to communicate to their own pro- fession any satisfactory marks of distinction, it would be idle and pernicious to pretend to put the general reader in possession of any tests which could be popularly under- stood. The diseases resembling consump- tion, from which patients have sometimes recovered, are the following: Sympathetic cough; imitations of the diaphragm by dis- eases of the fiver, inflammation of the wind- pipe, diseases in certain parts of the lungs themselves, or of their glands and cov erings, ulceration in consequence of active infl-am- mation, spitting of blood, and its conse- quences. The treatment of those who are supposed liable to consumption, has varied much in different periods; sometimes it has been treated on the stimulant and tonic plan; sometimes with exercise; sometimes on the antiphlogistic plan; andra multitude of remedies have been for a time extolled, and then laid aside and forgotten. They who are of the habit and make described in a former part of this article, or whose parents or relatives have either died of consumption, or who are evidently disposed to it, should pay particular attention to the slightest ap- pearance of the symptoms which threaten the disease, and should take every method for their removal. In such persons, we ought never to hear it negligently remarked, when they are affected with a cough,' Oh, it DISEASES. 341 is only a common cold:' this is too often the commencement of the long train of illness which is to lead them to the grave. A spitting of blood is never to be trifled with; if florid and frothy, it is to be treated by blood-letting and other antiphlogistic means; and all richness of living, and every thing tending to keep up too great fulness of blood, or to increase inflammatory action in the system, must be avoided for years after the spitting of blood disappears. But the« common forerunner of fatal consumption is the tuberculous disease; and to prevent the formation of tubercles, to discuss or dissolve them when formed, or to prevent them from getting into a state of inflammation, or to heal them up when suppurated, are the great desiderata in this disease. But the means of satisfying these indications are by no means easily found. One of the first objects to be attended to, is to regulate the diet of consumptive persons; little animal food is to be used, and a great part of the patient's living is to consist of milk, in its various forms, preparations and combina- tions. Care must be taken by such persons also, that no undue stress be given to the lungs or to the cavity of the chest; and, therefore every thing must be avoided, which requires strong exertion of the organs of breathing, such as violent or long con- tinued exercise, walking quickly up steep ground: loud or long speaking, or singing, must also be avoided; the person should not play on the flute or other wind instruments, and if he has been in the practice of speak- ing in public, it must be abstained from. An employment that requires much stooping, is bad for those threatened with consumption; they must, therefore give iip those seden- tary occupations which demand stooping at a desk or counter. A point of primaiy im- portance in the management of those who are of the consumptive habit, is the avoiding of exposure to cold; in numberless instances this exposure is to be considered as the exciting cause of the disease. In our va- riable climate, it is not easy for the most robust and cautious persons to pass a win- ter without some catarrhal affection; and for the phthisical, who are so much suscep- tible of all impressions from the atmosphere, it is almost impossible to avoid it. Hence the necessity of preventing as much as pos- sible all changes of temperature from injur- ing the body, by the use of flannel or fleecy hosiery worn next the skin; or what is still more approved, an under jacket of chamois leather. Hence, also, the propriety of re- moving to a warmer climate, and avoiding the cold and humid air of a northern winter. Gestation of various kinds has been much recommended; and as to the advantage derived from one kind, viz. riding, there is a testimony from Sydenham so strong, that it deserves to be quoted for its singularity. "Neither mercury in syphilis, nor bark in intermittents, is more effectual than riding in consumption; provided the patient takes care to have his linen well aired, and to continue his journey longenough; the longer as he is more advanced in life." Concern- ing such a testimony from such a man, so accurate an observer, and so candid a relater of what he saw, we must say that it is by far too strongly expressed; and must add ges- tation to the long list of consumptive reme- dies, which have deceived the hopes of both patients and physicians. Without expect- ing so much from riding as Sydenham did, we may still hold it as true, that riding is a proper and safe exercise, to be tried before patients are too weak to be the better for it; and that many have had their complaints much alleviated, and it would seem even cured, by the practice. Riding in a carriage, or using a swing, are also modes of gestation which may be conveniently resorted to; and a long established practice is to order pa- tients to take a sea voyage. One would naturally prefer doing this in the summer season, and recommend going from a colder to a warmer climate. With a view of reliev- ing the lungs, blisters have been recom- mended; and an issue in some part of the body may be of use. Such are the measures to be employed in cases where we appre- hend a future consumption; and in the chil- dren of consumptive parents, and in young persons who have had spitting of blood, or who seem by their nature and habit likely to fall into the disease, they should be early, and diligently, and unremittingly employed. When we are unsuccessful in preventing the advanced stages of the disease, and the expectoration of matter, and when hectic fever is confirmed, it is the part of a humane and skilful practitioner to palliate the pre- dominant symptoms as well as he can. We are unhappily as yet without any medicine which we know to have the power of curing ulcers in the lungs. A mixture, containing myrrh, has obtained some reputation, and is at least as innocent as other medicines of the same class. To allay the heat, the thirst, and other symptoms of hectic fever, and to cool the system, acids are usefully employed. We give from ten to twenty drops of the elixir of vitriol in a glassful of water, three or four limes a-day, or we may acidulate the patient's drink with very di- luted sulphuric acid: or lemonade may be given, provided it does not produce too great laxity of the bowels, or sourness of stomach. When there occur acute pains referred to some part of the chest; when the skin is hot and dry, and the pains are increas- ed by drawing a full breath; then, notwith- standing the apparent weakness of the pa- tient, it will be quite necessary to take away a little blood; and though the disease ulti- 342 DISEASES. mately is to prove fatal, repeated small bleedings give great relief, and on the whole, prolong the patient's life. In those cir- cumstances too, repeated blisters are neces- sary; and it is better to allow them to heal quick!}-, and put them'on afresh, than to keep up a discharge by an issue. Expec- torant and emollient mixtures for the cough, are to be given through the whole course of the disease. These are made of squill as the active ingredient, joined with balsam of Tolu, syrup, and cinnamon-water, or pep- permint-water; but large quantities, or many varieties of cough mixtures, as they are called, are unnecessary and improper. The cough is one of the most distressing and pertinacious of the symptoms of con- sumption; and for the relief of this, our great dependence is upon the various pre- parations of opium. There are some dis- advantages in the use of opium; it has a tendency to induce costiveness, and to check the expectoration; to increase the feverish heat, and the already profuse per- spiration; but the cough, the irritation, and the sleepless nights, are the principal sources of pain and suffering; and as we have not a more soothing drug than opium, we must be content to use it with all its drawbacks, and counteract its injurious tendency by other means. Another very troublesome symptom is the looseness of the bowels, which is both a cause and a sign of great debility; and which is with great difficulty checked or modera- ted; indeed in a great number of instances, it is found to be beyond the reach of medicine. We attempt to moderate this symptom, by giving astringent medicines, as catechu, or decoctions of logwood, or small doses of rhubarb; also by giving opium by the mouth, or by injections. The acetate of lead, com- bined with opium, in the dose oftwo grains of the acetate to one of the opium in the form of pill, given at bed-time, has in some instances the power of checking the loose- ness. The specks in the mouth are another annoying circumstance in the last stage of phthisis. They are to be treated in the mildest possible way, by very slight astrin- gent applications, as a weak solution of a little honey and Armenian bole. It is diffi- cult to abstain from attempting to counter- act the helpless debility which forms so prominent a feature in consumption; but we must not venture on nourishing diet, or wine and other cordials, for fear of increas- ing the cough, the heat, the thirst, and other hectic symptoms. A decoction of quassia, made by boiling six drachms of the bark in two pounds of water, may be given; a wine-glassful three or four times a-day, adding eight drops of laudanum to each dose; and one or two grains of the sulphate of iron may be given daily with aromatic powder, or made into pills with a crumb of bread. It would be wrong to conclude this arti- cle, without mentioning the strong hopes that were at one time entertained, that con- sumption would be cured by the use of foxglove. It is certainly a medicine of very surprising powers, and has great influence on the circulating system; it diminishes the strength and frequency of the pulse in a most remarkable manner, and may be re- garded as a most valuable assistant In les- sening the violence of inflammatory action. It may be given with this view, when such action occurs in any stage of consumption, either alone in doses often drops in water three times a-day; or added to the expec- torant mixtures in the proportion of one drachm to six ounces of the mixture, and a table spoonful given four or five times a-day. But we are not to hope, that any great or permanent good will arise from the use of foxglove in advanced pulmonary consump- tion. To the deeply interesting question—Can consumption ever be cured? we reply: That considering the fallacy attending much of our observations and reasonings on disease; considering that there are a variety of affec- tions presenting symptoms not to be distin- guished from those exhibited by true pul- monary consumption, which nevertheless get well; considering also that several pa- tients, undoubtedly members of consump- tive families, have by proper management been relieved of their ailments, and attained a long life, we should not be justified in giving the decided answer that consumption in every instance is incurable. But we must judge of every particular case by its own merits; must direct the most prudent pre- cautions where the disease is only threaten- ed; and aware of the melancholy results obtained in the experience of the' most learned, sagacious, and candid physicians, we must not excite ill founded hopes, where we see the disease decidedly formed. DYSPEPSIA. Stomach complaints, under their various forms, are exceedingly common diseases, and seem to have increased very much in modern times. They prevail most in large cities, among the sedentary, the luxurious, and those of studious habits. The young are generally exempt from them; and they do not usually make their appearance be- fore the age of thirty or forty. In a state of health, people are not con- scious of having a stomach at all; at least they never think of it, except when their attention is called by the demands of a keen and vigorous appetite,—so smoothly and quietly does the digestive process go on. DISEASES. 343 But no sooner is digestion impaired or in- terrupted, than the food, which otherwise is acted upon and dissolved into a homoge- neous mass by the gastric fluid, runs into a state of fermentation, produces a quantity of acid and wind, and gives rise to the vari- ous symptoms, to be afterwards enumerated. Not only does the stomach suffer from the presence of undigested aliment, but when this aliment passes into the duodenum, or commencement of the intestinal canal, it then also causes considerable derangement, and continues to produce irritation, more or less, throughout the whole passage. Moral causes very much influence the state of the stomach, such as excessive grief, and every kind of mental depression, anxiety about worldly affairs, intense thought, joined to a want of due bodily exercise and free and unconfined air. On this account, the city life, taking it alto- gether, is exceedingly apt to produce dis- orders of this nature. The influence of a variable atmosphere, also, as tending to de- range the biliary secretions, and the sym- pathy subsisting between the skin and the bowels, is a powerful cause of dyspepsia. Among those who live in. the pure and open air of the countiy, these atmospheric changes have comparatively little effect; but in cities and large towns, where the whole constitution is effeminated; where the external surface of the body is not ha- bituated to the vicissitudes of the skies; where moral causes are constantly operating injuriously on the digestive organs; and where air, imbued with millions of mias- mata, exhaled from every thing in the ani- mal, vegetable, and mineral kingdoms, is breathed, swallowed, and kept in contact with the skin; the effects are conspicuous in the sallow complexions, puny or capri- cious appetites, and imperfect digestion of the inhabitants. This state of the appetite and digestion, resulting from sedentary ha- bits, impure air, late hours, and mental perturbations, leads to an aggravation of the evil, by the recourse which is had to high seasoned dishes and stimulating drink, indulged in, more or less, by all classes of society. The nerves of the stomach are daily irritated by what is digested, while the nerves of the bowels are irritated by what is undigested. To these causes may be added the vitiated secretions themselves, not only of the stomach, but of the liver, pancreas, and all the innumerable glands that stud the surface of the alimentary ca- nal. These circumstances produce all the phenomena of indigestion, not only as re- gards the disorder in the organs of diges- tion themselves, but as respects the innu- merable affections of distant parts from syfnpathy with the stomach and other inter- nal viscera. The fact appears that, in ci- vilized life, the host of moral and physical causes of disease that are always in ope- ration keep the powers of the digestive organs below the standard of health, while the quantity and quality of our usual food and drink are calculated to impair these same organs, even if they were in a state of the most perfect integrity of function. Indigestion usually commences gradually, and in a very insidious manner. It may ex- ist for a very considerable time simply as a disorder of the functions of the stomach, but if this is long continued, a general fall- ing off of the system, a slow inflammatory state of the inner coats of the stomach and bowels, and sympathetic affections of other parts of the body, frequently succeed. The symptoms attending the case of a confirmed dyspeptic patient are thus accu- rately described by Dr. Paris:—He tells you that he begins to feel his usual avocations irksome and too laborious; that he has long suffered from a bad digestion, which by care and management he had been hitherto enabled to control; but that he has now little or no appetite; that his strength fails him, and that he fears he is 'getting into a bad way.' He finds that the slightest ex- ercise occasions fatigue, and deluges him with perspiration. On examining the tongue, it will usually be found coated on the pos- terior part, and on its centre, with a brown- ish fur; his bowels are by turns costive and too much relaxed; the pulse at this period is generally slow and small, although it is sometimes hard; his countenance is more pallid than usual; the eyes appear sunken, and the eyelids swollen, and the eyeballs are occasionally injected with yellow streaks. In some cases, heartburn and a sense of op- pression are experienced after meals, but in others the patient only complains of lan- guor and extreme listlessness. On some occasions a sense of constriction is felt about the fauces, and a difficulty of swallowing is experienced, as if the oesophagus presented some mechanical obstruction to the passage of food. Dizziness, unusual drowsiness, pains in the head, ringing in the ears, a dis- agreeable taste in the mouth, an altered state of the salivary secretion,—being some- times limpid like water, and at others thick and ropy,—palpitation, and a sense of faint- ness, are symptoms which also in a greater or less degree usually distress the dyspeptic sufferer. His hands are alternately hot and cold; in the former state they are dry, in the latter more usually damp. His nights are sometimes, but not generally, disturbed by restlessness and uneasy dreams. He wakes in the morning without that feeling of refreshment which follows repose in health, and is unwilling to rise from bed, or indeed to move. His limbs ache, the mus- cles of the trunk are even sore to the touch, and any change of position is attended with inconvenience. Every alteration of the 341 DISEASES. weather is felt as a serious evil; if it be- comes a degree or two colder, he creeps to the fire, and inveighs in terms of bitterness and sarcasm against the variableness of the climate; if its temperature be raised, he is oppressed with heat. His bowels become more and more intractable; the usual pur- gative ceases to produce its accustomed effect. He increases the dose; and, when it does operate, the action is too powerful, and its effects are not easily checked. A diarrhoea is established; and this again in its turn is superseded by still more obsti- nate constipation. 'If I could but obtain a medicine,' cries the invalid, 'that would keep my bowels in a regular state, I should soon become convalescent.' There lies the difficulty. The evil arises from the incon- stant and unsettled state of the alimentary secretions, and it is not easy to graduate an artificial stimulant, as that it shall always correspond with the varying state of the organs upon which it is to operate. The depression of his spirits increases as the disease advances; he gives his case up as lost, loses flesh, suffers a thousand distress- ing sensations, and fancies the existence of a thousand more; wandering pains are felt in the bowels and side, a tenderness in the epigastrium is experienced on pressure, the abdomen is often preternaturally tense, his breathing is occasionally oppressed, a short dry cough oppresses him, and expec- toration is extremely difficult. If, under such circumstances, the alvine discharges be inspected, they may present every va- riety of morbid appearance; they may be unnatural in colour, odour, consistency, fi- gure, or quantity. The mind becomes at length greatly de- pressed. Some dreadful imaginary evil seems impending, or some real evil, of tri- fling importance in itself, is quickly magni- fied into a terrific form, attended, appa- rently, with a train of disastrous conse- quences, from which the mental eye turns in dismay. If he happen to labour under any chronic complaint at the time, it is im- mediately converted into an incurable dis- ease, and the distresses of a ruined and orphaned family rush upon his mind, and heighten his agonies. He feels his pulse, and finds it intermitting; disease of the heart is threatened, and the doctor is summoned. If he ventures to go to bed, and falls into a slumber, he awakes in the midst of a fright- ful dream, and dares not again lay his head on the pillow. The eye may or may not be tinged yellow; but there is a peculiar muddiness or lack-lustre in the coats of that organ, with an expression of languor or irritability in the countenance, especially about noon, which are singularly character- istic of the malady, and indicate with un- erring certainty its existence to the experi- enced physician. In people beyond the age of 45, there is usually a greater defect of vision, particularly by candle-light, when the digestive organs are disordered, than when the functions of the stomach and liver are in good condition. The urinary secre- tion is generally disturbed, being either turbid or high coloured, with more or less of pink or "'white sediment. It is for the most part rather scanty than otherwise, with occasional irritation in passing it. Some- times, when the individual is in a state of nervous irritation, it is as limpid as pure water, made every half hour, and in large quantity in the aggregate. The skin and its functions are very much affected. It is either dry and constricted, or partially per- spirable, with feelings of alternate chilliness and unpleasant heat, especially about the hands and feet. The skin, indeed, in this complaint, is remarkably altered from its natural condition, and the complexions of both males and females are so completely changed, that the patients themselves are constantly reminded, by their mirrors, of the derangement in the digestive organs. The intimate sympathy between the exter- nal surface of the body, and the stomach, liver, and alimentary canal, is now univer- sally admitted, and explains the reciprocal influence of the one on the other. Many of the remote causes, indeed, of indigestion and liver affection, will be found to have made their way through the cutaneous sur- face. One of the most striking phenomena attendant on derangement of function in the liver and alimentary canal, is loss of flesh and of muscular power. The emacia- tion is easily accounted for, by the deficient supply of nutriment. But the loss of strength, in this com- plaint, is out of all proportion to the waste of flesh. This is one of the most character- istic features of the disease, and is much more connected with nervous irritation in the stomach and bowels, than with disorder of the liver. It is a sense of debility rather than actual debility; it is infinitely more distressing than real weakness. The least exertion, even that of stooping to take up a book, or stretching out the arm to take hold of any object, will cause such a feel- ing of inability for muscular action, as quite depresses the spirits of the individual. Yet, perhaps in less than three hours after this, when the food has passed from the sto- mach, or its remains from the bowels, the same individual will be capable of walking a mile with comparatively little fatigue. This is a point which should be particularly inquired into when questioning the patient; for the state above described is not one of actual debility, but of irritation. The pa- tient may, it is true, be much weaker than when in health, but this debility is uniform, and proportioned to the decrease of muscu- lar fibre; whereas the distressing sense of DISEASES. 345 debility, now under consideration, is out of all proportion to the emaciation, is not uniformly the same, and is always greater when there is food in the stomach, or bad secretions in the bowels, than when, both are empty. It is, in fact, a sympathetic debility, from nervous irritation in the ali- mentary canal. The distinction between these two kinds of debility is the more ne- cessary, as the treatment is somewhat dif- ferent. Bark, wine, rich food, and tonics, are not the remedies for debility arising from irritation of the stomach and intes- tines. The wretched feeling from this source is exasperated rather than relieved by tonics and stimulants, unless very care- fully employed in combination with sooth- ing medicines, and diet of very easy diges- tion. From the foregoing enumeration of causes which bring on disorders of the digestive organs, it must be obvious that much de- pends upon avoiding or removing such causes, in order to remove the disease. For this purpose, then, care should be * taken to regulate the quantity and quality of the food and drink; to persevere in re- «, gular exercise in the open air; to attend to » , the state of the clothing; and obviate as much as possible the moral causes. I In this disease, perhaps more than any other which affects the human body, more r will depend upon regulation of the food and drink than on all the medicines which can be taken. There are, however, many symptoms which occur in the confirmed disease, which it is necessary to get the better of, at the same time that the diet, &c. is regulated. Acidity of the stomach is a very frequent * attendant on indigestion, and seems to arise from the food passing into a state of fer- mentation; hence acid and v/ind are gene- # rated. One or two tea-spoonfuls of calcined magnesia, or twenty or thirty grains of car- bonate of soda, or of carbonate of ammonia, taken in any aromatic water, is the best means of obviating this; at the same time, attention to the state of the bowels is highly \ necessary. * Purgatives. The bowels are always de- ranged when the stomach fails to perform 1 its offices properly. Sometimes, and in ' some constitutions, there is obstinate cos- tiveness, but more generally there is a loose irregularity of the bowels; in all cases gen- tle purgatives are necessary; but severe purging is always to be avoided in this complaint. In general, one or two of the compound rhubarb pills of the shops, taken at bed time, will gently open the bowels, and clear the stomach; or if a stronger pill is neces- sary, one, or two, or three, of the com- pound colocynth pill may be taken; or an infusion of two or three drachms of senna with as much Epsom salts. Where there is derangement of the bilia- ry organs, Mr. Abernethy is in the constant practice of prescribing the mercurial, or blue pill; one of them to be taken at bed time, and to be followed by a dose of senna, or any of the neutral salts. Small doses of calomel may also be given in these cases, combined with any other mild purgative. Dr. Yates speaks in high terms of commendation of the sulphate of potass. "It appears to me," says he, "to have a more specific effect on the duode- num than the sulphate of magnesia. I give one scruple of it twice a day in the infusion of quassia, and three grains of the blue pill, with or without two grains of extract of aloes, according to the state of the bowels." A few grains—from five to six—of rhu- barb alone, or from ten to thirty grains of rhubarb and magnesia, may be often a use- ful purgative when the person is delicate, or the stomach irritable. When there is great irritation of the sto- mach and bowels of long standing,. and when there is reason to suspect a slow in- flammatory affection of the mucous coats of the stomach and bowels, the application of leeches to the seat of the pain or tender- ness at the upper part of the abdomen, and the utmost strictness of diet, which should be confined to farinaceous substances, are the means of cure chiefly to be depended upon. Flatulence very generally accompanies indigestion, and is a symptom only to be cured by attention to the other general rules. Dr. Paris says he has found small doses of the extract of hyosciamus, com- bined with two grains of ipecacuanha, pro- duce relief in attacks of flatulence which have resisted the ordinary methods of cure. Carminatives give but a very temporary relief. Diet for dyspeptics. All vegetable sub- stances should be avoided. Solid animal food, of the easiest digestion, is to be used, with stale bread or biscuits. In extreme cases, farinaceous food alone, such as gruel, arrow root, sago, &c. should form the diet, small quantities being taken at a time, at proper intervals. On this subject, Dr. Johnson has the fol- lowing observations:—"There is a great er- ror committed every day, in flying to medi- cine at once, when the functions of the stomach and liver are disordered, the se- cretions unnatural, and the food imperfectly digested. Instead of exhibiting purgatives day after day, to carry off diseased secre- tions, we should lessen and simplify the food, in order to prevent the formation of these bad secretions. In doing this, we have great prejudices to overcome. The 316 DISEASES. patient feels himself getting weaker and thinner, and he looks to nourishing food and tonics for a cure. But he will generally be disappointed in the end by this plan. From four ounces of gruel every six hours, he will, under many states of indigestion, de- rive more nutriment and strength, than from half a pound of animal food and a pint of wine. Whenever he feels any additional uneasiness or discomfort, in mind or in body, after eating, he has erred in the quan- tity or quality of his food, however restrict- ed the one, or select the other. If the food and drink irritate the nerves of the stomach, they must be reduced and simpli- fied, down even to the gruel diet above al- luded to. I have known dyspeptic patients gain flesh and strength on half a pint of good gruel thrice in twenty-four hours, and gradually bring the stomach, step by step, up to the point of digesting plain animal food and biscuit On six ounces of animal food, a biscuit, and a glass of water, I have known invalids dine for months in succes- sion, and attain, on this regimen, a degree of strength and a serenity of mind beyond their most sanguine hopes. In all or any of the various forms of dyspepsia which have been described, then, the diet is the first thing to be regulated. But it is quite preposterous to prescribe a certain quanti- ty, or even quality of food and drink, till the power of the digestive organs is ascer- tained. If, a few hours after eating, the patient feels a sense of distension in the stomach and bowels, or any of those symp- toms of indigestion which have been point- ed out; if he feel a languor of body, or a cloudiness of the mind; if he have a rest- less night; if he experience a depression of spirits, or irritability of temper next morn- ing,—his repast has been too much, or im- proper in kind, and he must reduce and simplify till he come to that quantity and quality of food and drink for dinner, which will produce little or no alteration in his feelings, whether of exhilaration immedi- ately after dinner, or of discomfort some hours after this meal. This is the criterion by which the patient must judge for him- self. The scale of diet must be lowered and simplified down to water gruel, if ne- cessary, otherwise a cure can never be ex- pected. But the invalid may ask, 'can I not have my ailments removed without abridging my appetites ?' No ! And the practitioner who undertakes the treatment under such conditions, betrays either a want of principle, or a want of judgment. Although there is much peculiarity of disposition, in regard to diet, observable in different individuals, and therefore some la- titude to be allowed on this account; yet experience has shown, that however the proper quantity of food may differ in differ- ent constitutions, there is one .broad rule as to quality, which is seldom inapplicable to one in a hundred dyspeptics. The least irritating, and the most easily digested aliment, is unquestionably farina- ceous food, at the head of which we may place good gruel. I have known many who could digest only this, without un- pleasant sensations in the stomach or other part of the body. When such is the case, the nerves of the stomach are in a high de- gree of morbid sensibility, and great cau- tion should be taken not to irritate them by attempts at more nutritious food. No per- son is in danger of starvation who can take a pint, nay, only half a pint, of good gruel in the twenty-four hours. Arrow root, sago, tapioca, rice, salep, are all in the same class; but few of them will bear repetition so well as gruel. When the nerves have been kept free from irritation for a certain time by this mild regimen; when the tongue cleans, the sleep becomes more refreshing, and the intellectual feelings and functions more tranquil, beef tea may be mixed with the gruel, then half an ounce or an ounce of chicken ventured on, and gradually in- creased. Whenever any uneasy sensations of mind or body occur, within the twenty- four hours after this trial of animal aliment, it should be decreased; or, if that will not do, wholly omitted, and the farinaceous food resumed. If no bad effects follow, the quantity of chicken may be progressively increased to six or eight ounces, with stale bread—but not too much of that. No par- ticle of any vegetable matter should yet be ventured on. While the farinaceous regi- men is necessary, no drink should be taken, unless thirst be urgent, when barley water, or toast and water, in small quantity, may be allowed. >\ hen the chicken can be borne, the drink should vary in quantity, according to the feelings of thirst, and the number of ounces of the animal diet which can be tolerated. From poultry, the dyspeptic should cau- tiously ascend to mutton or game, dressed in the simplest manner, and still with stale bread or biscuit. I would strongly advise that the quantity should never exceed half a pound in weight, even when that can be borne without a single unpleasant sensation succeeding. It is quite enough, and gene- rally too much. The invalid will acquire a degree of strength and firmness, not fulness, of muscle, on this quantity, which will, in time, surprise his friends, as well as him- self. When arrived at the power of digest- ing six or eight ounces of mutton, he may vary the kind of animal matter considerably. Lamb, hare, tender beef, tripe—nay, veni- son may be taken, provided the gokien rule be observed of always keeping to the DISEASES. 347 quantity which produces no languor after eating—no unpleasant sensation of mind or body during digestion. 1 can not urge this rule too strenuously on dyspeptics. Their happiness—perhaps their"welfare—and the happiness and welfare of many who are connected with them, depend on its strict observance. It is needless to dwell on the endless catalogue of improper dishes. All are impro- per for the dyspeptic, or at least dangerous, that are not included in the above. Even a mealy potato will often irritate the nerves of the stomach, (without any perceptible sensation there,) and pass undigested, after producing a great deal of wretched feeling in distant parts of the body. The same may be said of every kind of fruit and vegetable. There is such a tendency to form acidity in the weak and irritable stomach, vegetable matters are so prone to acidify, and acid is so peculiarly offensive to the morbidly sen- sible nerves of the intestines, that the dys- peptic invalid can not be too much on his guard against fruit and vegetables of every description, however innocent they may seem to be, as connected with disagreeable feelings in the stomach itself. As for cheese, pickles, nuts, onions, and a variety of provocatives, they are rank poison in dyspepsia, and as such should be religiously avoided. In respect to drink, my firm conviction is, that water is the best. The sooner that every species of stimulating drink can be laid aside the better. A cup of coffee after dinner is far preferable to wine. Malt li- quors are quite out of the question. The other meals are of some consequence to be attended to by the dyspeptic invalid. In the morning, if the nervous irritability is not in the highest degree, (necessitating the use of gruel,) coffee or Bohea tea, with well toasted bread, cold, and very little butter,—or, what is better, a little cold meat may be taken,—and nothing more till dinner, if at two o'clock. Where tyrant custom compels to dine late, a slice of cold meat and biscuit should be taken at one o'clock. The tea should be the same as the breakfast, but without animal food;— and a cup of gruel is the best supper. Where farinaceous food can be relished for breakfast, it is certainly better than tea; and the milk or cream should be sparingly used.' Bitters, or Tonics. The indiscriminate use of the various bitters in stomach com- plaints, often does a great deal of mischief, and, in many cases, only aggravates the disease, instead of alleviating it. Many hy- pochondriacs have been driven into a state of insanity by the stimulation of wine and tonics, when the morbid sensibility of the stomach was in a high degree. "Wine and tonics, like opium, will overpower the sen- sibility of the nerves for a few hours, in 2U these cases, and some sleep may follow; but the terrible exasperation of irritability which succeeds, when the first effects of stimulation are over, have produced many an act of suicide, besides the thousand lower grades of mental misery, to which the un- fortunate dyspeptic and hypochondriacal invalid is subjected by injudicious treat- ment. The dreadful depression of spirits and despondency of mind, resulting from this temporary exhilaration and excitement, are so much the more dangerous, as they too often lead to a repetition of the baneful causes that produced them. When there is simply a want of tone in the stomach and system generally, without any intestinal irritation, or derangement of the biliary organs, bitter remedies are most useful. Various substances, possessing the bitter principle, are in common use, such as quassia, gentian, Colombo, &c. &c. The preparation from Peruvian bark, or quinine, has now almost superseded all these, and is the most convenient, power- ful, and pleasant, that can be taken. It may be used in the following manner: sul- phate of quinia, four grains; aromatic sul- phuric acid, thirty drops; tincture of gen- tian, one ounce—mix. A tea-spoonful to be taken thrice a day, in a glass of toast and water. Bitters should in no case be used till the stomach and bowels are sufficiently cleared and corrected by mild laxatives, and until all symptoms of. irritation have been obvi- ated; nor should they ever be used when a full and indiscriminate diet is still persisted in. Dr. Abercrombie recommends the follow- ing powder as a useful tonic and aperient! sulphate of zinc, two grains; aloes, one grain; aromatic powder, five grains: to be taken three times a day. Mineral loaters. Watering places are generally resorted to by invalids. As af- fording a change of scene and air, they may be highly advantageous. The waters, too, so far as they are gently laxative and tonic, are beneficial; but they should never be drunk in the very large quantities they usually are by invalids resorting to them. To the stomach with weak digestive pow- ers, such large potations of fluid are calcu- lated to do more mischief than good. Blisters over the region of the stomach have been repeatedly used with advantage, especially in cases of intestinal irritation, accompanied with tenderness on pressure; and in cases, also, of obstinate vomiting. The external application of heat to the region of the stomach will often allay pains from indigestion, and aid the process of chymification. The application of heat to the feet will be attended with the same be- neficial consequences. Frictions with the flesh brush deserve a distinguished place 348 DISEASES. in the means of cure, and are not sufficiently practised in modern times. "If it were necessary to illustrate the utility of fric- tion," says Dr. Paris, "we have only to ad- duce the well known effects which are produced on horses by the operation of currying, and which can alone depend upon freeing the surface from the recrementi- tious part of the perspirable matter, and promoting a due circulation in the skin. In thus making them sleek, they become more gay, liveiy, and active, and will pre- serve their strength with half the quantity of food, than when it is given to them with- out such assistance." Tepid bathing, and, when it is found to agree with the constitution, sea bathing, will also be found of great service to the dyspeptic. Due attention to clothing will be of the greatest consequence; the effects of changes of atmosphere on the sympathies existing between the skin and bowels, have already been alluded to. The clothing should be so regulated as to preserve an equal temperature, and should neither be too light in summer, nor too warm in win- ter. Dyspeptics should rise early when their powers have been refreshed by sleep, and actively exercise themselves in the open air, till they feel a slight degree of fatigue. The dyspeptic patient should rise from his bed as soon as he wakes in the morning; for, as Mr. Abernethy justly states, ' many persons upon first waking feel alert and disposed to rise, when, upon taking a se- cond sleep, they become lethargic, can scarcely be awakened, and feel oppressed and indisposed to exertion for some time after they have risen.' He should then walk, or rather saunter, for some time in the open air, previously to taking his break- fast, the material of which is to be selected according to the principles already discuss- ed. He is now in a condition to follow his usual avocations; but it is a circumstance of no slight importance to procure an eva- cuation at this period, which is easily ef- fected by habit; a person who accustoms himself to the act at a certain hour of the day, will generally feel an inclination at the appointed season. The invalid should not allow his occupations, if sedentary, to en- gage him for more than three hours, after which, exercise on horseback, or by walk- ing, should be uniformly taken. The state of the weather ought not to be urged as an objection to the prosecution of measures so essential to health. Where the season of the year, and the situation of the patient, will allow the exercise, I strongly urge the advantages to be derived from digging; the stimulus thus given to the abdominal re- gion is highly salutary in dyspeptic affec- tions. The hour of dinner should not be later than three o'clock, and the patient should rest for an hour before he sits down to the meal. It is essential that the invalid should enjoy rest for at least two hours after dinner; that is to say, he should not enter upon any occupation or diversion that may occasion the slightest fatigue; to a gentle walk, or saunter in the garden, there can be no rational objection, espe- cially at that season of the year when such a pastime is the most inviting. At eleven he may retire to rest. The bed room should be well ventilated, and its temperature should, as nearly as possible, be that of the apartment from which the patient retires. A well stuffed mattress is to be preferred to a bed of down, and the curtains should not be so drawn as to exclude the free cir- culation of air. The invalid should be careful in not retiring to rest with cold feet: nothing contributes more readily to disturb- ed sleep, and uneasy dreams, than the un- equal circulation which takes place on such occasions. Dyspeptic Maxims. 1. The first object is to discover the origin and seat of the dis- ease, and the causes which have most likely brought on the complaint. 2. If dyspepsia simply depend upon a loss of tone of the stomach, and a deficiency of the juices necessary for digestion, after the bowels have been properly regulated by mild laxatives, bitters and tonic medi- cines may be given with great advantage; the diet also to be strictly attended to. 3. If there is an irritability of the stomach and bowels, with oppression, uneasiness, flatulence, and a disordered state of the alimentary canal—sometimes costiveness, but more generally an irregular looseness; a rigid abstinence from the usual full diet, and all stimulating liquors, together with the regular administration of laxative medi- cines, are indispensable for a cure. 4. If this state of the stomach and bowels be combined with derangement of the bili- ary organs, small doses of mercurial medi- cines, as calomel or blue pill, are to be joined to the other laxatives, together with due attention in preserving and restoring the proper functions of the skin, by warmth, frictions, &c. 5. If the dyspeptic disease have conti- nued for such a length of time as to pro- duce an inflammatory state of the mem- branes of the stomach and bowels, mild cooling laxatives, bleeding with leeches, and the most strict attention to low diet, are indispensable. 6. Acidity and flatulence may be relieved by small doses of magnesia, carbonate of soda, or carbonate of ammonia, joined with aromatic medicines; but permanent relief depends entirely on the removal of the dis- ease. 7. All violent purging is injurious in this disease. The bowels should be gently DISEASES. 349 opened, and this regularly, by small doses of mild laxatives. 8. The administration of tonics and aro- matic stimulants will always do mischief, when there exists nervous irritability of the alimentary canal, and more particularly so, when there is any inflammation of the internal membranes. Nor should these medicines, in any case, be given until the bowels are regulated by laxatives, and the proper restrictions as to food and drink are at the same time put in practice. 9. The lightest kinds of animal food, and the lean parts lightly cooked, should con- stitute the diet. All vegetables are to be avoided; stale bread and biscuit should be used. 10. In extreme cases, the food should "Consist of gruel, arrow root, or sago. 11. A small quantity of food is to be taken at once, observing proper intervals between meals, that the digestion of one may be completely finished before com- mencing the other. Excess in food is to be particularly avoided. 12. Exercise should be taken between meals, and three or four hours after dinner; care being taken not to engage in fatiguing exercise immediately before or after a meal. 13. Exercise is indispensable for the healthy performance of the different func- tions of the system. Walking is the best exercise, invalids accustoming themselves to it by degrees. Horse exercise is also highly beneficial. Riding in a coach is the lowest species of animal exertion, and is not sufficient to keep up the healthy func- tions. Travelling, change of air, &c. are highly beneficial to dyspeptics. 14. Friction with the flesh brush, parti- cularly over the region of the stomach, is highly beneficial. 15. Tepid bathing may be used with ad- vantage; as also the cold bath, where cir- cumstances will permit. 16. When moral causes have brought on the complaint, these are to be obviated as much as possible; but, during their influ- ence, a strict attention to abstemiousness in diet, to regulation of the bowels, and to ex- ercise in the open air, will tend very much to alleviate the sufferings. 17. The clothing should be warm and comfortable; and great attention is to be paid to keeping the feet dry and warm. WATERBRASH. Waterbrash is a peculiar affection of the stomach, in which the patient brings up frequently a considerable quantity of thin watery liquor. This complaint attacks mostly persons past the middle age, par- ticularly females, and the fit comes on ge- nerally in the morning and forenoon. It usually begins with a severe pain at the pit of the stomach, attended with a sense of constriction, and soon after a quantity of thin watery fluid is thrown up, which is some- times insipid, at other times of an acid or acrid taste. The causes of this complaint are various, but whatever disorders the sto- mach may give rise to it in those so disposed. It appears to be owing to a peculiar state of stomach irritation; and is most certainly re- lieved by the use of the white oxide of bis- muth, from two to three grains made into pills with extract of gentian, three times a day. This medicine will often perfectly cure waterbrash; but attention to the diet and regimen laid down under dyspepsia is of much consequence, and will be absolute- ly necessary in order to render the cure permanent. A diet of plain animal food may be allowed, with which may be united the use of biscuits, home-made bread, and preparations of rice and milk. Daily exer- cise abroad must also be taken, and friction, with the flesh-brush, over the region of the stomach and bowels is of no small service. If the bismuth is not effectual, the follow- ing will often be of great service:—Soap, fifteen grains; blue mass, fifteen grains; ipecacuanha, five grains; extract of bella- donna, three grains; gum myrrh, fifteen grains—divide into fifteen pills, and take one every eight hours. They may be taken alone, or each pill washed down with three table-spoonfulls of infusion of quassia or gentian. JAUNDICE. Jaundice is characterized by yellowness of the eyes and skin, whitish or clay-colour- ed stools, and saffron-coloured urine, which communicates to substances immersed in it a saffron dye. It comes on with languor, inactivity, loss of appetite, bitter taste in the mouth, low- ness of spirits, and costiveness, or looseness. As it advances in its progress, the skin and eyes become tinged of a deep yellow; there is a sense of heat and pricking in the skin; nausea; vomiting; sense of uneasiness or pain in the bowels and towards the right side, and other symptoms of indigestion. The stools are of a clay-colour, or white, or very dark; the pulse is generally slow, yet sometimes, especially where the pain is acute, it becomes quick and hard, and there is a feverish heat and dryness of the skin. The disease, when of long continuance, and proceeding from a chronic affection of the liver, or other neighbouring abdominal organ, is often attended with dropsical swellings, and sometimes with dropsy of the belly. Jaundice is generally described as oftwo kinds, viz. the yellow and the green. In the first, the skin and the white of the eyes are more or less tinged of a yellow colour; 350 DISEASES. in the second, the skin and the white of the eyes are tinged of a green colour, more or less mixed with yellow, but the green colour is very predominant. In some parts of the skin the green colour is very deep, so as to have some blackness in its hue; and this circumstance has given rise to the name of black jaundice, by which this form of the disease has been often distinguished. The green jaundice by no means occurs so frequently as the yellow jaundice. It is most common at the middle and more ad- vanced periods of life, and appears more frequent in men than in women. It is in general more difficult of cure than the yel- low jaundice. The most frequent causes of jaundice are, the presence of biliary calculi (or stones) in the gall-bladder, and bile ducts; spasmodic xonstriction of the ducts themselves; pres- sure upon the ducts, either by collections of hardened excrement, or by tumours of the neighbouring organs, or swelling of the glands; general and severe disorder of the intestines, and other digestive organs. Cos- tiveness and loaded bowels is a frequent cause; and disease of the right kidney, or even of the right lung, may give rise to it. The complaint is often closely connected with irritation of the internal surface of the intestines, and the liver ma}' be but incon- siderably affected. An irregular or sedentary mode of living will produce it as well as intemperance, especially continued indulgence in spiritous liquors. Great mental agitation will cause it in those disposed to it. The immediate cause is the absorption of bile into the vascular system, by which means it is mixed with the blood, and circu- lates with it. The principal objects of treatment are, to allay irritation in the intestinal canal, and to remove the obstruction existing to the free passage of the bile, through the biliary ducts, and along the intestines. It will be frequently found, that the best means of allaying irritation in these parts will be the most effectual in removing the jaundice. In the young and robust, bleeding from the arm will often be demanded, especially in recent cases; in more debilitated subjects, cupping over the stomach and region of the liver is generally an important remedy. The patient ahould also take a warm bath at ninety-six or seven degrees, every other morning about eleven o'clock, with the following pills during the day: Castile soap, a drachm and a half; rhubarb, in powder, eight grains; ipecacuanha, in pow- der, ten grains; oil of juniper, ten drops; syrup of orange peel, a sufficient quantity to make the whole into twenty-four pills. Three to be taken twice or thrice a day. Or when there is a good deal of pain in the bowels, the following may be used instead: compound extract of colocynth, and extract of henbane, of each, a drachni; divide into twenty-four pills; one, two, or three to be taken as above directed. Sometimes rather active purging with calomel, and neutral salts, is very useful, but it must be resorted to with great caution where any positive disease is apparent in the liver, stomach, or other adjacent organ. Gentle purging with the neutral salts is perhaps the most beneficial mode; one or two drachms of both the Epsom and Glau- ber's salt may be dissolved in half a pint of lukewarm water, and taken every morning for a fortnight; and resumed for another fortnight or three weeks after being laid aside for a week. Dr. Baillie states, that he has found the practice of keeping up a gentle action on the bowels, by means of the neutral salts, to be very useful in green jaundice. The infusion of columbo, or compound infusion of gentian, are sometimes beneficial stomachics, for use during the day. Where there is a great deal of torpidity about the biliary ducts, which is unaffected by other remedies, electricity promises to be of much service. A few slight shocks may be passed daily in the course of these ducts. When jaundice originates in positive dis- ease of the liver, or other abdominal organ, it can only be removed by such remedies as are adapted to the cure of the latter. Should obstinate costiveness, and accumu- lated excrement, be the cause, a purgative clyster must be frequently administered, with purgatives by the mouth, warm fo- mentations, and the warm bath. For the relief of acute pain in the pit of the stomach, and bowels, not produced by inflammation of these parts, the most effi- cient remedies are hot fomentations, warm emollient clysters of thin starch and oil, and pills of opium and hemlock. A grain of opium may be united with five or six grains of extract of hemlock, and given every three or four hours, if the pain be owing to spasm, which it commonly is. If inflamma- tion be present, bleeding, of course, must be resorted to. The warm bath, warm fomentations to the abdomen, and gentle aperient medi- cines, are means applicable to every case of jaundice, from whatever cause it may arise. The bitter-sweet (dulcamara), has been praised for its excellent effects in this dis- ease, and it is, without doubt, a powerful medicine in many cases. If the foregoing means fail in affording satisfactory re ief, it may be tried with much propriety in the following manner: infuse a pound and a half of bitter-sweet in a quart of water, over a very slow fire, for seven or eight DISEASES. 351 hours, then, after removing it from the fire, and allowing it to become cold, press the bitter-sweet as dry as possible, and strain it for use. The plant should, if possible, be of the last year's growth, and fresh gather- ed; and it should be cut into pieces of four or five inches long, and every piece beat flat, before it is infused in the water. The dose is a quarter of a pint every morning, fasting. During the use of this medicine, the urine of the patient should be examined daily, and when it ceases to deposit a sedi- ment, the dose of the infusion should be decreased one-third, and in a few days left off. This is said to have been employed, in numerous instances of severe jaundice, with complete success. Dr. Scott, of England, has recommended the nitro-muriatic acid bath as a valuable remedy for jaundice, as well as for all other severe diseases in which the biliary organs are principally concerned. Should the disease assume a scorbutic form, the administration of the vegetable and mineral acids, as advised under scurvy, must make a part of the general treatment. In all cases, daily exercise is useful, and should be used freely, but short of much fatigue. Horse exercise is particularly ad- visable. The diet should be mild, but suf- ficiently nutritious, being regulated by the rules laid down in dyspepsia. Occasionally, infants are attacked with jaundice soon after birth, which will gene- rally yield to a dose of castor oil, or any other active purgative. When a purge is not sufficient to remove it, an emetic of ipecacuanha wine will be advisable and ef- fectual. Many persons who have resided long in a hot climate contract a sallow, yellowish complexion, which hue often pervades the whole skin; this is generally regarded as a mild sort of jaundice, or as arising from the absorption of the bile, but it is usually of a different nature. In most instances, it is not owing to this cause, but to a peculiar alteration in the circulation, on the external surface of the body, in consequence of the skin's sympathizing with a weakened and irritated condition of the digestive organs, more especially of the stomach and bowels. These organs at all times exert a marked and powerful influence on the skin; when they are in health, and performing then- functions with energy, we find the skin soft and smooth; when they are disordered and weakened, it is uniformly harsh, dry, and unpleasant; and as the exhausting ef- fects of sultry climates greatly enervate the digestive canal, in this we see a sufficient reason for the sallow, rough, and unhealthy condition of the skin, so often witnessed in persons lately returned from a tropical re- gion. COEIC This disease is indicated by a pain more or less intense, principally in the region of the navel; without fever, frequently inter- mittent, and which is, in most cases, dimin- ished upon moderate pressure being applied to the abdomen. This pain gives to the patient sometimes the sensation of a strong twisting of the intestines, and sometimes of a violent tension, as though the bowels were threatened with a rupture; sometimes the pain is referred to one spot; at others, it appears gradually to change its situation, and pass along the course of the intestinal tube. To the pain is frequently joined an extreme anxiety; a sense of oppression, and a rumbling of wind in the bowels; occasion- ally a chilliness of the surface, attended with cold sweats; most generally there is nausea, flatulency, and a costive state of the intes- tines. This disease, which is produced by a great variety of exciting causes, consists in an irregular"or spasmodic contraction of one portion of the intestines, while frequently the part above this contraction is morbidly distended. Most generally, the exciting cause is an irritation applied immediately to the lining membrane of the tube: it may pither he induced by excess in eating; by improper articles of diet; by acrid and poisonous substances, eaten by mistake; by retained feces; by a vitiated- condition of the excretions of the bowels; by a morbid accumulation of gaseous matter, produced either by the fermentation of substances introduced into the stomach, or probably secreted by the intestines when in a state of disease; various concretions formed in the bowels; worms; certain metallic poisons, 8ic. will also produce it. Any cause tending to destroy the tone of the stomach or bowels, to increase their ir- ritability and derange their functions, will predispose to an attack of colic. It has been customary for practical wri- ters to divide the colic into several species, according to the different causes which have given rise to it; and as the treatment differs in some respects, according to its cause, we shall follow this plan, confining ourselves, however, to those varieties of most common occurrence. We shall treat it, therefore, under the following divisions: 1. Colic of indigestion; or that produced by articles eaten as food, excess in eating, 2. Flatulent colic; or that induced by flautus distending the bowels. 3. Colic from costiveness; or that from re- tained feces. 4. Painters colic; or that from the poison of lead. 352 DISEASES. 5. Bilious colic. 1. Among the most common symptoms occasioned by an excess in eating, whereby the stomach is loaded beyond what is com- patible with the healthy performance of its functions, is a violent colic, accompa- nied with nausea, headache, and dizzi- ness, preceding the ejection of the con- tents of the stomach by vomiting; an 1 ter- minating subsequently in a griping loose- ness of the bowels. But it is not only by excess of food that this species of colic is produced; it is occasioned also by the quali- ty of the aliment: various high-seasoned and made dishes; certain articles of a highly in- digestible nature; malt liquors; cider and wines of a bad quality; the stones, kernels, husks and enveloping membrane of various fruits, swallowed when the latter have been eaten, &c, frequently give rise to it. We find it, however, in many instances origin- ating after meals, from causes more obscure, and accompanied by various additional symptoms of a much more violent and dis- tressing nature, as though the food itself had proved poisonous, or some poisonous substance had been intermixed with it. Occasionally these additional symptoms con- sist of an intolerable sense of suffocation; a sense of constriction in the throat; the face and eyes are swollen; with excessive thirst; a burning heat over the whole surface; a sense of itching or prickling in the skin, and an eruption, sometimes in the form of minute raised points, at others, in that of larger elevations; the cuticle pealing off on the subsidence of the attack; in addition to which we sometimes have a species of delirium, with twitching of the tendons. At other times the accessary symptoms con- sist of great anxiety; difficulty of breathing; dejection of spirits; spasms of the limbs, as well as of the intestines and abdominal muscles; tenesmus; coldness of the extremi- ties; loss of sight and hearing; convulsions or coma. All the above symptoms occur in some individuals; in others they are va- riously united. The first of these tWo last species of colic arises in general from a peculiar idiosyn- cracy; a peculiar condition of the stomach at the time of eating; or from some peculiar deleterious principle connected with animal foods of a particular description. The articles of animal food which in general give rise to the species of colic under consideration, are various shell-fish; muscles; land crabs; lobsters; conger eels; the yellow-billed sprat; and a variety of other individuals of the fish kind. Animal substances, in the process of cooking; or in the different processes to which they are subjected, with the view of preserving them for future use; or from their being improperly or too long kept, may un- dergo a change, rendering them improper articles of food; and when taken into the stomach, giving rise to that peculiar dis- turbance in the digestive function, consti- tuting the disease of which we are speaking. The second variety mentioned of the colic of indigestion, is produced generally by eating deleterious vegetable substances, either mixed with our food, or eaten in mistake for esculent articles. It may like- wise be produced, as in the former species, by a peculiar idiosyncrasy in the individual; or a certain state of the digestive organs at the time, causing those vegetable substan- ces, which are eaten by other persons with- out any inconvenience, to produce the symptoms previously enumerated. The treatment in all the varieties of this species of colic, is to be commenced with an emetic, to unload the stomach of the offending matter; where the disease has been induced merely by a surfeit, ipecuan- ha will be most proper; in some cases, even warm water will be sufficient; but in the two other varieties, a more prompt and powerful emetic is demanded, and it has here been recommended to prescribe im- mediately a full dose of the sulphate of zinc. The emetic is to be followed by a brisk ca- thartic, which may be aided in its operation by purgative injections. In the second va- riety, the vital powers of the system are in general rapidly, and to a most alarming extent, exhausted; it hence becomes neces- sary, as soon as possible after the evacua- tion of the stomach, to rouse the system, by the administration of the most diffusible stimulants and cordials, such as sulphuric ether; ginger tea; capsicum; and vinegar di- luted with water and sweetened, should be drunk in abundance: according to Orfila, it would appear that strong doses of ether is the cordial best adapted to these cases. These remedies may be aided by stimulant applications to the extremities, and all the other means of rousing the vital powers from their state of exhaustion. In the second va- riety, the treatment differs but little from that already laid down. The great indica- tion is to get rid of the offensive matter as quickly as possible, by active emetics and purgatives; afterwards to rouse the system by external stimulants; and to subdue the irritation and general convulsions by opiates. A mixture of vitriolic ether and laudanum is an excellent internal remedy; and in many cases, much advantage will be derived from the plentiful use of diluted vinegar, sweet- ened with sugar. Of course, the above plan of treatment must be varied according to the symptoms and degree of violence ex- hibited by each case. In some, the simple removal of the contents of the stomach and bowels will be sufficient. 2. Flatulent Colic. In addition to the ge- neral symptoms of colic, in this species we meet with a considerable and unequal dis- DISEASES. 353 tension ofthe abdomen, occurring suddenly. There is a rumbling of wind in the intes- tines, and a frequent expulsion of it both by the mouth and per anum, occasioning some relief to the patient; the pain is also diminished by pressure upon the abdomen, bending the body forward, &c. This va- riety of colic is produced by every thing which occasions derangement in the func- tions of the stomach and intestines, and hence it is frequently complicated with dyspepsia, and a variety of other disorders, attended with, or succeeded by, a loss of tone in those organs. In many cases of the disease, the affection appears to be induced by a morbid production of air by the bow- els themselves, but in general it is depend- ent upon the use of fermentable substances, as articles of diet, particularly from the ve- getable kingdom. The fruits of the season, cabbage, beans and pease, new cider, per- ry, small wines, beer and porter, honey, onions, &c. &c. being introduced into the stomach when that organ is in a state of debility, frequently undergo a rapid fer- mentation, and give rise to an enormous development of gas, producing the symp- toms peculiar to this species of colic. There is also in some individuals an idiosyncrasy In reference to certain of the articles enu- merated, in consequence of which they re- sist the action of the digestive organs in even their ordinary state of health, and produce more or less disturbance every time they are eaten. In this form of the disease, our indica- tions are to relieve the spasm, expel the gaseous matter distending the intestines, and afterwards, by a proper regulation of diet and regimen, and the judicious admi- nistration of tonic remedies, to restore the healthy functions of the stomach and bow- els. Immediately upon an attack of flatu- lent colic, we should administer opiates in combination with some aromatic or diffusi- ble stimulant, and at the same time apply rubefacients or stimulating fomentations ex- ternally to the abdomen. The best internal remedy is probably a combination of the vitriolic ether or Hoffman's anodyne and laudanum, in proportions suited to the age ofthe patient and the violence of the case, exhibited in a draught of aniseed or mint water, or the compound tincture of laven- der; at the same time we may administer injections, composed of some aromatic, combined with laudanum; the one most to be depended on is composed of a couple of drachms of turpentine and a sufficient quan- tity of laudanum rubbed up with a proper portion of some thin mucilage; assafoetida combined with laudanum, has also been recommended both by the mouth and in the form of injection. In many cases, the volatile alkali will give prompt relief. Af- ter the pain has somewhat subsided, it will be proper to administer an active but mild cathartic; the best is probably magnesia, combined with calomel, to which should be added a drop or two of some essential aro- matic oil. After the disease is removed, the treat- ment necessary to restore the tone of the stomach will be the same as that laid down in the article on dyspepsia. 3. Of that variety of colic depending upon a constipated state of the bowels, the indi- cations are to procure a discharge of the impacted feces, and to allay the spasm af- fecting the intestines; which indications are to be effected by the use of purgatives and injections, the warm bath, warm fomenta- tions, and where the spasms are violent and obstinate, the patient young and robust, by bleeding. We are to recollect, in every obstinate case of colic, that we do not pos- sess a more prompt and powerful means of subduing spasmodic action and pain, than the lancet, employed with judgment. It may also be observed, that it is not uncom- mon for a violent attack of colic to termi- nate in inflammation of the intestines, which may in every instance be prevented by a prudent abstraction of blood. The warm bath affords us also, in many cases, a powerful auxiliary to our other remedies, when properly managed. Colic is a very common complaint in in- fants and young children; it arises in them in general from the following causes: from the retention of meconium; wind confined in the intestines; some defect in the milk of the nurse; improprieties of diet; worms, costiveness, &.c. In them, colic is to be treated on precisely the same general prin- ciples as have been already laid down in reference to the disease when it occurs in adults; the remedies being adapted, how- ever, in their kind and their doses to the difference of their age and other circum- stances. 4. Painter's Colic. This is the name gene- rally given to that variety of the disease produced by lead introduced under certain ^circumstances into the system, and there acting as a poison. The attack of this disease is usually pre- ceded for some time by a costive state of the bowels, foul tongue, bitter taste in the mouth, sense of weight in the abdomen, and flatulence. The pain is at first dull and remittent, but progressively grows more violent and continued. The pain is generally, during the whole course of the disease, seated at the pit ofthe stomach; as, however, it increases in violence, it extends from thence to the arm, navel, back, loins, rectum and bladder. From the navel it sometimes shoots with so much violence to each side, that the patient declares he feels as though he were about being cut in two. Nearly all the external muscles are 354 DISEASES. rendered sore to the touch by the violence of the pain, as though they had been af- fected with rheumatism; sometimes this soreness is so great as to render the patient incapable of bearing the weight of the bed clothes or the slightest touch; occasionally, the violence ofthe pain alternates between the stomach and the external muscles; the pain being greatest in the stomach, while the external muscles are comparatively at ease, or being diminished in violence in the stomach and bowels, it rages through the external muscles. Nausea and vomiting are early symptoms, and as the pain in the sto- mach augments, the sickness likewise in- creases; even on the second day from the attack, the retchings are violent, and the matter discharged consists mostly of acrid slime and vitiated bile; ordinarily this dis- charge produces a momentary relief to the patient, but, as long as the pain continues, the same morbid matter is secreted and poured into the stomach, and the retchings return with increased violence, or their place is supplied with bitter eructations and hiccup. The abdomen is equally tense, and it is ordinarily retracted; a te- nesmus, more or less painful and urgent, attends the disease, producing frequently a discharge of bloody mucus; the costiveness is generally very obstinate, and when feces are brought away, they are small in quan- tity, and composed of hard rounded lumps, like the excrement of sheep or goats. When the stools are more frequent and greater in quantity, the patient experiences from the discharge very considerable relief. The pulse, notwithstanding the severity of the sufferings, is but little affected in the com- mencement, or until after some days; on the fourth or fifth, however, it becomes quicker, and, according to Pariset, of an extraordinary hardness, which does not give wav to bleeding or other remedies; nor is it diminished in those limbs which have be- come paralyzed by the disease. Towards the close of the malady, there is generally a pain round the edges of the feet and the extremities of the toes, which are often red and swollen, and apparently gouty. In a mild degree, and under the most appropri- ate plan of treatment, the disease will sel- dom be removed under several days; but if violent, neglected or improperly ma- naged, it will continue for weeks or even months, with short intervals of ease, and terminate finally in a peculiar species of palsy, especially of the extremities, or in death, preceded by deafness, blindness, delirium or epileptic fits. Excepting where the malady has been of considerable obstinacy, and has continued for some length of time, the paralysis is scarcely ever complete; the power of the muscles being only weakened; their sense of feeling remains, and they are occasionally affected with pains. When the paralyse persists for any length of time, the muscles ofthe limbs affected waste away, and never regain their former bulk. Almost always this paralysis is confined to the superior limbs; it may be confined, it is said, to one arm, to a single hand, or even to one ofthe fingers. The train of symptoms we have now de- scribed, is produced by lead in some form introduced into the system. Thus the dis- ease is most frequent among the labourers employed in lead mines and smelting fur- naces; it attacks, particularly, painters who make use of colours formed from prepara- tions of that metal: those who prepare these colours; those employed in the manufac- ture ofthe different salts or oxides of lead; plumbers; potters; glaziers; polishers of glass; type founders; printers, &c. It has been said, also, to be produced by sleeping in rooms newly painted with white lead; by eating pickles, apple butter, and other acid substances preserved in earthen ves- sels glazed with vitrified oxide of lead, and by drinking wines and cider, the sourness of which has been destroyed by the use of some preparation of this metal. Where the patient is young, of a robust habit, and the symptoms of the case vio- lent and obstinate, the use of the lancet is indicated, and the practitioner should take away a quantity of blood proportionate to the exigency of the case and the effects which are produced by it during the opera- tion, which is in fact the only rule by which we can ever judge as to the extent to which bleeding should be carried in this disease. Immediately after the first bleed- ing, the warm bath is an admirable remedy and should never be neglected. The internal agent upon which most de- pendence is to be placed in painter's colic, is a combination of opium and calomel. This prescription, when given in sufficient doses, will seldom fail in relieving the vio- lence of the pain, and in producing a free and copious evacuation from the bowels. In violent cases, two grains of opium and from fifteen to twenty of calomel should be given twice or thrice in the course of the day. At the same time, the action of the calomel upon the bowels should be solicited by repealed doses of castor oil and frequent emollient injections. In chronic cases of the disease, attended with palsy of the arms or hands, and shooting pains through the abdomen and limbs, administering the ca- lomel so as to produce a slight soreness of the mouth, will often cause the removal of these symptoms. After copious depletion and the use of the warm bath, blisters will occasionally be found a useful remedy. Applied to the sto- mach, they will relieve the distressing nau- sea with which the disease is often attended. DISEASES. 355 Other remedies have been recommended by different writers, but the foregoing is confessedly the one from which the greatest amount of good will be obtained. By some of the German physicians, alum is extolled as almost a specific in this species of colic, and Dr. Percival of England, who gave it in the dose of fifteen grains every tour or six hours, declares that the third dose sel- dom failed to mitigate the pain, frequently entirely to remove it. A combination of alum and sulphate of zinc is also highly spoken of by Mosely. The nitrate of silver is another remedy recommended in the treatment of painter's colic, particularly in its advanced stages, when palsy ofthe arms or hands is present. After the disease is subdued, the bowels are to be kept in a regular state by mild laxatives; the diet of the patient is tobeunirritatingand moderate in quantity; regular exercise should be taken daily in the open air, and sudden changes of temperature carefully guarded against. The occasional use of the warm bath and frictions of the surface, morning and even- ing, will aid greatly in restoring tone to the bowels. 5. Bilious Colic. This is a disease of fre- quent occurrence during our summer and autumnal months, particularly in the south- ern and middle states. It is a febrile affec- tion, appearing at the same time, and under similar circumstances as bilious fever, dy- sentery, cholera morbus, t^c. It is pre- ceded by a chilliness and all the other symptoms peculiar to the commencement of fever. The disease is marked by a vio- lent and intolerable pain of the bowels, which in some cases seem to be, as it were, tied together, and in others closely pursed . up, and with a sensation as though they were bored through with a sharp pointed instrument; the pain occasionally abates, but quickly returns. In the beginning, the pain is not fixed to one particular spot, as it is in the progress of the disorder, while vomiting also is less frequent, and the bow- els more easily yield to the action of purga- tives; but, as the pain increases, it becomes obstinately fixed to one place; frequent vo- miting succeeds; the bowels are more cos- tive, until at length the symptoms rapidly increasing in violence, unless the patient be relieved by the interference of the phy- sician, a total inversion of the peristaltic action of the bowels occasionally takes place. Every thing administered by the mouth, or injected into the rectum, is then thrown up violently by vomiting; the mat- ters discharged from the stomach are vari- ous in appearance; sometimes of a green, yellow or dark colour; even feces have been known to be ejected by the mouth in the advanced stage of violent cases. In this disease there is violent irritation of the bowels, in consequence of which they 2V are thrown into a state of spasmodic contrac- tion, by the vitiated secretions poured into them from the liver and surrounding glands. The disease terminates, if left to itself, either in ileus, or the violence of the irritation in- duces inflammation, sphacelus and death. Notwithstanding the formidable nature of bilious colic, if the practitioner be called in sufficiently early, and attack it boldly and perseveringly by appropriate remedies, he will seldom fail in relieving it, and re- storing his patient to a state of health. To attain this desirable end, however, his remedies must be of the most active kind, and administered in doses commensurate with the violence and rapidity ofthe symp- toms. In every case where the symptoms are of any considerable violence, particularly if the patient be of a robust habit, and the pulse tense and accelerated, it will be pro- per to commence the treatment of bilious colic by drawing off blood from the arm. No direction can be given in relation to the proper quantity of blood necessary to be taken away; this must be left to the judg- ment of the practitioner, who will adapt it to the violence of the symptoms and the effects produced upon them during the flow ofthe blood. Immediately after the bleeding, a dose of calomel and opium in combination, should be administered by the mouth, and the pa- tient immersed in a warm bath; or if this be not practicable, warm fomentations should be applied over the whole of his abdomen, and continued for some length of time. When by the first bleeding the violence of the pain is not considerably abated, leeches or cups should be applied over the abdo- men, and repeated, if necessary. The dose of calomel and opium is to be graduated according to the violence of the case, always recollecting that large doses will in general be required, and that to carry the first dose to a sufficient ex- tent, is preferable to repeated exhibitions of the medicine. The quantity given should be seldom less than ten grains of the calomel to one or two of the opium. In many cases, however, the violence of the disease will require these quantities to be doubled. If, after a reasonable interval, a manifest mitigation in the symptoms be not produced, the calomel and opium should be repeated. This prescription will relax the spasm ofthe bowels, determine to the cutaneous exhalants, and at the same time excite the healthy action of the liver, and unload the bowels of the diseased se- cretions by which the irritation is kept up. The action of the calomel may be augmented by injections of a laxative na- ture thrown into the rectum and fre- quently repeated; or, where the stomach will receive and retain it, we may follow 356 DISEASES. the calomel by a solution of sulphate of magnesia, or castor oil, in repeated doses. If the stomach be very irritable, and fre- quent vomiting be present, this will in general be relieved by the calomel and opium; we may at the same time, however, exhibit the effervescing mixture, and a large blister should be applied over the stomach. In every case where the symp- toms are violent and obstinate, the applica- tion of a blister, a ter the employment of warm fomentations has been continued for some length of time, will be of advantage, and should not be neglected. After the vio- lence of the disease has been removed, we should next direct our attention to restore to the liver and alimentary canal their healthy action. This is to be done by a continuance of the calomel, particularly in divided doses, combined with opium and ipecacuanha; by the occasional use of the warm bath, and by a proper regulation of diet and regimen. The calomel in the above manner should be continued until the discharges from the bowels are perfectly natural, every appear- ance of febrile symptoms removed, and the skin has resumed its natural moisture and softness. The diet of the patient should be light, nourishing, easy of digestion, and taken in small quantities at a time. He should par- ticularly avoid all fatty, coarse and irritating articles of food, and all stimulating liquors; he should make use of moderate exercise, but above all, riding on horseback. As bilious colic is a disease which is easily reproduced by any impropriety of diet or regimen, or by exposure to cold or damp, all these exciting causes of the disease should be carefully guarded against by the patient for. some considerable time. He should be particularly guarded against over heating himself, either by exposure to the sun or over exertion, and particularly when such has been the case, should he be cau- tious not to expose himself to cold, either by throwing off any portion of his usual cloth- ing, sitting in a draught of air, going out into the night air, or drinking cold fluids. His bowels should be kept moderately open either by the use of the ripe fruits of the season or some gentle laxative, and hi every case, where it can be accomplished, the patient should be recommended to remove, at least for a season, to a healthy country situation. DIARRHEA. Though a disease of frequent occurrence, and very generally recognized without much difficulty by the medical practitioner, a proper definition of diarrhoea is by no means easily given. Cullen defines it to be a disease consisting in evacuations by stool, mor,e frequent and of a more liquid matter than usual. But it is very evident, that this definition is applicable not only to diarrhoea, but to every disease of the bow- els attended with more frequent or less consistent discharges than take place during a state of health. It has likewise been de- fined an increased fecal discharge, without fever, griping or tenesmus. But as all of these symptoms do occasionally occur in diarrhoea, and the latter especially, often to a considerable extent, this definition is, of course, equally defective. The stools in diarrhoea, however, being more or less fe- culent, being generally passed more fre- quently than in health, the disease being most commonly unattended with any con- siderable degree of fever, and when griping and tenesmus are present, their less degree of intensity will commonly enable us to distinguish diarrhoea from dysentery, the only disease with which it is liable to be confounded. The discharges from the bow- els in diarrhoea are very various in appear- ance and frequency, being sometimes mere- ly natural feces of a watery consistency; at others, a frothy fluid, apparently in a state of fermentation, and of a sour smell; again, they may be thin, and either of a bright yellow, of a dark or bright green, or more or less of a brown colour; frequently they are mixed with a considerable portion of mucus, and occasionally are slightly streak- ed with blood. They may take place but four or five times in the course of the day, or may be almost constant, an evacuation occurring every few minutes. When the discharges are considerable, they soon re- duce the strength of the system; the pa- tient becomes emaciated; digestion is im- paired or destroyed; the face and skin be- come pale, and finally of a dirty yellow; the surface is dry and rigid; the extremities be- come swollen. The discharges from the bowels, in protracted cases, generally con- sist of a dark watery fluid, of a very offen- sive odour; a slow fever ensues, and the patient finally expires in a state of extreme exhaustion. The cause of diarrhoea is an increased peristaltic action throughout the whole or a greater part of the intestinal canal. This increased action may be induced either by an irritation immediately applied to the mucous coat of the intestines, or by the irritability of this part being increased'from an undue determination of blood to it, in consequence of irritating substances taken into the stomach; indigestible or too much food, or the action of cold upon the exter- nal surface ofthe body. According to the exciting causes of diarr- hoea and the appearance of the discharges, it has been divided into three distinct spe- cies. The finit, in which the discharges DISEASES. 357 are the ordinary feces, but morbidly thin and copious, is produced by eating an im- moderate quantity of food, or such as is improper in quality, and which either passes into the intestines imperfectly digested, or undergoes fermentation, and thus becomes a source of irritation. This species of diarrhoea is in general at- tended with some degree of nausea, eructa- tions, flatulency, and a degree of griping m the bowels; the discharges, as we have said, are generally natural feces, immode- rate in quantity and morbidly fluid; they are occasionally mixed with undigested por- tions of food; are sometimes frothy, and frequently of a sour smell. This species of diarrhoea, in general, after continuing for a short period, if its exciting cause be not repeated, works its own cure, by removing out of the body the irritating substances by which it has been produced; but, as there is generally some degree of irritation pro- duced in the mucous membrane of the sto- mach and intestines, which is very apt to be increased and rendered more permanent by the continuance ofthe disease sufficient- ly long for nature to effect a cure, it is much better in every instance to cut it short by the administration of appropriate remedies, and a strict attention to regimen. An emetic should be first exhibited, with the view of unloading the stomach of its morbid contents. A dose of ipecacuanha is in general to be preferred. The emetic should be followed by some mild aperient, such as magnesia and rhubarb, or calomel and rhubarb. The bowels being by these means well cleansed, the cretatious mix- ture, or lime water and milk, and an opiate at bed time will, in almost every case, ef- fect a cure. The same rules in regard to diet will be proper here as in dyspepsia. During the continuance of the diarrhoea, some advantage will be derived from the use of rice water, and if the bowels continue in a weakened condition subsequent to the treatment already laid down, an excellent prescription will be found in the cretatious mixture, with the addition of a proper pro- portion ofthe tincture of kino. The second species of diarrhoea, is that in which the feces are thin, copious, and of a bright yellow, green or brown- ish hue. It is produced by an increased secretion of bile, more or less vitiated. The common cause of this species of diar- rhoea, is a high degree of atmospherical temperature; and hence, it is a common complaint in the commencement of our summer months; and among Europeans, upon their first arrival in tropical climates. The intimate sympathy existing between the skin and hepatic system is such, that the surface of the body can not, for any length of time, be subjected to the stimulus of a high degree of atmospheric heat, with- out the liver being likewise thrown into increased action; and in consequence, pour- ing into the intestines an increased amount of bile, differing more or less from its natural condition, according to the degree and con- tinuance of the cause, and other circum- stances. There can be no doubt, that in its healthy condition, and ordinary quality, bile is a necessary stimulus to the intestines, exciting the latter to the due performance of their functions; but when secreted in excess, or changed in quality, it becomes a morbid stimulus, and an inordinate action of the intestines is the consequence, produ- cing the disease under consideration. If this species of diarrhoea be simple and moderate in extent, and not of long contin- uance, nor connected with extensive irrita- tion ofthe liver and alimentary canal, it is a disease of but little moment or danger; but under a contrary state of things, it is apt to degenerate into cholera, bilious colic, fever, or dysentery. Besides the peculiar appearance of the feces already remarked, bilious diarrhoea is attended with some degree of nausea, griping, and tenesmus; often with consider- able heat ofthe skin. Its cure is to be effected by a purgative of calomel, followed by a combination of rhubarb and magnesia, or castor oil; with the view of carrying off, by its operation, the increased quantity of bile from the in- testines. Advantage will be derived from the plentiful use, at the same time, of mild diluents, such as toast-water, rice-water, flax tea, &c. Mild fluids, gently acidulated with the vegetable acids, as well as sub-acid fruits,. have been highly recommended, in this species of diarrhoea. Where the disease is very considerable, and the appearance of the discharges much changed from their natural condition, the best treatment will be the administration of small doses of calo- mel, opium and ipecacuanha; as calomel five grains, opium three grains, ipecacuanha eight grains; to be divided into eight powders, and one given every three hours. After the bilia- ry secretion has, by these means, been cor- rected, an opiate andlight astringents will ba proper. During the disease, the diet ofthe patient must be light and unirritating, and his clothing adapted to the temperature of the season; above all, must he avoid expo- sure to the heat of the sun, over exertion, fatigue, &c. In the third species of diarrhoea, the dis- charges are nearly watery; and composed, in a great measure, of a fluid secreted from the mucous follicles and vessels of the in- testines; which latter are, in general, in a state of very considerable irritation, amount- ing, in some cases, to a low state of inflamr mation. This form of diarrhoea, in general, takes 358 DISKASES. place when a degree of cold and moisture of the atmosphere suddenly succeeds to heat; or when the body, in a state of in- creased perspiration, is exposed to damp or cold, cither partially or generally. It has likewise been observed to affect the crews of vessels, who in a short space of time pass from a dry and warm to a cold and moist cli- mate; thus we are informed by Mr. Macart- ney Ro-s, that in the outward bound pas- sage of the vessels engaged in the whale fishery, it is a frequent occurrence for the seamen to be affected, soon after their arri- val in the northern seas, with the species of diarrhoea we are now considering'. These vessels generally leave England during the month of March, when the weather is com- paratively temperate, and in a week or two afterwards arrive within the arctic cir- cle; after they have remained, however, for some time exposed to the latter climate, the cases of diarrhoea, which arc numerous on their first arrival, daily decrease; and the few new cases which occasionally occur, are invariably produced, according to this writer, by those affected being, in the course of duty, suddenly called from their beds, and exposed to an intensely freezing atmos- phere. In mucous diarrhoea, the discharges, as we have observed, are most generally composed of a thin mucous fluid, occasionally slightly streaked with blood; there is often consid- erable griping, and not unfrequently slight febrile symptoms, a dry skin, furred tongue, and some degree of thirst. The cure is to be commenced by an emetic, which not merely empties the sto- mach from any substance it may accident- ally contain, the passage of which into the intestines might become a cause of irritation, but by its action upon the skin, it tends to restore its healthy functions, and deter- mines the circulation from the bowels to the external parts ofthe body, and thus dimin- ishes the increased excitement ofthe vessels ofthe former. Subsequent to the emetic, immersion in the warm bath, or bathing the feet in warm water, followed by frictions to the surface, is a remedy in the highest de- gree beneficial. A dose of oil should in general be early administered, and after its operation, small doses of ipecacuanha, opi- um and calomel, in the following prescrip- tion, should be directed every two or three hours: ipecacuanha, ten grains; opium, three grains; calomel, three grains, divided into ten powders, one of which is a dose; the good effects of which will be aided by the patient remaining in bed, taking plenti- fully of some tepid mucilaginous, or mild diluent drink; and by the occasional use of warm pediluvia; or, where it can be appro- priately administered, the warm bath. Of the good effects in this disease, ofthe ipe- cacuanha, either alone or combined with opium, we have the testimony of many of the most respectable physicians. In ordinaiy cases, these measures very generally succeed, in a short period, in put- ting an end to the disease. In other instan- ces, however, the disease continues some- times for a length of time, attended with frequent watery discharges, considerable gripings, exhaustion ofthe patient's strength and general emaciation. In these cases, opiates by the mouth, or by injections into the rectum, the warm bath, and a blister to the abdomen, will frequently remove the complaint; but where they fail, we must resort to astringents; one ofthe most effec- tual, is a grain of the acetate of lead, com- bined with half a grain of opium, eveiy three hours; followed, after a few doses have been taken, by castor oil, or magnesia and rhubarb. Another article, which in many cases has been found highly beneficial, is a strong decoction made from the saw dust of mahogany, or from logwood, or dewberry root; the kino, and other astrin- gents, may also be resorted to, as occasion may require. In the stage of the disease of which we are now speaking, the diarrhoea appears to be kept up by a chronic irritation of the mucous membrane of the bowels. In this form of the disease, flannel next the skin, and a mild abstemious diet of rice and milk, thick- ened milk, and the like, are essential to the cure. Besides the causes already enumerated, diarrhoea may be produced by fear, grief, anxiety, and other depressing affections of the mind; and upon the removal of these causes, it will generally cease; if not, the administration of an opiate, and some slight astringent, will be proper. Diarrhoea frequently, also, results from the sudden repulsion of various cutaneous eruptions. In these cases, such a treatment as will reproduce the original affection of the skin, is demanded: the remedie's gene- rally successful, are an emetic; the warm bath; blisters, or mustard poultices, to the seat of the external disease, &.c. . We have, heretofore, considered diarrhoea in its simplest form, and submitted at an early period to curative measures: it unfor- tunately happens, however, that from the repeated application of its causes; from a debilitated or broken down condition ofthe constitution; or, very frequently, from mis- management in its first stages, diarrhoea assumes a chronic form, constituting then a disease obstinate, frequently fatal, and al- ways difficult to treat. The discharges be- come extremely fluid and frequent, dark coloured, and of a more or less fetid odour; the appetite ofthe patient is destroyed; his strength greatly diminished, and his body extremely emaciated; the skin is rough, dry, and of a dirty yellow hue; the tongue is DISEASES. 359 dry, frequently parched, and always of a brown or dark mahogany colour; so irrita- ble is the whole tract ofthe intestines, that whatever drink or food the patient takes, immediately throws them into action, and not unfrequently passes through them in the same state in which it was taken in the stomach. In some cases, this species of diarrhoea is attended with much straining, or tenesmus. Dissections have discovered, after death from chronic diarrhoea, various diseased conditions ofthe mucous coat ofthe intes- tines, thickening, ulceration, &c. The treatment proper in chronic diarrhoea, is by no means easily laid down. That which has most generally succeeded, has been, 1. The administration of small doses of calomel, at regular intervals, combined with opium and ipecacuanha, in equally minute portions. This prescription, while it tends to keep up a beneficial action on the sur- face, would appear, also, to diminish the morbid irritability of the intestines, and at the same time, correct the vitiated condi- tion of the secretions poured into their cavity. 2. The frequent use ofthe warm bath; warm fomentations to the abdomen, and a flannel roller applied moderately tight over the latter; all of which would appear to act in removing the diseased state of the bowels, by their tendency to keep up a constant healthy action upon the surface. 3. The application of blisters to the ab- domen. 4. A proper regulation of diet; which should consist of articles light, easily digest- ed, and of a soft consistency; such as various preparations of the farinacea with milk, such as rice, flour and milk, thickened milk, &c. The patient should be kept in bed; and an occasional opiate, either by the mouth, or by injection, will be frequently service- able in allaying the griping, &c. In regard to astringents, their use re- quires much judgment; and the greatest caution is demanded, not to check, by their administration, too quickly, the discharges; as dropsy, or even more fatal consequences, have been known to result. Any of the articles of this class may be employed, when their administration has been thought expe- dient. Much advantage will be derived from the acetate of lead, opium and ipecacu- anha combined, with the occasional interpo- sition of a dose of castor oil. By the sur- geons of the United States army, on the frontiers, during the last war, an injection ofthe infusion of galls, with laudanum, was found to succeed. Diarrhoea of Infants. The number of evacuations daily passed by infants without prejudice to their health, is more than those passed by adults; and when they amount to four or five, it is not to be regarded as pre- judicial, unless the health be impaired, or some symptom appear of the child not thriving. When looseness happens in in- fants, the appearance of the stools is very various. 1. They are light green, and have a sour smell. Such stools are accom- panied with fretfulness and griping, but are readily cured by a purge of rhubarb and magnesia, or of magnesia, four grains; rhubarb, three grains, and ipecacuanha, a quarter of a grain. The diet of the child should be rice water, arrow root, or milk boiled and thickened with rice flour, and the diet and the bowels ofthe nurse should also be regulated. Immersing the child in a warm bath is often beneficial. 2. Some- times the stools are slimy, either from ex- posure to cold or irritation of the bowels, and they are also streaked with blood. If there be great pain or fever, we have rea- son to fear that one part of the gut has been taken within another. The warm bath, leeches and fomentations to the belly, and a dose of castor oil are the proper remedies. The diet should be the same as above. 3. The stools may be very liquid and of a dark colour, occasioning what are called watery gripes. This form of looseness very speedily brings down the infant's strength, and must be carefully attended to. It is an attendant on teething, and arises also from bad milk, improper food, impure air, exposure to cold, or some mismanagement of the child. The treatment differs in no- thing from that directed in the last variety. Very minute doses of calomel, as one-sixth of a grain, combined with a grain or two of magnesia and prepared chalk, and a quar- ter of a grain of ipecacuanha, repeated every three hours, will often produce very speedy relief; and the irritation of the bowels is to be allayed by giving a clyster of starch with a little laudanum, for three or four successive nights. The state of the teeth is to be attended to, and warm cloth- ing should be worn by the child. 4. Some- times large quantities of clay-coloured stools are passed, not liquid, but rather consistent; by these the strength is greatly reduced in a very short time. Rhubarb and magnesia, with a grain or two of calomel, followed by purgatives of senna, opiate frictions, and attention to the diet, are the means to be tried; but the disease in question is fre- quently fatal in spite of them all. 5. The stools are sometimes of a dark green colour, and resemble chopped spinnage. Such stools are passed in the course of croup and other acute diseases; they are also occa- sioned by frequent doses of calomel. The treatment is the same as in the third variety. 6. At times, the stools consist principally of the food in an unchanged state. This must obviously be a very weakening and dan- 360 DISEASES. gerous affection. If it occurs after other illnesses, it indicates that the powers of life are nearly exhausted; but if it arises from teething, or other temporary irritation, it will cease upon the removal of the cause producing it. Rhubarb in small doses, al- terative powders of calomel and rhubarb, and a proper change of the diet, are to be had recourse to. The various kinds of looseness may pass into one another, and the particular causes of the complaint may be difficult to distinguish. Whatever be the original form of looseness, when it is continued any length of time, certain symp- toms are induced which indicate great dan- ger. Either very great emaciation is pro- duced, or the brain becomes affected; and the child dies from dropsy in the head. DYSENTERY. Dysentery is an inflammatory affection of the lining membrane of the larger bowels, in which the stools are frequent, and often bloodv, attended with griping and tenes- mus, the ordinary excrement being seldom discharged, and when it is, the quantitv is small, and voided in the form of hard lumps. Fever very generally attends the acute form ofthe disease. The disease sometimes comes on with shiveiing, succeeded by heat and thirst, and other symptoms of fever; at others, the affection of the intestines is the first symp- tom. There exists unusual flatulence in the bowels; severe griping; frequent in- clination to go to stool; tenesmus; loss of appetite; nausea; vomiting; frequency of pulse; and a frequent discharge of a small quantity of a peculiarly fetid matter by stool. This matter varies in appearance, being sometimes pure mucus, or mucus mixed with blood; pure unmixed blood; pus or a putrid sanies; containing often films of a membranous appearance, or small fatty masses, floating in a large quan- tity of liquid matter. Hardened excrement is likewise sometimes passed. There follow great emaciation and debility, quick and weak pulse, sense of burning heat, and in- tolerable bearing down ofthe bowels. This complaint appears under an acute, and a chronic form. In the acute form, the symptoms are urgent and clearly inflamma- tory, the natural feces very rarely appear- ing, the pain and tormina great, and blood often passing in large quantities. It termi- nates, for the most part, within a month. The chronic species is generally a conse- quence of the acute, and is, as its name imports, of a less inflammatory and more protracted character than the latter: here the stools are often frequent, loose, and have much the appearance of the natural excrement, but mixed with blood and mu- cus, and passed with severe tenesmus or bearing down at the anus. Persons who have never before been at- tacked with dysentery, or only after a long interval of health, more especially if of a strong, or temperate habit, are most like- ly to have it in the acute form, at the com- mencement at least: while those who have repeatedly suffered from it, or whose con- stitutions have been broken down by ex- cessive fatigue, intemperance, or other causes, will often be attacked by the chro- nic species, even from the beginning. The dissection of those who die of dysen- tery, invariably discloses,an inflamed and ulcerated state ofthe internal membrane of the lower intestines, and especially of the colon, thus proving that the essence of the disease consists in an inflammation of those parts. The liver is sometimes found dis- eased, but this is probably only a secondaiy affection, found chiefly, or exclusively, in those who had a previous disposition to liver complaint. The principal causes are, suppressed perspiration; a damp atmosphere succeed- ing to a high temperature; and exposure to noxious exhalations and vapours. The dis- ease is occasionally epidemic. It is most common in summer and au- tumn, and in weak, ill fed, or intemperate habits. The indications of treatment in acute dy- sentery, are to subdue the local inflamma- tion, to allay irritation, and to restore a healthy secretion from the skin; and these objects are most certainly secured by blood- letting, calomel, and anodynes, especially opium with ipecacuanha. Almost the whole of these remedies are called for, in proper succession, and according to the symptoms that present themselves, in all very severe cases, especially in hot climates. If the pain and tenderness of the belly are considerable, and the pulse full and hard, sixteen or twenty ounces of blood should be drawn from the arm directly, and it ought to be quickly repeated if these symptoms, denoting inflammation, continue but little abated by the first bleeding. The extent to which blood-letting may be car- ried in this disease, must depend in a great measure on the strength and age ofthe pa- tient, the intensity of the pain, and hard- ness of the pulse, and the quantity of blood passed. Whenever these circumstances are combined, it ought to be freely employed, until the symptoms are mitigated. In the majority of cases, the application of leeches to the lower part of the belly w ill be very useful, whether general blood-letting be resorted to or not. In many instances, a large blister may be laid over the abdomen with much advantage, after the symptoms of the disease have been reduced by bleeding. DISEASES. 361 If severe bilious symptoms are present, a dose of calomel and rhubarb, ten grains of each, may be advantageously employed after bleeding, and followed in the course of a few hours by a dose of castor oil. A combination of calomel or blue mass and ipecacuanha will often be found of in- estimable service in this complaint. A grain of calomel, or three of the blue mass, a grain of ipecacuanha powder, with a third of a grain of powdered opium, may be made into a pill, and given three times a day; or, a grain of calomel and four grains of Dover's powder, made into a pill in the same manner, may be administered thrice daily; the other measures above prescribed being previously employed. These com- bina ions of calomel with an anodyne are sometimes ofthe greatest advantage. In the commencement of acute attacks of dysentery, more especially if the inflamma- tory symptoms run very hfgh, opium should not be given, either in a liquid or solid state. In such a condition, our chief regard must be directed to lessen the existing in- flammation by blood-letting, leeches, the warm bath, and emollient clysters. As an anodyne in this complaint, there appears none so suitable and efficacious for general use, as Dover's powder, that is, the com- pound ipecacuanha powder. If, therefore, it is not exhibi.ed through the day, as one of the principal remedies, a dose of eight or ten grains may be given, in the form of pills, every night. In regard to diet, it should be mucilagi- nous and diluting, consist chiefly of barley, rice or gum water during the inflammatory stage ofthe disease; and these only in very small quantities. Subsequently, prepara- tions of sago, rice, arrow root, milk and the like may be allowed, and to them the pa- tient should be confined for some time after recovery. • When the patient begins to recover, his appetite sometimes outstrips his digestion, and care must, consequently, be exercised, not to exceed a very moderate quantity of food, even where the appetite is keen; for if too much be indulged in, the intestines will suffer increased irritation, and a se- vere relapse invariably follows. The horizontal posture and perfect rest, must be constantly observed, and the great- er the irritation the more requisite they are. The patient ought not to give way to the frequent inclination to stool, but stifle it as much as possible. The stools must be immediately removed from the patient's chamber, which should be freely ventilated at all times, and kept perfectly clean. For the constant griping and tenesmus which attends this disease, the best remedy is frequent injections of thin starch, com- bined with olive oil, and after the violence of the disease has been reduced, thirty to forty drops of laudanum may be added. During convalescence, flannel should be constantly worn next the skin, and the most scrupulous attention be paid to avoid dews, damp night air, and sudden atmospherical vicissitudes, more especially in hot or un- healthy climates. If pain and irritation are still occasionally felt, four or five grains of the compound ipecacuanha powder may be taken at bed time. In chronic dysentery, (that is, the pro- tracted species of the disease, in which the acute inflammatory symptoms have subsi- ded, or been subdued,) our objects are nearly the same as in the acute variety, only we are called upon constantly to remember, that debility is invariably associated with this form ofthe complaint, and therefore every proper means of preserving and increasing the general strength must be employed. Of all the remedies yet discovered for chronic flux, calomel or the blue mass, with ipecacuanha and opium in combination, the frequent use of the warm bath and frictions of the skin, are, undoubtedly, the safest and the best. Many patients, tormented for a long time by this painful malady, have been speedily relieved, and ultimately complete- ly cured, by this invaluable medicine. It is equally adapted to the protracted dysen- tery so often met with in hot climates, and to that of colder regions. The diet in chronic dysentery must, of course, be mild, unirritating, and chiefly farinaceous. A very excellent diet here, is flour and milk, well boiled together, which, with a very little sugar and nutmeg, is highly relished by the debilitated patient. The patient must constantly wear a flan- nel bandage round the bowels, and keep the feet and legs warm by wearing woollen stockings and drawers. Injections of flaxseed, or thin starch, olive oil and laudanum, are highly benefi- cial when a constant tenesmus attends the complaint. CHOLERA MORBUS. The prominent symptoms of cholera mor- bus are, inordinate and continued discharges from the stomach and bowels, sometimes tinged, to a greater or less extent, with bile; spasmodic pains of the bowels and limbs, and often, in the early state of the disease, heat of the surface and accelerated pulse. Cholera is most prevalent in hot climates and unhealthy situations; in the more tem- perate climates, it makes its appearance only during those months when the atmos- pheric temperature is the highest. In those districts where bilious fever is a 362 DISEASES. prevalent disease, the cholera likewise oc- curs most frequently, and its symptoms are marked by the greatest degree of violence. The persons most subject to its attacks are such as are of gross habits, who lead sedentary lives, or are intemperate in eating and drinking. The exciting causes of the disease are exposure to cold and moisture when the body is in a sta'e of perspiration, sudden changes from heat to cold, improper articles of food, as those of an acrid nature, and difficulty of digestion, unripe fruit, cabbage, cucumbers, melons, and the like. Cholera morbus is occasionally ushered in by chills, pains of the head, vertigo, propensity to sleep, and a sense of numb- ness in the limbs. Sometimes the disease commences gradually; at others, it attacks suddenly. At first the patient is troubled with acid eructations and pains in the sto- mach; these symptoms are soon followed by vomiting, which is almost constant. At first the contents of the stomach are dis- charged; afterwards a fluid, sometimes green, whitish or colourless, and at others, dark coloured, or even black. Discharges from the bowels of a similar character occur simultaneously with the vomiting. The pa- tient, at the same time, experiences great thirst, pains in the stomach and bowels, and tension of the abdomen. If the disease be violent and protracted, the limbs are affect- ed with spasm, the strength is greatly pros- trated, the surface of the body and limbs become cold, the pulse small, frequent and often imperceptible, a cold clammy sweat breaks out, and is succeeded by continual hiccup, delirium and death. Cholera is frequently attended with an internal sense of burning, and constant agi- tation of the body. The continuance of the attack is variable. In violent cases, when proper remedies are not early resorted to, death takes place in a few hours; in milder cases, it may conti- nue with slight intervals for several days. In the ordinary cases of cholera morbus, particularly when the discharges are green or tinged with bile, the best practice is to give the patient plentifully of some mild diluent, as toast, gum, barley or rice water; to place his feet in warm water, and subse- quently administer an injection of a pint of thin starch, a tea-spoonful of sweet oil and forty to sixty drops of laudanum. In all violent cases, especially when the pain of the bowels is constant and severe, the free application of leeches to the abdo- men, mustard poultices to the extremities, and the administration by the mouth of a grain or two of opium, in a pill, will be demanded, and will often arrest the disease almost instantly. The same injection as recommended above, will also be beneficial when the discharges from the bowels are frequent and copious. After the vomiting and purging are suspended, it will be pru- dent to administer a dose of calomel, or of blue mass ten grains, and opium,one grain, which may require probably tube repeated on the ensuing day; the patient at the same time confining himself strictly to thin gruel or panado, encouraging the healthy func- tions of the skin by the warm bath and frictions, and carefully guarding against cold and damp. In those cases in which the powers of life appear to be sinking, the skin becoming cold, the pulse small and feeble, and a con- stant hiccup taking place after the vomit- ing, the patient should be placed carefully in a warm bath, after coming out of v\ hich his skin should be wiped perfectly dry by brisk frictions, and mustard poultices ap- plied to the inside of his legs and arms, and over the stomach; at the same time we may administer by the mouth a tea-spoonful of the following mixture: compound spirits of lavender, two ounces; vitriolic ether, two drachms; laudanum, one drachm. The dose should be repeated every one, two or three hours, according to the urgency of the symptoms. As it is all important in these cases to put as early a stop as possible to the discharges from the bowels, which often continue after the vomiting has ceased, injections composed of a pint of water, in which has been dissolved twenty grains of sugar of lead and two grains of opium, may be administered every three or four hours. After the disease is arrested, calomel or the blue mass and opium should be adminis- tered, and the diet and regimen directed above observed. For a long time after recovery, great caution must be observed by the patient to avoid cold and damp, all heating and indi- gestible articles of food, fatigue, exposure to the night air, and every species of in- temperance. EPIDEMIC OR MALIGNANT CHOLERA. This severe and fatal disease commenced in the interior of India, in the summer of 1817, and with but few and short intermis- sions has continued to prevail from that pe- riod to the present. It has spread over nearly the whole of India, visited Africa, the greater part of Europe, Canada, the United States, and South America; and it appears destined in its future progress to ravage every habitable portion of the globe. During the long period it has continued to prevail, and in the wide extent over which it has spread, many millions of the human race have been affected by it, a large num- ber of whom it has consigned to the tomb. The circumstances connected with the DISEASES. 363 rise, spread and progress of cholera, indicate the dependence of the disease upon some morbid condition of the atmosphere, the exact nature of which has as yet escaped, and, perhaps, ever will elude our researches. Like all other epidemics, however, its oc- currence, violence and malignancy are pow- erfully influenced by certain well known causes, many of which it is in our power to remove or escape from; and in this manner we may either prevent an attack ofthe dis- ease, or render it comparatively mild, and divest it of its fatality. Cholera has invariably prevailed most extensively, and been attended with the greatest mortality in the neighbourhood of marshes; in low, wet districts; along the low, muddy banks of rivers; and in crowded towns and villages, where ventilation and cleanliness are neglected. The greatest number of those attacked by the disease, have been among the poor, the vicious, and the intemperate; they who reside in low, damp and filthy huts and cellars; they who are continually exposed to fatigue and the inclemencies of the weather, without suffi- cient protection; and they who are obliged to subsist on unwholesome or unnutritious aliment. When persons in easy circum- stances have been attacked, the disease has almost invariably been caused by excessive fatigue; intemperance in eating or drinking; the habitual use of intoxicating drinks; ex- posure to cold or damp, or to the night air; improper food, or that which is stimulating, indigestible, or liable to speedy fermenta- tion; too long fasting; the use of impure water, or acid drinks; prolonged wakeful- ness; a broken down constitution, or debili- ty from previous disease, or an advanced The avoidance of an attack of cholera will depend upon the removal of all the above predisposing or exciting causes, or as many of them as are under our control. The course of conduct to be pursued by individuals, to insure immunity from the disease, is to seek, ifpossible,apure, healthy situation in the country; to five temperate- ly on plain, nutritive food, plainly cooked; to relinquish entirely rich, high seasoned soups and sauces; all made dishes and pas- try; salted, dried and smoked fish; pork, geese, ducks, crabs and lobsters; all crude, flatulent and acid vegetables; and all stimu- latingdrinks, whether distilled orfermented. They should make use of active, regular exercise, in the open air, avoiding, how- ever, fatigue; partake of regular and suffi- cient sleep; avoid all crowded assemblies, the night air, wet and damp, and as much as possible, all care and anxiety, and every undue excitation ofthe passions. Personal cleanliness is all important; hence the daily use of the warm bath, or sponging the sur- face ofthe body, night and morning, with 2 W tepid water,, and friction of the surface, should never be neglected. With the ob- servance ofthe above precautions, it is sel- dom that an attack of epidemic cholera need be feared, even in places where it is prevailing the most extensively. The symptoms of epidemic cholera are somewhat various in different cases. The attack of the disease is generally preceded for some time, often many days, by a disor- dered state of the digestive organs. The individual is affected with griping pains in the stomach and bowels, or a sense of ful- ness, weight and uneasiness in the abdo- men; he feels languid, disinclined to exer- tion, whether of body or mind; a rumbling noise is almost constant in the bowels, as of wind passing through a fluid; there is often pain and giddiness in the head, and pain in the knees and loins, with flying stitches in the calves ofthe legs; the tongue is covered with a white or yellowish mucus; the ap- petite is diminished, and the thirst increas- ed. Most commonly the patient is affected with nausea, and frequent thin discharges from the bowels, or a constant inclination to go to stool, without any thing excepting perhaps a little slime being passed, some- times streaked with blood. The pulse is very various, sometimes full and strong, at others small and contracted. Some indi- viduals are affected with the foregoing symptoms during the prevalence ofthe epi- demic in their vicinity, without being at- tacked by cholera; in others, particularly in the intemperate, the discharges from the bowels soon become more copious, thin and watery, each evacuation being succeeded by a sense of extreme exhaustion or faint- ness, and the attack of cholera is developed in a few hours; the latter may be produced almost instantly, in those affected with the premonitory symptoms, by errors in diet, intemperance, exposure to cold and damp, or extreme fear. It is all important, during the prevalence of the epidemic, to pay strict attention to every, even the slightest, disorder of the stomach and bowels, and remove them at once, by appropriate remedies. In the young and robust, bleeding from the arm will be demanded; and in other cases, when the symptoms are violent, cups over the surface ofthe abdomen will be found to af- ford prompt and effectual relief. In every instance, the warm bath, or bathing the feet in warm water, followed by friction over the abdomen and extremities, is an important remedy. When the discharges from the bowels are slight, and merely thinner than natural, particularly if attended with griping and tenesmus, a dose of castor oil, combined with twenty or thirty drops of laudanum, should be administered in the morning, and an injection of thin starch, and forty drops of laudanum at bed time. 564 DISEASES. When the evacuations from the bowels are more copious and fluid, the following pills will in general arrest them, and produce natural and consistent stools, when com- bined with cups to the abdomen, the warm bath, and friction: blue mass,from fifteen to twenty grains; opium, two grains and a half; ipecacuanha, five grains; to be made into five pills, one of which is to be given every two or three hours, according to the urgen- cy of the symptoms, and continued until the healthy functions of the stomach and bowels are restored. The patient should be confined to rice or toast water, taken cold, in moderate quantities at a time; and after the disease is completely removed, he should be restricted to well boiled oat meal gruel, panado, milk thickened with rice Sour, or beef tea. The attack of cholera nia\ be divided into three distinct stages. In the first, there is almost constant vomiting and purg- ing, of a thin flocculent, almost transparent fluid, like rice water; attended with violent spasmodic pains of the stomach and bowels, which come on at intervals; inordinate thirst, and in severe cases, painful and violent cramps ofthe legs and arms. The skin is warm, bathed in perspiration, and has a pe- culiar soft, doughy feel. The tongue is moist, and covered with white mucus. The hands and feet are often cooler than the rest of the body, while the abdomen is of an increased temperature. The pulse is sometimes full and firm; at others soft, or small and hard. The countenance is ex- pressive of deep distress; but the mental faculties are unimpaired. The urine is either deficient in quality, or its secretion is entirely suspended. In the second stage of cholera, the dis- charges from the bowels still continue, at- tended with vomiting; the vomiting, how- ever, sometimes ceases, or comes on less frequently; the patient complains of pain, or a sensation of burning in the stomach; the cramps of the extremities continue, with equal violence; the heat ofthe skin is greatly reduced, and the whole surface of the body is covered with a profuse, cold, clammy perspiration; the tongue is deci- dedly cold; the skin ofthe extremities have a corrugated appearance, as if soaked in warm water; and in common with that of the face, has a livid appearance; the eyes are sunk, the features contracted, the pulse small and feeble; there is great thirst, and a constant desire for cool air; the secretion of urine is completely suppressed; the men- tal faculties are still unaffected. In the third stage of the disease, the whole surface of the body, as well as the tongue and inside ofthe mouth, is icy cold, of a deep blue or purple colour, and con- stantly covered with a profuse perspiration, which stands in large drops upon the skin; the extremeties arc corrugated; profuse in- voluntary discharges of a colourless fluid are poured from the bowels; the voice is low, husky, and almost extinct; no pulsa- tion can be detected in any ofthe superfi- cial arteries, and the action of the heart is slow and feeble; the respiration is short and quick, with a peculiar heaving ofthe chest; the patient complains of a burning heat at the stomach, and craves incessantly cold water and fresh air; he is extremely restless, tossing about in every direction, or else lies in a kind of doze, with half closed eyelids; the mental faculties are still unimpaired. After continuing in this state for a longer or shorter period, he expires. The moment an attack of cholera has ta- ken place, a prompt resort should be had to active remedies; the loss of a few hours often seals the fate of the patient. If the pulse be full and strong, and the attack re- cent, a vein should be opened in the arm, and a quantity of blood drawn off; the pulse being watched during the operation, if it sink, the arm should be at once tied up, and cups applied over the abdomen and along the spine. When bleeding from the arm is not thought advisable, the cups should be applied at once. The limbs of the patient are then to be well rubbed with the volatile liniment, and mustard poultices put on the ancles, thighs and wrists. An injection of one pint of thin starch, half an ounce of sweet oil, and sixty drops of laudanum, will often be advantageous. The patient should be supplied from time to time with a table spoonful of iced water; or, when this is instantly rejected by the stomach, a tea spoonful of powdered ice, every fifteen minutes. If any symptoms of a congested state of the brain be present/1 cups should be applied to the head, or nape of the neck. When the stomach becomes calm, the blue mass, in doses of from three to five grains, with half a grain of opium, may be given every three hours. This very generally produces, in a short time, con- sistent dark coloured stools, which are fol- lowed by natural evacuations. After re- covery, the same precautions in regard to diet are necessary, as after the removal of the premonitory symptoms. In the second stage, the frictions, poul- tices, cups to the abdomen, and ice inter- nally, should be resorted to, as in the first. If on opening a vein in the arm, a few ounces of blood can be obtained, the pulse will often be found to rise with the flow of blood, and warmth return in the extremi- ties. The frictions should be frequently repeated, dry heat applied to the feet, and an anodyne injection jriven, as in the fore- going stage; after reaction has been fully established, the blue mass and opium are to be given, as above. In the third stage, but little can be done DISEASES. 365 to Save the life of the patient. Cups may be applied to the abdomen, and along the spine; and the patient should then be wrap- ped in dry blankets, and supplied with small portions of powdered ice every ten or fifteen minutes. Injections of thin starch, with sixty drops of laudanum, and twenty grains of sugar of lead, may be given occa- sionally; they have been known, in some cases, to arrest the discharges from the bowels, which is an object of very great importance. Should the skin become warm- er, and the pulse perceptible at the wrist, the case should be treated as directed in the second stage. For a long time after recovery from cholera, the utmost care should be observed in regard to diet, and to avoid exposure to cold and damp, and fatigue. The slight- est disorder in the stomach, should be at once attended to, and removed; a relapse is easily excited by the least inattention or imprudence, and it is often more un- manageable than the first attack. CHOLERA UF INFANTS. This is a very common and destructive disease in most of our large towns during the summer and autumnal months. It oc- curs in children from a few days to two years of age, but seldom beyond the latter period. The predisposition to it appears to be produced by a heated and impure air, and hence it prevails most extensively among the children of the poor. Its ex- citing causes are the irritation of teething, improper or too much food, or exposure to cold and damp. It generally begins with a looseness of the bowels, which continues for several days without the stomach being much af- fected; in many cases, however, the child is attacked from the first by an almost con- stant vomiting and purging, attended with considerable fever. The matter discharged from the bowels is at first greenish, some- times slimy, mixed with blood; but in vio- lent cases, the discharges soon become per- fectly limpid, like water. The child ge- nerally suffers considerable pain, which causes it to be fretful, never easy in one posture, and to draw up the feet, and fre- quently to utter loud screams. The pulse is quick and frequent, the thirst inordinate, the fluid taken being immediately discharg- ed. The fever and all the symptoms in- crease towards evening. The head is usually very warm, while the extremities retain their usual heat, or in violent cases, become somewhat cold. In some cases the infant becomes affected with delirium, tosses its head backwards and forwards, and attempts to bite or scratch its attendants. The abdomen is frequently swollen and tense. The body becomes rapidly and ex- tremely emaciated; the eyes languid, hol- low and glassy. The insensibility of the system is often so great, that flies may alight upon the half open eyelids as the child lies in an imperfect dose, without ex- citing a motion in the eyelids to remove them. Sometimes vomiting continues with- out purging; more frequently, the purging continues without the vomiting. In the advanced stages of the disease, the stools are often profuse and very offensive; in other cases they are small in quantity, and composed merely of the food and drinks taken. The disease is sometimes fatal in a few hours, or it may last for many days, re- ducing the little patient to a perfect skele- ton; the skin becomes of a dark brown hue, and covered with livid specks; the mouth is affected with aphthae, and hiccup or con- vulsions come on, which quickly terminate in death. Sometimes dropsy in the brain is produced, and after continuing many daysj destroys the life ofthe patient. The means of preventing this disease are all important, for in too many instances it does not admit of a cure. These consist, 1st. In removal, if possible, to the cool fresh airof a healthy part of the country; or if this can not be effected, the child should be taken out frequently in the open air, in the arms or in a carriage, or when it resides near a large river, sailing daily in an open boat is an admirable preventive. So pow- erful an influence has pure, cool air over this disease, that the mere removal from the hot, confined and unwholesome air of the city, has been known to arrest the disease almost instantly. Even the occurrence of a cool day will abate its violence, and pro- duce a favourable change in its symptoms. 2dly. In a proper diet. The breast milk of the mother, or when the child is weaned, preparations of milk, with biscuit, rice, barley, arrow root or tapioca, or plain beef tea;, or chicken water, with stale bread, should be the only aliment allowed, parti- cularly during warm weather. Fruit, rich meats or gravies, pastry, spices and stimu- lating drinks, are almost certain to produce the disease in the predisposed. 3dly. In a strict attention to cleanliness. The apart- ment of the child, as well as its clothing, should be kept perfectly clean and dry, and its body should be immersed daily in a tepid bath, and subsequently dried by gen- tle friction with a soft cloth. 4thly. In proper clothing. The clothes should not be too warm, so as to overheat the infant, nor so thin and light as to expose it to the influence of every slight change in the temperature of the air. When the disease has occurred, it should be attended to in its earliest stage. The moment the infant is affected with diarrhoea, it should be immersed in a warm bath, and one of the following powders given to it 360 DISEASES. every three hours: magnesia and prepared chalk, of each, three grains; ipecacuanha, a quarter of a grain. At the same time it is to be confined solely for food and drink to the breast milk, or to rice water, sweet- ened with loaf sugar. The warm bath may be repeated the ensuing day, and the belly should always be enveloped in a soft flannel roller, not too tightly drawn. When the discharges from the bowels are very thin and copious, and attended with but little fever, and no symptoms of an affection of the head, an injection may be given of a gill of thin starch with three or four drops of laudanum, according to the age of the child. When the patient appears to suffer from much pain, has a hot, dry skin, a tumid ab- domen, and much heat exists about the stomach, leeches should be applied upon the upper part of the belly, in numbers proportionate to the age and strength of the infant, and the violence of the symp- toms. The warm bath should be repeated night and morning. A tea-spoonful of cold water may be allowed every quarter of an hour, but the ordinaiy drink should be rice or gum water. Leeches to the temples or behind the ears, with cold applications to the scalp, are all important, also, in those cases in which the head is veiy warm, or symptoms of irritation of the brain or deli- rium are present. In such cases, mustard poultices may likewise be applied to the soles of the feet. The vomiting is often extremely violent, and almost continual in these cases; one of the best remedies that can be employed is a very small dose, say one sixth of a grain, or even less, of calomel, repeated every half hour or hour, together with a few leeches to the stomach, and the warm bath. The best mode of administering the calo- mel is to rub it up in a mortar with a little dry loaf sugar, and then sprinkle it upon the tongue; when the vomiting is severe, cold toast water, or coffee without sugar or milk, is the best drink. When the vomiting is removed and the discharges from the bowels abated, a com- bination of three grains of magnesia, the same quantity of prepared chalk, one eighth of a grain of calomel, and one sixth of a grain of ipecacuanha, may be given every three hours, until natural evacuations are procured. In the advanced stages of cholera infan- tum, we ma/attempt the removal of the disease by the frequent use of the warm bath, a blister over the stomach, anodyne injections, composed of thin starch and a few drops of laudanum; and internally, some light astringent, as kino, decoction of dew- berry root or geranium maculatum, with a change of air and a diet of boiled milk, thickened with rice flour. After recovery, the same rules are to be observed as were directed for the preven- tion of the disease. ILIAC PASSION. A severe and painful affection ofthe bow- els, in which the patient is racked with most acute pain, accompanied with costive- ness and vomiting, and this not only of the contents of the stomach, but also of bile, and even of matters proceeding from some portion of the intestinal tube yet farther from the stomach. So completely is the downward progressive motion of the bow- els inverted, that articles which have been given by way of clyster, have been known to be vomited by the mouth. Costiveness sometimes precedes the disease for some days, and the pain is felt very much about the navel. These symptoms may occur without fever, but it is unlikely that so violent suffering and such disordered action of the intestines should not both excite much irritation in the nervous system, and also induce inflammation in the bowels; and therefore, if the iliac passion be not very quickly relieved, we may expect soon to find heat, thirst, restlessness, quickened pulse, and pain in some part of the abdo- men on pressure. We are informed by ex- amination of the bodies of those who have died of this disease, that a spasmodic action or cramp takes place in some part of the intestines, or that one part of the gut is drawn within the other; and the knowledge of this circumstance leads us at once to be cautious in our prognostics, and to the ne- cessity of prompt and decided treatment. Iliac passion arises from food that dis- agrees with the stomach and bowels, long continued costiveness, hardened stools, some metallic poisons, and cold applied to the feet or other parts of the surface. In cases of iliac passion, it is always ad- visable to bleed, and that even largely and repeatedly, both to prevent inflammation coming on, and to take off the spasm ofthe bowels. This removal of spasm is to be further promoted by the application to the belly of flannels wrung out of hot water, or by putting the patient in the warm bath. It would be a most desirable object to give purgative medicines by the mouth, in order to restore the downward action of the in- testines, and to discharge any irritating matter; but unhappily the stomach is apt to reject them all, and to frustrate our pur- pose. In this state, we must have recourse to opium, which frequently relieves the pain, stops the vomiting, and permits us to use the proper purgative medicines. For this purpose, the tincture is not so good as solid opium, one or two grains of which will remain on the stomach, when thirty or forty drops of the medicine in a liquid form DISEASES. 367 Would be rejected. Patients should en- deavour to refrain from drinking any thing till the opium has allayed the irritation. The abdomen should be freely leeched and a large blister may be applied to that part; it will probably be an effectual remedy, with the only disadvantage that we have to wait some time for its good effects. If the opium, leeches and blister diminish the irritability of the stomach, we are to try the exhibition of calomel, giving four grains every hour; and it is better retained when given dry or with a little loaf sugar, than when mixed with jelly or any similar sub- stance. A dose of senna, or castor oil, or sulphate of magnesia, may be given an hour after the third or fourth dose of the calo- mel. From half an ounce to an ounce of turpentine often proves a most effectual purgative. Clysters should never be omit- ted; at first the milder kinds should be tried, as a large quantity of warm gruel, with a little oil, or salt; or an infusion of senna, with a portion of sulphate of mag- nesia. These should be thrown in with considerable force. If these remedies fail, a very effectual, but a very hazardous one must be tried, the injection of an infusion of tobacco, in the proportion of a drachm of the leaves to an English pint of water. This is very generally followed by the most remarkable sickness, relaxation of the sys- tem, and depression of strength, and must never be given but under the direction and personal superintendence of an experienced practitioner. It was at one time thought a proper mode of practice to remove the ob- struction of the bowels by mechanical means, as by the weight of large quantities of quicksilver; but a moment's reflection must show, that from the numerous convo- lutions of the intestines, and the numerous changes of their direction, no column of mercury can make the direct pressure re- quisite to remove the obstructions that may *m be in various parts ofthe bowels. Metallic quicksilver generally passes through the bowels, without undergoing any change. WORMS. There are several kinds of worms which infest the intestinal canal of man, but the chief are the ascarides, or small white thread worms, mostly found in the rectum, or last gut; the lumbrici, or long round worms, usually found in the small intestines; and the taenia, or tape-worm, which occupies the upper part ofthe intestinal tube, and is occasionally found in every part of it. Worms can hardly exist in so sensible and highly organized a part as the intestines, without producing some degree of irritation there, and we are certain that irritation can not take place in that canal without pro- ducing, sooner or later, and in a greater or less degree, disagreeable effects in various parts of the system, and especially in the stomach and head. Hence these animals frequently occasion a variable appetite, which is sometimes deficient, at other times voracious; pains in the stomach; fetid breath; nausea; headach; vertigo and gid- diness; cough; irritation about the nose and anus; disturbed sleep; and a disordered state of the bowels. In children, hardness and fulness of the belly frequently occur, with frequent slimy stools, and sometimes convulsion fits. In adults, as well as in children, worms not unfrequently give rise to severe epileptic fits, and sometimes occa- sion great emaciation. Worms most frequently appear in persons of a relaxed habit, especially in those whose digestive organs are disordered. An ex- cessive use of vegetable food, of fruits, of sugar, or any other saccharine substance, very strongly favours their generation. The reason why children are more infested with them than adults, appears to be chiefly be- cause they are allowed to indulge to excess in eating sweet things, to the partial or total neglect of salt. Simple irritation of the stomach and bow- els will often produce all the symptoms above described, and, in some cases, it is difficult to ascertain whether worms do or do not exist in the bowels, when none have ever been discharged. In such instances, we can determine the real nature of the case only by an attentive consideration of all the symptoms, and the patient's habits, more particularly with respect to the use of food. The fundamental principle in the treat- ment of worms is, to restore health to the system generally, and the stomach and in- testines in particular, and thus not only to dislodge the worms, but to render them in- capable of reproduction. On this principle, it will be found almost invariably, that those medicines and plans of treatment, are the most eligible, which tend directly to invi- gorate the whole constitution, at the same time that they expel the worms. A great deal has, at different times, been said about the efficacy of certain medicines in the cure of worms, but many of these are unnecessary or even injurious. There are few cases which will resist the proper use of salt, more especially if the usual means of invigorating a weakly constitution be resorted to, and rich food, flatulent and crude vegetables and saccharine substances be avoided as much as possible. Salt is a natural and necessary stimulant to the diges- tive organs; it excites them to a healthy and vigorous action, and is particularly ob- noxious to all kinds of worms. Persons troubled with these animals should, there- fore, increase their quantity of salt at each meal; lessen that of" every kind of sweet 368 DISEASES. food; avoid partaking much of vegetables; regulate the bowels by the occasional em- ployment of a purgative, as castor oil, mag- nesia and rhubarb, or a pill of three grains of soap, two of aloes and one of gamboge, and avail themselves of the usual means of strengthening the general habit, by having recourse to active exercise daily, early rising, the use of the tepid bath, frictions ofthe skin, &c. These measures are highly advisable and useful, whatever kind of medicine be employed. At the same time, a dose of salt and water—for example, an ounce or two of common salt, dissolved in nearly half a pint of water, should be taken in the morning, fasting, and repeated at the end of three or four days. This will gene- rally act as a purgative, and will certainly bring away almost every kind of worm. If necessary, the repetition may be extended to a third or fourth time, and in very severe cases, the quantity of salt used at each dose may be increased to three or four ounces. This plan is applicable to the cases of children, as well as to those of adults. As a purging portion for young children, half an ounce of salt dissolved in a quarter of a pint of water, will usually be sufficient. Preparations of iron are sometimes very useful in expelling worms, and in strength- ening the alimentary canal, so as to preclude their reproduction. They are, in general, very appropriate remedies when consider- able debility has been induced from the irritation excited by the worms. Therefore, if the patient be averse to using the salt and water purgative, he may take occasionally the following pill: carbonate of iron, three grains; ipecacuanha, half a grain; extract of gentian, one grain; aloes, half a grain; not forgetting to attend, at the same time, to the advice given above respecting diet and regimen. By degrees the quantity of carbonate of iron should be increased to double what is ordered above. Camphor has been highly praised, for its virtues in cases of worms, by many eminent physicians. An Italian physician of the name of Brera, who has lately published an approved work on verminous diseases, has great confidence in it, and asserts, that he has always employed it with marked success. Eight or ten grains of this sub- stance may be dissolved, by means of a few drops of rectified spirit of wine, in an ounce and a half of water, and a tea-spoonful taken twice or thrice a day. This may be tried alone, or taken in the intervals be- tween the use of the salt and water purga- tive. It appears to be particularly effica- cious in the destruction of the long round worms (lumbrici). For tape-worm, the oil of turpentine is an effectual remedy. An ounce may be given to an adult, or half an ounce to a child, and may be repeated the second or third time in the course of a fortnight. It may be swallowed simply suspended in water. It is seldom advisable to repeat it more than three times, unless under the direction of a medical practitioner. Lately, the pomegranate bark has been found very useful in obstinate cases of tape- worm. It appears to have advantages over the oil of turpentine, from its being quite harmless, not nearly so disgusting, pro- ducing its effect with great rapidity, and in not requiring any preparative treatment. The mode of administering it is, by boiling two ounces of the bark in a pint and a half of water down to a pint, the whole of which is to be taken in the course of the morning, fasting, in four draughts, with an interval of half an hour between each. Sometimes it will bring away the worm on the first day, in other cases it is necessary to repeat the medicine to the second, third, and even fourth time, precisely as above directed. In the small white thread worm, so often infesting the last gut in children, half a pint or a pint of lime water should be injected once a day, and calomel and jalap or a dose of castor oil, be given once a week, for three or four weeks. Or, instead of the lime water, a strong decoction of worm- seed, or a solution of salt and water, may be injected after the same manner. This plan is generally successful. The bristly down ofthe pods of cowhage is also a powerful remedy for worms. A great number of other medicines have been recommended, as pink root, tin filings, male fern, tansey, rue. Several of them are very useful; but the preceding reme- dies are the most powerful and the best, and will very rarely fail in affording satis- factory relief. Worm lozenges, and other patent medi- cines sold for the core of worms, are com-' posed chiefly of calomel, or some other" active purgative. They are, no doubt, sometimes beneficial, but the foregoing measures are by far more eligible, and those who adopt them will find no need of resort- ing to any secret preparation. The best diet and regimen for persons troubled with worms is that recommended for dyspepsia. We would remark, that while plenty of salt eaten with fresh animal food is useful in cases of worms, salt meat is very objectionable. POISONS. A knowledge of the phenomena produ- ced by such poisonous articles as may be taken into the stomach, either intentially or by accident, and of the treatment necessary to be pursued to counteract their effects, and preserve the life of the patient, is a subject of very great importance, not mere- DISEASES. 369 ly to the medical practitioner, but to everv individual in society. The effects produced by many poisonous substances, take place with such promptness, that but little time is presented for the exhibition of remedies,' and the patient is often destroyed before the physician arrives; whereas, had a proper treatment been immediately instituted, the fatal result might have been prevented. The subject of poisons, when investiga- ted in relation to all the points involved in it, is one of very great interest to the physi- cian, the medical jurist, as well as to all who are liable to be called upon in the solemn and highly responsible character of a juryman, whether upon an inquest or in a court of justice, to determine upon the cause of death in any given case, where a suspicion of murder exists; or to decide upon the guilt or innocence of a fel- low-being arraigned for administering dele- terious drugs, for the pnrpose of destroying life. To enter into this investigation would, however, far exceed the limits to which we are necessarily restricted: we shall confine ourselves, therefore, to a brief account of the leading effects produced by the intro- duction into the stomach of the various clas- ses of poisons, the antidotes proposed for the principal articles of these classes, and the general medical treatment demanded in cases of poisoning. Poisons may be divided into the corrosive or acrid, the narcotic, and those acting both as corrosives and narcotics, the narcotico- acrid. The symptoms resulting from the first class, in addition to the particular taste of the article itself, are heat, irritation, or an extraordinary and sudden sensation of dry- ness, constriction and roughness, at the root ofthe tongue, and in the gullet; these are succeeded by violent efforts to vomit, and sharp pains in the stomach and intes- tines; there is also great thirst, copious dis- charges by vomiting and stool, attended with much straining, and followed by hic- cup; a sense of constriction across the dia- phragm, and difficulty of breathing; pain is generally felt about the kidneys, followed by stranguiy: convulsions at length come on, or cramps of the hands, trembling of the limbs, extinction of the voice, repeated fainting, cold sweats, and usually a hard and irregular pulse. The narcotic poisons produce the follow- ing effects: stupor, numbness, a great incli- nation to sleep, coldness and stiffness ofthe extremities, a cold sweat of a fetid or greasy nature; swelling ofthe neck and face; pro- trusion of the eyes, with a haggard cast of countenance; thickening of the tongue; frequent vertigo; impaired or depraved vision; delirium; general debility; palpita- tion ofthe heart; the pulse at first full and strong, afterwards becomes unequal and in- termittent; there is also paralysis of the lower extremties; retraction of the lips; general swelling of the body, and swelling of the veins. At the conclusion of the dis- ease, slight convulsions and pain are some- times present. The effects of the narcotico-acrid poisons are distinguished by a combination of seve- ral of the symptoms of both the foregoing classes. There is generally agitation; pain; acute cries; sometimes stupor, and convul- sive motions ofthe muscles ofthe face, jaws and extremities; vertigo, and occasionally extreme stiffness of the limbs, and contrac- tion ofthe muscles of the thorax; the eyes are red and starting from their sockets, the pupils frequently dilated; there is often great insensibility to external impressions; the mouth is full of foam; the tongue and gums livid; with nausea, vomiting, frequent stools, &c. Often, these symptoms attack in paroxysms, and the patient is left com- paratively easy for a few moments. It may appear easy, from an attention to the symytoms we have recited, to distin- guish the nature of the poisonous article, under the effects of which the patient is la- bouring; but nevertheless, in practice, no- thing is generally more difficult. Substan- ces veiy different in their nature, produce similar effects; as for example, cantharides, certain acrid vegetable substances, and the caustic minerals. The difficulty is increas- ed by the circumstance, that articles of or- dinary food, perfectly innoxious in them- selves, so far as regards any poisonous pro- perty, in certain conditions of the stomach, and in certain constitutions, when eaten, sometimes cause the most alarming symp- toms. Roasted cheese, fish, crabs, lobsters, clams, mushrooms, or even apples and cherries, have been known to produce the most alarming symptoms, and cause a sus- picion of poison having been taken. A va- riety, also, is frequently observed in the symptoms caused by the same poison, in different persons. Many circumstances may conduce to this, such as 1st. The mode in which the article has been taken. When swallowed in a liquid form, the effects of a poison are generally more prompt and marked, than when it is taken in a solid state. 2d. If the article be taken on a full or empty stomach, its effects will vary; being much more rapid and certain, in the latter case, than in the first. 3d. The circumstance of vomiting oc- curring immediately, or not until after a considerable time, will produce a difference in the effects of the poison. In the former case, the article may be rejected from the stomach before it has had time to produce any injurious effects. Thus, large doses of arsenic have been taken intentially as a poison, but in consequence of copious vomit- 370 DISEASES. ing instantly following, the lives of the in- dividuals have been preserved. To distinguish cases of poisoning from accidental affections of the stomach, pro- duced by other causes, demands, on the part of the practitioner, a judicious and cautious examination of every circum- stance relative to the character and disposi- tion of the patient; the possibility of his having procured poison; the article of which he had last eaten or drank; the vessels in which it had been contained; the patient's own confession, if able to speak; the rela- tion of his friends, 8cc. The diseases and symptoms most likely to be mistaken for the effects of poisons, are probably those produced by idiosyncracy, indigestion, and sudden and unexpected illness. But the most striking cases of resemblance to the effects of poisons, probably occur in those who, after being long accustomed to a par- ticular species of food, for the first time use another kind. The town of Martigues, in France, is almost entirely inhabited by fish- ermen, who live upon fish from their infan- cy. Fodcre, during the last year of his resi- dence there, often prescribed meat soup to his patients, but in every instance, its administration was followed by violent nau- sea and vomiting. They confessed it was the first time they had ever used aliment prepared from meat. The treatment, in cases of poisoning, varies according to the individual articles taken. As a general rule, in those cases in which the corrosive and acrid poisons have been swallowed, the indications of cure are, 1st. To endeavour to discharge the poison as quickly as possible from the stomach. 2d. To endeavour to destroy its poisonous properties, by the administration of anti- dotes. And 3d. To prevent or subdue inflammation. The first indication is to be effected by the administration of an active emetic; or, if vomiting has already occurred, in general by the copious administration of diluents; or we may attempt to remove the article from the stomach, by an appropriate pump. The different antidotes will be pointed out, when we consider the individual poisons. The third indication is to be fulfilled by the remedies detailed, when speaking of gastritis and enteritis, namely: bleeding, both general and local; fomentations, blis- ters, &c. Arsenic. This is an article very frequent- ly made use of to destroy life; it is, also, often taken in mistake for other articles, nearly resembling it in their external ap- pearance, either of an innocent or medicinal character. The frequency of accidents from this poison, requires that we should treat of it rather more minutely than will be ne- cessary in relation to most ofthe other sub- stances belonging to this class. Arsenic may be taken in such quantity as merely to produce disorder of the stomach and system, without necessarily destroying life; or it may be taken in such quantities as to produce death at a later period than twenty four hours; or, lastly, the quantity may be such as to induce death within twenty-four hours. Albriter, in the Edin- burgh Medical and Surgical Journal, has given a description of its effects, according to the above arrangement, drawn from a careful comparison of all the cases which have occurred in the course of his reading; which description we shall follow: When in the slightest portion, the symp- toms produced by arsenic, are uneasiness at the stomach, with a sense of heat. When the dose is somewhat greater, but not so great as to produce death, violent vomiting is commonly the first symptom; although, in some instances, it is preceded by a sense of heat in the tongue and throat: in other cases, these sensations are not felt during the whole course of the disease. When the vomiting is immediate, and the poison has been taken on a full stomach, the patient seems to owe his escape to the poison being discharged before it has had time to act. The next symptom claiming attention is purging, sometimes of blood; but purging is less frequent in the slight cases, than in those where the degree of poisoning is greater. In the region of the stomach and bowels, pain is frequently felt; it is often, however, rather an unsupportable uneasi- ness and oppression than pain, properly speaking. The stomach is not described as swelling: in one case in which there was hiccup, eructation and difficulty of breath- ing, the abdomen is said not to have been tense or swollen. A sensation of coldness, especially of the extremeties, with cold sweats, seems nearly always to have been present, with general paleness of the face and surface: and in some cases languor, faintness, and a tendency to sleep. In this degree of poisoning, convulsions are not frequently observed; and thirst and fever are seldom present: in one case only, is a sense of heat in making water mentioned. In the second degree of poisoning from arsenic, when the patient lives a day or two, the first sensations are heat and thirst; vom- iting or inexpressible distress. The first is less frequent than the two others; purging is not mentioned as a symptom; in one case griping is noticed; in two, the abdomen was tumid; in one there was great feebleness and lassitude; in all, convulsions took place; in one case, impeded deglutition, pain in the stomach, tenesmus and hoarseness, are noticed as having occurred. In the third degree of poisoning, when death takes place within a few hours, the symptoms succeed each other rapidly, or oc- DISEASES. 371 cur at the same time; fainting and general de- bility almost invariably precede the vomit- ing, which occurs in most cases, as well as purging and griping. In one case, there was vertigo, with general pains and loss of speech; convulsions did not often occur; there was sometimes hiccup. In a few cases there was much heat and thirst; fre- quently the patients complain of a sensation of intense cold; this, in one case, was ac- companied with palsy ofthe limbs and cold sweats; death seems to have generally pro- ceeded from exhaustion and rapid sinking of the vital powers. In none of the cases in which the poison was taken internally is there any mention of delirium or any affec- tion of the mind. The indications in the treatment of poi- soning from arsenic are, 1. To remove the poison. 2. To protect the stomach and in- testines from its effects. 3. If the patient survive sufficiently long, to diminish in- flammation. The removal of the poison is to be at- tempted by emetics of sulphate of zinc, or if vomiting be present, by the aid of dilu- ents or a vegetable emetic. Tartrite of antimony should never be administered. But when vomiting does not quickly ensue from these means, the urgency of the case demands a resort to more direct remedies. The stomach may be washed out by means of a large elastic tube and syringe; in this manner, a quantity of liquid is to be thrown in, so as to dilute or suspend the poison, and by means ofthe syringe, the whole may be again withdrawn. By this procedure, we may, in many cases, succeed in saving the life of the patient; the invention claimed by several late British physicians, is due, we believe, to Dr. Alexander Monro; but Dr. Physick was the first who tested its practicability by actual experience. The second indication may be effected by means of milk, lime water, soap, and drinks sweetened with sugar or honey. Fatty or oily substances are of doubtful utility. According to Renault, they are actually dangerous, rendoring the effects of the poison more certain. In a case reported by Joseph Hume, life was saved by administering freely, after vo- miting had ceased, retching and pain, how- ever, remaining, the carbonate of magnesia, with laudanum suspended in water; one or two cases subsequently reported are in fa- vour of this practice. The third indication is to subdue inflam- mation by the same remedies as in ordinary inflammation ofthe stomach. For arsenic we unfortunately possess no antidote, strictly speaking. The sulphate of potash had once a high reputation as such; but so far from this being the case, it is itself a poison, and the experiments of Renault have proved that it increases the 2X poisonous effects of arsenic. Sulphur has been proposed, on the principle of its uniting with the arsenic; it is, however, deserving of no confidence. Charcoal was suggested in consequence of the experiments of Ber- trand, but according to Orfila, it is without efficacy. Dr. Chisholm recommends the juice ofthe sugar cane as the best antidote for arsenic. Corrosive Sublimate. Besides the ordinaiy symptoms caused by corrosive poisons, the present article produces a peculiar sense of stricture and burning heat in the throat and gullet, increased when attempts are made to swallow; there is also a dysenteric affec- tion, bloody vomiting, and sometimes di- minished or even suppressed secretion of urine. The treatment of poisoning from this article is to administer an emetic, or if vomiting is present, as large a quantity of the white of eggs, well mixed with water, as the stomach can contain. By the expe- riments of Orfila, it is proved that albumen decomposes corrosive sublimate, forming a triple compound, consisting of albumen, muriatic acid and calomel. Dr. Taddei of Italy, has lately recommended wheat flour, starch or gluten, mixed with water, as an antidote to corrosive sublimate; hence, when the whites of eggs are not at hand, either of the latter should be employed as directed above. Along with these, bleeding, &c. may be had recourse to, to overcome the inflamma- tion already excited. The plentiful use of mucilaginous drinks is also very useful as an accessary remedy. The antidotes to cor- rosive sublimate are, therefore, albumen and vegetable gluten. 3. Emetic Tartar. This substance, in large doses, is undoubtedly a poison. It is by no means, however, so destructive as either ofthe foregoing. The remedies are, if vomiting be present, to wash the article from the stomach by large draughts of tepid drinks; ifvomitingbenot present, to excite it by tickling the throat and fauces, and by the administration of large quantities of warm water. If, notwithstanding these means, vomiting be not induced, we are to resort to antidotes. These are decoctions or infusions of any astringent vegetable substances. The following may be em- ployed: a decoction of bark; strong tea; decoction of galls, or of oak bark, or any of the other astringent roots or barks. The above articles are named in the order of their efficacy. From the experiments of Berthollet, the Peruvian bark would appear most certainly efficacious, and when it can be procured, should invariably be preferred. When the vomiting is excessive, opium may be administered. To remove the secondary symptoms, the antiphlogistic treatment generally will be demanded. 4. The Salts of Copper. These, in cer- 372 DISEASES. tain doses, are all poisonous. Verdigris or the impure carbonate, is the one most com- monly employed. The symptoms are the same as in the case of other corrosive poi- sons. We are to endeavour, when it has been taken, to evacuate it from the sto- mach by the same means as have already been mentioned. Sugar was one econsider- ed as the antidote for this poison. Sub- sequent experiments, however, have les- sened the estimation in which it was at first held, and have pointed out albumen as the article most to be depended upon; hence, the whites of eggs mixed with water are to be administered at first; their operation being aided by the use of large quantities of sugar and water. Should inflammatory symptoms remain after the presumed eva- cuation of the poison, bleed actively. For the removal of the spasmodic affections that are apt to remain, opium and antispasmo- dics will be required. 5. Sulphate of Zinc. When taken in an overdose, vomiting should be excited by copious draughts of warm water, emollient drinks, &c. Milk is the proper antidote. Inflammation is to be prevented by the or- dinary means, and irritation allayed by opium. 6. Muriate of Tin. The treatment is the same as in the former article; milk, ac- cording to the experiments of Orfila, is also its proper antidote. 7. Nitrate of Silver. When accidentally taken in an overdose, a solution of common salt in water is to be administered; at the same time, the patient should take plenti- fully of emollient and mucilaginous drinks. Muriate of soda is proved, by the experi- ments of Orfila, to counteract the effects of the salt, and hence is its antidote. 8. Nitrate of Bismuth. The same gene- ral treatment as in the case of other corro- sive poisons, with milk and mucilaginous drinks plentifully administered. 9. The Salts of Lead, when taken in large quantities produce poisonous effects, and when gradually introduced into the system, they produce a peculiar species of colic, which has been already treated of. When taken in an overdose, the proper treatment is to endeavour as speedily as possible to empty the stomach by the or- dinary means. The sulphate of soda or of magnesia is the most effectual antidote for lead; it should be given in strong solu- tion; at the same time, mucilaginous drinks and purgatives are to be administered. In- flammation is to be prevented by bleeding. 10. Sulphuric Acid. Taken in an undi- luted state, or in large quantities, it pro- duces all the symptoms attendant upon violent inflammation of the throat, gullet and stomach, or when concentrated, it may destroy at once the lining membrane of those parts. Large quantities of water, containing cal- cined magnesia in suspension, must be in- stantly administered; or, if not at hand, soap and water, chalk and water, or diluted lime water. The caustic must be neutral- ized, or the patient is inevitably lost. The subsequent treatment will depend upon the degree of* inflammation present. Demul- cents, barley water, gum water, whey, milk diet and emollient injections will al- ways be proper. 11. Nitric Acid. When taken in excess, the treatment is the same as in the case of the foregoing. 12. The Alkalies. For these, when taken in excess, vinegar and lemon juice are the most valuable remedies; they are to be aided by the plentiful use of mucilaginous drinks and emollient injections. The re- maining treatment will depend upon the degree of inflammation. 13. Barytes. All the salts of this earth, • excepting the sulphate, are poisonous in certain doses. When taken, vomiting is to be excited, and the plentiful use of a solu- tion of sulphate of soda or magnesia com- menced with early. These decompose the poison and produce the insoluble sulphate, which of course is inert. The treatment for the secondary stage is to prevent or subdue inflammation. 14. Nitrate of Potash, when taken in excess, is a poison producing inflammation ofthe stomach, &c. Treatment, vomiting, mucilaginous drinks and bleeding, accord- ing to circumstances. 15. Muriate of Ammonia. The treatment is the same as in the last case. 16. Acrid Vegetable Poisons. The treat- ment for poisoning from these is, 1st. To dislodge the article from the stomach as speedily as possible, by vomiting. 2d. To administer large quantities of mucilaginous drinks, emollient injections, &.c. 3d. To prevent inflammation by the antiphlogistic remedies generally. 4th. Overcome vio- lent irritation and spasm ofthe stomach and bowels by opium. Narcotic Poisons—Opium. When opium or any of its preparations are taken in a large quantity, so as to act as a poison, the following symptoms are usually perceived within a short period: insensibility and in- capacity of exercising muscular motion; respiration scarcely perceptible, and a small and feeble pulse, which usually becomes full and slow; as the effects of the poison increase, the state of lethargy becomes more complete; deglutition is suspended; the breathing is occasionally stertorous; the pupils are insensible to the application of light; the countenance is livid or pale and cadaverous, and the muscles of the limbs and trunk are in a state of relaxation; vomiting sometimes supervenes; death is often preceded by convulsions. In cases of DISEASES. 3 73 recovery, a weakness will sometimes be left in the lower extremities, nearly approach- ing to paralysis, and the bladder will be unable to retain its contents. The following are the directions of Orfi- la for treating a case of poisoning from opium. 1st. Induce vomiting, if possible, with sulphate of zinc, sulphate of copper, or tartarized antimony. In endeavouring to induce vomiting, great quantities of watery fluids will be improper, as they dissolve the opium and promote its absorption. The vomiting should, therefore, be accomplish- ed without the administration of any more liquid than is necessary to dissolve the emetic. The operation of the emetic may be ac- celerated by tickling the fauces with the finger, a feather, &c, but as one of the ef- fects of this poison upon the stomach is to render the latter insensible to the impres- sion of emetics, much time should not be lost in vainly waiting until they shall ope- rate, when by the aid of the gum elastic tube and syringe, the contents of the sto- mach may be pumped out and fluids after- wards injected, so as entirely to wash out every portion of the poison. The patient should not be allowed to remain quiet in one position, but should be moved about between two assistants; stinging with net- tles or even the application of a cowskin has been proposed, and put in practice, un- der these circumstances, with good effect. Sinapisms on the extremities should never be neglected. The affusion of cold water is also a remedy of considerable efficacy in rousing the system from the state of stupor in which it is thrown by the effects of nar- cotic poisons, particularly the one under consideration; large pitchers or buckets of the water should be splashed from a height over the head and shoulders of the patient, or over his whole body, and persevered in until the patient indicates a return to a state of animation. The second rule of Orfila is to bleed the patient immediately after the evacuation of the opium and repeat the operation if ne- cessary. 3d. Administer now, alternately, water acidulated with any vegetable acid, and a strong warm infusion of coffee. The ex- periments of Orfila have shown that the exhibition of vegetable acids previously to the evacuation of the opium, is highly im- proper, as they accelerate and aggravate the action of the poison; after, however, the latter has been entirely discharged from the stomach, water acidulated with vinegar, lemon juice, or other vegetable acid, tends to diminish and correct its ef- fects upon the system, to which, also, the infusion or decoction of coffee is admirably adapted. 4th. In about ten or twelve hours, ad- minister an injection, and let the arms and legs of the patient be well rubbed with the flesh brush, soft coarse flannel or some sti- mulating application. Dr. Beck states that he has known the most happy results at this particular juncture, and during the lat- ter comatose stage, from repeated injections of a strong watery solution of assafoetida. So long as any ofthe opium is suspected to be retained in the intestines, purgative clysters should be continued. The residue ofthe narcotic poisons, when taken in sufficient quantities to produce deleterious effects upon the system, are to be treated on the same general principles. DIABETES. Diabetes is a considerable discharge of urine, for the most part excessive, of a violet smell and sweet taste, and attended with great thirst and general debility. It often makes its approach insidiously, and may arise to a considerable degree, and exist for some weeks without being parti- cularly attended to. It is accompanied mostly with a very voracious appetite; an insatiable thirst; a dry, harsh skin; a clammy tongue; a sense of weight, or even acute pain in the loins; and frequently with a hay-like scent or odour issuing from the body. The kidneys discharge a fluid usually very lim- pid and large in quantity, though sometimes tinged with green, like a diluted mixture of honey and water, and possessing a sweet taste, more or less powerful; the pulse is quicker than in health; the flesh wastes rapidly; and, in a very advanced stage of the disease, the feet and legs swell, and the skin becomes cold and damp. A trou- blesome costiveness frequently attends, and sometimes an affection of the lungs. The quantity of urine evacuated by dia- betic patients is generally profuse, and, in some instances, has amounted to the aston- ishing amount of sixteen or twenty quarts in twenty-four hours. This disease is occasionally to be met with in early life, but generally occurs at a more advanced period, especially in consti- tutions broken down by intemperance. The predisposing and exciting causes are chiefly such as debilitate the general system, as the abuse of spirituous liquors, cold applied to the body, immoderate evacuations, crude unwholesome diet, and the excessive use of mercury. Medical men differ respecting the imme- diate cause of diabetes, but the most gene- ral opinion is, that it is dependent upon a morbid action of the stomach and other digestive organs, which necessarily, there- fore, constitute its real seat. The distinguishing sign of diabetes is, the presence of sugar in the urine. 374 DISEASES. The most successful plan of treatment hitherto discovered, consists in a strict ad- herence to a diet of animal food, to the almost total exclusion of every kind of vege- table matter, together with the use of tonic astringent, and narcotic medicines, the most efficacious of which are, the mineral acids, particularly the nitric,—lime water,—bark, —whortleberry powder,—preparations of steel, and opium. Blood-letting, also, is sometimes advisable. In this disease, the animal salts are deficient in the urine, while sugar is secreted in considerable quantity, and these means are calculated to yield the former, and to counteract the latter, at the same time that they are capable of correct- ing the morbid action of the digestive or- gans. The nitric acid is a medicine of great im- portance, as it is both tonic and astringent, and it has, in several cases of diabetes, been found to succeed alone. It may be taken in the following way: nitric acid, one drachm and a half; barley water, nine ounces; simple syrup, one ounce: mix, and take two table-spoonfuls, in the like quan- tity of water, three times a day, gradually increasing the dose to four table-spoonfuls. The late Dr. Ferriar of Manchester, re- commends a combination of bark, whortle- berry, and opium, after having used it with success, and it is no doubt a useful formula: yellow bark, in powder, whortleberry, in powder, of each, one scruple; opium, in powder, half a grain: mix. To be taken four times a day, in a glass of lime-water. He recommends lime-water for the common beverage. Opium is, in many instances, eminently serviceable, and has been most advantage- ously employed in large doses. It can not be trusted to solely for effecting a cure, but will often prove a valuable auxiliary to the other means employed to overcome the existing irritation. The purified opium may be administered in doses of from one to three grains, three times a day, either alone, or in conjunction with the nitric acid, lime-water, bark, or any other tonic. Whatever medicine is resorted to, daily friction over the region of the kidneys, with camphorated liniment, should be per- severed in at the same time; and in obsti- nate cases, it will be advisable to try the effect of an issue made in that part. Blood-letting has been strongly recom- mended in this disease by Dr. Watt, of Glasgow, and is countenanced by many able professional men. But it is not appli- cable to those cases which are the result of advanced years and of a debilitated consti- tution. But, where the constitution does not seem seriously affected, a cautious use of the lancet may frequently be useful. It was Dr. Watt's plan to bleed to the extent of fourteen or sixteen ounces, two or three times a week, till he had made an evident impression on the complaint. HLOODY C1UNE. Voiding of blood along with the urine may be occasioned by external violence, as blows or bruises; or may be the conse- quence of violent exercise, as in riding or jumping; or it may be occasioned by the irritation of a stone in the kidney or blad- der; it may also take place without any cause that we may be able to assign. In some cases, the quantity of blood lost is very large indeed, and the debility induced is of the most alarming kind. In the treat- ment of the disease, we are to be guided by the cause. When it is occasioned by external violence, we are to diminish in- flammatory symptoms by general or topical bleedings, by giving mild purgatives, and directing the patient to drink largely of diluent liquors, to which a little nitre may be added, in order to dilute the contents of the bladder. If the symptoms lead us to believe that stone or a gravelly complaint is the cause of the disease, the primary affection must be attended to, for the treat- ment of which, see stone and gravel. The spontaneous voiding of blood is to be check- ed by the application of cold to the region of the bladder, and even by injecting cold water into the rectum. Small doses of opium may be given to allay irritation; and acids are to be employed with a view to their refrigerant effect. When blood is discharged by urine, mixed with purulent matter, twenty grains of the powder ofthe whortleberry may be given three times a day. INCONTINENCE OF CHINE. Incontinence of urine signifies the flowing out of the urine without the patient being able to prevent it. This may arise from weakness induced by various causes, as old age, palsy, the abuse of acidulous mineral waters, hysterical and epileptic paroxysms, injuries ofthe head, and comatose diseases. When it arises merely from relaxation of the bladder, the cure is to be attempted by tonics given internally, and by cold appli- cations to the parts. The tincture of can- tharides may be given, in the dose at first often drops, twice a day, gradually increas- ing it, till some pain is felt at the neck of the bladder. A blister applied to the peri- neum, or to the lower part of the back, is often very serviceable. Incontinence of urine may also arise from irritation, as that produced by a stone in the bladder, by the pressure of the child's head in the latter months of pregnancy, or from hardness and enlargement of the pros- tate gland. The removal of this diseased DISEASES. 375 state must depend on its causes. When it arises from pregnancy, it will go off upon delivery; but when from stone in the blad- der, nothing will do good but the extrac- tion of the stone. In schirrus of the pros- tate, the cure is probably impossible. Relief may occasionally be given by muci- laginous or opiate medicines; or other nar- cotics, as hemlock, especially when given in clyster. When no relief can be obtained, contrivances must be resorted to, to prevent the constant discharge of urine, and to protect the neighbouring parts from being scalded. RETENTION OF URINE. There are two different states of disease in which the urine is not passed as usual; either when it is not secreted in the kid- neys; or when, although secreted in those organs, and conveyed into the bladder, it is not discharged from that cavity. It is this last affection that is denoted by reten- tion of urine. The distinguishing symptom is a swelling at the lower part of the belly, occasioned by the distended bladder, and this accompanied by pain on pressure, fever, and deficiency of urine, either total or par- tial. Sometimes, the bladder may be dis- tended, although there be a partial flow of urine, and without great care, the practi- tioner may be deceived by this circumstance. If violent efforts take place, some portions of urine may be expelled, and the patient may be supposed merely to labour under a strangury. By examination of the lower belly, and the introduction of the catheter, the disease may almost always be ascertain- ed. Retention of the urine may arise from palsy of the bladder, which is not an unusual eccurrence in advanced life. Palsy of the bladder may be owing to a person not eva- cuating the bladder when nature prompts him to do so. Retention of urine occurs also in bad typhus fevers. It comes on sometimes gradually, with a degree of de- bility which hinders the patient from com- pletely emptying the bladder, so that he still feels a desire to do so. The inconve- nience increases; at length, the patient is unable to discharge any urine, and the blad- der rises above the pubes. The urine is to be drawn off by the catheter, and when this relief is given, it is not unusual for the bladder to recover its tone; pretty speedily, wlien the complaint has come suddenly on, and more gradually, when it has been gra- dual in its progress. In addition to the re- gular emptying of the bladder, we are to try the effect of cold applications to the parts, and of blisters to the sacrum. The urine may be retained by inflammation of the neck of the bladder. Here the symp- toms are acute and urgent, and demand the employment of the antiphlogistic regi- men; bleeding, general and local, clysters emollient drinks and anoxiynes, with the in- troduction of the catheter; and if the urine is not drawn off by it, we must puncture the bladder. For the method of doing this, we refer to books of surgery. surniEssioN of urine. Suppression of urine signifies, that the* kidneys do not secrete the urine in the same quantities as formerly. The remedies adapted to this complaint, when it is an original one, are bleeding, diuretics, as cream of tartar, the sweet spirits of nitre, squill, the warm bath, &c. If the suppres- sion of urine arises from fever or other complaint, our attention is to be directed to the primary disease, as well as to that particular symptom. STRANGURY. This is a frequent desire of making water, attended with much difficulty and pain in voiding it. It arises from various causes, as an inflammation of the urethra, of the neck of the bladder, or other neigh- bouring parts, the application of a blister when the matter of the cantharides is taken into the body, the internal use of canthari- des in powder or in tincture, excess in ■ drinking vinous or spirituous liquors, or from gravelly particles in the passage. It is sometimes a symptom of gout, and very often arises from disease of the prostate gland. When strangury is owing to the application of a blister, the patient should drink plentifully of diluent liquofs, as bar- ley-water or thin gruel, to which a little nitre or other diuretic medicine may be added. In severe cases, fomentations to the urethra and neighbouring parts may be required; and it will be proper to use clys- ters to evacuate the bowels, as the accumu- lation of feculent matter must increase the strangury, from whatever cause it originates. If the strangury is an attendant on inflam- mation of these parts, it must be treated by local blood-letting, by leeches, by cooling purgatives, by fomentations, the warm bath, &c.; and if from spasm, an opiate by the mouth or by clyster, will be proper. If the strangury proceeds from organic disease, it will be the business of the surgeon to as- certain the cause, and to apply the proper remedies; while care must be taken not to add to the disease by the use of improper drinks or articles of diet, as wines, or ardent spirits, rich meats, acrid salts, aromatics, or the like. DYSURIA. Pain or difficulty of passing urine. This may arise from various causes, and requires to be treated accordingly. If from inflam- 376 DISEASES. mation of the passage, this is to be removed by local bleeding, by purging, and the other remedies proper in such cases; if from spasm, this is to be relieved by opium, the warm bath, or other antispasmodics; if from stone in the bladder, this is to be primarily at- tended to. Dysuria is often very trouble- some to children. The pain appears to be very great, as they shriek long and violent- ly, and seem ready to go into fits, but on getting the urine passed they instantly be- come quiet. The prejudices of nurses are in favour of giving gin on such occasions, which invariably proves injurious. A little very thin gruel, with a few grains of the carbonate of potash, and a drachm of the spirit of sweet nitre, may be taken. The bowels are to be kept open by manna or castor oil; and in the paroxysms of pain, the child is to be put into the warm bath up to the waist, or to have fomentations and gen- tle friction applied to the lower part ofthe belly. DISEASES OF MENSTRUATION. Though the general period of the com- mencement of menstruation is about four- teen, it may, from particular circumstances, and in certain constitutions, not make its appearance for some time after that period. Provided the health does not suffer, there is in reality no occasion for alarm or anxiety, although the term should be later by a year or two in one girl than in another; but it is difficult to persuade women themselves of this; and they are apt to ascribe every ill- ness or uneasy feeling to the non-appearance of this discharge. It sometimes indeed hap- pens, that a veiy great degree of sickness and loss of health occur in young women who are long of menstruating; and in the article green sickness, we shall detail the symptoms and treatment of persons in that situation. The non-appearance also gives rise to cough and various sympathetic affec- tions; so that both the patient herself and her friends and medical attendants, are al- ways very glad when the womb assumes its healthy action; and they look forward to the establishment of this as affording hope of relief from many ailments that afflict fe- males about that age. Every means, there- fore, that is consistent with prudence and propriety, ought to be used to bring on healthy menstruation, when it seems too long delayed. Of those, the best are such as contribute to the general health and vigour of the system, such as a mild, nourishing diet; the tepid, or warm bath; gentle exer- cise, either on horseback or on foot, &c. The bowels are to be particularly attended to; and purgatives are sometimes, by sym- pathy, very effectual in bringing the uterus into action: of these, none are more benefi- cial than aloes, and the various pills of which aloes forms a principal ingredient. Symptoms must be palliated as they arise. The cough is to be treated by squill, by bleeding, or a blister; we are to discrimin- ate as accurately as we can between it and consumption, and apply the proper reme- dies, as before directed. When the menses do begin, it may be a year or two before they go on in a proper manner; the interval may be two, three, or four months, the quantity variable; and this, for some time, may consist with good health, and at last, the regular monthly period may be established. Matrons should pay par- ticular attention to the conduct and manage- ment of their young friends at this period. Any irregularity, which, at another time, might have passed with impunity, will now be productive of serious consequences, and may lay the foundation of ill health, and give a shock to the constitution from which it will not recover. Wet feet are to be con- sidered as peculiarly dangerous; sometimes they check the discharge altogether, some- times they give rise to a copious and debili- tating flow. Suppression ofthe menses. Independent- ly of pregnancy the menses may be check- ed or suppressed after their first establish- ment. The most frequent causes of this obstruction are cold, passions ofthe mind, or diseases. We are to endeavour to bring them back by remedies adapted to the oc- casion, by warm fomentations, purgative medicines, bleeding, opiates, or tonics; va- rying our plan according to circumstances, and using means more especially about the time when we may expect the efforts of nature to co-operate with our endeavours. The effects produced by suppression on the constitution are various; in many cases it may give" rise to fulness of blood; and re- lief is then only to be obtained by bleeding, low diet, bathing the feet in warm water, and moderate doses of sulphate of magnesia or Epsom salt. When accompanied with great debility, we must follow the same plan in obstruction, as we do in the non-ap- pearance ofthe menses. Immoderate flow of the menses. A too copious discharge of blood from the womb is a frequent complaint. It may continue for a much greater number of days than it ought to do, or its quantity may be exces- sive. This is a state of menstruation very difficult to cure, and productive of very de- bilitating effects on the body. The coun- tenance of the woman becomes pale and haggard; there is a dark circle round the eyes, an aversion to motion, and great sus- ceptibility of fatigue on slight exertion. The stomach is out of order, the bowels are slow, the lymphatic system is torpid, and symptoms of threatening dropsy appear. We are to order the patient to observe the utmost ouietness to; keep in the horizontal DISEASES. 377 posture; we are to give gentle laxatives, in order to prevent all straining at stool; to direct some mild astringent medicine, as the infusion of rose-leaves with a little sul- phuric acid, or the elixir of vitriol. If there be much heat and strength of pulse, we suppose that there is too great a determina- tion of blood to the uterine system, and we shall give great relief by using the lancet. When one period of copious discharge is got over, our care should be to prevent the next from being equally so. This is to be done by avoiding fatigue in the interval, by moderation in diet, by avoiding costiveness, by losing a little blood from the arm, if there be too great fulness or inflammatory tendency in th^e system, and by a prudent use of sulphuric acid and other astringents, as alum whey. A drachm of alum will cur- dle a pint of milk; a few ounces of the whey sweetened to render it palatable, may be taken as often as the stomach will bear it. Difficult or painful menstruation. A state of menstruation different from the former, consists in a very difficult and painful per- formance of that function. It is to be treat- ed by fomentations to the belly, back, and loins; by giving opiates during the severity of the pain; by avoiding cold; by giving medicines which promote perspiration, and encouraging it by giving diluent drinks, and keeping in bed. In some cases, instead of a fluid discharge every month, there is formed a membra- nous substance, which is expelled with great pain, and which, when carelessly looked at, has the appearance of an abor- tion. It is of great consequence for practi- tioners to know this, as an innocent and virtuous person might be suspected unjust- ly. When the uterus has put on this ir- regular action, it is believed that the woman can not conceive; but there are some cases that show this not to hold universally. A great variety of medicines have been tried for the cure of this affection, but none are to be depended upon. If curable at all, it is generally by the efforts ofthe constitution itself. Medicines are to be given to palliate pain, debility, costiveness, or any other ur- gent symptom. Cessation ofthe menses. The time of life at which this discharge ceases, differs in different women, but it usually does so between the age of forty-two and forty- six. The symptoms which occur, also vary much; in some it stops at once, with- out any disorder of the constitution; in others, it returns after uncertain and irregular intervals, and in variable quantity, for months or years, before it finally stops. Though many women, at this period, have a great variety of ailments, these are rather to be considered as indications of a change occurring in the constitution, than as de- pending altogether on the diminution or absence ofthe discharge. They who have not enjoyed regular good health, they who have not borne children, or who have been weakened by frequent miscarriages, gene- rally suffer most at this period of life. To others, again, who, during that part of their lives when menstruation went on regularly, had much pain, or were troubled with ner- vous disorders, the cessation of the dis- charge is an era which brings them better health than they ever enjoyed before. If no bad symptom occur at this time, there is no call for any interference by regimen, by evacuations, br any other way; but if there be symptoms of fulness, or tendency to fe- verish complaints; if there be headache, flushings of the face, or of the palms of the hands, with restlessness in the night, pains in the loins or belly, or eruptions on different parts of the body; such fulness must be brought down by spare living, proper exercise, laxative medicines, and occasional blood-letting; taking care not to create a habit of using this last evacuation. GREEN SICKNESS. Chlorosis, or green sickness, is a com- plaint which occurs chiefly in girls about the age of fourteen years, and is character- ized by a pale, blanched complexion, lan- guor, listlessness, depraved appetite and indigestion, and the non-appearance of the monthly discharge. It is called green sick- ness from the pale, livid, and greenish cast ofthe skin, so commonly present. The symptoms consist chiefly in a gene- ral sense of oppression, languor, and indi- gestion. The languor extends over the whole system, and affects the mind as well as the body; and hence, while the appetite is feeble and capricious, and shows a desire for the most unaccountable and innutrient substances, as lime, chalk, &c, the mind is capricious and variable, often pleased with trifles, and incapable of fixing on any serious pursuit. The heat of the skin is diffused in-egularly, and is almost always below the point of health; there is, conse- quently, great general inactivity, and parti- cularly in the small vessels and extreme parts of the body. The pulse is quick but low, the breathing attended with labour, the sleep disturbed, the face cold, the nos- trils dry, the bowels irregular or confined, and the urine colourless. There is also, sometimes, an irritable and distressing cough; and the patient is thought to be on the verge of consumption, or perhaps to be running rapidly through its stages. Con- sumption, however, does not follow, nor is the disease found fatal, although it should continue, as it has done not unfrequently, for some years. The principal cause is indigestion occur- ring at the age of puberty, combined with 37H slow degrees, and give little inconvenience; '" or it may discharge fetid matter, and give , rise to frequent debilitating discharges of blood; or hectic comes on, and the patient J sinks in a miserable manner. * If inversions be discovered early, the uterus may be replaced. If it have protru- r ded out ofthe vagina, it is, first of all, to be returned within it; if it have not, we pro- ceed directly to endeavour to return it, by cautiously grasping the tumor in the hand, and pushing it upwards. If we push di- DISEASES. 381 rectly, without compressing the tumor, we sometimes bring on violent bearing down pains. These are occasionally attended with increase or renewal of flooding. If we succeed, we should carry the hand into the uterus, and keep it there for some time, to excite its contraction. If inversion has not been discovered early, it is more difficult, nay, sometimes impossible to reduce it, owing chiefly to contraction of its orifice. In such cases, it is not prudent to make very violent efforts, as these may excite convulsions. We must in every instance alleviate urgent symptoms, such as fainting, retention of urine, or inflammation, by suitable means. When the uterus can not be replaced, we should at least return it into the vagina. We must palliate symptoms, apply gentle astringent lotions, keep the patient easy and quiet, attend to the state of the blad- der, support the strength, allay irritation by opiates, and the troublesome bearing down by a proper pessary. If inflammation come on, we must prescribe blood-letting, laxa- tives, &c. In this way, the uterus con- tracts to its natural size, and the woman menstruates as usual, but generally the health is delicate. POLYPI IN THE WOMB. These are of various sizes and consisten- cy; they are sometimes broad and flat at their base, sometimes they have a narrow neck. They occasion a discharge of blood at times; but when small, they are not pro- ductive of much inconvenience. But if they become large, they give rise to symp- toms both troublesome and dangerous. There is violent bearing down pain, dis- charges of blood, or of fetid dark coloured matter from the vagina, pain or difficulty of making water, irritation of the rectum, and a frequent desire to go to stool. When very large, the polypus hangs out from the passage. If the disease be not relieved, the pains become more violent, the consti- tution is affected, and the continual dis- charge greatly weakens the patient. As the patients themselves can not dis- tinguish tumors from other diseases pro- ducing similar symptoms, their existence must be ascertained by the examination of a practitioner; and their removal effected by a surgical operation, either by the knife or by ligature, performed by a surgeon well acquainted with the structure and connexions of the parts. No internal reme- dies will do any good till the tumor is re- moved. When this is accomplished, the general health is to be improved by proper diet and tonic medicines. CANCER OF THE WOMB. Cancerous affections of the womb, when in a state of ulceration, constitute one of the most deplorable diseases which can af- flict humanity. Cancer of the womb most generally attacks at the decline of life, though not exclusively so. At first, the patient has an uneasy feeling of weight at the lower part of the belly, with heat or itching. Afterwards, shooting pains occur; then a pain, giving a gnawing, burning sensation, seems fixed in the region of the womb. This pain is attended by the dis- charge of ill-coloured, sharp matter, which irritates and corrodes the neighbouring parts. As the disease continues, almost every function of the body becomes disor- dered. Sickness and vomiting come on, the bowels are torpid and irregular, hectic fever, and great emaciation ensue, and the spirits are dejected and desponding. Swell- ings of various glands, and watery swellings of the limbs not unfrequently occur. Simi- lar symptoms as in the early stages of can- cer, may arise from other complaints in the womb, as from polypous growths; the na- ture of the disease should therefore be, if possible, ascertained at an early period, that the one may be removed, and the other kept from rapid advancement and ulcera- tion, so far as we are able. Cancer in the womb appears to begin with a thickening and hardness of that organ; which we sus- pect, when there are pains in the thighs and back, a bearing down when the patient is using exercise, and occasional discharge of clotted blood. Our directions to the patient in such cases, are to use a milk and vegetable diet, to abstain from animal food and distilled or fermented liquOrs, to lose a little blood occasionally, to take frequently a dose of laxative cooling salts, and to use the warm bath. Ofthe nature of cancer ofthe womb, we are as ignorant as of cancer in any other part of the body; and when the disease is established, we are as destitude of any re- medy. In the periods of deplorable suffer- ing which terminate with the life of the pa- tient, we can do little more than palliate symptoms; and the whole tribe ofnarcotic medicines have been brought into requisi- tion on such occasions. Opium, belladonna, hemlock, and various others, have been tried, and failed. Mercury, in every shape, is absolutely pernicious in cancer. The melancholy distress to which pa- tients are reduced by cancer of the womb, disposes the minds both of themselves and their friends to listen with eagerness to the promises of relief, which ignorant and in- terested empirics so liberally make to them. But all such promises must be met with the most obstinate incredulity. The learned, the experienced, and the candid members of the medical profession declare, that, as yet, no drug has been found capable of curing cancer by acting on the constitution; and whoever suffers herself to be deluded 382 DISEASES. by the boasts of those whose only aim it is to vend their nostrums, loses the time that might be better employed, and neglects those suggestions which might palliate, though they can not cure her complaints. RIIECMATISM. This complaint is divided into two spe- cies, the acute and chronic rheumatism, which, as they differ, in some measure, in their symptoms and treatment, will be treated of separately. Acute Rheumatism. Acute rheumatism consists in pain, inflammation, and swelling usually about the larger joints and surround- ing muscles; which symptoms often wander from one part to another; the urine deposits a red sediment, and the accompanying fever is in general inflammatory. Acute rheumatism usually commences with languor, chilliness succeeded by heat, thirst, restlessness, and a quick pulse; there is also a sense of weight, coldness of the limbs, and confyied bowels. In the course of a day or two, inflammation, with acute pain, tumor, and tension, makes its appear- ance in one or more of the larger joints of the body. The pain is frequently transitory, and apt to shift from joint to joint, leaving the part previously occupied, swollen, red, and extremely tender to the touch. The pulse now becomes full and hard; the blood, when drawn from a vein, is cupped, exhibiting the inflammatory surface; the tongue preserves a steady whiteness; the bowels are commonly very costive; the urine high coloured; and often there is a profuse sweating, unattended by relief. Sometimes, however, the pain is the first symptom, and the fever follows. When the pain is not very severe, and confined to a few parts, the fever is slight; when it is severe and felt in many parts, the fever is more considerable, and it is most so when the pains extend over the whole body. Both the pain and fever generally suffer an increase in the evening, and a remission towards morning. The pains are much in- creased on the slightest motion requiring the action of the muscles affected, and are most severe, as well as most apt to shift their place, in the night time. The fever abates sooner than the local symptoms, and is rarely protracted beyond a fortnight or three weeks. The pains, for the most part, are the last symptom which leaves the patient. They often begin to abate about the eighth or tenth day, but frequently continue, with more or less severity, to the thirtieth or fortieth. Sometimes they con- tinue for months or even years. Cold or damp applied when the body is heated, is the most usual cause of rheuma- tism; and the young and vigorous, and those between the age of puberty and thirty-five, are most subject ta it. It is more frequent in the beginning and to- wards the end of winter, than at any other season. Persons who arc full of blood are fre- quently attacked by it, and whatever occa- sions a sudden fulness of habit may be ranked among its exciting causes. The only disease with which rheumatism is liable to be confounded is gout, (tout, however, is preceded by more evident symptoms of indigestion; comes on more suddenly; attacks the smaller joints; and has not so strongly marked an increase of the fever and other symptoms at night, as we witness in acute rheumatism. The chief remedies in the inflammatory or acute rheumatism are, blood-letting, mild purgatives; diaphoretic or gentle sweating medicines; calomel, opium, and emetic tartar combined, and the wine of meadow- saffron; and, if they are skilfully employed, they very generally procure a satisfactory termination of the disease in a moderate time. In the commencement, the fever is in general considerable, and sometimes vio- lent, when the patient should be bled from the arm to the extent of from ten to sixteen ounces, which may be repeated every day to the second, third, or fourth time, accord- ing to the severity ofthe fever, and the age and strength ofthe patient. A mild purge, as a dose of Epsom salts, or the following draught: Epsom and Glauber's salts, of each, two drachms; mint water, an ounce and a half; tartar emetic, two grains; tinc- ture of senna, two drachms, should follow the bleeding-, and may be continued every other morning until the bowels are fully evacuated; the following medicine being given every three hours during the day: powdered nitre, one. drachm; tartar emetic, two grains; calomel, twelve grains; for twelve powders. Together with these remedies, a dose of Dover's powders may be given every night at bed time. It relieves pain and inflamma- tion, and sometimes has much influence in shortening the term ofthe disease. In respect to general blood-letting, it ought to be observed, that it should not be employed for the purpose of relieving pain, when the general excitement does not war- rant it. It is the activity of the heart and arteries alone which is to direct us in the use of the lancet, the abstraction of blood in acute rheumatism being always propor- tioned to the force and hardness of the pulse. It must also be regulated, in a great measure, by the age, strength, and habits of the patient, and his residence, whether in town or country, ought to be considered. If the patient be young and vigorous, two or three bleedings will generally be follow- ed by much relief, if the first abstraction of blood is not found sufficient; and the repeti- DISEASES. 383 tion of the blood-letting will be still more necessary and useful when a free and lux- urious mode of living is added to youth and strength. Patients who enjoy the ad- vantages of a healthful country residence, will bear bleeding in this disease much better than those who inhabit populous cities, or marshy districts. In conjunction with general blood-letting, as well as in those cases in which bleeding from the arm is not deemed advisable, the free ap- plication of leeches to the part affected will be productive of the most decided re- lief. After the disease has been treated in this way for a week or ten days, should the pains still continue severe, the wine of meadow saffron may be administered. This medicine is not applicable to-the beginning of the complaint, but towards the decline it is frequently of much service in allaying pain and inflammation in the joints; but it must not be used very freely. Forty or fifty drops of it may be taken in any agree- able vehicle, twice a day, when the pain is violent; or it may be taken in the following form: solution of acetate of ammonia, half an ounce; wine of meadow saffron, forty drops or half a drachm; syrup of poppies, a drachm; camphor mixture, an ounce; to be taken every six hours, while the pain requires it. "When the fever has been subdued by the foregoing means, and some days have elapsed from the first attack of the malady, the best course is, to give the opening medicine recommended above, three or four times a week, with a pill of one grain of calomel, a third of a grain of opium and one sixth of a grain of emetic tartar, every night and morning. As a local application to the swollen and inflamed joints, the simplest is the best, such as fomentations with lukewarm water, or a mixture of four ounces of spirit of wine and eight ounces of camphor mixture, after the fever has abated. For any stiffness or chronic pains left in the joints after the dis- ease has been removed, bathing the parts with lukewarm salt and water, and then rubbing them once a day with some stimu- lating liniment, will generally be the most effectual means of removing those symp- toms. When convalescent, the patient should likewise resort to moderate exer- cise, both within doors and in the open air; and, as soon as his strength will permit, a walk of several miles, every other day, will be found of eminent service in restoring use to the limbs, and perfecting the recovery. The diet ought to be very spare in the commencement, and throughout the dis- ease mild and diluting, consisting chiefly of milk whey, and the usual farinaceous de- coctions, as barley water, toast water, thin gruel, &c. As he becomes convalescent, he must gradually return to a more nourish- ing diet of eggs, bread, biscuit, &c. and finally, ofthe lighter species of animal food. The temperature of the patient's room should be as uniform as possible, and of a moderate warmth. Some think he should be laid in blankets, but this is, in general, improper. Chronic Rheumatism. Chronic rheuma- tism differs from acute in being attended with little or no fever or inflammation, the chief symptoms being pain and swelling in the larger joints, and in the course of cer- tain muscles. The latier is clearly the same disease as the former, consisting in an inflammatory action of the tendons and ligaments, but of a less intense grade. The chronic species becomes fixed most frequently in the loins, hip, knee, and an- kles, but every large joint is liable to its attacks. The general heat of the body seldom exceeds the natural temperature, and the pulse is rarely quicker than eighty strokes in a minute; the joints are swollen, but not to so great a degree as in the acute species, being of a pale hue, cold and stiff, roused with difficulty to perspiration, and always comforted by the application of warmth. The same causes give rise to this as to the acute species; and violent strains and spasms will cause chronic rheumatism where the constitution is peculiarly disposed to the malady. As we have just remarked, no difference exists between the two forms of the disease, excepting in the degree of inflammation by which they are produced, and the greater deviation of the parts affected in the chronic species, from their natural condition; it is evident that the treatment will not differ much in the earlier stages of chronic rheu- matism from that laid down for the acute variety. Bleeding from the arm, however, will seldom be required, but cups or leeches to the affected joints will often be proper and decidedly beneficial. The bowels, at the same time, should be kept free by the use of mild purgatives; any of those directed in gout may be employed. When the dis- ease has been of long standing, and the patient much debilitated, the most effica- cious remedies are those of a warm bal- samic nature, and which promote the in- sensible perspiration; such are guiacum, turpentine, camphor, cajeput oil, mustard, and the compound ipecacuanha powder. Lqcal stimulants are likewise often of great service, more especially the stimulus of gal- vanism and electricity. In the whole catalogue of medicines re- commended for the relief and cure of rheumatism, there is none more appropriate and useful than Dover's powder, for it is eminently serviceable in relieving the pains, disposing to sleep, and keeping up a gentle 384 DISEASES. and salutary discharge from the skin, which of all others, is the evacuation affording most benefit in cases of this description. Four grains of this powder may be made into a pill with a little extract of gentian, and given three or four times a day; about a quarter of a grain of aloes being added to each pill, to prevent costiveness. At the same time, the affected parts may be rub- bed thrice a day, for a quarter of an hour, with one of the following liniments: water of ammonia, one ounce; olive oil, two ounces; or, an ounce and a half of the above, with the addition of half an ounce of spirits of turpentine; the painful joints be- ing always wrapped in flannel. If the pains are very severe, and the patient's general health appears deranged, a grain of calomel, two grains of the antimonial powder, and a grain of opium, may be made into a pill with a little conserve, and taken every night at bed time. This pill will sometimes be found of great value. In addition to these means, a tepid bath at ninety degrees should be used every other morning, for about half an hour or forty minutes; or a trial be given to the air pump vapour bath, if within the patient's reach. Next in efficacy to the Dover's powder, is the volatile or ammoniated tincture of guiacum, which may be tried in doses of thirty, forty, or fifty drops, every four hours, dropped on sugar, or taken in milk and water. The liniment being applied locally, and the calomel pill taken at night, with the warm bath occasionally, as just advised. If these fail, the oil of turpentine may be taken internally, and is sometimes very useful. Half an ounce of this oil may be mixed with an equal quantity of sweet spirit of nitre, of which mixture a tea- spoonful, three times a day, in any agree- able vehicle, is the proper dose. Should the complaint prove particularly obstinate, which is not uncommon, a trial may be made ofthe following pills, instead of those made with the Dover's powder alone.- compound ipecacuanha powder, thirty-six grains; extract of hemlock, pre- pared in vacuo, one drachm; gum guiacum, in powder, twenty-four grains; aloes, in powder, four grains; divide into twenty- four pills. Two or three to be taken three times a day. Of course the liniments before recom- mended, with the calomel pill at night, and the warm bath, must not be neglected while taking these pills. The arsenical solution is a medicine which has been highly recommended by Dr. Bardsley, of England, and others; but, from its activity, it ought not to be used till the foregoing remedies have failed of suc- cess. It is, in general, of no use in recent cases, and in young persons; but in the long standing attacks in old subjects, it will sometimes perfectly succeed after every previous expedient has failed. The meadow saffron has been much ex- tolled of late years by some respectable practitioners. It is certainly much more applicable and safe in chronic rheumatism than in the acute species, or gout. If it be used moderately, and in conjunction with .the other approved remedies here noticed, it will often be of much service; but if trusted to alone, and incautiously employed in large quantities, it can hardly fail to "be injurious. In such large quanti- ties, it will, undoubtedly, mitigate the pa- tient's sufferings, but it will also irritate his stomach, and disturb his digestion. Thirty or forty drops of the wine of meadow saf- fron may be taken, twice a day, mixed with five grains of magnesia, and two ounces of water. The local stimulants of most service here, are liniments composed of ammonia; as, water of ammonia, one ounce; olive oil, two ounces: or the foregoing with the addi- tion of one ounce of spirits of turpentine; or the burning of moxa, and electricity or galvanism. Whatever liniment is applied to the affected parts, it should be rubbed in frequently, and with active friction, by the patient himself. The friction can hardly be too long continued at one time, or too frequently resorted to, for it has alone wrought wonders in desperate cases. Dr. 1 Balfour, of Edinburgh, has published a use- ful book on the good effects of friction and compression in rheumatism, in which he relates numerous examples of its efficacy in ■; the worst cases. Admiral Henry, of Eng- j land, was almost a cripple from a very pro- j tracted attack of chronic rheumatism, and \ he cured himself by the steady use of fric- 1 tion alone. Besides-the hand he employed .•■ small pieces of wood, rounded at the top, '| with which he used to rub and compress the stiff and painful parts. In severe and * obstinate instances, the moxa may "be tried, m which has sometimes been very successful 1 in removing stiffness and pain in inveterate •M forms of this malady. ^1 Electricity, in the form of aura or sparks, 1 or in slight shocks, is worthy of much con- ' fidence; and the same may be said of gal- I vanism. The operation of galvanism is , more soothing and agreeable to most per- Lj sons than that of electricity, and, perhaps, I is commonly more efficacious here. It has, 1 undoubtedly, effected great and salutary J changes in this painful complaint, and ought J not to be neglected if the more common plans of treatment fail. The vapour bath is also of eminent ser- vice in many cases. It may be used at about one hundred and ten degrees, once or twice a week. By promoting a free per- | spiration it greatly relieves the internal parts. " DISEASES. 385 The air pwnp vapour bath has been found of remarkable service in many extreme cases of chronic rheumatism, even when accompanied with stiffness and contraction of the joints and muscles, and after the va- pour bath, applied in the usual manner, had failed to produce any beneficial effects. The air pump bath is a local application to the parts immediately affected, and com- bines the powers of the most effectual fo- mentations with those of dry cupping; so that by removing the weight of the atmos- phere from the injured parts, and promoting a free perspiration at the same time, it re- solves its obstruction, imparts a freedom to the local circulation, and effectually assists nature in her efforts to change the diseased condition of action present, for one that is healthy. If the case requires it, it may be used alternately with galvanism, and these remedies united, are, in some obstinate cases, much more efficacious than either of them employed alone. The tartar emetic ointment, rubbed near the seat of any fixed and severe rheumatic pain, will bring out a. large crop of pus- tules, and sometimes afford essential and prompt relief. Acupuncturation has lately been recom- mended in this disease, and may be tried in severe cases, where the preceding re- medies fail. It consists in making a small puncture in or near the part of the body affected, with a long needle. The puncture produces little or no pain, and should be followed by no bleeding. A single punc- ture is sometimes found sufficient to re- move pain; and if it shoots to another part, that is punctured in the same way as the original seat of the irritation. Now and then, acupuncturation appears to have been followed by very striking advantages; but, in general, the improvement of the general health must be attended to at the same time. The best remedies for chronic rheuma- tism originating in a syphilitic affection, or accompanying secondary symptoms, are, a pint of compound decoction of sarsaparilla, taken in divided doses during the day, with an alterative pill, every night, or every other night; either ofthe following may be employed: calomel, ten grains; emetic tar- tar, two grains; guiacum, one scruple; to be made into ten pills with a little simple syrup; or, blue mass, half a drachm; ipeca- cuanha, five grains; soap, ten grains; ex- tract of belladonna, three grains; to be made into ten pills. At the same time, we should recommend the warm bath at ninety- five degrees, thrice a week, country air, and a mild, nutritious diet. The clothing should be warm, and the diet light and nutritious, but moderate in quantity, so that the stomach may never be overloaded. As an article of clothing for the rheumatic, an under waistcoat of cha- mois leather is, generally, of very great service, and sometimes proves of the most striking advantage. If the lower extremi- ties of the body are much affected, drawers also, made of the same material, should be worn. This leather washes like linen, only it must not be washed in hot water. For the first day or two, it usually-feels cold and uncomfortable, but soon becomes more comfortable than flannel. It is proper to have several sets, and to change them fre- quently. Before concluding this article, it is neces- sary to apprise the reader that we frequent- ly meet in practice with flying or fixed chronic pains, attended by stiffness, which imitate rheumatic pains, but are owing to a disordered state ofthe stomach and bowels; indeed, some of these cases may be correct- ly called rheumatic. In such instances, the symptoms of indigestion will generally pre- sent themselves more or less clearly mark- ed, and the most effectual remedies will be those pointed out under that complaint, especially the alterative pill, directed above, every night, with a light bitter infusion and carbonate of soda, as follows: compound infusion of gentian, five ounces; carbonate of soda, two scruples: dose, two or three table-spoonfuls every three hours, in a tum- bler of water, through the day; the bowels being kept regular by the following pills; aloes, ten grains; soap, ten grains; ipecacu- anha, three grains; gamboge, ten grains, for ten pills, one for a dose; to be repeated every three hours. Another valuable plan in these particular instances is, to take half a pint of the compound decoction of sarsapa- rilla, twice a day, with five grains of blue pill and five of extract of hemlock, made into two pills, every night. If the pains are severe, the patient may increase the quantity of hemlock here ordered, and take ten grains of it, once or twice a day, with five grains ofthe blue pill in the whole, daily. Whatever medicine be resorted to, the diet and regimen laid down under dys- pepsia must be attentively pursued; con- siderable exercise on foot or horseback be- ing taken every day, with friction, early rising, &c. GOUT. There is a very great difficulty in pre- senting a definition of this affection, which shall be applicable alike to all its varying forms. In its common and most genuine character, it may be defined a disease, the predisposing to which is very frequently hereditary, marked by a violent pain, for the most part in the ball or first joint of the great toe, with redness, tumor and general febrile symptoms, returning at intervals; the attacks being preceded by evident 3S6 DISEASES. symptoms of a deranged condition of the digestive functions, and when these termi- nate, leaving the patient in his ordinaiy state of health. The local affection fre- quently alternating with disease of the sto- mach and other internal organs. Gout may be divided into three varieties, the acute, the chronic and the relrocedent. Gout sometimes comes on very suddenly, particularly in its first attacks. In general, however, the inflammation of the joint is preceded by various symptoms indicating a want of vigour in different parts of the body. The patient is incapable of his usual exertions, either of mind or body; becomes languid, listless, and subject to slight fever- ish attacks, especially in the evening; he complains of pains in the head, coldness of the feet and hands, impaired appetite, flatu- lency, heartburn, spasms of the stomach, and the usual symptoms of indigestion. He is oppressed with heaviness after meals, and a disturbed, unrefreshing sleep ensues. The bowels are seldom regular, being cither constipated or too much relaxed; the mind, at this period, being generally irritable, anxious, and alarmed at the least appearance of danger. A deficiency of perspiration in the feet also, with a distend- ed state of their veins, cramps, and numb- ness of the feet and legs, and other strange sensations, often presage the approaching fit. The duration of these symptoms, pre- vious to the fit, is various; sometimes only a day or two, at other times, many weeks. The fit sometimes makes its attack in the evening; more commonly, about two or three o'clock in the morning. The patient goes to bed free from pain, and is awaken- ed about this time by a very acute pain. generally in the first joint of the great toe, the pain often resembling that of a dislo- cated bone, with a sensation as if hot water were poured on the part. It sometimes extends itself over all the bones of the toes and fore part of the foot, resembling the pain occasioned by the tension or lacera- tion of a membrane. Cold shivering is felt at the commencement of the pain, which is succeeded by heat and other symptoms of fever. The pain and fever increase, with much restlessness, till about the middle of the succeeding night; after which they gradually abate, and in the most favourable cases, there is little either of pain or fever for twenty-four hours after their first ap- pearance. The patient, as soon as he ob- tains some relief from pain, generally falls asleep, a gentle sweat comes on, and the part which the pain occupied, becomes red and swelled. In most cases, however, the pain and fever return on the succeeding night with less violence, and continue to do so for several nights, becoming less severe till they cease. buch is a simple fit of acute gout. But it often happens, that after the pais has abated in one foot, it attacks the other, where it runs the same course; and in those who have laboured under repeated attacks of the disease, the foot first attacked is often seized a second time, as the pain in the other subsides, which is again attacked in its turn, and they are thus alternately af- fected for a considerable length of time. In other cases, it seizes on both feet at the same time. After frequent returns, it be- gins to seize upon the joints of the hand, and at length the larger joints. When the gouty tendency is very great, almost every joint of the body suffers; the pain, when it leaves one, immediately fixing in another. In strong people, the whole fit is gene- rally finished in about fourteen days. In the aged, and those who have been long subject to the gout, it generally lasts about two months; and in those who are much debilitated, either by age, or the long con- tinuance of the disease, till the summer heats set in. In the first attacks, the joints soon recover their strength, and suppleness; but after the disease has recurred frequent- ly, and the fits are long protracted, they remain weak and stiff, and at length lose all motion. The above are the symptoms of acute or regular gout. Chronic gout, (which is by some physi- cians called irregular gout,) is the disease of a weakly or debilitated constitution. Here the inflammation and pain are more slight, irregular, and wandering, than in the acute; there is only faint redness ofthe affected joint, or no change at all from the natural appearance of the surface; much permanent distention of parts, or continued swelling, with impaired moving power; and no critical indications of the disease termi- nating. The symptoms are always asso- ciated with a disordered state of the diges- tive organs, a languid or oppressed circula- tion, and much nervous irritation in the system. The patient is distressed with va- rious uneasy sensations in the stomach, as flatulent distention, craving or deficient appetite, heartburn, &c.; the bowels are either costive, or too much relaxed; flutter- ing sensations are often felt about the heart; the painful sensations felt in the affected part are rather those of heat and coldness alternately, than of the more continued burnings which take place in the acute form of the disease: the spirits are depress- ed, and the mind very irritable. The subjects of chronic gout are gene- rally such as have, for a considerable time, laboured under regular attacks ofthe acute form of the disease; this, however, is not universally the case; for in some weakly or enfeebled constitutions, the gout soon be- gins to assume the chronic form. Retrocedent gout is that form of the dis- DISEASES. 3S7 ease in whfch the morbid action is suddenly transferred from the joint, or other external part affected, to some internal organ, as the stomach, intestines, head, &c. Whatever tends to produce an unhealthy fulness of the blood-vessels, disorder the digestive organs, and impair the vigour of the system, may be ranked among the causes of the gout. Perhaps the principal causes are an indolent and luxurious life, or a sedentary and studious one; hereditary predisposition; anxiety or vexation of mind; excessive evacuations of any kind; cold; a flatulent diet, or immoderate indulgence in fermented or acid liquors; the suppression of any accustomed discharge; sudden ex- posure to cold when the body is heated; wet applied to the feet; costiveness; a vari- able climate. These may act both as pre- disposing and exciting causes. It seems indisputable, that the more vio- i lent the fit, and the longer its continuance, / the more the gouty disposition is confirmed; and the oftener the attack is renewed. I A continued imprudence, intemperance, i or excess in diet, disposes the gout to be- | come chronic, and at last retrocedent, and f to attack the stomach in the enervated, and the head in the corpulent. This disease is distinguished from rheu- }' matism by the previous symptoms of indi- gestion above noticed, which do not occur in rheumatism; by the pains attacking par- ? ticularly the smaller joints, while rheuma- tism occupies the larger;—by the deeper , redness and greater swelling of the parts affected in the gout than in rheumatism; and by the age of the patient, his habit of >' body, and mode of living. The treatment of acute gout naturally re- solves itself into that proper while the fit is on, and that, required during the intervals. Before the treatment proper d iring a fit of the gout is entered upon, it is proper to .. \ observe, that when a patient is warned of . \ the probable approach of a gouty paroxysm, |A by the occurrence of drowsiness, heartburn, W flatulence, costiveness, pricking and numb- ness in the lower extremities, coldness of the legs and feet, general chilliness, and i other premonitory symptoms, which the ri subjects of the disease are well acquainted f with, it will be invariably advisable to at- tend to these signs, and to resort to suitable remedies without delay, since by proper management the threatened attack may fre- quently be averted; and if this object can not be accomplished, the paroxysm will be I thereby rendered milder, and probably shorter. The preventive remedies will vary t according to circumstances. In all cases, complete abstinence and the use of some mild diluent, as toast or barley water, are all important measures. In the young, the V robust and plethoric, or whenever there is considerable hardness or fulness of pulse, 2 Z the abstraction of a few ounces of blood will be beneficial, the bleeding being fol- lowed by a gentle purgative of magnesia and rhubarb, or of a wine-glassful of the following every two hours, until free eva- cuations from the bowels are procured: senna, one ounce; manna, half an ounce; sulphate of magnesia, one ounce; cinnamon, half an ounce; to be made into a tea with three half pints of boiling water. After the operation ofthe purgative, the feet may be immersed in warm water before retiring to bed at night. In those cases where the debility of the patient is such as to forbid a resort to bleed- ing, leeches over the stomach will often be found advisable, with the purgative of mag- nesia and rhubarb, the warm'bath, and fric- tions over the whole surface of the abdo- men every evening, and at bed time, one of the following pills: blue mass, twelve grains; aloes, four grains, ipecacuanha, two grains; soap, eight grains; oil of cin- namon, two drops; for four pills. When the paroxysm of regular gout has commenced, if the patient be of a robust constitution, and the disease is attended with evident symptoms of inflammation and febrile excitement, bleeding from the arm, proportioned in extent, and repetition to the degree of existing inflammation and fe- ver, followed by such purgatives as are cal- culated to produce a free and speedy eva- cuation of the bowels, without inducing much irritation, will be found to be the treatment best adapted to relieve the pre- sent sufferings of the patient, and to pre- vent their return in future. The purgatives best adapted to the case, are either magne- sia and rhubarb, castor oil, the compound senna tea, or calomel, one grain; antimo- nial powder, one grain; compound extract of colocynth, three grains; to be made into a pill with simple syrup. This pill may be given at night, and the next morning the following mixture: calcined magnesia, fif- teen grains; Epsom salts, a drachm and a half; vinegar of meadow saffron, a drachm; mint water, an ounce and a half; syrup of orange peel, a drachm. The purgatives should be repeated, until a healthy condi- tion of the intestinal discharges are pro- cured. After the employment of general bleed- ing and purgatives, if the local affection still continue with any violence, leeches or cupping glasses may be applied in the vi- cinity of the latter, and followed by a blis- ter. The affected part should be freely exposed to the cool air, and while we avoid every excitement of body or mind, the patient is to be strictly confined, so long as the fit continues, to the same diet and drinks as are adapted to ordinary cases of inflammation; acidulated fluids should not, however, be allowed him. Such is 388 DISEASES. the plan of treatment we should recommend for a case of acute gout, and though it will be found to differ widely from that advised by many eminent practitioners, who, con- sidering gout to be a disease of debility, or a salutary effort of nature to guard the sys- tem from other and more fatal diseases, de- nounce in the strongest terms bleeding and all evacuating lemedies, and wrapping the affected limb in flannel, allow the paroxysm to run its course without interference on their part; vet, as well from the most ra- tional views in regard to the nature of the disease, as from ample and conclusive ex- perience, the propriety of the course we have directed, and its beneficial effects, are established beyond the possibility of doubt. One of the most efficacious and best lo- cal means of relief in cases of acute gout, consists in the use of a warm evaporating lotion, as that advised by Sir Astkv Cooper in common inflammation, consisting of two ounces of spirit of wine mixed with eight ounces of water; or that strongly recom- mended by Dr. Sciidamore, which is made by mixing together four ounces of spirit of wine, and eight ounces of camphor mix- ture. After having rendered the lotion se- lected agreeably lukewarm, by immersing a tin cup containing it, in a basin of very hot water, it is to be applied to the affected part by means of rags of fine linen, which are to be renewed as often as they become dry. It would be improper to use either of these lotions hot or cold, because, when hot, they are found too stimulating, and when cold, there is a risk of checking the gouty action too suddenly. During the night, when the lotion can not be used, the part may be covered with a piece of oil silk, just the size ofthe linen rags. Poultices to the inflamed part were for- merly much resorted to, and are still, per- haps, too commonly employed. When used hot, they are liable to the same objec- tion as hot lotions—that of being stimulant; and when applied cold, they in general suddenly check the local action, and are, therefore, often followed by alarming symp- toms. But a poultice made by wetting a sufficient quantify of fine bread crumb, with one of the above lotions hot, and ap- plying it to the inflamed joint when it has become just comfortably lukewarm, is often of considerable service in relieving the pain and inflammation, and sometimes agrees remarkably well. This poultice may be repeated twice in the twenty-four hours. Under symptoms of very severe suffer- ing, it may frequently be advisable to apply some anodyne directly to the part affected, in addition to the internal use of opium, and the extract of belladonna appears to be a very appropriate and efficacious applica- tion for this purpose. A drachm of this extract may be mixed with an ounce of spermaceti ointment, and a sufficient quaiv tity of this mixture, to cover the affected part, spread on lint, and applied over the seat of pain. In urgent cases, it mav be repeated twice or thrice in the twenty-four hours, if necessary, and sometimes its tran- quillizing effects will be augmented by covering it with the bread poultice, made with spirit of wine and camphor mixture, as just described. Sydenham long ago pronounced a fluid, diluting diet, the proper one in a fit of the gout; and such a diet is still recommended .' by the best informed of the profession. Under very acute symptoms, the nourish-^ ment must be wholly fluid, unstimulating, and rather small in quantity, until the se-' lfy verity of the inflammation, &c. has been t^ subdued, and the patient is beginning to « recover. The best food for the patient irt j this stage, is bread and milk, light bread puddings, gruel, barley water, and rennet whey. Koasted apples, grapes, and oranges, are likewise generally admissible; and when the patient begins to recover, an egg may be added to the above, and sometimes a little bit of chicken or roast mutton for din- ner. It should be particularly noticed, that even a small excess or impropriety in diet, during a gouty paroxysm, always materially aggravates and prolongs the attendant suf- ferings, and sometimes gives rise to severe erysipelas, either in conjunction with the disease, or as an immediate sequel to it. In a severe fit of the gout, and during the height of it, the patient is of necessity confined to his bed in a helpless state, and then the affected limb must be carefully, ' placed on small pillows, in the most easy •] position; but except under such extreme circumstances, the patient ought not to in- M dulge in bed beyond what is unavoidable. ^ When able, he should every morning leave % the bed for the couch or the chair, having 5 his legs raised and supported in the most £ easy position; and, in proportion as pain i and inflammation abate, should gradually M employ such further exertion as relieves rather than produces irritation. Subsequent I stiffness and debility of the limbs are inva- 4 riably to be counteracted, in a great degree, j by moderate and early efforts at exercise, j carefully attempted. 9 When the patient is convalescent, he li must, notwithstanding, continue the use of j the proper alterative and aperient medi- f cines for some time; indeed, until all the \ secretions assume a healthy character; and 1 these remedies should be accompanied with a mild, moderate, and suitable diet and re- j gimen. For, at this period, the chief indi- cations of treatment are, the restoration of the digestive functions to a healthy state, 1 and the weakened limbs to a due degree of ,J strength, and the means just alluded to are, undoubtedly, the most appropriate and effi- DISEASES. 389 tient for pie accomplishment of these pur- poses, with which vegetable bitters and mineral tonics may sometimes be advantage- ously united. The pill composed of calo- mel, James's powder, and extract of colo- cynth, previously mentioned, will answer well as an aperient; it is certainly a useful form, and will be of much service to many gouty individuals. The proper object, at this period, in the employment of opening medicine, is gently to clear the bowels, and excite healthy secretions from them, with- out inducing a direct purgative effect. It is a common practice, in the state of convalescence, to recommend a stomachic and strengthening medicine to be taken during the day, and either a vegetable bit- ter, or some preparation of steel, is usually selected by medical men. It will generally be best to commence with a bitter infusion combined with an alkali, and from that to proceed to the use of some preparation of steel. Sometimes the alkaline solution alone proves a valuable tonic to patients recover- ing from a fit of the gout. A tea-spoonful may be taken, thrice a day, in barley water, or milk and water. As a mineral tonic, the tincture of muriated iron, or the tincture of ammoniated iron, are eligible forms. Twen- ty drops of the former, or thirty of the lat- ter, may be taken twice or thrice daily, in an ounce and a half of infusion of columbo, or of cascarilla. The diet, during the state of conva- lescence, should consist of a moderate quantity of the most digestible animal food, once a day, with eggs, bread, and different preparations of rice and milk; and change of air and scene, with suitable exercise, will always be very serviceable. The limbs, especially the affected parts, should now be regularly sponged with lukewarm salt and water every morning; and after the skin has been wiped quite dry, they should be well rubbed with the hand, or flesh brush, till a comfortable glow in the parts is produced. This prac- tice, if persevered in, will generally be very effectual in removing debility and stiff- ness of the joints. Should any particular feebleness exist, in addition to the morning sponging, the following liniment may be freely rubbed over the joints twice a day: compound camphor liniment, and compound soap liniment, of each, an ounce and a half; tincture of Spanish fly, three or four drachms. If the lower limbs are affected with swelling, the use of a calico or flannel roller will be found useful. During the intervals, we have it in view to prolong them, and to render the suc- ceeding fit mild and regular, or entirely to prevent its return; and the most powerful means of accomplishing these desirable ob- jects, are the strict observance of a suit- able and moderate diet, active exercise in a salubrious air, and early rising, united with a proper use of aperient, alterative, and stomachic medicines. A proper diet and regimen have long been regarded as among the most essential parts of the treatment of gout, as well in the intervals as during the fit; indeed, they are of such pre-eminent utility, that they will alone often display a remarkable power in bettering the condition of the patient, and sometimes even nearly approach to a curative effect, while without them, no other means will be attended with any great or lasting benefit. If the patient be of a full habit, especially if young, and not long afflicted with the disease, his diet should constantly be very mild, and rather small in quantity, consisting chiefly of ve- getable food; but if he has been long ha- rassed by the disease, and is deficient in strength, his diet, although mild, and mo- derate in quantity, ought to be nourishing, and should, therefore, consist of a suitable proportion of animal and vegetable food. Ardent spirits are altogether inadmissible in every case, and the strong and plethoric should avoid wine. Ale and all the stronger malt liquors must also be forsaken. The information given on this subject under dyspepsia will assist the gouty in the selec- tion of those articles of food which are the best for them; and they should never for- get, that moderation in quantity must be invariably the order of the day. The gouty patient must retire and rise early; change, if possible, the air of the crowded city for that of a healthy spot in the countiy; and use daily active exercise, proportioned to his strength. In the intervals, the condition of the stomach and bowels should claim constant and especial attention, as it is highly neces- sary that they should be preserved free from any accumulation, or irregularity in their action. The principal indications of treatment in chronic gout, are to lessen irritation in the stomach and intestines, and restore their healthy secretions; to strengthen them and the constitution at large, and to apply mild applications of a soothing, cooling quality, to the affected joints. . It is clear, that the best means of obvi- ating irritation in the digestive organs, and of imparting increased strength to them, and the system generally, is by perseverance in the proper use of aperient, alterative, anil strengthening medicine, combined with a mild, moderate, and nutritious diet, a cor- reot regimen, and daily exercise in an open, salubrious air; with which the occasional use of anodyne medicine must be united. The due regulation of the bowels is of the first consequence; but from the local ir- ritation in the bowels, as well as the general 390 DISEASES. debility which is present, purgatives must be avoided. If the bowels can be regulated by diet and exercise, so much the better, but if not, mild aperients, chiefly of a warm, aromatic quality, should be resorted to, once, twice, or thrice a week, or as occa- sion requires. For occasional use, the fol- lowing mixture will be proper, and some- times prove particularly beneficial: calcined magnesia, four scruples; Epsom salts, six drachms; mint water, five ounces; vinegar of meadow saffron and syrup of common saffron, of each, half an ounce; but for or- dinary use, a warm laxative pill, as the fol- lowing, is preferable: compound extract of colocynth, compound rhubarb pill, of each, half a drachm; calomel, twelve grains; oil of carraway, five drops; to be made into fifteen pills with simple syrup; two for a dose. Generally speaking, calomel should not make any part of the aperient adminis- tered, unless the secretions are in a very vitiated condition, as evidenced by the un- healthy appearance of the stools, urine, and tongue, when small doses of calomel, given every second or third night, either with the aperient ingredient, or as fol- lows, will be of great service: calomel, twenty grains; emetic tartar, four grains; resin of guiacum, powdered, two scruples; to be made into twenty pills with conserve of roses; or, calomel, twenty grains; anti- monial powder, twenty-five grains; resin of gu'acum, powdered, two scruples; to be made into twenty pills with conserve of roses; dose of either, a pill every night, or every night and morning. The Seidlitz powders are often a useful aperient for the gouty. It must be particularly noticed, that the proper object in the employment of aperients in this form of gout, is to keep the bowels clear without irritating them, or weakening the general system; and that, in resorting to a mercurial alterative, care should be exercised not to allow it sensibly to affect the constitution by its specific operation, as whenever it affects the mouth, or renders the pulse quick and hard, its injurious effects are certain. The alterative pill last mentioned, taken twice or thrice a week regularly, is frequently very benefi- cial, and sometimes six ounces of the com- pound decoction of sarsaparilla may be ad- vantageously taken, twice a day, at the same time. As tonics, the alkaline solution, with in- fusion of cascarilla, gentian and colomba, and preparations of steel, merit the most confidence. In the beginning, the patient should take only half a tea-spoonful of the solution, twice or thrice a day, in water, or infusion of cascarilla, and gradually increase to a tea-spoonful and a half, or two tea- spoonfuls, at a dose. Its continued use al- most always favours the natural action of the bowels,—a circumstance of no small moment to the gouty. In most cases, the w arm bath is a useful auxiliary. The local treatment of chronic gout is similar to that recommended for the acute form. The lotion of spirit of wine and camphor mixture, should be applied when- ever there is any tenderness or inflamma- tion in the part's affected, or if there be much pain, the belladonna ointment. Leech- ing will be of service in chronie gout, whenever the local pain and swelling are very considerable. When the inflammatory symptoms of the joints have been removed, the system of sponging the joints and lower extremities with lukewarm salt water in the morning, and active friction afterwards, twice in the day, with the stimulating lini- ment, will be found highly useful. To relieve the pains of the chronic form of the present disease, the milder kinds of anodynes should be given, such as Dover's powder, in small doses, in conjunction with the saline effervescing draught, the extract of garden lettuce, or the solution of acetate of morphia. Four grains of Dover's pow- der may be taken at bed time, or three grains twice or thrice a day, in conjunction with the saline draught, which augments its good effects. Or five grains of the ex- tract of garden lettuce may be taken, when the pain calls for it. Ten or fifteen drops of the solution of acetate of morphia is like- wise a valuable anodyne in these cases. It is advisable to take it in soda water, or the effervescing mixture. But the patient ought not to place too great a dependence on medicine, since a proper diet and regimen, sufficient active exercise, and change of air and scene, will sometimes be of more service than all the drugs of the apothecary, and are invariably of considerable use. The diet should con- sist of mild nourishing food, in moderate quantity; his hours of rising, and retiring to rest, should be early, and habitually ob- served; all anxiety of mind, and severe studious habits, must be avoided; and he should be as much in the open air as possi- ble. The advice given on these points un- der dyspepsia will be applicable here. Temperance, and exercise judiciously re- sorted to, and persevered in, have often wrought great and salutary changes in the gouty man's constitution. We would here earnestly recommend friction to the notice of the gouty sufferer. As a mode of exercise, and means of invii gorating both locally and generally, it is of the highest value, and is particularly worthy of our attention in this complaint, because the patient is so frequently rendered inca-> pable, for a long period, of resorting to the usual modes of exercise with much advan- DISEASES. 39l tage. tlnckr such circumstances, friction may be employed as an agreeable and cer- tain means of restoring energy, at first to the limbs, and ultimately to the whole frame. It promotes circulation and per- spiration, resolves obstructions, reduces swelling, and thickenings, and when per- sisted in daily, has an amazing effect in strengthening weak parts. It is applicable to the state of convalescence both from acute and chronic gout, and should be used twice or thrice a day, for ten, fifteen or twenty minutes, or more, at each time. If the patient is not able to do it himself, an active servant must be employed until he is able, which will soon occur. It may be performed with flannels, flannel gloves, or a flesh brush. The latter is in general the best instrument. In resorting to this re- medy, the limbs and parts principally af- fected by the disease should claim the chief attention, but it may be carried over every part of the body with great effect. Next to the limbs, the region of the stomach and bowels ought to be attended to, and it is of very considerable service in promoting di- gestion, and increasing the appetite. We have already said, that when the gout suddenly quits the limbs, and fixes on some internal organ, as the stomach, bow- els, lungs, or head, for example, it is called relrocedent gout. The general idea of the nature of this affection, is, that it is spasmo- dic; but it may be either spasmodic or in- flammatory. The parts most commonly attacked in such cases are, the stomach and intestines, and the symptoms present are exquisite pain and spasm, and usually sick- ness. If the attack be purely spasmodic, the muscles of the belly are rigidly con- tracted, pressure affords relief, and the pulse is not much affected. When, on the other hand, it is inflammatory, the parts are tender, and will not bear the slightest weight or pressure, and the pulse is either small and indistinct, or full, hard, and op- pressed. In very delicate nervous subjects, the attack is often spasmodic; in the cor- pulent or vigorous, it is generally inflam- matory, especially when it has followed im- prudent exposure to cold. The treatment of retrocedent gout will, therefore, differ, according as the attack in the stomach, intestines, or whatsoever part is affected, is spasmodic or inflamma- tory. If we have reasons, from the above considerations, to consider it spasmodic, five or ten grains of calomel should be given directly, which may be immediately follow- ed by an injection, made by dissolving an ounce of Epsom salt in a pint of barley wa- ter or thin gruel, and then adding two ounces of olive oil, and when the stomach will retain a purgative medicine, by the compound senna tea. Fomentation of the bowels by means of flannels wrung out of hot water should likewise be employed at the same time, and if speedy relief is not gained by these means, fifty or sixty drop9 of laudanum, or of the solution of acetate of morphia, must be given in any warm drink, and repeated, if necessary, every1 half hour, till the pain abates. Ether, either alone or combined with laudanum, is also useful; and should the attack have followed excess or imprudence in diet, and sickness be present, Vomiting should first be promoted by giving warm slops, and twelve or fifteen grains of ipecacuanha powder in water. If the attack occur in a person of a full vigorous habit, and there is reason to regard it as inflammatory, the usual means for checking inflammation must be resorted to with promptness and decision. Sixteen or twenty ounces of blood must be taken from the arm, and the operation be repeated in a short time, if the pain continues; leeches may also be applied over the bowels; warm fomentations to the abdomen; and a mus- tard poultice be applied to the feet, in order to solicit back the gout to the extre- mities. After bleeding has been resorted to, a large blister should be immediately applied near the part affected. When gout attacks the head, it is gene- rally of an inflammatory nature, and will require cupping, blisters, mustard poultices to the feet, &.c. BLEEDING FROM THE NOSE. A spontaneous discharge of blood from the nose, occurs most commonly in young persons, and is very frequently succeeded at a latter period by bleeding from the lungs. Persons considerably advanced in age are not, however, entirely exempt from it. One of the most obstinate cases on re- cord, was in a patient upwards of forty-five years of age. The discharge of blood from the nostrils is most generally preceded by some degree of local heat and itching, and frequently by a sense of weight and numb- ness at the root of the nose. There is, oc- casionally, flushing ofthe face; a throbbing of the temporal arteries; a ringing in the eal.s—and sometimes a pain, fulness or sense of weight in the head; yet not unfrequently the blood issues suddenly from the nostrils without any of these previous symptoms. The quantity of blood discharged, as well as the continuance of its flow, are extreme- ly various in different cases; sometimes, af- ter a few drops have flowed from the nose, the hemorrhage ceases and does not again return for many months; in other cases the discharge continues for many hours, or re- turns daily; while again the discharge is oc- casionally very profuse. The most com- mon exciting causes of this disease are, cold applied to the feet; sneezing; exposure to 392 DISEASES. the direct rays of the sun; an accidental blow upon the root of the nose; a con- siderable shock imparted to the body, as in accidentally stumbling; irritating sub- stances accidentally inhaled into the nos- trils; violent fits of passion, &c. Some curious cases are related in which, in consequence of peculiar idiosyncrasies, I bleeding from the nose has been brought on 1 by smelling an apple or rose, or by the ringing of bells. When this disease occurs in the young, robust and plethoric, it is seldom one of much consequence; after the bleeding has continued for some time, it, in such cases, generally ceases of itself. When, howev- er, it is more profuse or of frequent occur- rence, it is the duty of the practitioner to put a stop to it, and endeavour to destroy the liability of its return. To effect the first object the patient is to be kept in an erect posture—all those portions of his clothing being removed which appear to have the least tendency to impede the free return of the blood from the head; he is to be exposed to a current of cool air, and if of a full habit, or considerable febrile excite- ment be present, a vein in the arm should be opened and an adequate quantity of blood drawn off. This is especially impor- tant in every instance where the symptoms, such as pain and heaviness of the head, flushed face, throbbing of the temporal ar- teries, &c. indicate any considerable de- termination to the brain. A dose of some sa- line purgative, as Epsom salts, is now to be administered; and if the bleeding still con- tinue, cold water may be applied to the nose by means of wet cloths or a sponge; as also to the forehead, to the back of the neck, to the genitals, &c.; these cloths are to be renewed as soon as they acquire any increase of temperature. By the employment of these means, in ordinaiy cases, seldom much difficulty will be experienced in arresting very speedily the flow of blood. But when the bleeding is very profuse or still continues but little abated, other remedies will be demanded. It has been recommended to plug up the nostrils with simple lint, or with lint steeped in cold vinegar, in a solution of sugar of lead, sulphate of zinc or other astringent—or covered with moistened charcoal. These plugs can of course be of benefit only in those cases where the bleeding is from the anterior portion ofthe nostrils; when it pro- ceeds from the mucous membrane lining the posterior portion of the cavities of the nose, notwithstanding these plugs, the blood may continue to flow into the mouth in con- siderable quantities. Various means have been proposed for applying pressure to the vessels in this latter situation, but no one appears to be well adapted to this purpose. We'should advise, therefore, to trust to other remedies. Dr. Darwin relates the case of a lady, in whom the bleeding from the nose had con- tinued for several days. The common means for arresting it failing, she was directed to immerse her whole head in a pail full of cold water, to which a few handfuls of salt had been added, on which the bleeding im- mediately ceased and did not return. Her pulse continuing hard, it was found neces- sary to open a vein in her arm on the ensu- ing day. The same expedient has been re- sorted to in similar cases, and with a like - prompt effect. In obstinate cases of bleeding from the '-• nose, much benefit will be derived from the application of a blister to the nape of \ the neck, or between the shoulders. Dr. Archer, of Norfolk, relates a remark- . able instance of the efficacy of a blister in arresting a profuse bleeding from the nose. Every remedy that could be suggested had been put in practice, but failed in putting a stop to the discharge; the patient was nearly exhausted, when, on the fifth day, a blister was applied to the back part of the neck; no sooner did it begin to draw than the bleeding ceased as if by a charm; as soon, however, as the blister completely healed, the bleeding returned; the blister was applied anew and kept open for some time; the discharge of blood again ceased, and the patient recovered his health. A case is also related by a Dr. J. P. Street, where the application of a blister to the neck was equally efficacious under similar circumstances. Other physicians speak fa- vourably of this practice. Stoll recommends emetics in cases of this kind. We can not, however, approve J| of their employment. As soon as the he- ^ morrhage is arrested, proper measures are to be taken to ensure the patient against , its return. All the exciting causes are to I be carefully avoided; if the patient be of a sanguine or plethoric habit—he must be confined principally to a vegetable diet, and use regular moderate exercise; while his bowels are to be kept regularly open by 1 occasional doses of some saline purgative. ■ SPITTING OF BLOOD. Spitting of blood, or haemoptysis, is a discharge of blood from the lungs or wind- pipe. ' It is generally preceded by a sense of weight, anxiety, and pains about the breast, ^ with some degree of difficulty of breathing, i often a sense of heat, sometimes under the '. breast-bone, and sometimes moving from place to place; and a little before the blood: ji appears, there is frequently a saltish taste in the mouth. At length a tickling at the a DISEASES. 393 top of ther windpipe occasions hawking, which brings up a little blood of a florid colour, and more or less frothy. As the quantity of blood increases, there is a rat- tling noise in the windpipe before it is brought up, and then it comes less by hawking than by coughing, which is some- times the case from the first. These local symptoms are often preceded by general chilliness, with weariness of the limbs, pains of the back and head, costive- ness, frequent full pulse, and other symp- toms of fever. This disease is often of an alarming cha- racter, from its indicating a tendency to consumption of the lungs, especially when it occurs in persons with a narrow chest, and of a consumptive appearance. If it be followed by cough, pain, or difficulty of breathing, the danger is considerable. Those of a sanguine habit, slender make, and delicate constitution, are most subject to it, and it occurs most frequently at from fifteen to thirty-five years of age, and in spring or autumn. Fulness of blood dis- poses to it, and so does great sensibility and irritability, combined with a narrow con- formation ofthe chest. The occasional causes of this affection are, external heat,—a considerable and sud- den diminution ofthe weight of the atmos- phere,-—whatever increases the force ofthe circulation,—violent exercise or straining,—■ the external application of cold and mois- ture. When blood is discharged from the sto- mach, it is called vomiting of blood, and is usually in much more considerable quanti- ty, than when it takes place from the lungs,—of a darker colour,—more gru- mous,—often mixed with other contents of the stomach, and commonly unattended with cough. In the present disease, it is brought up by hawking or coughing, is of a florid red colour, and mixed with a little frothy mucus. A discharge of blood from the lungs may appear either in the sanguine and florid, or in the debilitated and pale. In the former case, it is accompanied with increased ac- tion of the heart and arteries, and the blood is florid and tenacious; in the latter, it is attended with general laxity or debility, weak vascular action, and the blood is thin, and of a diluted red. Of course, the treat- ment must vary, in some degree, in these opposite states ofthe constitution. In spitting of blood occurring in persons of a sanguine temperament, whose strength is little or not at all impaired, the most im- portant remedy is blood-letting. A vein should therefore be opened in the arm, and a quantity of blood drawn off, varying from twelve to twenty ounces, according to the urgency of the case, the age and constitu- tion of the patient, and the strength and fulness of the pulse. If the discharge of blood from the lungs be not arrested by the first bleeding, the pulse still continuing strong and full, and the skin of the patient parched and hot, the abstraction of blood from the arm should be repeated after a short interval, and followed by the application of from six to twelve cups to the fore part of the chest. In those cases in which the pa- tient is debilitated and the pulse not at all or but little excited, the bleeding from the arm should be omitted, but the application of cups to the chest, is in nearly all cases required, and the propriety of its repeti- tion must be determined upon from the general symptoms of each case. Upon the early and judicious employment of the lan- cet and cups, or of the latter alone, the safety ofthe patient, in all attacks of spitting of blood will mainly depend. In conjunc- tion with the lancet, nauseating doses of tartar emetic will often be found eminently beneficial. Either of the following pre- scriptions may be employed: tartar emetic, one grain; water, one ounce; dose, a tea- spoonful every three hours; or, nitre, one drachm; tartar emetic, one grain; water, two ounces; dose, a tea-spoonful every two hours; or, nitre, powdered, one drachm; tartar emetic, two grains; calcined magne- sia, fifty grains, for twelve pills; dose, one every three hours. When the discharge of blood from the lungs is very profuse, immersing the pa- tient's feet in hot water, to which a quantity of salt or mustard has been added, will often aid in arresting it. Nitre alone has been strongly recom- mended, and* is often of great importance. The Italian physicians have unlimited con- fidence in it, and employ it in large doses, as a drachm dissolved in cold water, re- peated three or four times a day. It may be given in this way, or in doses of ten grains, repeated eVery hour or two, till the urgency of the symptoms subsides, and then at longer intervals. It should not be continued longer than two or three days at a time. Subsequently to bleeding and the appli- cation of cups, a large blister should be ap- plied over the whole chest, and if the symptoms of the disease are not sensibly relieved by the first, after it is healed, a se- cond should be put on, which is preferable to keeping up the discharge from the first by means of irritating ointments. Blisters will be advisable in all cases after bleeding; when the disease occurs in debilitated sub- jects, they constitute our most important remedy. Fainting is often serviceable in checking bleeding from the lungs, and it is, there- fore, improper to use means to prevent it, where the bleeding is considerable. On this account, cordials, strong odours, and 394 DISEASES. every other means of rousing the patient, should be avoided, in every case of active haemoptysis, occurring in full habits. At the same time that the above reme- dies are resorted to, the temperature ofthe patient's room should be kept as low as possible, by the usual means, as cold ex- ternally applied is sometimes of great ser- vice. In extreme cases, cloths wet with the coldest water may be freely applied to the chest, between the shoulders, and to the genitals. Dr. Rush was in the habit of di- recting, in cases of profuse bleeding from the lungs, a tea-spoonful of table salt, pow- dered; which the patient is slowly to swal- low in its dry state. The prescription may be tried, but it should not be trusted to, to the exclusion of other remedies. Digitalis, or foxglove, is a medicine which has been recommended as of considerable value here; it may be given in doses of from half a grain to one grain of the pow- dered leaves, every second or third hour in the commencement, and aTterwards twice or thrice a day. It is sometimes highly valuable when spitting of blood threatens to terminate in consumption, in young per- sons of a florid complexion. The sugar of lead is another remedy of very considerable efficacy in many cases of spitting of blood, after due depletion by the lancet and cups; it may be given in the following manner: sugar of lead, twenty grains; ipecacuanha, four or five grains; powdered digitalis, three or four grains; to be made into ten pills with conserve of roses; dose, one every three hours. After the bleeding from the lungs has been arrested, it often happens that a constant irritating cough continues; to relieve this, one of the following pills at bed time will be advisable: sulphate of morphia, two grains; ipecacuanha, one grain; powdered digitalis, two grains, to be made into four pills. In this complaint, particularly when it occurs in persons of a sanguine habit, or florid complexion, whose strength is little or not at all impaired, the diet should be scanty, and of a mild vegetable description, as barley, rice, gum or toast water; all kinds of animal food, and stimulating liquors must be forbidden, and the quantity of drink should be small. The use of acidu- lous fruits, as oranges, lemons, &c. and ve- getable acids, are proper, and whatever is taken should be cold. All muscular exer- tion, or even great exertion of mind is hurtful. If, however, this malady occurs in an enfeebled constitution, the diet must be nourishing, though very mild, consisting of panado, gruel, milk, and eggs. Here change of air, and very gentle exercise, are advisable. After the bleeding has stopped altoge- ther, the patient must resort to means to prevent its recurrence in future, and, for this purpose, they who are of a full habit should constantly observe a mild and chiefly v egetable diet, and moderate exercise, with the occasional use of saline laxatives; while they who are weakly and delicate must endeavour to strengthen the chest, and constitution at large, by a cautious diet and regimen, with warm bathing, daily exercise proportioned to their strength, and change of air and scene. They who are subject to a spitting of blood should carefully avoid elevated, cold, and bleak situations, and choose a flat or low country where the air is heavy. If the place is sheltered at the same time, it will be still more desirable. 'I his advice is of great importance, as the most valuable re- medies will generally fail of any good effect in this complaint, so long as the patient continues in an unfavourable situation. They who have been once affected with the disease, should be constantly on their guard. The occasional application of cups to the chest will be beneficial, or an issue may be kept open on some part of the breast. VOMITING OF BLOOD. In vomiting of blood the discharge takes place from the stomach. It is generally preceded by nausea, loss of appetite, flatu- lence, and other affections of that organ and parts in its neighbourhood. There is often pain or uneasiness of the left side, with anxiety, and a sense of tightness in the chest. The blood discharged is generally dark coloured, clotted, and often mixed with some of the contents of the stomach. In some cases there is also a discharge of dark coloured blood by stool. The amount of blood vomited is various. Sometimes a large quantity is thrown up at once, when the disease ceases, and does not again oc- cur; but in general the vomiting is repeated at short intervals, until the patient is com- pletely exhausted. Vomiting of blood may occur in persons of a full habit and robust constitution, but is most common in those w ho are weakly, or who have laboured for a considerable time under a disease of the digestive organs. Whatever greatly deranges the functions of the stomach, or produces diseases of the liver or spleen, may give rise to it: and the most frequent causes appear to be grief, or other depressing or violent passions; cos- tiveness, especially if occurring in a con- stitution in which the stomach is peculiarly irritable; blows on the region of the organ affected; fulness of habit combined with an intemperate mode of life; the suppression of the menstrual flux, or of the discharge from bleeding piles; acrid substances.taken into the stomach, and the abuse of emetics and active purgatives. DISEASES. 395 It is, in general, easily distinguished from spitting ofblood, by the blood being here brought up by vomiting, and by its being of a deep modena colour. It is also gene- rally mixed with some of the contents of the stomach. In spitting of blood, on the contrary, the fluid discharged from the lungs, is brought up by hawking or cough- ing, and is of a bright red colour. When a person is attacked with vomiting of blood, he should be kept perfectly qui- et, in a room, the air of which is rather cool than warm, and his dress should be loosed so as to prevent any pressure upon the stomach. If the complaint occur in a per- son of a full habit, and possessing consider- able general strength, it will be proper for him to lose twelve or fourteen ounces of blood from the arm; and if considerable pain or tenderness of the stomach remain after the loss of blood, cups or leeches should be applied over that organ. In cases occurring in debilitated habits, or where the discharge of blood has already lowered considerably the strength, cups alone over the stomach will be proper, and cases will occur in which these should be applied without scarifying. If the bowels are costive, they should be opened by a common injection. The thirst in this complaint is always considerable; it may be allayed by the patient taking small quantities of gum or toast water perfectly cold. In many cases where the vomiting is incessant, advantage will be derived from the administration of an occasional spoon- ful of iced water, or even of powdered ice. When the vomiting of blood has been produced by suppressed menses or a ces- sation of the discharge from bleeding piles, leeches should be applied about the upper part of the thighs, or to the arms; the pa- tient's feet should then be immersed in hot water, to which salt or mustard has been added, and afterwards mustard poultices applied to the ancles. Great judgment is required to decide upon the propriety and extent of local and general bleeding in cases of vomiting of blood.—Whenever considerable irrita- tion of the lining coat of the stomach is present, the recovery of the patient will mainly depend upon their skilful employ- ment; while in those cases in which the pa- tient is exhausted from previous disease or from the amount of blood thrown off from the stomach, an inconsiderate resort to the lancet may hasten his death. After the use of cups, if the disease still con- tinue, a blister over the stomach will occa- sionally be found useful. If it be necessary, from the great dis- charge of blood, promptly to put a stop to the vomiting, twenty-five grains of ipecacu- anha should be taken, and if the first dose fail to stop it, a second may be administered 3 A after an interval of two or three hours. Ipecacuanha is frequently of very great ser- vice in the present complaint. It is appli- cable to the case of strong as well as weak- ly persons. The super-acetate, or sugar of lead, also , is, in many cases, a medicine of great value here, as well as ift all other profuse bleed- ings. Combining it with the ipecacuanha is often advantageous, we may give two grains of the sugar of iead with two of the latter. Calomel in grain doses will in some instances speedily arrest the vomiting; it should be given combined with five grains of gum arabic, and mixed with a little water. After the blood has ceased to flow, and the patient begins to recover himself, the further treatment of the case will depend in a great measure upon the nature of the symptoms which remain. Leeches or cups to the stomach will be demanded, in most cases. The diet recommended under Dyspepsia will, in general, be the most proper, and an attention to the rules there laid down, for the improvement of the general health and strength, can seldom fail to be follow- ed by satisfactory results. DROPSY. Dropsy is a disease consisting in the ef- fusion and collection of a watery fluid in certain cavities and cells, where it is not perceptible in the healthy state. Thus, water may be accumulated in the ventri- cles of the brain, in the chest, in the belly, and the cellular texture generally, giving rise to a train of symptoms, different in each particular case, and requiring particu- lar modes of cure. Water effused in the ventricles of the brain gives rise to a varie- ty of distressing symptoms, which generally prove fatal; this disease is usually called dropsy in the head, and is treated of under that title. Dropsy in the chest, or water effused be- tween the investing membrane of the lungs and the lining membrane of the ribs, is not so conspicuous by its external appearance as it is distinguished by the dangerous symptoms to which it gives rise. The disease to which the term dropsy is most usually applied, is that general swel- ling over the whole body, of a soft and doughy feel, accompanied with great weak- ness, and other symptoms to be hereafter described; or it is that swelling ofthe belly from the accumulation of fluid, which often distends it to a prodigious size. General Dropsy, or Anasarca, is a swelling chiefly under the skin, at first appearing on particular parts only, but at length gradu- ally extending to the whole surface. The reason of this progressive swelling is the free communication between all the parts 396 DISEASES. of the cellular substance; another illustra- tion of which is to be found, in the free passage of air into all the surface of the body, when it has escaped from the lungs in consequence of a wound. The swelling in dropsy is always soft and uniform over any member; and when pressure is made with the finger, a pit or hollow is formed by the water being pressed out of some of its cells, into the neighbouring ones. Soon after the pressure is removed, the swelling returns to its former fulness. This is tech- nically called pitting on pressure. Gene- rally, the swelling appears first on the low- er extremities, and that only in the evening; it is not very perceptible in the morn- ing. The more a person has been in the erect posture through the day, the greater is the swelling towards evening. It is easy to be seen, that this is owing to the water making its way downwards by its own weight; while the recumbent posture during sleep allows it either to diffuse itself equal- ly over the whole body, or if the quantity be great, and the disease far advanced, to accumulate in the upper parts of the body, and to occasion the swelled face, and closed up eyes, which some dropsical patients ex- hibit in the morning. Sometimes the fluid which is accumulated in the cellular texture immediately under the skin, oozes out through the pores ofthe cuticle; sometimes being too thick to do so, it raises the outer skin in blisters. Sometimes again, the skin not allowing the water to pass through it, is hardened by distension, and gives the swelling an unusual degree of firmness. If, from any cause, an inflammation should occur upon a dropsical limb, it is of a bad kind, spreading along a great extent of sur- face, like the rose, and too frequently end- ing in gangrene. General dropsy is almost always attended with scantiness of urine, which is generally high-coloured, and after cooling, lets fall a copious reddish sediment. There is also an unusual degree of thirst; and both these last symptoms are to be as- cribed to the watery parts of the blood passing into the cellular texture, whereby they are prevented from diluting the acri- mony of the urine, and from moistening the mouth, the fauces, and the other parts which in the healthy state are dependant on the action ofthe salivary or other similar glands. The appetite is generally bad; and there is a feeling of debility, with sluggish- ness, drowsiness, and disinclination to mo- tion. Dropsy is very often a veiy tedious disease; and the patient dies after long suf- fering, sometimes from the respiratory or- gans becoming oppressed with the load of watery fluid; at other times, life sinks ex- hausted from a universal failing of the di- gestive and nervous powers. As dropsy consists in the preternatural accumulation of a watery fluid in various parts of the body, the first step, in our in- quiry is to ascertain whence tins unusual quantity of fluid proceeds. In health, a watery fluid is poured out from what are termed exhalant arteries, into every cavity of the body, and into every cell of the cellular substance, to moisten the parts, to render motion easy, and to diminish friction. The absorbent vessels carry off the effused fluid; and by the proper energy of these two sets of vessels, a well balanced action is kept up, and all accumulation is prevent- ed. Now, if the watery fluid is poured out in greater quantity than natural, the absorb- ents will not be able to take it up: and if the power of the absorbents is by any cause weakened, they will not take up the quan- tity effused, though it should not be larger than natural. Increased effusion may be owing, either to a preternatural increase of the ordinaiy exhalation, or from vessels which carry watery fluids being ruptured. Exhalation may be increased by whatever prevents the free return of the blood from the arteries into the veins. This obstruc- tion to the free entrance of the bfood from the terminating arteries into the commen- cing veins, may exist very far from these ex- tremities, even in the heart itself; and hence diseases of the heart and great vessels are often known to occasion dropsy. Former- ly, dropsy was believed to be universally a disease of debility, or diminished action; but a certain grade of inflammatory action is now acknowledged to be a very common cause of dropsy. A tumor pressing on the vessels of a limb, causes a watery swelling of that limb; and a tight ligature or garter, or even the difficult passage of the blood from its own weight, causes a limb to swell towards evening. Hence, also, disease of the liver, by obstructing the free circula- tion of the immense quantity of blood, which should pass through it, occasions an exhalation into the cavity of the abdomen, and produces dropsy of the belly. On the same principle, also, we explain the drop- sical swelling which takes place in the legs and thighs of pregnant women, from the bulk of the uterus pressing on the great vessels which return the blood from the lower extremities. Another cause of in- creased exhalation is believed by some to be a laxity or weakness of the exhalant ves- sels; a symptom and a part of that general weakness which sometimes pervades the whole system. Hence, exhausting diseases of various kinds, copious and long contin- ued discharges of blood, or any other weakening causes, produce a debility of the system, which leads to dropsy. In- temperance in the use of strong liquors, es- pecially dram-drinking, is one of the most common, intractable, and fatal causes of dropsy. Dram-drinking has a doubly inju- rious effect; it disorders and debilitates the DISEASES. 397 whole sysltem, thus producing general drop- sy; and it occasions hardness of the liver, and that obstruction in it which lays the foundation for dropsy of the belly. If there be a greater proportion than there ought to be of the watery parts of the blood, this may give rise to an increased exhalation; and sometimes, though rarely, dropsy is produced in this way, by drinking much watery fluids, which fluids pass oft' by the exhalants. Profuse bleeding has been al- ready mentioned as causing general debili- ty, and as producing dropsy; but it may also do so by causing a diminution ofthe proper proportion of the red globules and fibrine of the blood, which are not so easily re- paired as the watery portion. There may not only be increased exhalation, but di- minished absorption, depending on the same general causes of debility. From the account given of the causes of dropsy, it is evident that while they con- tinue to act, it will be useless to attempt carrying off the effused fluid, and there- fore one of our first objects must be to put a stop to those causes. In that species of dropsy which is accompanied by a strong and full pulse, we are to lessen the inflam- matory action and give freedom to the heart and blood-vessels, by copious bleeding; and we miyst divest ourselves of the prejudice so long maintained, that dropsy in every case is a disease of debility. When the in- flammatory action is over, the swelling soon disappears. In a dram-drinker, or an indo- lent debilitated person, it will be in vain to give drugs, or to direct any particular re- gimen however salutary, till these bad ha- bits are given up. We are next to attempt to get rid of the water already accumulated. Sometimes very strong purgatives, particu- larly those which produce large watery stools, procure a very rapid discharge of the accumulated fluid; of this kind are the resinous purges, as gamboge, scammony, and the like; or jalap in combination with aloes, scammony, gamboge, or cream of tartar. A powder for this purpose may consist of eight grains of aloes, ten of jalap, and six of gamboge or scammony, to be taken in a bolus, or suspended in syrup or mucilage. A purgative of great but dan- gerous efficacy in dropsy, is the elaterium, or wild cucumber; a medicine of great ac- tivity, but rather uncertain, and requiring the greatest caution in its administration; the dose at first is not more than the eighth part of a grain of the extract. Another class of remedies much used in dropsy, are diuretic medicines; and could we insure the success of their operation, we should be better pleased to carry off the dropsical waters in this way, than by any other me- thod whatever. Cream of tartar is, per- haps, one of the best diuretics in general dropsy; squill, alone or combined, in drop- sy of the belly; and foxglove, in water of the chest. Another method of evacuating dropsical water, is by making a number of small punctures in the skin, reaching to the cellular substance; and a great quantity of water often runs off in this way; but from the unhealthy state of the constitution, such punctures are very liable to run into morti- fication; and even the spontaneous bursting of the skin is followed by the same bad ef- fect, so that practitioners are by no means fond of attempting to let off the water by punctures. The dread of the same conse- quences from wounds in dropsical patients, renders us unwilling to advise setons, is- sues, or blisters, which have been recom- mended for the discharge of the water. Cabbage leaves, applied to a limb, have at times appeared to encourage a very copi- ous exudation of fluid from the surface. Emetics and sudorifics have been recom- mended, but are not now much trusted to for promoting the discharge or absorption of dropsical waters. It is an important im- provement in the cure of dropsies, that the patient is not resteicted in the quantity of fluid which he chooses to drink, but that a plentiful allowance of watery liquors is con- sidered as rather conductive to a cure, by conveying to the kidneys any diuretic we mean to employ, and even as of itself great- ly promoting their action. Friction is another means of promoting the action of the ab- sorbents; and exercise, if the patient can take it, may have the same effect; and when the swelling is abated in the morning, skil- ful and equable bandaging will prevent the swelling of the legs towards night. When by these or other means, we have managed to get rid ofthe water already effused, our next object is to prevent its re-accumula- tion; and by strengthining the system, to complete the cure of the disease. Exer- cise, and the proper regulation ofthe diet, are important items in this plan; and are to be accompanied, in the debilitated, by tonic medicines, as Peruvian bark, bitters, and the preparations of iron. Great attention is to be paid to the state of the bowels; and we must not neglect to keep up a proper action of the skin and of the kidneys. DROrSY OF THE BELLT. In this form of dropsy, the water is accu- mulated, in general, within the cavity ofthe belly. In some cases, however, it is said to be effused between the lining membrane of that cavity and the abdominal muscles, while most writers include under this head, also, dropsy of the ovaries, and all cases in which the water is contained in cysts, as when it affects the liver, spleen, omentum, Sec. In all these cases, the characteristic symptoms of the disease are a tense swel- ling of the abdomen, accompanied by a 398 DISEASES. fluctuation of fluid within it, more or less evident. As the several varieties of dropsy above enumerated, seldom occur without some degree of effusion into the cavity of the abdomen, and as in most cases it is ex- tremely difficult to distinguish them from each other, previous to death, we have thought it proper, on the present occasion, to consider them all under one head—no- ticing any symptoms or remedies particular- ly referable to each as we pass along. Dropsy of the abdomen is accompanied generally by the same symptoms as were enumerated in the variety last treated of; there is lassitude or disinclination to mo- tion; a dry skin; loss of appetite; thirst; costiveness, and scanty urine. Occasion- ally, the disease commences by external dropsy, particularly of the lower extremi- ties; at length, however, the abdomen be- comes tumid, and more or less rapidly swells to a size sometimes enormous. The swelling of the abdomen may or may not be accompanied by some degree of general drops}, such as a pale or discoloured skin; tumefaction of the face and eye-lids; the surface pitting upon pressure with the fin- gers, &c. As the fluid accumulates in the abdomen, the breathing becomes more and more d.fficult, especially in a horizontal position. Flatulency is frequently a dis- tressing symptom. Pains of a colicky nature are occasionally complained of in the sto- mach and intestines, and the sleep is always more or less short and disturbed. In wo- men, the menstrual flux is very commonly interrupted, and few cases of the disease occur in which piles are not an attending symptom. The swelling of the abdomen is uniform in those cases in which the fluid is contained within the peritoneal cavity; but when the case is one of ovarian or en- cisted dropsy, it is generally found that one side or some particular part of the abdomen is more protuberant than the rest. ' The feeling of weight as well as the distension of the abdomen, will vary in some degree, according to the position of the patient's body. They are always greater when the latter is erect; when recumbent, the weight is felt most on the side on which the pa- tient lies; and the distension is somewhat decreased on the side which is uppermost. Jn the majority of cases, the practitioner, by applying his rigl)t hand on one side of the abdomen, the patient sitting or stand- ing, and tapping gently with the left on the opposite side, will be sensible of a distinct fluctuation of the contained fluid. In some cases it will be even obvious to the ear. The pulse, the temperature of the skin, the state of the tongue, and other symp- toms, vary greatly in different cases, ac- cording to the cause by which it has been produced; and when dependent upon dis- ease of some important organ, many symp- toms will be added to those just enume- rated. While abdominal dropsy may be produced by all the causes which give rise to general dropsy, it is most commonly de- pendent upon a diseased condition of the liver, spleen, or other ofthe abdominal vis- cera; or an acute or chronic inflammation affecting the peritoneum, by whatever cause occasioned. Blows upon the abdo- men, exposure to cold, violent straining of the abdominal ,muscles, &c. have been known to give rise to it. In the course, also, of certain eruptive complaints, such as measles, scarlet fever, &c, particularly when the eruption has been imperfect or suddenly disappears, from imprudent ex- posure or an improper treatment, dropsy ofthe belly occasionally very rapidly shows itself. The distinction between abdominal, ova- rian and incistcd dropsy generally is, as already remarked, with difficulty establish- ed in by far the majority of cases. In ovarian dropsy, however, if it be watched from its commencement, it will be found that at first, before the belly is great- ly enlarged, a tumor may be felt, wh.ch is moveable, and falls from side to side as the patient changes her position in lying, or as- sumes suddenly the erect posture; and at a later period, the abdomen will be found unequally prominent, one side being swol- len to a greater extent than the opposite one. Dropsy of the belly requires to be care- fully distinguished from a state of pregnan- cy. Occasionally, pregnancy and abdomi- nal dropsy may occur together. The last is certainly an extremely perplexing case, and when the pregnant condition of the uterus is not suspected by the patient or practitioner, the life of the child and even that of the mother may be greatly endan- gered. In regard to the treatment of abdominal dropsy, nearly the same remedies will be demanded as in the preceding variety. The same circumstances will call for the use of the lancet in the one as in the other, name- ly, febrile symptoms, attended with a con- tracted, or full and hard pulse, aiid parti- cularly if, in the case of ascites, these be at- tended with pain upon pressure of the ab- domen. It will, indeed, be found in general, that where the disease has come on suddenly, in the young, or those of a comparatively robust constitution, more or less of those symptoms will be present, which demand blood-letting to a greater or less extent. In many cases, local bleeding by leeches to the abdominal parietes, may be employ- ed in conjunction with, or even to-the ex- clusion of general bleeding, particularly in the early stage ofthe disease. The same purgatives antidiuretics under DISEASES. 399 similar circumstances of the disease are de- manded in this form of dropsy as in the pre- ceding. The compound powder of jalap and cream of tartar; gamboge; elaterium; nitre, by itself, or in combination with squill and calomel; digitalis and diluent drinks, will, in different cases ofthe disease, be frequently found very rapidly to dimin-- ish the swelling. So frequently is the ex- istence of dropsy of the belly connected with a deranged condition of the liver, that an alterative course of mercury, pro- perly timed, forms a remedy of no little importance in this form of dropsy, and when aided by the judicious administration of re- medies which act upon the kidneys, by in- creasing their secretion, has succeeded in dispersing the accumulated fluids, and in conducting the case to a favourable issue. In ascites, dependent on disease of the liver or other organ, the urine is generally loaded with bile, and scant in quantity, de- positing, on cooling, a pinkish or red sedi- ment, and according to Dr. Blackall, is not coagulated by heat or nitric acid. Our most certain diagnosis, however, is obtained from the history of the case and the pre- sence of symptoms referable to a diseased condition of some one of the abdominal viscera. A remark of some importance may be made here, that every condition of the general system is not equally favourable to the remediate operation of mercurial pre- parations when administered with a view to their specific effects. It is stated by Maclean, Blackall, and other writers on the disease, that some firmness of the ge- neral habit is demanded for the successful administration of mercury in dropsy; whilst in a depraved or broken down constitu- tion, in which, to use the words of Black- all, "the coagulable part of the blood rea- dily passes off by the kidneys, its effects are equivocal and even hazardous." It is unnecessary to add, that mercury is also improper during very considerable arterial excitement. All the benefit derivable from mercury in those cases of the disease in which its administration is proper, may be obtained by merely putting the system gently under its influence, without inducing a profuse salivation. Blisters, which are rather a doubtful re- medy in external dropsy, are certainly in most cases of dropsy of the belly, particu- larly in its earlier stages, a remedy from which much good is to be anticipated. In those cases dependent Upon a congested or inflamed condition of the viscera, or of the peritoneum, after suitable direct depletion by the lancet and leeches, a blister applied over the diseased organ or to the interior portion of the abdomen, by aiding in the cure ofthe affection upon which the dropsy depends, must have no little effect in faci- litating the removal ofthe latter also. Frictions over the abdomen have been recommended as a very effectual means of dispersing the swelling. Thus frictions with olive oil will frequently re-establish the urinary discharge with considerable prompt- ness. It is now generally agreed, that the oil is useful only to prevent excoriation. Besides the olive oil, frictions with various medicatedoils and liniments have likewise been proposed; but we believe frictions with the hand, dipped in oil; with a soft cloth, or with the flesh brush, to be equally efficacious to any other plans proposed; while, a circumstance of the first import- ance to insure their success, they may be repeated much more frequently, and at shorter intervals, without danger of inducing excoriation. In ovarian dropsy, we have but little hopes of obtaining much good from any plan of treatment. Particular symptoms are to be palliated by appropriate means. Cos- tiveness is to be avoided by a due attention to the bowels, and when necessary, by oc- casional laxatives. Should the enlarged ovary pressing upon the neck of the blad- der, prevent the free discharge of urine, the introduction of a catheter becomes ne- cessary; while pains are to be relieved by leeches, fomentations and blisters; or when of a hysterical or spasmodic nature, by opium. In dropsy of the belly, we have it in our power, when the water is contained in the peritoneal cavity, to evacuate it at once by the operation of tapping, and when internal remedies have been productive of no suc- cess, or when the swelling of the abdomen has arisen to such a height as greatly to in- commode the patient, or impede much his respiration, this operation should certainly be performed, and it will never fail greatly to diminish the patient's sufferings, by re- moving the effects resulting from the weight and pressure of the accumulated fluid, and by this means prolong his life for many years. It has been asserted, that when even the patient and his physician have been deprived "of every hope of a cure being effected, and have resorted to the discharge of the fluid by tapping, with the view merely to gain a few days of ease, a complete cure has been obtained, the dropsy disappearing completely after the operation. In general, however, tapping must be considered only as a palliative measure, the instances in which it has been followed by a radical cure being exremely rare. When tapping has been decided upon, and a fluctuation is distinctly felt, it can not be too early performed; nor need we fear again and again to repeat it, should it be demanded by the symptoms. At every 400 DISEASES. operation, the whole quantity of fluid should, if possible, be drawn off, and during its flow and subsequently, a gentle and uni- form pressure should be made upon the abdomen by an appropriate bandage. Tap- ping has likewise been proposed in ovarian dropsy, operating at the most prominent part of the tumor, on the right or left side, according as one or other ovary is affected. As a palliative means, it may be put in practice; sometimes, however, the fluid, from its consistency or its being contain- ed in separate cysts, will not pass through the canula, and never is the operation to be expected to effect a cure. DROPSY OF THE CHEST. In this form of dropsy, the effused fluid is accumulated within the thorax, either in the cavities of the pleura, or within the ca- vity of the pericardium. It is so difficult to distinguish by any constant or striking symptoms between these two varieties of dropsy of the chest, that we have thought it useless to consider them separately. Dropsy of the chest is marked in its commencement by few symptoms calcu- lated particularly to direct the attention of the patient to the nature of his disease. Soon, however, he experiences some diffi- culty in respiration; anxiety at the pit of the stomach; frequent shivering; a slight, dry cough, or some catarrhal symptoms* and an indisposition to bodily exertion. In most cases, during convalescence from some disease of the chest, the patient becomes affected with difficulty of breathing; cough; sense of weight about the stomach, and an augmentation of these symptoms in the re- cumbent position, indicating that effusion of a fluid has taken place in the chest. The difficulty of breathing is always augmented by exertion or motion of any kind, or when the body is in a horizontal posture. The sleep is painful and disturbed with fright- ful dreams, and frequently it is interrupted by a sudden start, or a painful feeling of suffocation, which gradually decreases to- wards morning. The sense of weight at the pit of the stomach or along the insertion of the diaphragm, is particularly experienced when the patient is erect. A dropsical swelling of the extremities, but especially ofthe feet, is perceptible towards evening. The countenance of the patient assumes a livid appearance, intermixed with a deadly paleness; many times he complains of a numbness of the left arm; his eyes have an anxious stare; frequently the inferior eye- fid is swollen; his pulse becomes weak and irregular, sometimes intermittent; his throat is dry, and the tongue thickly coated; there is much thirst, frequent palpitations of the heart, and the urine is small in quantity and high coloured. As the disease pro- gresses, the difficulty of breathing becomes peculiarly distressing, and the patient can obtain no rest but in an erect posture. The difficulty of respiration is very generally greatly augmented also, when the patient attempts to lie upon the side opposite to that upon which the effusion has taken place. The face and extremities are cold; the cough becomes moist, and the expecto- ration now and then bloody. As all the symptoms which we have now enumerated may, however, be produced by other dis- eases than the effusion of a fluid in the ca- vity ofthe chest; as for instance, by various organic diseases of the heart, by asthma and affections of the larger blood vessels, some other distinguishing symptoms of hy- drothorax have been pointed out by vari- ous physicians, to a review of which it be- comes necessary that we should pay a few moments attention. A dropsical swelling of the external parts of the chest, when it occurs, establishes with considerable cer- tainty the presence of effusion within the thorax. This symptom is, however, ob- served but rarely. Cullen and other phy- sicians of extensive practice, never noticed it; and Hoffman regards it as the indication of an extensive collection of pus in the chest. The elevation or projection of the ribs is a more frequent symptom of hydrothorax, particularly in its advanced stages, or when the fluid is considerable and occupies but one of the pleura; the chest is more swollen, more rounded on the side of the effusion, and the intercostal spaces become enlarged by the gradual separation of the ribs. The swelling of the chest is occasion- ally attended also with dropsical swelling of the integuments, when the existence of effu- sion within is still more evident; neverthe- less, the same phenomena may be produced by the presence of pus in the cavity of the chest. Various percussions and examinations of the chest with the hand and ear have been put into practice, with the view of detect- ing the presence ofthe contained fluid. By applying the hand to the sides, and using a slight degree of percussion, we are sometimes, but not always, able to distin- guish a degree of fluctuation; this is said to be rendered more evident when the patient places himself upon his hands and feet. It was long since directed that the chest of the patient should be struck in diflerent parts with the flat ofthe hand or the points ofthe fingers united; if the sound produced be that of a cavity filled with air, no effusion has taken place; but if, on the contrary, the sound be similar to that produced in striking a mass of solid flesh, as the thigh or but- tock, we may conclude that the cavity of DISEASES. 401 the chest is.£Iled with either serum or pus. If the position of the patient's body be now changed, and the part which had before given the sound as from a solid body sounds as though empty, and the part which had been found natural assumes the former sound, there is no doubt, it is said, that a fluid has been effused in the chest; the very height of which, when the body is erect, it is pretended, may be determined by a frequent and cautious repetition of this mode of examination. There can be no doubt of this difference of sound being easily perceived; but it is rather to be con- sidered as a circumstance confirming the diagnosis drawn from the presence of the majority of the other symptoms than con- clusive of itself, for besides the impossibility of determining by it whether the contents of the pleura be pus or serum; the exist- ence of extensive adhesions between the lungs and pleura; a tuberculous condition of the .former; aneurism and enlargement of the heart, and various other diseases of the chest or of its contents, may equally with the effusion of serum into its cavity, destroy the hollow sound, which in a healthy condition of the chest is experienced upon percussion. By a particular instrument called the stethescope, we recognize the effusion in .. the chest, principally by the absence in every other part except at the root of the lungs, of the peculiar sound communicated to the ear by "the act of respiration in a healthy condition of the chest. The presence of an effusion of fluid in the chest is by no means a circumstance incompatible with life, and even tolerable health; so long, at least, as the quantity of fluid be not so considerable as to compress the lungs and interfere with or suspend their functions. Some degree of dropsy of the chest may exist, therefore, without any symptoms leading us to suspect it during the life of the patient; for the same reason too, the march of the disease is generally slow; but when the quantity ofthe effused fluid is so great as to cause a visible separa- tion and elevation of the ribs, there is but little hope ofthe patient escaping a speedy death. The difficulty of respiration be- comes now intolerable; the patient is under the necessity of constantly retaining the erect posture, with his mouth open and his body inclined to the side on which the effusion is most considerable, while he con- stantly betrays the utmost anxiety for fresh air; his hands and arms, as well as his face, become extensively swollen; a cold sweat covers a part of his body, until at length he becomes insensible to his sufferings, and sinks gradually into the arms of death. The continuance and termination of drop- sy of the chest, however, depends much upon the nature of the causes to which it owes its origin. These causes are very numerous; many of those already laid down as productive of general and abdominal dropsy, are occasionally causes also of the variety of dropsy before us. Whatever im- pedes the circulation through the thoracic viscera, as well as an inflamed condition of the pleura, may give rise to it. Certain diseases of the heart, such as aneurism of its ventricles or auricles, poly- pus, concretions in its cavities, augmented size of its parietes, &c. have a considerable influence in the production of dropsy of the chest. The same effect may be pro- duced by an obliteration, dilatation, ob- struction or compression of the pulmonary veins, occurring as a consequence of cer- tain chronic affection's ofthe lungs. Aneu- rism of the aorta, deformity of the chest, various diseases of the lungs, &c. are also occasional causes of this variety of dropsy. Effusion of serum into the chest, to a greater or less extent, is very generally the conse- quence of long continued or mismanaged pleurisies, particularly in certain constitu- tions. An inflamed condition of the liver, as well as obstructions in that organ, may also give rise to the disease. The serum effused into the chest may vary in quantity, from a few ounces to several pounds, so that nearly the whole cavity of the chest appears to be filled with it. When dropsy of the chest is dependent on or connected with organic disease of the thoracic viscera, the dropsy is necessa- rily sooner or later fatal; frequently death is preceded by the occurrence of general dropsy; at other times symptoms of general dropsy accompany the disease from its commencement. A spitting of blood has been generally considered as an indication of the near approach of death. The pa- tients frequently perish suddenly from suf- focation, even when the more violent symptoms had appeared to assume a fa- vourable change. In the young and those of a comparatively healthy constitution, when unconnected with organic affections of the heart and large blood vessels or when occurring from inflammation of the pleura, dropsy ofthe chest may, by a proper course of remedies, frequently be removed. In its treatment, the same general reme- dies are demanded as in the former varie- ties; the lancet will probably be more gene- rally required in dropsy of the chest than in either of the oth^r forms of dropsy. To reduce the action of the heart and arteries; overcome a degree of local inflammation affecting the pleura; or facilitate the circu- lation through the thoracic viscera, by un- loading them of a portion of the blood with which they are oppressed, both general and local bleeding, particularly by leeches or cups to the chest, will be proper. The indications for the evacuation of blood are 402 DISEASES. to be drawn from the hardness or fulness and quickness of the pulse; the pain and oppression at the chest; the age and con- stitution ofthe patient, &c, while the quan- tity to be drawn, as well as the repetition of the operation, must be decided upon by the extent and continuance of the above gene- ral symptoms. It is unnecessary to say, that to derive from bleeding the advantages which in very many cases it is capable of affording, requires no small degree of judg- ment for the proper management of the remedy, and a careful consideration of all the symptoms of the case, before it is em- ployed or relinquished. It has been supposed that drastic purga- tives are not so well adapted to dropsy of the chest as to general or abdominal drop- sy, and hence the cream of tartar and other saline articles have been more commonly preferred. Notwithstanding, however, the general opinion is against the more active purgatives in this disease, yet Dr. Ferriar recommends in its treatment, in the highest terms, one of the most drastic articles we possess, namely, elaterium. The astonish- ing relief, he observes, which it affords in the difficulty of breathing occasioned by thoracic dropsy, even in persons of the most advanced age, must place it in the first class of remedies for this disease. Gamboge is with many practitioners a favourite remedy in dropsy. Dr. Ferriar considers it as one of the least nauseous of our laxatives, and he relates several in- stances of dropsy in which, when given in combination with the nitrous or vitriolic ether, the article proved peculiarly effica- cious. His mode of exhibiting it is, five grains of gamboge and two drachms of vi- triolic ether, repeated two or three times a week in some agreeable fluid. He found this prescription to act both upon the bow- els and kidneys; and in cases of dropsy of the chest, where, from the quantity of fluid accumulated, there was imminent dan- ger of suffocation, he informs us that he has repeatedly given very prompt relief by the following prescription: gamboge, four grains; nitrous ether, one drachm; tincture of senna, two drachms; syrup of buck thorn and mint water, of each, half an ounce, to be repeated twice or thrice a week; the cream of tartar and the following diuretic drops being employed on the intermediate days, namely: oxymel of meadow saffron, oxymel of squills, tincture of tobacco, and nitrous ether, equal parts of each; dose, a tea-spoonful in a little water every three hours. Emetics have been proposed in the treat- ment of this as well as the other varieties of dropsy already treated of. It requires no little tact, however, to discriminate pro- perly those cases in which their operation will be proper and most successful. It must be evident, that where the effusion in the chest is complicated with organic dis- ease of the heart and great vessels, that emetics are of doubtful propriety; in other cases, however, they may be employed, and probably sometimes with good effect. Of diuretics, nearly the whole class have been employed in dropsy of the chest, but by general consent it is acknowledged, that some of these articles are much more effi- cacious in this form of dropsy tlian in others. Thus the squill is very generally considered as the diuretic best adapted to the removal of effusion in the chest. In the early stage of this disorder, remarks Dr. Blackall, me- dical treatment does a great deal, princi- pally by means of diuretics, and the squill is by far the most powerful of them. Accord- ing to the same author, it is especially use- ful in cases attended with oppression ofthe chest, scanty, high coloured urine, full of sediment and not coagulable; he has seen it also, however, sometimes serviceable in cases in which the urine was partially coa- gulable. "But," he remarks, "in propor- tion as the disease becomes more marked by its extreme constitutional characters,' in- flammation and a weakness ofthe digestive organs, it fails in its effects or is even inju- rious." The squill may be exhibited in substance or tincture, or the vinegar of squill may be employed. Blackall recommends thirty drops of either of the latter, three times a day, gradually increased to forty or fifty drops; as a general rule, it is to be given in as large a dose as the patient can bear without nausea. In most cases, the combination of squill with nitre and calomel is to be preferred to the article by itself, and in this combination it becomes the best diuretic we can employ. Various combinations of the squill with other articles are highly spoken of by dif- ferent writers on the disease. Dr. Ferriar informs us, that in some constitutions the tincture of squill in conjunction with the syrup of buckthorn proves veiy powerfully diuretic; while Blackall considers the diure- tic effects of the article to be increased by the ammoniacal mixture and the viuiolic ether. Digitalis is another remedy of very con- siderable efficacy in dropsy of the chest. Dr. Maclean is strongly in favour of its use in almost every case, particularly when oc- curring in a weak, delicate, irritable consti- tution, with a thin, soft and smooth skin. During the use of the remedy, the state of the pulse, the stomach, the bowels, and the sensorial function, should be constantly and attentively watched by the practitioner. "If," remarks Maclean, "these be care- fully watched, and the medicine withdrawn as soon as any of them are materially affect- ed, I hesitate not to affirm, that no serious DISEASES. 403 inconveniemce will ever ensue from it, and that it may be administered with as much safety as any of the more active medicines in daily use." In many cases, the digitalis is increased in efficacy by combining it with the saline diuretics, with the Dover's powder, and with squill. According to the experience of Dr. Baillie, the most efficacious prescription in hydrothorax is squill combined with digita- lis and mercury, in the proportion of one grain of powdered squill, half a -grain of digitalis, and five grains of the blue mass, repeated twice or thrice in the course of the day. The alkalies have been highly esteemed remedies in almost all the forms of dropsy; in their favour, we have the testimony of some of the first practical men. Notwithstanding, however, this evidence in their favour, we should never trust to them merely on account of their diuretic powers. In many cases of dropsy of the chest, where the disease is accompanied with general weakness or a disordered condition of the functions of the stomach, inducing the formation of an acid in the upper portion ofthe bowels, by combining with the squill a proper portion of the car- bonate of potash, we remove many unplea- sant symptoms, and improve greatly the condition of the digestive organs; and it is pretty much to these cases we should be inclined to restrict the employment of al- kalies. In some cases of general weakness, in place of adding the alkali to the diuretic we are exhibiting, it may with propriety be given combined with bitters, with opiates, rhubarb or chalybeates, and with good ef- fect. That in some cases of hydrothorax, opi- ates may be exhibited with beneficial ef- fect, there can be no doubt. When the disease is accompanied with a convulsive breathing in its advanced stages, a grain of opium and about half a drachm of Hoff- man's anodyne liquor in a little water, and repeated at short intervals, will be found generally to afford very considerable relief. When, also, the cough is very distressing, disturbing the patient's sleep, and aggra- vating the leading symptoms of the disease, expectorants, in which opium enters as an ingredient, will occasionally quiet the cough and enable the patient to obtain some degree of rest; for this purpose, ei- ther a combination of one grain of opium, one of ipecacuanha and ten of nitre, or the following, will be best adapted: acetate of squill, one ounce; sweet spirits of nitre, one ouhce; sugar, three drachms; lauda- num, one drachm; water, one ounce; dose, a tea-spoonful occasionally. As a means of retarding the progress of the disease, or of seconding our other reme- dies, setons and issues have been occasion- 3B ally made use of, applied either to the ex- tremities or to the chest. The diet in dropsy of the chest should vary according to the symptoms and stage of the disease; being light and moderate in quantity in the earlier periods, especially of those cases attended with symptoms of irritation in the thorax, and though of a more nourishing quality in the advanced stages, and in cases accompanied with symptoms of general debility, yet one rule must be invariably observed, namely, that the food be unirritating and easily digested. So intimate is the sympathy between the stomach and the thorax, that an overloaded or irritated condition of the former can not fail of increasing all the symptoms of dis- ease in the latter. Brisk frictions of the surface, particularly of the extremities, frequently repeated, have been recommended, and are no doubt frequently of much value in many cases. As soon as the patient is capable of gen- tle and regular exercise, particularly by sailing or riding in a carriage, or on horse- back, it should be enjoined upon him, care being taken that he be appropriately clothed, and observe every caution against exposure to damp or cold, and all sudden vicissitudes of weather. From the earliest ages of our art, it has been recommended to obtain an issue for the fluid effused in the thorax, by an open- ing made into the cavity of the pleura through one of the intercostal spaces. While this operation is always to be con- sidered merely as a means of palliation in extreme cases, there are many very pow- erful objections to its common employment. Nevertheless, in cases where, after failure of all the remedies which have been re- cited, the difficulty of breathing is distress- ing and the danger of suffocation imminent, the fluctuation of the water being apparent or the parietes of the chest being bulged out on the side affected, as a last resource and a means of alleviating the misery ofthe patient and prolonging his life, the opera- tion may be attempted. MEASLES. An eruptive disease arising from conta- gion, attended with catarrhal and pneu- monic symptoms, from which few indivi- duals of the human race are exempt, but which attacks them only once in the course of their life. As it is generally children who are affected with measles, and as it is a disease accompanied with very dangerous symptoms in many cases, we shall, there- fore, give a pretty full description of its symptoms and treatment. When the contagion of measles has been received into the body, the patient, for 40 f DISEASES'. some time, feeTs indisposed at intervals, and then appears well again. At last, a shiver- ing and coldness come on, soon followed by increased heat, thirst, and other fever- ish symptoms, with sickness, loss of appe- tite, vomiting, and in some rare cases, with convulsion-fits; but these are far less com- mon than in the commencement of small- pox. Sometimes the fever is sharp and violent from the first; sometimes it is more obscure and mild, but it generally is very violent before the measles show themselves on the skin, which generally happens on the fourth day from the attack of shivering or cold stage of the fever. From the very commencement, there are all the symptoms of catarrh, hoarseness, a very frequent rough cough, difficulty of breathing, swell- ing and redness of the eyes and eye-lids, and a running of sharp acrid matter from the eyes and nose. With all this, there is often severe headach, throbbing of the tem- ples, and great drowsiness. The eruption generally appears on the fourth day, first about the face and under the chin, and then on other parts ofthe body. It first appears in small red points; but a number of these come together, and form themselves into semicircular patches, in the intervals of which the skin is not very much different from its natural appearance. It is by this, that the eruption is distinguished from that of scarlet fever, where the skin is uniform- ly of a bright red colour. The eruption is very slightly prominent, and appears a lit- tle rough to the touch. The eruption con- tinues pretty bright for two days, but about the third it fades a little, and becomes of a brownish hue; and in a short time, about two days more, it totally disappears, and a powdery scaling off of the outer skin takes place. A looseness ofthe bowels occasion- ally comes on when the eruption is sub- siding. The fever is sometimes of alarm- ing violence, and it does not, in general, subside when the eruption comes out; on the contrary, its violence is occasionally in- creased till after the fading ofthe eruption. Whether the fever subsides or not, the cough commonly continues with great se- verity for a considerable time; and the dif- ficulty of breathing increases, and is accom- panied with pain and other symptoms mark- ing a degree of inflammation of the chest. This tendency to inflammation ofthe chest and disorder of the lungs, is what renders the measles so troublesome and dangerous a disease; and in too many cases brings on a protracted illness, or causes sudden death, when the disease appears to be going en- tirely off. The danger in measles is owing to the tendency they have to end in acute catarrh or inflammation of the lungs; but in some rare epidemics, they have been known to assume a putrid or malignant form. The time when measles generally make thei/ appearance as an epidemic, is about the month of January, and they continue till some time in May; though, from particular circumstances, there may be cases at any time; and, from the numbers that generally take them in one epidemic, the measles aid not very prevalent each successive year, but intermit for a year or twor till a new succession of subjects for the disease comes into existence. It is a matter of high importance to regu- late the temperature in which patients should be kept during measles. Happily the absurd and destructive practice of load- ing the patient with bed clothes, and heat- ing his system by hot rooms and large fires, and by giving strong aromatics and stimu- lants, is now almost universally exploded; and in no class of diseases, has a return to a better plan beeu more beneficial, than in eruptive diseases. The safe and rational plan, is to keep the patient in measles in an equal moderate temperature, avoiding all un- necessary, artificial, and external heat, and taking care that the patient, on the other hand, be not exposed to cold. In the ear- ly stages of measles, the fever is sometimes of the most alarming appearance, and re- quires the abstraction of blood from the arm; but in general, the symptoms are light, and it is not necessaiy to do any thing more, than to supply the patient plentifully with mild diluent drinks, to administer a gentle laxative, and to sponge the head and temples with tepid vinegar and water; or if the eyes be much affected, to apply tepid milk and water to them. If the oppression and difficulty of breathing be great, before the eruption comes out, it is of great ser- vice to put the patient into the warm bath, and to repeat this once or twice, if the ur- gency ofthe symptoms continues; in gene- ral, this helps out the eruption, and rd lieves the patient. Some physicians of great ability, recom- mend an emetic, as always useful at the commencement ofthe disease, and the prac-. tice is worthy of attention. After it has operated, a purgative medicine may be given and repeated, so as to preserve the bowels in a lax state, as, Epsom salt, one ounce; tartar emetic, two grains; water, eight ounces; dose, a table spoonful every two hours. The diluting drinks recom- mended in inflammatory diseases, such as barley water, tamarind-tea, and the like, should be taken freely; and all animal food and stimulating liquors must be avoided. But when the symptoms are severe, and there is a good deal of pain in the chest, with difficulty of breathing, blood-letting must be resorted to; as, in addition to the object to be fulfilled in mild cases, we have here to prevent or remove inflammation in the chest. It is seldom, however, that these DISEASES. 405 symptoms come on till the eruption is go- ing off, and the abstraction of blood should never be resorted to early in the disease, unless it be clearly necessary. Under the circumstances just stated, of great difficulty of breathing, and an unusuallyhardpul.se, from six to eight ounces of blood should be taken from the arm, and if these symp- toms continue little or not at all relieved by the first evacuation, the operation should be repeated to the same extent. The ap- plication of leeches to the chest is often advisable, in addition to the general bleed- ing. After the loss of blood, a blister should be applied over the chest; the pur- gative solution with diluting drinks, and a low diet, being resorted to, as just advised. In the severer forms, the diet, of course, must be very spare and low, and the pur- gative medicine may be administered a lit- tle more freely than is necessary under the milder attacks. With regard to exercise, if the patient find himself inclined, from the commence- ment, to remain in bed, he should not be prevented; at the same time, there is no oc- casion to confine him to it against his incli- nation. In all cases, towards the period of the eruption, he feels fatigued, and averse to motion. Whether he be in bed or not, extremes of heat and cold are equally to be avoided. If cough be troublesome, it will be useful to breathe the steam of warm wa- ter, not through an inhaler, but over a large basin, with the head covered with a flannel large enough to hang over its edges; by this means the inflamed eyes will also have the benefit of the relaxing vapour. If the oppression of the chest, pain, and hard pulse should return, as they are apt to do on the disappearance of the eruption, blood-letting or cupping must again be had recourse to, however freely they may have been employed before. Opium should never be given to relieve the cough, as it generally fails in effecting this object, and always increases the fever and restlessness. One of the best medi- cines for this purpose, after the use of the lancet has been carried to a proper extent, is the following: Extract of hemlock, ex- tract of henbane, of each, half a drachm; ipecacuanha, in powder, twelve grains.— Mix, and divide into twelve pills; one to be taken three times a day. From half a pill to a pill may be given to children above a year old, and below ten years. In measles a spontaneous looseness proves the most favourable crisis. When mode- rate, it should not be interfered with, and even when it appears excessive, only the mildest astringents should be given in small doses, so as to lessen, but not altogether to remove it. In case the measles should suddenly dis- appear, endeavours should be immediately resorted to in order to restore the eruption to the skin. The patient must be placed in a warm bath, blisters be applied to the inside ofthe thighs or legs, and to the chest, and a little warm lemonade be given fre- quently, with ten drops of antimonial wine every hour, which may be taken either by itself, or in warm balm tea. Some of the most troublesome conse- quences of measles, are a hoarseness, cough, shortness of the breath, and inflammation ofthe eyes. The hoarseness is often best removed by astringent gargles, when there is no fever nor difficulty of breathing. For the cough, we would recommend the pills above prescribed. A gentle purgative fre- quently relieves the shortness and difficul- ty of breathing; and, if that fail, a blister to the breast frequently repeated, or the tar- tar emetic lotion rubbed freely into the same part, are the best means. To mode- rate and remove the inflamed state of the eyes, exposure to the light should be avoid- ed, and the eyes be frequently washed with a lotion, composed of ten grains of sugar of lead, one ounce of water, and half an ounce of rose water. After the inflammation has been subdued by means of quietude, low diet, and exclusion from the light, and the complaint assumes an indolent character, one of the most efficacious remedies is the diluted ointment of nitrated quicksilver, or citrine ointment. It is, however, to be remarked, that blood-letting sometimes removes, most promptly, the symptoms remaining after measles. Thus it will remove cough, al- though unaccompanied by fever, or the other symptoms denoting inflammation. It may, therefore, be tried to a small extent, when the previous means fail to remove the cough, difficulty of breathing, and other symptoms above mentioned. It will be necessary cautiously to avoid exposure to cold, for some time after the, patient has recovered. SCARLET FEVER- Scarlet fever is a febrile affection, which derives its name from the bright scarlet eruption with which the whole surface of the body becomes covered. The disease varies considerably in the violence and dan- ger of its symptoms in different cases. It may appear under a very mild form, with- out any disease of the throat, or accompa- nied with very considerable pain and swell- ing of the fauces, and occasionally, when it occurs as an epidemic, the affection of the throat assumes a very dangerous and ma- lignant character. Scarlet fever is propa- gated by a specific contagion, like small- pox or measles, and like them is believed by the best observers to attaok a person only once during life; though the apparent 406 DISEASES. exceptions to this remark are more nume- rous in scarlet fever, than in the other two diseases above mentioned. On the third or fourth day after exposure to the conta- gion of scarlet fever, a feverish attack oc- curs; and about the second day of this fe- ver, a bright scarlet rash appears on the surface of the body, and within the mouth and about the fauces. The milder form of scarlet fever is dis- tinguished by the rash, with a moderate degree of fev er, and with very little affec- tion ofthe throat. The rash first appears in innumerable red points about the neck and face, and by the next day they are seen over the whole surface of the body. About the fourth day, the eruption is at its height, and on the fifth it begins to decline. The surface of the fauces and mouth appears red, and little red points appear on the tongue rising up through the white crust which covers it, and when this crust comes off, the whole is red and sore, and the points are still prominent, giving an appear- ance like a strawberry., There is sometimes considerable swelling of the face, and of the throat. This is the mild form of the disease, so mild as hardly to require the aid of medi- cine, but which by mismanagement and officiousness, may have the feverish symp- toms increased, and some inconvenience, if not danger, induced. The patient should be kept cool and quiet, should not be over- loaded with bed clothes; his diet should be sparing, and cooling drinks and mild laxa- tives should be recommended. In other cases of scarlet fever, the febrile symptoms at the commencement are more severe; there is a sensation of stiffness and pain on moving the neck, and it is also painful to swallow; the voice is thick, and the throat feels rough and straitened. The heat of the surface rises in a most remarka- ble manner: not only to the sensations of the patient or observer does the heat seem greater, but the thermometer shows it to be 108° or 110°; that is, more than ten degrees above the natural standard. There is sick- ness, headach, great restlessness, and deli- rium; the pulse is frequent, but feeble, and there is great languor and faintness. The tongue is of a bright red colour, especially at the sides and extremity, and the rising points are very conspicuous. The rash does not appear so early as in the milder scarlet fever, and is seen in patches, very frequently about the elbows. Sometimes it vanishes and appears again, at uncertain times, without any corresponding change in the general disorder. When the rash is slight, or goes off early, there is little scal- ing off of the skin; but in severer cases, large pieces ofthe skin come off, especially from the hands and feet. The swelling and inflammation ofthe throat sometimes go off without any ulceration; but, at other times, slight ulcerations form on the tonsils, and at the back of the mouth; and whitish specks are seen, intermixed with the red- ness, from which a tough phlegm is secret- ed, which clogs the throat, and is very troublesome. This kind of scarlet fever is not unfrequently followed by great debili- ty, or the occurrence of other diseases, as inflammation of the eyes, or dropsy, or an inflammatory state of the whole system, or by water in the brain. In other cases, the throat is greatly swollen and within assumes a black colour; the patient discharges from the mouth and nostrils a dark, putrid sanies, occasionally mixed with dark coloured blood; the breath is extremely offensive; the pulse small and quick, and the face tumid and of a leaden or violet hue; and the patient frequently dies from suffocation at an early period. In regard to the treatment of scarlet fever, it is in general proper to begin with giving an emetic, especially if we at all suspect the stomach to be loaded with undigested matter; and we are very soon after to ex- hibit laxative medicines, which are truly one of our most important remedies in this disease. A dangerous and exhausting loose- ness, which takes place towards the fatal termination of ill-managed scarlet fever, for a long time excited great fears and preju- dices against the use of laxative medicines in this disease; but better observation has convinced us, that so far from being detri- mental, laxative medicines, early and pru- dently begun, have the best effect in miti- gating the disease, and in preventing the collection of that putrid and offending mat- ter in the bowels, which is so sure to pro- duce wasting diarrhoea when it is suffered to accumulate. To lessen the burning heat of the skin, nothing is at all comparable to the free affusion of cold water, which, when employed prudently and at the proper time, cools the surface; and from a state of the most painful and restless irritation, brings the patient to comparative ease and tranquillity. It is in this disease that the powerful remedy of the cold affusion has maintained its ground; in the scarlet fever it should never be omitted, as its salutary effects are speedy and certain, and nothing else with which we are acquainted, is capa- ble of affording such immediate relief. Nor is this to be considered merely as a tempo- rary expedient; it has the best effect in shortening the disease; and in some cases where a long and tedious illness might have been expected, the cold affusion has seem- ed to put a very early period to it. If the timidity of practitioners or friends still re- fuses the cold affusion as too formidable, they must not object to the washing or sponging of the whole body with cold wa- ter, or vinegar and water; and till the heat DISEASES. 407 of the body is reduced by these means, it is in vain that we give internal medicines to procure perspiration, or to allay restlessness and induce sleep. After washing, it is not at all unusual for the formerly harassed pa- tient to fall into a gentle and refreshing sleep; and a mild and breathing sweat comes out over the whole body. This super- sedes the necessity of sudorific and anodyne medicines; and provided we attend to the bowels, keep away stimulant and nourish- ing food, give the drink cold or acidulated, and employ proper gargles for the mouth and throat, the drugs we administer may be very few indeed. . , The inflammatory state of the system which often follows scarlet fever, is not unfrequently accompanied with a swelling resembling dropsy; but we are not to re- gard this last as a sign of debility, or to be deterred from the use of very active remedies. Bleeding to a considerable ex- tent is neoessary, both by leeches, and from the arm, if the patient be old enough; brisk purgatives are to be freely administer- ed, and the inflammatory and dropsical tendency to be combated by the use of fox- glove and other diuretics. When the in- flammatory action has subsided, and the dropsy appears to be the principal malady, we are to give tonic medicines and nourish- ing diet, along with such medicines as in- crease the flow of urine. If there seems a determination to the head, our practice must be decided and active; bleeding and purg- ing according to the urgency of the symp- toms. In the more fatal form of scarlet fever, the malignant and putrescent symptoms are more rapid and severe, the general system is much oppressed, and the throat and neighbouring parts are affected with rapidly spreading ulcerations. It is this which has obtained the name of putrid sore throat. This form of scarlet fever begins like the preceding, but in a day or two shows symp- toms of peculiar severity. The rash is usually faint, and the whole skin soon as- sumes a dark or livid red colour. The heat is not so great nor so permanent as in the other kinds; the pulse is small, feeble, and irregular, there is delirium and coma, with occasional fretfulness and violence. The eyes are suffused with a dull redness, there is a dark red flush on the cheek, and the mouth is incrusted with a black or brown fur. The ulcers in the throat are covered with dark sloughs, and surrounded by a livid base; there is a large quantity of tough phlegm which impedes the breathing, oc- casioning a rattling noise, and increasing the pain and difficulty of swallowing. A sharp discharge comes from the nostrils, producing soreness, chops, and even blis- ters. There is severe diarrhoea, spots on the skin, bleeding from the mouth, bow" els, or other parts, all of which portend a fatal termination to the disease. Sometimes the patients die suddenly about the third or fourth day; at other times in the second or third week; gangrene having probably arisen in the throat or some part of the bowels. They who recover have often long illnesses from the ulceration spreading from the throat to the neighbouring parts, occasioning suppuration of the glands, cough, and difficulty of breathing, with hectic fever. In treating this variety of scarlet fever, the advice of Dr. Willan, and Dr. Wither- ing, can not be too strongly recommended to the reader's confidence and attention. The former able physician remarks, "the best mode of practice here is to administer gentle emetics repeatedly during the first stage, according to the plan recommended by Dr. Withering, in a judicious treatise on this disease." An emetic should be given as soon after the attack as possible, and repeated, if necessary, every morning for several days. When the symptoms of fever and inflammation run high in the be- ginning, it will often be of the greatest service to draw off some blood from the arm or by leeches applied around the throat, immediately after the operation of the first emetic. Vomiting in this disease not only tends to take off the dry burning heat of the skin by relaxing it, but unloads the throat and fauces of the fluids that gorge and distend them. Both the above distin- guished physicians had great experience in the treatment of this malady, and trusted almost entirely to full, free, and repeated emetics, to conduct it to a favourable ter- mination, in those cases in which the symp- toms were not highly malignant. Dr. Wil- lan says, when an emetic wholly fails in its operation, the patient seldom recovers. Mild aperients are likewise necessary, and a combination of calomel and rhubarb is generally the most useful. A grain of calomel, and eight grains of powdered rhu- barb, may be given to a child of ten years old, every other morning. At the commencement of the disease, cold affusion or ablution is strongly advised by the most eminent physicians. It must hot be resorted to except where the heat of the skin is great and equal throughout the whole body, and without perspiration, and then it is often of the greatest service in moderating the subsequent symptoms. The patient may be stripped naked, and cold water be dashed over him every even- ing for the first three or four days; or the whole body may be quickly sponged with cold water. The refreshment is often in- stantaneous, and operates like a charm. Antiseptic gargles should be frequently employed, and the room be often and free- ly fumigated with the nitrous acid vapour, 408 DISEASES. or sprinkled with the chloruret of lime. A very useful gargle may be made by mixing a drachm of muriatic acid with seven ounces of barley water, and an ounce of honey of roses, or we may employ a gargle made by dissolving from five to ten grains of alum in water. In.young children, gargling is im- possible^ hence their throats must be freely washed with the preparations here directed several times a day. When the state of the throat is bad, these applications should be made strong, and be frequently used. In many cases, the free application of lunar caustic to the ulcers in the throat has been found highly beneficial. Towards the decline of the disease, it will generally be advisable to administer mild strengthening medicines, of which a decoction of bark with the muriatic acid is the most appropriate and effectual. Two ounces of the decoction, with five or six drops of the acid, and a drop or two of lau- danum, may be given to a child of twelve years old, three or four times a day. Or instead of this, the carbonate of ammonia may be administered. Two drachms of the carbonate of ammonia may be dissolved in five ounces of water, of which two tea- spoonfuls are to be taken every two, three, or four hours, in a little water, according to the urgency of the symptoms. In the beginning, the diet should be spare and mild, because the inflammatory symptoms then run high; but afterwards those of debility prevail, when the food should be nutritious, but moderate in quan- tity, consisting of jellies, preparations of arrow root, sago, oatmeal gruel, and the like. If the symptoms are malignant to- wards the decline ofthe disease, the throat being deeply affected with spreading foul ulcerations, the bark, acids, together with a light but nourishing diet, must be freely given. As scarlet fever is one of the most conta- gious of diseases, it is highly necessary, where many individuals live together, as in families and schools, to make a separation between the infected and the sound, as soon as the disease appears. In boarding schools, there should always be apartments in which children who are ill, especially of infectious disorders, should be kept. If a child, on the very first appearance of dis- ease, be sent to the sick room; if there be no unnecessary intercourse; if there be pro- per attention to ventilation and cleanliness; if the attendants be careful to wash their hands, and be a little in the open air before they approach the rest of the family, there is every reason to hope that the infection will not spread. The proof of this may be found in the experience of medical men, who rarely, if ever, are transporters of con- tagious diseases. All alarm and agitation should be repressed; and even fumigation, as tending to excite apprehension, may be dispensed with> provided the utmost care be taken to produce a thorough ventilation through the house. How long after the dis- ease has ceased it may be communicated is uncertain; it has been known to be given by a patient a fortnight after the rash had dis- appeareds and Dr. Bateman says there is little doubt, that so long as the least scaling of the skin continues, the contagion may be propagated. Dr. Hahnemann^ of Liepsic, has asserted nightshade to be a preventive of scarlet fe- ver; and, since the year 1818, several prac- titioners in the north of Europe have re- peated his experiments, and they find them founded in truth. The first of these, Dr. Brendt, of Castrin, affirms, that all who employed this remedy escaped the infec- tion; and his account is corroborated by Dr. Muhrbeck, of Dearmin, in Western Po- merania, who says he has used it for seven years, and with equal success: he adminis- tered it to all those who dwelt in the houses where the disease prevailed, continuing its use until a falling off of the outer skin had taken place in those attacked. Dr. Dusten- bourg, of Warbourg, has also published an account of a series of experiments, confirm- ing these statements; and several subse- quent memoirs have appeared,*all equally corroborative of this virtue in the night- shade. The formula generally recommend- ed is, a solution of two grains ofthe extract of nightshade in an ounce of any distilled water; and to children from one to ten years of age, from one to five drops of this solution is given four times a day, from ten years of age and upwards, from six to ten drops is given, also four times in the twenty- four hours. It will not be necessary to continue it longer than two or three weeks, SMALL-POX. The universality of small-pox, and the severity of its symptoms, rendered it for- merly an object of extreme interest, espe- cially to parents; and although from the discovery of cowpox, its ravages on life and beauty have been less general and fatal, it must still remain a matter of importance ac- curately to distinguish and successfully to treat it. There are two forms assumed by small- pox, termed by physicians distinct and con- fluent, and popularly, though with less ac- curacy, a good and bad kind; which are so varied in their symptoms and general ter- mination, as to require a separate descrip- tion. Distinct Small-Pox. The patient is seized with coldness, or shiverings, which soon abate, and are followed by a hot stage, which lasts for two or three days; during which, children are liable to sickness and DISEASES. 409 vomiting, to starting in their sleep, or to epileptic fits; and adults are disposed to sweating. Towards the end of the third day, the eruption appears, and increases during the fourth day. It commonly ap- pears first on the face, then on the lower parts, and is completed over the whole body on the fifth day. The fever commonly abates upon the coming out of the erup- tion; the sickness, vomiting, fits, and other oppressive symptoms go off; and the pa- tient is, for the time, free of uneasiness. The eruption appears in small red spots, hardly rising above the skin, but which by degrees form pimples. On the fifth or sixth day, a small vesicle, containing a colourless fluid, appears on the top of each pimple. These get broader on the seventh day; and about the eighth, are raised into round pus- tules. These pustules are surrounded with a circular inflamed border; and as they in- crease in size, about the eighth day, the face is considerably swelled, and the eye- lids are sometimes completely closed. The matter in the pustules noW becomes thick and white, or yellowish, exactly resembling the matter of an abscess. On the eleventh day, the swelling of the face subsides, and the pustules appear quite full. On the top of each, a darker spot appears? and at this place, the pustule, on the eleventh day, or soon after, is spontaneously broken, and a portion of the matter oozes out? in conse- quence of which the pustule is shrivelled and subsides; while the matter oozing out, dries, and forms a crust upon its surface. Sometimes a little only of th« matter oozes out; and what remains in the pustule be- comes thick, and even hard. After some days, both the crusts and the hardened pus- tules fall off, leaving the skin which they covered of a brown red colour; and it is only after many days, that the skin in these places resumes its natural colour. In some cases, the parts covered suffer a scaling off ofthe skin, and a small pit or hollow is left. This is the course of things on the face, and successively, the pustules on the rest ofthe body take the same course. On the tenth and eleventh days, a swelling arises in the hands and feet, but this goes off as the mat- ter ripens. When the pustules on the face are numerous, there is some degree of fever about the tenth and eleventh days; but in distinct small-pox, it soon abates. An un- easiness in the throat, with a hoarseness of the voice, comes on about the sixth or se- venth day, and much saliva flows from the mouth. This soon becomes thick and tough, and being with difficulty spit out, is pro- ductive of great uneasiness. The inside of the mouth and throat has numerous pus- tules; and in all probability, the whole in- ternal surface of the bowels is affected in the same manner. In the apartment of those affected with small-pox. there is in many cases a strong, peculiar, and nauseous smell, which remains even for months after the disease has entirely subsided. When the pustules blacken, the whole appear- ance is very loathsome, and presents a striking contrast to the blooming health and beauty which existed but a few days before. Confluent Small-pox, This kind of the disease is marked by the greater violence of the feverish symptoms in the first attack, by the strength of the convulsions, which sometimes destroy the patient even before the eruption appears; and by the very great number and clustering together ofthe pus- tules, especially on the face. After the eruption, the fever abates a little, but never goes off entirely r- and soon after returns with severity, and continues through the whole course of the disease. The vesicles appear sooner on the tops of the pimples* they are not of a round figure, but irregu- lar; and numbers of them run together, forming large patches. The matter does not become thick and yellow as in the dis- tinct small-pox, but the vesicles appear flat and shrivelled; and where the skin is to be seen, it is pale and flaccid. The se- condary fever about the eleventh day is re- newed with considerable violence. It is not any difference in the contagion, or in the matter inserted, if the disease be communicated by inoculation, that causes the difference in the malignity of the dis- - ease; as it not unfrequently happens, that a child with small-pox of a very bad kind, imparts the disease to another, who takes it in a very mild and favourable way; and the reverse of tins also very often happens. The cause seems to be in the state of the constitution receiving the infection. After the small-pox has gone off, there is great tendency to boils and inflammatory symptoms in different parts of the body; and, like the measles, it often calls into energy various unhealthy actions, producing swelling of the glands of the neck, oph- thalmias, and the like. Many lose their sight by injuries done to the eyes, during the inflammatory period of the disease. Another unpleasant consequence is the pittings which occur after small-pox, to- tally disfiguring the countenance, and al- together altering its expression. In the treatment of small-pox, we are not to expect the sickness, vomiting, heat, thirst and fever, which occur before the eruption appears, to be totally escaped by any class of remedies; but they may cer- tainly be very much alleviated, and their influence on the subsequent disease much diminished. One very alarming symptom, especially in children, is the occurrence of convulsions. This symptom, as well as the very severe feverish ones, used to be much aggravated by the hot regimen formerly in 410 DISEASES. vogue; and they are materially alleviated, Or even prevented by the free admission of cold air, and of tepid or even cold bathing. The same heating plan was undoubtedly the cause ofthe abundant confluent small- pox, so general under that practice; by which such numbers lost their life, or their eye-sight, and were otherwise so much pit- ted and scarred. It is found that a cooling plan of treatment is by far the best, in the early stages of the disease; that it renders the eruptive fever moderate, and prevents many ofthe inflammatory and putrid symp- toms which would otherwise occur after- wards. 80 confirmed is it by experiment, that the confluent nature ofthe small-pox is very much occasioned by heat, that on any particular portion of the body we can, by covering it with plasters, bring out a more plentiful crop of pustules than on others; and since the more rational and cooling plan has been in use, fewer persons appear with the numerous pits that former- ly were left, both on the face and other parts of the body. In an adult person, if the fever be very violent, it will be proper to admit cold air very freely, to give pur- gative medicines and cooling drinks; and in those of a full and plethoric habit, blood- letting will be necessary. Dr. Currie, of Liverpool, even employed the affusion of cold water, with the effect of evidently rendering the disease milder. The giving of an emetic at the commencement of small- pox is a good practice, both as determining to the skin, and freeing the stomach and first passages from undigested aliment, which would aggravate future symptoms. The irritation during the ripening of the pustules is so great, that we are compelled to allow anodyne medicines, taking care to prevent costiveness by laxative medicines and clysters. For the swelling of the throat and the salivation, we apply blisters exter- nally, and employ cleansing gargles of va- rious acids, and preserved fruits. When secondary fever occurs in small-pox, it is to be treated by purgatives, cool regimen, and prudent blood-letting. The conva- lescence is sometimes very tedious; and like measles, small-pox excites scrofula and other disorders of the constitution. Some- times large boils form in different parts of the body; these are to be treated with poultices and the usual dressings; and in many cases these boils, even when large and painful, may be considered as salutary, and having a tendency to diminish unhealthy action in the other parts of the body. No means have yet been devised to prevent the pitting left by small-pox. cow POX. An eruption of a vesicular nature, which arises from the insertion of a peculiar mat- ter into the system, either at a scratched or an abraded part. As this matter is obtained from an eruption on the teats and udders of cows, the disease produced is called cow- pox,- the matter is frequently denominated vaccine matter, and the whole affair, inocu- lation and its consequences, is called vacci- nation. About the third day after the insertion of the virus of cow-pox, either by puncture or by slight incision in the arm, a small in- flamed spot may be observed in the part where the inoculation was performed: next day, this spot appears still more florid, es- pecially if the person be warm; and by passing the point of the finger over it, a degree of hardness and swelling in the part is readily perceived. On the fifth day, a small pale vesicle occupies the spot where the inflammation was, and the affection be- gins to assume the characteristic appear- ance of cow-pox. In place of inflammation, extending around the base of the vesicle, at this period, as is common in small-pox and most other pustular diseases, the whole has a milky white appearance. The vesicle is now turgid, but evidently depressed in the centre, while the edges are considera- bly elevated. For the next two days, the vesicle increases in size, and retains the same character; so that by the seventh, it has acquired very considerable magnitude, and is of a circular form if the inoculation was performed by a puncture; or of an ob- long form if done by an incision; but in both cases the margin is regular and well defined, while the centre, becoming still more depressed, and a small crust forming there, and the edges becoming more tur- gid, give the whole a very particular ap- pearance and character, which, in my opi- nion, may readily serve to distinguish this affection from every other. The structure of this vesicle, as may be perceived at this period, is singular, and very different from the structure ofthe pus- tule which occurs in small-pox. In small- pox, the whole fluid of the pustule is con- tained in one entire or undivided cavity, and may be all readily evacuated by one small puncture. In cow-pox, however, it is very different; for here the vesicle is greatly subdivided, or is composed of many cells, the whole somewhat resembling a honey comb, with a general covering from the cuticle. About the eighth day from the time of inoculation, inflammation begins to appear around the base of the vesicle. This in- creases for two, or perhaps three days more; and when at the height, the inflamed part >s in general quite circular, and from half an inch to two inches or more in diameter. This inflamed circle, or areola, acquires an erysipelatous brightness; and the whole, more especially the part contiguous to the DISEASES. 411 vesicle, feels veiy hard and tense. At this period also, the vesicle still retains the concave appearance; the crust in the centre has considerably increased in size, and be- gins to assume a dark or brownish colour, while the turgid edge assumes more of a shining appearance, as if the contained fluid were passing into a purulent state. About the eleventh day, the vesicle has attained its greatest magnitude, and then the sur- rounding inflammation and hardness begin to abate; and it is curious to observe, when this takes place, that the redness generally disappears first from the neighbourhood of the vesicle, and thence gradually towards the edge of the areola, often leaving at the last a complete but slender florid ring or circle of inflammation, marking the circum- ference of the faded areola, the inner part having changed to a dingy yellow. The fluid in the vesicle, which was before very thin and transparent, is now more viscid and slightly turbid; and, after this period, the whole is quickly converted into a smooth, shining, and somewhat transparent dry crust, of a dark brownish or red colour. This crusr, unless forcibly removed, will remain upon the part for one, or sometimes two weeks, and then fall off, leaving the parts underneath quite sound and entire. Such, then, is the general course of the affection as it appears at the part inoculated; and, in the greater number of instances, especially in children infected with this ail- ment, little more is to be remarked; in some, however, and particularly in adults, marks of a constitutional affection are com- mon. About the eighth day from the time of inoculation, the glands in the axilla become a little swelled, odcasioning pain and stiff- ness on moving the arm. Headach, shivcr- ings, a frequent pulse, and other febrile svmptoms take place; and these have been observed to continue from a few hours to two or more d..ys. These symptoms, how- ever, are so slight and transient, as to re- quire no aid from medicine. About the twentieth day after the inocu- lation, the dry, contracted, and black scab is detached, and leaves a permanent circu- lar scar about five lines in diameter; the surface being marked with very minute pits or indentations, denoting the number of cells of which the vesicle had been com- posed. The affection above described derives the highest value and importance, from its operating such a change in the human con- stitution a. effectually and permanently to secure it from the danger of small-pox; and almo-t universal!v to render it incapable even of receiv'.ng'the contagion of that for- midible and loathsome disease. A fact so wonderful, and a result so beneficial, de- serves to be established by the strongest 3 C evidence; and irt a learned and inquiring ag-e, a discovery of such vast importance was not likely to be admitted without the strictest investigation. More than thirty years have now elapsed, since Dr. Jenner, of Gloucester, announced the discovery that has conferred immortality on his name, that cow-pox is an effectual preventive of small- pox; and in these years, observation and experiment on the most extensive scale, in every quarter of the globe, have assured us, that with as few exceptions as belong to any research connected with the pheno- mena of living beings, our confidence may remain unshaken. On a subject like this, in which mankind of every rank and profes- sion are interested, it is peculiarly the pro- vince of a professedly popular work to be full and explicit; and we shall therefore, in the remainder of this article, give a his- torical account of the progress and present state of vaccination; we shall state the de- gree of confidence we are warranted to have in it as a preventive of small-pox, and assign some reasons why it should be uni- versally adopted. t was long observed in several of the diaries in England, particularly in Glou- cestershire, that an eruption frequently appeared on the udders and teats of the cows, which was communicated to the hands of those who milked them; and that those persons who had been thus affected, and who never had undergone small-pox, were afterwards incapable of being infected with that disease, either by inoculation or by exposure to the most virulent contagion. The knowledge of a fact so curious and important was long confined to those among whom it was a familiar occurrence, till Dr. Jenner examined the subject with care and attention; and, with the candour and bene- volence of an enlightened mind, published it for the benefit of mankind. After satis- fying himself of the truth and correctness of the fact, Dr. Jmner, in the year 1798, published an account of this most remark- able affection; and his description of its causes and effects aroused the attention of mankind, and the astonishment of the me- dical world Extensive and strict investiga- tion was made; and though many arguments, and some facts were brought forward which seemed adverse to the preventive powers of cow-poX, yet its incalculable utility was at last evinced; and observation and expe- rience furnished evidence enough to satisfy fullv the Bailliesand Heberdens, the Monros and Gregorys-of Britain, as well as the phy- sicians of Europe, Iru'ia, and America. When Dr .tenner began his inquiry, he inoculated with the matter of smull-pox manv persons who, thirty or even fifty vear"? before, had undergone the cow-pox; and such persons completely resisted the small-pox. Three persons hud received the 412 DISEASES. cow-pox without any intention, merely by handling the infected animal; but Dr. Jen- ner inserted by inoculation some of the vaccine matter in another person, that he might more accurately observe the progress of the affection. It was remarkably slight, but distinctly marked in all its stages; and having inoculated the person who had un- dergone it, with small-pox matter, he found that that affection, slight as it was, had completely secured him from taking small- pox. Here then was an important disco- very, that matter from the cow, intention- ally inserted into the body, gave a slighter ailment than when received otherwise, and yet had the same effect of completely pre- venting small-pox. Dr. Jenner having ino- culated several persons from a cow, took the matter from the human vesicles thus produced, and inoculated others, and others from them again; thus making it pass in succession through many individuals, and with the same good effects in preventing small-pox. In the many years that have elapsed since these first experiments, cow- pox matter has probably passed through a succession of above a thousand individuals, and preserved its properties undiminished. The period of discussion and opposition at first was very short, and the observations and experiments of Jenner and his follow- ers seemed so satisfactory, that cow-pox inoculation was every where practised, both by private practitioners and in public es- tablishments; and this with such success, that from many populous districts all over the world, small-pox was entirely banished; and many medical men, for a great part of their noviciate and early practice, knew only by reading and report that so horrid and loathsome a disease had ever existed. A discovery of so great and general im- portance was not to be expected to pursue its triumphant career without opposition. Instances were ostentatiously brought for- ward of persons who had been vaccinated, and who had taken small-pox in spite of the preventive; some doubted the utility of the practice altogether, while others be- lieved that after a certain number of years, the preventive powers of cow-pox were totally lost. In the first eight or ten years after vacci- nation was introduced, there were many reasons why disappointments should hap- pen. To make a slight scratch on an in- fant's arm, and to insert a little matter, without having any subsequent disease to watch, seemed so trifling and easy a busi- ness, that multitudes of persons became professed vaccinators. Clergymen, mid- wives, parents, and benevolent individuals were ready to inoculate for cow-pox. But many of them never looked to the vesicle afterwards to ascertain whether it had gone through its regular stages; many prevented the system from being affected, by drawing away the greater part ofthe vaccine matter to inoculate others; and few were aware that there are certain states of the system and diseases ofthe skin, which prevent the cow-pox from having its usual and proper effect. When all this is taken into account, we need not wonder that many -who are said to have been vaccinated should after- wards be found to have taken small-pox; the wonder rather is, that such sanguine and careless conduct was not followed with more calamitous results. Vet in spite of it all, it is an undoubted fact, that for a consi- derable number of years, small-pox was hardly ever seen. Some cases of eruptions, however, at length did appear, which can- did and unprejudiced physicians could not overlook: persons who in their infancy had been vaccinated to the complete satisfaction of their medical attendant, having reached the age of ten, twelve, or fourteen years, were seized with eruptions very much re- sembling small-pox in the previous symp- tom?, the appearance of the pustules, and the general fever. These eruptions were believed to be chicken-pox, a disease which requires considerable accuracy of attention to distinguish it from small-pox, especially at its commencement, and which by no means unfrequently attacks persons who have gone through the regular- small-pox. When this explanation could not be adopt- ed, from the complete dissimilarity of the disease in question to chicken-pox, they who still were unwilling to cast away the advantages of vaccination, acknowledged that if it did not absolutely and universally secure from small-pox, it wrought such a change in the constitution, that the person who was seized with small-pox took the dis- temper in a form greatly mitigated, and nearly free from danger. It was stated also, that it was not so true as it is generally thought, that a person can not have small- pox twice; that many instances are on re- cord of its occurring more than once in the same individual; and that there was reason to think that chicken-pox was not a disease arising from a distinct and specific conta- gion, but merely a kind of small-pox, changed or modified by various circum- stances, either in the constitution of the person attacked, or in the character of the epidemic. If small-pox did not secure from a second attack of small-pox or from chick- en-pox, it was possible that cow-pox might not do so; and it remained for medical men to watch narrowly, and report faithfully, the degree of security afforded by vaccina- tion. For a considerable number of v ears after the introduction of the new practice, the small-pox had been always very mild, and therefore the efficacy of vaccination had not been very severely tried; but about the yew 1816, a smali-po'x epidemic, of great DISEASES. 413 extent and virulence, aroused the attention of medical men anew to a strict inquiry into the preventive powers of cow-pox. Many who were seized with small-pox were found never to have been vaccinated; but among the multitudes who were affected with eruptive disease during that wide-spreading epidemic, not a few were found to have been regularly and satisfactorily vaccinated, either by private practitioners or public es- tablishments. Medical men now inquired with much anxiety, and with laborious re- search, into the history of former small-pox epidemics; and from ample experience and observation it was established, that a person may have small-pox twice; and that a first attack, though it lessens, does not altoge- ther destroy the susceptibility of the same individual to a second attack. That a se- cond attack may appear, either in a regular form of small-pox, or in some of its modifi- cations, sw'me-pox, hives, &c: that small- pox, and at least some other eruptive dis- eases, are produced by the same specific contagion, and that the diseases produced by it are modified by various causes, as peculiarity of constitution, the severity of the epidemic, or by the patient having un- dergone some previous eruptive disease, which had power to protect the system from the usual severity of small-pox: that cow- pox possesses this protecting power in a remarkable degree, as the body which has been subjected to it will not receive small- pox by inoculation, though it will some- times receive it when the atmospheric con- tagion is very active: that when small-pox does occur in the vaccinated, it is generally mild and free from danger; that small-pox does not protect the constitution from small- pox neither so generally nor effectually as cow-pox does, since the cases of a second attack were found to be more numerous and more severe than those cases which oc- curred after cow-pox. Nevertheless, so slow is the progress of reason and truth, so difficult to conquer prejudices or to alter habits, that many people would rather have their children pass through small-pox than trust to vacci- nation; and medical men are yet to be found who will comply with their wishes in this respect. Yet there are many reasons against this practice. Though the small-pox is in general rendered milder by inoculation, yet it is by no means invariably so; many to whom it was imparted in this way have been known to have a severe and fatal dis- ease- and in others who did recover, many marks were left, and the lurking maladies of the constitution, as scrofula, &c. were called into operation, as certainly as after natural small-pox. Inoculated small-pox does not infallibly secure the individual from a second attack, either in the regular form or in what is called horn-pox, swine- pox, &.c. Of those carefully observed in the epidemic at Edinburgh in 1818, one- twelfth part who had previously passed through small-pox took it again, and two out of seventy-one died. Even although a mild small-pox may be communicated by inoculation to one person, he may infect his neighbours with small-pox of the most malignant kind; these may infect others, and thus the security of one may be dearly bought to the community by the sufferings and death of thousands. While small-pox inoculation is continued, we can never hope to render general the safe and easy prac- tice of vaccination, which insures a mild and modified disease to any who may. be infected with small-pox contagion. The enligntened and honourable part of the medical profession have, with hardly an ex- ception, refused to inoculate with small- pox matter; and it is only those who take advantage of the ignorance and prejudices of the vulgar, who are active in keeping up the pernicious practice. '1 he Board of the National Vaccine Establishment, in their report for the year 1820, say, "We find that the multitude, in many places, have been so infatuated as to accept the proffer- ed services even of itinerant inoculators. Hence a perpetual source of contagion is supplied and kept up." Nor is the evil yet likely to be at an end; for in the Lon- don newspapers, at the commencement of September, 1827, it is stated, that the small-pox is kept up by the more worthless class of apothecaries, who inoculate with that disease for five shillings a head. Under some, of the arbitrary goverments of the continent, where power can be exerted for good as well as ill, the practice of vaccina- tion is enforced by legal enactments, and inoculation for small-pox is prohibited un- der severe penalties; the consequence is said to be, that in some of their states, small-pox has ceased to exist. The spirit of political liberty will hardly tolerate legis- lating on such a subject, though it is not easy to see why it should not be brought under police regulations as well as the plague; but, till this be done, we can only hope that the superior advantages of vacci- nation will commend themselves to the no- tice and support of the well informed classes of society, and by their influence be ex- tended to its lowest ranks, and in this way alone will small-pox be extirpated. Were vaccination some formidable and dangerous operation, attended with certain present suffering, and communicating only a distant and doubtful advantage, one might feel reluctant to recommend it, and might consider much argument and persuasion necessary. • But when the whole affair con- sists in two slight scratches, followed by a vesicle or two, wdiich must be very much mismanaged indeed to give the child a mo- 414 • DISEASES. mentis uneasiness, and which is all over in fifteen days, we are ashamed to waste many words in advising parents to subject their children to so easy a process. A common bleeding, a purge or a blister, which many people submit to in order to preserve health, is far more severe to the constitution than the whole process of cow-pox. The simple affection from vaccination, (for it can not be called a disease,) has been proved by the experience of thirty years to secure the constitution from small-pox with far greater certainty than small-pox secures from a second attack of that epidemic; and instead of a crop of fiery pustules and sup- purating boils over the whole body, there is no eruption except at the spot where punctures have been made. This is of it- self a most powerful reason for preferring vaccination. Small-pox, when given by inoculation, in many cases filled the body with scars, and left the face pitted and dis- figured; and it was observed, that of those who applied to public charities for blind- ness, two-thirds had lost their sight by small-pox. From all such calamitous cir- cumstances cow-pox is entirely free. In the crowds who frequent public places, or are seen on the streets of great towns, how- few who have grown to youth and manhood within the last thirty years, present the melancholy wrecks of beauty which were formerly so often seen. Vaccination then is recommended by the mildness of the practice, by the security it affords against dangerous small-pox, by the fewness of its vesicles, by its being attended with no risk to others, and by its preserving unimpaired the beauty of the countenance. The reli- gious scruples against inoculating with small-pox, which were entitled to respect, have no foundation here. Some might con- scientiously consider it as a tempting of Providence, to inflict a severe and danger- ous disease which it was possible might be escaped; and a good man would be very unwilling to purchase the possible security of his own child, at the risk of infecting a whole neighbourhood; but all such fears for vaccination are groundless; the patient himself can not be called ill, his friends may approach him with perfect safety, and he communicates no infection to the atmos- phere around him. Proofs that vaccination has been properly performed. It has been said in a thousand instances, that such and such a person has had small-pox after having been inoculated, meaning by this, inoculated for cow-pox. But it does not follow, that because a per- son has been inoculated, he can be consi- dered as vaccinated, or endowed with that security against small-pox which vaccina- tion affords. If the puncture at which mat- ter was inserted, heals without the forma- tion of a vesicle, either from there being too little matter applied, or from its being washed off with the blood, or rubbed off by the clothes, the most ignorant can not think that in such a case, cow-pox has affected the constitution. Some have inoculated with common purulent matter, or with cow-pox matter when the vesicle was be- ginning to turn; or they have broken all the vesicles too soon, and taken away the matter which should have affected the con- stitution. Vaccination has been found to fail when there is extensive chronic disease ofthe skin present. Now, to know whether vaccination is perfect, besides its going through the regular stages, and leaving a distinct and characteristic mark, the follow- ing test has been proposed by the late Mr. Bryce of Edinburgh, and very generally adopted as satisfactory. When the vaccine inoculation has been performed, and the vesicle is going on properly, a second ino- culation is performed on the other arm, in the course of the fifth day of the process; and it is found, that when the system is properly affected, the second puncture is covered with a vesicle, which, though smaller, goes through its stages, and is surrounded with an inflamed circle, so as to finish its course at the same time as the first. The security afforded by vaccination is not at all diminished by the lapse of time. Dr. Jenner found, that persons on whom vacci- nation had been performed thirty, and even fifty years before, resisted completely the infection of the small-pox; and in the ex- tensive epidemic of 1818 and 1819, Dr. Thomson found, that the mildness of small- pox which occurred after vaccination, was not at all influenced by the more or less remote period at which vaccination had been performed. Those persons, therefore, were mistaken, who assert that the secu- rity against small-pox goes on decreasing in proportion to the length of time that has elapsed. Cow-pox does not occasion other diseases. Another assertion equally ill-founded has been made against vaccination, that other diseases, and especially skin diseases, par- ticularly measles, have been more frequent and severe, since the introduction of vacci- nation. .Let it be remembered, that all that the most zealous advocates for vaccina- tion claim, is its power of preventing almost entirely, and certainly of greatly mitigating, the severity of small-pox. If therefore, a hundred children are saved from dying by small-pox in the first years of life, there are a hundred more subjects for the other dis- eases of childhood over which vaccination has no corrtroul; a hundred more to be af- fected by hooping cough, by scarlet fever, by measles, or by croup. In such a case, other diseases will appear on the bills of mortality to be more frequent, but this is not the fault of vaccination. Neither are DISEASES. • 415 the diseases of children at all more fatal of late years than before cow-pox was heard of. The universal observation of the most experienced practitioners attests the con- trary. It must appear evident therefore, that in the whole history of the vaccine inocula- tion, the medical profession have conducted themselves with the liberality and candour for which they are so honourably distin- guished. As the small-pox generally at- tacked individuals in the interesting and helpless period of childhood, when parents would spare no cost within their power to bring them easily and safely through that loathsome disease, the conducting of this branch of practice was a certain and lucra- tive source of revenue to medical men; yet, when they believed a sure preventive had been found, they did not with cruelty and selfishness conceal it, but spread it through the world for the benefit of mankind. When the experience of revolving years convinced them that their first hopes were too sanguine, and that they had admitted too unreservedly the efficacy of cow-pox as a complete preventive of small-pox, they were not ashamed to acknowledge their error, and to rate the value of cow-pox at a lower rate, but still as a most important standard. CHICKEN-POX. A disease ofthe eruptive kind, in various particulars resembling small-pox, and apt to be confounded with it. At present, there is a considerable difference of opinion among medical men, with respect to the nature and even the existence of chicken- pox as a distinct disease; some considering it as such, while others consider it only as a modification of small-pox, occasioned by the previous occurrence either of small-pox or of cow-pox. While the matter contin- ues undecided, we shall describe it as a distinct disease, and mention some of the symptoms in which it differs from small- pox. Chicken-pox arises from a peculiar contagion, and attacks persons only once in their lives. It is preceded by chilliness, by sickness or vomiting, headach, thirst, restlessness, and a quickened pulse. After these feverish symptoms, which are gene- rally slight, pimples appear on different parts of the skin, in the form of small red eminences, not exactly circular; having a surface shining, and nearly flat, in the mid- dle of which a small clear vesicle soon forms. On the second day, this is filled with a whitish lymph; on the third day, the fluid is straw-coloured; and on the fourth day, the vesicles which have not been broken begin to subside. Few of them remain entire on the fifth day; and on the sixth, small brown scabs appear in place of the vesicles. On the ninth and tenth days, they fall off, without leaving any pits. Chicken-pox is generally a dis- ease of little or no danger; requiring only some mild laxative medicine with diluent drinks, avoiding exposure to cold, and at- tending to the diet, and to the bowels du- ring recovery. If in any case the fever should be more severe, stronger purgatives may be necessary; and some medicine may be given to promote perspiration, and to diminish fever, as small doses of antimo- nials; with the spiritus mindereri, or a little nitre added to the drink. The principal marks of distinction be- tween chicken-pox and small-pox are the following: The small-pox commences with a variety of severe symptoms of approach- ing fever, with vonvting, and even some- times with convulsions; and at a period generally well defined, viz. the third day, the fever abates a little, and the eruption appears; but in the chicken-pox the fever is milder, and more uncertain in its dura- tion: the pimples of chicken-pox are more quickly formed into vesicles or pustules than those of the small pox are: the fluid in chicken-pox does not acquire the thick purulent consistence of that in small-pox; and in chicken pox, the crusts or scabs are formed far earlier than in small-pox: lastly, in chicken-pox there is no secondary fever. ERYSIPELAS. By erysipelas is understoood an inflam- mation of the skin alone, or of the skin in conjunction with the subcutaneous cellular tissue. Like other inflammations, it varies in degree and extent, in different cases. When it effects merely the external surface ofthe skin, in which case the latter is red, not sensibly swollen, soft and without fluc- tuation, the disease is termed erythema. The cases to which the term erysipelas is more generally applied, are marked by the same symptoms, but of a mere intense grade; there is greater redness, consider- able tumefaction, a peculiar burning pain, and an effusion takes place beneath the cuticle, raising the latter in the form of blisters of various sizes; very generally there is effusion also in the subcutaneous cellular tissue. The most aggravated form of the disease is termed phlegmonous ery- sipelas,- in this both the skin and cellular membrane are inflamed, and extensive col- lections of matter and sloughing ofthe cel- lular structure are quickly produced. The parts most commonly affected with erysipelas, are the face and limbs; less fre- quently, especially in adults, the surface of the chest and abdomen. In a few instan- ces, the disease has been known to pervade DISEASES. the entire surface ofthe body; cases of this description are very generally fatal. Erysipelas is confined to no particular age, sex or constitution. It is more com- mon, however, in infants and young chil- dren, as well as in the aged, than in persons about the middle period of life. It like- wise more frequently attacks females than males; and persons of a sanguine and irri- table temperament, and of luxurious and intemperate lives, are more liable to its at- tacks than others. In some cases, the disease is confined to a very small space, in others it extends over the whole head and face, or occupies an entire limb. It not unfrequently commen- ces at a point, and gradually extends in everv direction, until it involves a very large portion of the skin. In other instan- ces, in the part first affected, the inflam- mation runs through its various stages and disappears, while it extends over a new surface to pursue the same course. In this manner, it may travel gradually from the head to the feet. In other cases, again, the erysipelas may suddenly disappear from the part primarily affected, to reappear in another and remote part of the body. It occasionally happens, that when the disease very suddenly disappears from the. skin, 6onie internal organ, and particularly the brain, in cases of erysipelas of the face, sud- denly present all the symptoms of inflam- mation. The part affected with erysipelas in its 6'nuplest form, presents the ordinary symp- toms of inflammation, namely, swelling, heat and redness. The swelling, however, is softer, more irregular and diffused than in common inflammation; the heat is moie intense, and the accompanying pain is a burning or smarting, similar to that from the application of mustard or scalding wa- ter; the redness is brighter and more in- tense, and disappears upon pressure, but returns the moment the pressure is re- moved. When erysipelas attacks a limb, in general the whole circumference ofthe latter becomes enlarged, and the skin pre- sents a kind of smooth shining appearance, and a somewhat doughy feel, as though a fluid was effused beneath it, which is, in fact, the case in most instances, when the disease is of anv violence or extent. When the face is the seat of erysipelas, the fea- tures become deformed; the mouth is often drawn towards one side; the nose is enor- mously enlarged, and the eye lids becom- ing swollen, close up entirely the eyes. After a few days, the period differing in different cases, vesications, varying in size, arise upon different parts of the inflamed surface, especially towards its centre. They are of an irregular form, and filled with a fluid, at first clear and watery, be- coming subsequently straw coloured and opaque. The cuticle, after a time, gives wav, allowing the fluid of the vesicles to escape, which drying generally upon the skin, covers it with thin scales. About the eighth or ninth day of the disease, but oc- casionally much later, the redness of the affected surfaces changes to a brownish or yellow hue; the vesicles entirely subside, and the cuticle dries anti scales off. Such is the ordinary course of erysipelas, but numerous varieties appear in relation to its intensity, course, continuance and ter- mination, in different individuals. In slight cases it may terminate in a few hours or days, with the occurrence of little or no vesication; in others, it will continue for weeks or even months; the vesications causing, in some instances, large and trou- blesome sores. In general, the disease is preceded and accompanied with fever, varying in its cha- racter according to the constitution, age, and general state of health of the patient. In the young, the robust, and those of full habits, we have a very decided attack of fever, and often of considerable intensity. When the factor scalp is the seat of erysi- pelas, therp tfr* often pain and oppression of the head, inclination to sleep, coma or delirium. The tongue becomes dry and brown; the pulse rapid and feeble, with great loss of muscular strength. In other cases, the heart and nervous system arc less af- fected, but we have pain in the stomach, foul tongue, a bad taste in the mouth, nau- sea and constipation. The symptoms of phlegmonous erysipe- las are the same as those which mark the simple form of the disease; but they inva- riably assume a more aggravated character. The swelling is considerable, extending, often, over the entire surface of a limb; it is firm and.of a deep red colour. When not arrested by a prompt and active treat- ment, the inflammation ends very rapidly in suppuration and sloughing of the cellular membrane. The matter formed is not, as in common inflammation, confined within a circumscribed cavity, but is diffused throughout the cellular membrane, giving to the limb a peculiar feel like that which would be produced by a quagmire or mo- rass. Very soon the skin bursts at one or more points, and large portions of the cel- lular substance, resembling wetted tow, are discharged, together with large quantities of matter, through the openings. Such cases, unless properly managed, terminate very generally in death; or when nature, after great and long continued suffering to the patient, effects a cure, a degree of per- manent deformity or lameness, is very often knovvn to remain. Erysipelas is produced by the same cau- ses as other inflammations. It may result from cold and various irritants applied to DISEASES. - * 417 the skin, or it may be produced sympa- thetically from irritations seated in the stomach and bowels. Phlegmonous erysi- pelas very generally results' from wounds, bruises, extensive ulcerations, or from the influence of cold. The treatment of erysipelas does not dif- fer materially from that proper in other in- flammations. In young persons, when the disease is of any extent and accompanied with much feve.-, bleeding from the arm and leeches to the seat of the disease, re- peated according to circumstances, with either of the following purgatives will, in general,be demanded: Calomel, five grains; rhubarb, ten grains; tartar emetic, an eighth of a grain; or, sulphat of magnesia, one ounce; tartar emetic, one grain; water, six to eight ounces; dose, a large table spoon- ful every two hours. The patient should, at the same time, be kept upon a very ab- stemious diet, and at perfect rest, in a cool well ventilated chamber. The best local application in these cases is cloths wet with cold water, and frequently repeated. When the disease occurs in the old and debilitated, local bleeding by leeches will frequently be demanded; but it will at the same time, be necessary to keep up tlie strength of the general system by a nourishing diet, and by the bark. After bleeding and the use of purgatives, if the erysipelas continue with evident symptoms of disorder of the digestive or- gans, two to four grains of calomel, com- bined with two or three of the antimonial powder, may be given every six hours for one, two or three days; or we may employ in the same way the calomel with chalk. During convalescency from erysipelas, the same precautions must be observed as in other inflammations, to prevent a re- lapse. In many extensive cases of erysipelas, blisters to the edges of the inflamed part, will have the effect of very speedily arrest- ing the disease. In phlegmonous erysipelas, the free use of the lancet and leeches is demanded at the very commencement of the attack; the bowels should be evacuated by some brisk purgative, as the compound senna tea, and then the calomel and antimony freely ad- ministered, interposing an occasional dose ofthe saline purgative, directed in the case of simple erysipelas. The bleeding from the leech bites in this form of the disease, should be encouraged by warm fomenta- tions, as it is important to arrest it in its earlv stage. If, notwithstanding the above remedies, the inflammation still continues, incisions with a lancet through the inflamed skin and cellular membrane will be proper; the part is then to be covered with cloths wrung out of warm water, and subsequent- ly with a bread and milk poultice. When suppuration has taken place, extensive in- cisions are all important to give vent to the matter and dead portions of cellular structure; after these have been discharged, a bandage to the part will promote its healing. PURPURA. Purpura means an efflorescence consist- ing of small, distinct, purple specks and patches, attended with general debility, but not always with fever. These specks and patches are occasioned by an extravasation of blood, under the cuticle, from the ex- tremities of the cutaneous vessels. The petechia, or spots like flea-bites, which oc- cur in bad typhoid fevers, the appear- ances of stripes in similar cases, and the livid marks common in sea-scurvy, are in- stances of purpura. There is one species of purpura, of con- siderable severity and danger, to which no English or popular name is given: Medical writers call it purpura hxmorrhagica, from the profuse discharges of blood which sometimes occur, and endanger, if not de- stroy the life of the patient. We shall give the description of the disease from Dr. Bateman, and add such remarks as may appear useful. The petechiae are often of a large size, and are interspersed with livid stripes and patches resembling the marks left by the strokes of a whip, or by violent bruises. They commonly appear first on the legs, and at uncertain periods afterwards, on the thighs, arms, and trunk of the body; the hands being more rarely spotted with them, and the face remaining generally free. They are usually of a bright red colour when they first appear, but soon become purple or livid. In the spots which appear on the tongue, gums, palate, and inside of the cheeks and lips, where the cuticle is ex- tremely thin, it breaks from the slightest force, and the effused blood is discharged. The gentle pressure on the skin, even such as is applied in feeling the pulse, will often produce a purple blotch, like that which is left after a severe bruise. The same state of things which gives rise to the effusions under the cuticle, pro- duces likewise copious discharges of blood, especially from the internal parts, which are defended by more delicate coverings. These haemorrhages are often very profuse, and not easily restrained; and therefore sometimes prove suddenly fatal. This singular disease is often preceded for some weeks by great lassitude, faint- ness, and pains in the limbs, which render the patient incapable of any exertion; but, not unfrequently, it appears suddenly in the midst of apparent good health. It is always accompanied with extreme debility and depression of spirits; the pulse is com- 418 DISEASES. monly feeble, and sometimes quickened; and heat, flushing, perspiration, and other svmptoms of slight febrile irritation, recur- ring like the paroxysms of hectic, occasion- ally attend. The disease is extremely uncertain in its duration: in some instances it has terminated in a few days; while in others it has con- tinued not only for many months, but even for years. When the disease terminates fatally, it is commonly from the copious discharge of blood, either suddenly effused from some important organ, or more slowly from several parts at the same time. The causes of this disease are by no means clearly ascertained, nor its patholo- gy well understood. It occurs at every period of life, and in both sexes. The ra- pidity of the attack, the acuteness of the pains in the internal cavities, the actual in- flammatory symptoms that sometimes su- pervene, the occasional removal of the dis- ease by spontaneous haemorrhage, the fre- quent relief derived from artificial discharges of blood, and from purging, all tend to ex- cite a suspicion that some local visceral con- gestion or obstruction is the cause of the symptoms in different instances. When purpura is accompanied with a white and loaded tongue, a quick and somewhat sharp, though small pulse, oc- casional chills and heats, and other symp- toms of feverishness, however moderate; and if at the same time there are fixed in- ternal pains, a dry cough, and an irregular state of the bowels, blood-letting to a con- siderable extent, but cautiously employed, and free and repeated evacuations of the bowels, by medicines containing some por- tion of the submuriate of mercury, will be found most beneficial. The continuance or repetition of these evacuants, must, of course, be regulated by their effects on the symptoms of the complaint, or on the gen- eral constitution; and by the appearance of the excretions from the intestines, and es- pecially of the urine; to which last excre- tion, Dr. Combe, of Leith, has very pro- perly directed our attention. In a case, which he treated successfully by blood- letting, he found the urine contained abun- dance of albumen, as happens in inflam- matory dropsies. When the urgency of the haemcrrhagic tendency has been di- minished by these means, the constitution rallies, though not rapidly, with the assis- tance of the mineral acids, and the decoc- tion of bark, or cascarilla, or some prepara- tion of iron, together with moderate exer- cise, and nutritious diet. The similarity of the spots and patches to those which occur in sea scurvy, and the discharges of blood from the mouth in both diseases, have led some to confound them together, and to consider purpura haemoi-r- hagica as a disease of debihn, to be treated by the mineral acids, tonics, bark and winej but there seem to be two species of pur- pura haemorrhagica, the one accompanied by fever, and a disease of increased action; the other a chronic affection, and not at- tended by fever, inflammatory blood, or serous urine. Our practice must be regu- lated by the individual cases, and not a lit- tle, perhaps, by the state ofthe urinary se- cretion. ITCH. A well known cutaneous disease, which commonly arises from infection communi- cated by touching the body or clothes of a person already infected, or by using the same bed-clothes as those who have it. It is greatly owing to the want of cleanliness, and seems to be very prevalent among the inhabitants of cold countries. The itch ap- pears in small pimples about the fingers, the wrists, the thighs, and the middle of the body; it attacks every place except the face: the itching is very troublesome, and the scratching, by breaking the pustules, causes the disease to spread still more. Some- times the pustules are large, and filled with purulent matter like boils. This purulent kind principally occurs in children between the age of seven and fourteen. The irrita- tion of itch is almost entirely local, and does not produce general fever. In some species of itch, but not often, minute in- sects are found in the reddish streaks or furrows near the pustules, but not in them; but in the vast majority of cases the com- munication of the disease does not depend on the transfer of insects, but on that of the matter. For this filthy disease, sulphur is an ef- fectual and long established remedy. It may be taken internally, or applied to the skin, formed into an ointment with lard or butter. The parts affected are to be well rubbed every night; or if they are very ex- tensive, one half may be rubbed in the morning, and the other in the evening. Five or six applications commonly cure the disease; but it is prudent to continue the rubbing for a few days after the cure is ap- parently completed. 1 he only objection to the sulphur is its disgusting sm'ell and appearance. These may be disguised by the addition of strong smelling perfumes composed of essential oils, and other sub- stances; and in order to cure the disease without sulphur, various other remedies have been tried. The root of the white hellebore made into an ointment, or a de- coction, has been known to cure the itch; it is one of the ingredients, along with sal ammoniac, in many of the itch oii.tments. Sulphuric acd has a'so been recommended and corrosive sublimate. But for common and general use, nothing ought to super- DISEASES. 419 sede the almost unfailing powers of sul- phur. In addition to the use of this reme- dy, the warm bath, repeated daily, will greatly accelerate the removal of the dis- ease. The patient should always be fed upon a mild unirritating diet, composed principally of vegetables. TETTER. There are two kinds of what are called tetter, the dry and the humid, and of each of these there are several varieties. I. The Scaly Tdler, the psoriasis of Wil- lan, exhibits more or less roughness and scaliness of the cuticle, with a redness un- derneath. Sometimes the eruption is diffuse and continuous, and sometimes in separate patches, of various sizes, and of an irregular figure. The surface under the scales is tender and irritable, and the skin is often divided by deep fissures. It is commonly ' accompanied by some constitutional disor- • der, and is liable to cease and return at f certain seasons. Some have a hereditary predisposition to tetter; women of a dry skin and languid circulation are subject to it; and it affects them more particularly after lying in, or during a state of chlorosis. In children, it is not unfrequently produced by the many sources of irritation to which they are ex- *^|iosed. It is observed in both sexes, con- f nected with gout; and in those who are predisposed to this eruption, slight occa- > sional causes appear to excite it; such as * being overheated by exercise, the unsea- sonable employment of the cold bath, a copious use of acid fruits, vinegar, or crude vegetables, and some peculiar mixtures of food. In the commencement of the eruption, when it appears suddenly, and the constitu- tion is obviously disordered, a moderate antiphlogistic treatment must be pursued. A gentle purgative, as magnesia and rhu- barb or an occasional Seicllitz powder, ,-■ should be administered, and the diet made light, by abstracting every thing stimulant. This regimen, indeed, is requisite through- out the course of this disease, which is im- mediately aggravated in sympathy with ir- > ritation of the stomach, whether by spices, fermented or distilled liquors, pickles, or vegetable acids; whence the disuse of these articles contributes materially to its cure. In the early and inflammatory stages, even the mildest substances irritate the skin and aggravate the distress of the patient. A decoction of bran, a little cream, or oil of almonds, sometimes produce case; but the use of preparations of zinc or lead is com- • 1 monly detrimental If the constitutional disturbance ha^ subs dod, the internal use of carbonate of potash, with tepid washing 3D with simple water, or milk and water, will gradually remove the complaint. II. The Humid or Running Tetter, the impetigo of Willan, is characterized by the appearance of small pustules. It is not ac- companied by fever; it is not contagious, nor communicable by inoculation. It oc- curs chiefly on the extremities; the most common variety appears in circumscribed patches, which are usually small and some- what circular on the upper, and large, oval, and irregular on the lower extremities. The patches at first consist of clusters of yellow pustules, set close together, and surrounded by a slight inflammatory border; in a few days, the pustules break, and dis- charge their fluid; the surface is red and shining, as if it were stretched, but exhibit- ing numerous minute pores, from which a considerable thin discharge is pourpd out, accompanied with much troublesome itch- ing, heat, and smarting. This discharge dries partially into thin greenish scabs, from under which it still continues to ooze. In the course of three or four weeks, the scabs fall off, but are liable to be renewed, as well as the discharge. It can not often be traced to any obvious cause. A predisposition to it appears to be connected with the sanguine temperament, with a thin soft skin, and a relaxed and bloated habit of body. Certain seasons appear to have great influence on the dis- ease, in those who are predisposed to it. At the commencement of humid tetter, it is useful to administer flowers of sulphur internally, in such quantities as not to in- duce purging; and if there is much irritabi- lity of the skin, a portion of soda, nitre, or carbonate of potash may be combined with it. Diligent washing with tepid water is at the same time to be employed. When more inveterate, it requires mercurial alter- atives, as the blue pill, or calomel and rhu- barb. The best ointments are those made with oxide of zinc or acetate of lead. When the irritability is less, the pitch ointment, or citrine ointment, diluted with five or six times its weight of lard, is often found to be very beneficial. SHINGLES. This is a disease characterized by a num- ber of vesicles, most commonly around the waist, like half a sash; but sometimes like a sword-belt across the shoulder. It veiy rarely surrounds the body completely; hence a popular, but groundless apprehen- sion, that if the disease goes round, it will be fatal. The disease is usually preceded, for two or three days, by languor and loss of appetite, rigors, headach, sickness, and a frequent pulse; with a heat and tingling in the skin, and shooting pains through the 420 DISEASES. chest, and at the pit ofthe stomach. After these symptoms, more or less severe, there occur, on some part of the trunk, red patches of an irregular form, at a little dis- tance from each other; upon each of which, numerous small elevations appear, clustered together. In the course of twenty-four hours, they enlarge to the size of small pearls, and are filled with a limpid fluid. The clusters are surrounded by a narrow red margin. During three or four days, other clusters continue to rise in succes- sion, and with considerable regularity. About the fourth day, the v esicles acquire a milky or yellowish hue, which is soon followed by a bluish or livid colour of the bases of the vesicles, and of the contained fluid. Several of them run together; and those which are broken, discharge a small quantity of a serous fluid for three or four days; this concretes into thin dark scabs, which soon become hard, and fall off about the twelfth or fourteenth day. Where there has been considerable discharge, numerous pits are left. The feverish symptoms com- monly subside when the eruption is com- pleted ; but sometimes continue much longer, probably from the itching and smarting of the vesicles. Though resem- bling some other eruptive diseases, in its rise and decline, it is not contagious, and persons may have it more that once. The disease, in general, is slight, and free from danger. It chiefly attacks young persons. It is most frequent in the summer and autumn, and arises not unfrequently from exposure to cold after violent exercise. It has come on after bowel complaints, and after the pains ofthe chest, following acute affections of the lungs. It does not require severe or active treat- ment. Gentle laxatives, as magnesia and rhubarb, castor oil, compound senna tea, or Seidlitz powders, and when the deep- seated pains are severe, diaphoretics with anodynes, as the Dover's powder, or a tea- spoonful every three hours of the following mixture: water, four ounces; sulphat of morphia, one to two grains; tartar emetic, one grain; cinnamon water, one ounce; with a light diet, is all that is requisite in the cure. A little simple ointment is to be applied to the ulcerated surfaces, to pre- vent their being injured by the clothes rub- bing or sticking to them. KING-WORM. The ring-worm is a disease of the skin appearing in small circular patches, or rings of vesicles round the circumference of a circle of apparently healthy skin: these ve- sicles are small, and contain a transparent fluid, which is discharged in three or four days, when little dark scabs form over them. Sometimes there is a succession of the circles on the upper parts of the body, as the face and neck, and the arms and shoulders. Dr. Batcman thinks that though the ring-worm has been observed in several children in one school or family, at the same time, it is not contagious, but is proba- bly to be attributed to the season or some other common cause. There is another disease of the scalp, popularly termed ring- worm, and manifestly contagious, to which we shall advert, when we have spoken of the treatment ofthe true ring-worm. The ring-worm is not unfrequently, by the com- mon people, besmeared with ink; and by the use of this, or other astringent and sti- mulant applications, the pain and itching \ are much relieved; and other solutions of the salts of iron, copper, or zinc, or alum, or ointments into which the same ingredi- ents enter, will answer a similar purpose. The infectious ring worm. This more formidable and infectious species of ring- worm appears in distinct patches of an irre- ' gularly circular figure, on the scalp, head, and neck. It commences with clusters of small light yellow pustules, which soon break and form thin scabs over each patch; and these, if neglected, become thick and bard by gathering on one another. If the scabs are removed, however, the surface of the patches is left red and shining, but studded with white elevated points, in some of which, minute globules of pus again appear in a few days. As the patches extend, the hair covering them becomes lighter in its colour, and sometimes breaks ' a off short; and as this process is repeated, ' j the roots of the hair are destroyed, and at ..""j length, there remains uninjured, only a narrow border of hair round the head. It generally occurs in children of three or •! four years old and upwards, and often con- * tinues for several years. It can be consi- ' dered as about to terminate, only when the redness and exfoliations disappear together, and the hair begins to grow of its natural colour and texture. The disease seems to originate spontaneously in children of feeble f ' ■! and flabby habits, who are ill fed, uncleanly, and not sufficiently exercised; butit is , principally propagated by the actual con- veyance of the matter from the diseased to the healthy, by the frequent contact of the and gentle friction, aided by proper diet j and regimen, with occasional purgatives; taking care to avoid all exposure to cold j and moisture, and to keep the swelled parts covered with flannel or warm cloth- l ing. When we find our attempts to pro- » mote resolution of the tumours to be un- J availing, we must apply emollient poulti- ^ ces; and at the same time give nourishing 'diet to invigorate the system, and bring on / a kindly suppuration. It becomes a mat- i ter of importance, how to treat the ab- scesses when matter is formed; whether to y let them break, or to open them with the lancet. AVhichever way they be opened, there is a probability of a long continued f discharge; and the surgeon should state to the friends of the patient, that by allowing the matter to be discharged by a lancet, he has it in his power to make a small and ef- t fectual opening; wdiereas the matter, if the swelling be left to itself, will perhaps break out in several different places^ and nothing be gained with respect to the continuance of the after-discharge, or the prevention of unseemly scars. When the ulcers remain >• open and spread, a variety of applications will be necessary. Sometimes a stimulant "M dressing is required, as ointment of yerdi- 7 gris, or basilicon; at other times, simple » dressing, as lard, or cerate, is all that can be borne. Sometimes a degree of inflam- mation will suggest the propriety of a 1 poultice, but this must not be continued F long, lest we induce a relaxation of the f parts around. We must vary our treat- f ment also by the application of different I washes, astringent or cooling, as sulphate of zinc, or sugar of lead. Sea-water some- times is of service. But under every treat- \ ment, scrofulous ulcers disappoint our hopes, and continue open for a tedious time; and, at length, in many cases, with- out any perceptible cause, they suddenly put on a healthy action, and heal up, not to break out any more. The constitutional treatment during this period, should be as healthful and invig- orating as possible; good diet, air, and ex- ercise are necessary; a residence in the country, or sea-bathing, are useful auxili- aries. Some practitioners have spoken with great commendation of the warm bath for scrofulous patients. It is to be perse- vered in for a considerable time. With respect to medicines given internally for the cure of scrofula, the list is long, and therefore unsatisfactory. One drug after another has been tried, and found not to answer. Among others, iodine, muriate offline, and the preparations of iron have been tried, and have been found perhaps the most beneficial. In some cases, it may be advisable to open an issue in some other part of the body, at a distance from the ul- cers or glands which we fear may come to suppuration. It will be seen, that in the foregoing account of the symptoms and treatment of scrofula, we have confined ourselves to the external form of it, princi- pally shown by the ulcerations and swel- lings of parts within our sight; but there are many internal diseases which occur in scrofulous habits, as dropsy of the head, curved spine, white swelling, consumption, &c. which are treated of under their res- pective heads. RICKETS. The disease called rickets is chiefly in- cident to infants between the ninth month and second year of their age, but sometimes appears between the second and sixth year. The children who are affected with rickets are mostly those who live in. moist and damp places, who are poorly fed, and who are not kept cleanly. Since the labouring classes have been collected in large manu- facturing towns, it appears to be on the in- crease. The disease comes on slowly, with a flabbiness of the flesh, wasting of the body, paleness of the countenance, and some degree of swelling of the face. The head appears large in proportion to the body, and the joinings of the bones, are more incomplete than usual;. while the opening of the head is very large. The forehead becomes unusually prominent, and the neck appears small. The teeth are long of cutting, and soon spoil and drop out. The ribs get flattened, and the breast-bone rises, the spine is bent, the bones at the joints are large, and the long bones between the joints, being smaller and unable to support the weight of the body, bend and continue crooked. In many cases, the child is weak, disinclined to ex- ertion, or unable to walk. The appetite 424 DISEASES. continues pretty good, but the stools are frequent and loose, and the belly is much swelled. Children affected with rickets, in general have their mental faculties very acute, even prematurely so; but in a few cases, they are morbidly dull. Sometimes the disease abates, and the child recovers its health; but the deformity and bending of the bones remains through life. One of the most distressing cases of rickets is that which leaves the female pelvis distorted and contracted, and hence subject to diffi- cult labour, or even rendering labour im- practicable. The remedies proper in the cure of rickets are those of a strengthening kind, applied to the whole system, and to the stomach in particular. Warm or sea bath- ing, the pure air of the countiy, removal from damp and moist places, and attention to cleanliness, are,among the first requi- sites. The diet is to be nourishing, and when the debility is great, it will be proper to give bark or quinine, and the prepara- tions of iron. A proper degree of exercise is to be given by carrying the child in a horizontal posture, avoiding all attitudes that might add to the deformity. The di- gestion is to be assisted by the administra- tion of rhubarb, with a little calomel, and an occasional emetic. The belly and back are to be rubbed with some stimulating lini- ment or anodyne balsam, as camphorated oil, or the soap liniment. When the teeth- ing of rickety children is difficult, we are to apply the appropriate remedies; and in every instance, to pay most particular atten- tion to the stomach and bowels. A rising of one shoulder sometimes occurs in young women between twelve and fourteen, and is to be regarded as a degree of rickets. The arm of that side should be tied up, and the other alone employed for some months. Steel stays, very accurately fitted, should be worn for a long period. SCCRVT. Scurvy is a term which has been very generally misapplied, both in popular dis- course and in the writings of medical au- thors. By such inaccuracies, it has been used to signify a great number of very dis- similar disorders of the skin; and indeed it became quite general to give the name of scurvy to any eruption, or long continuing scaliness, for which there was no appropri- ate name at hand. By medical writers, and by the well-informed non-professional man, the term scurvy is now applied to that dis- ease which is produced by a long abstinence from fresh vegetable food, exposure to damp, and the influence of the depressing passions, and which is therefore frequently observed in long voyages, in camps, and in besieged towns. Scurvy comes on gradually, with heavi- ness and aversion to motion, with dejection of spirits, anxiety, and great debility. The countenance becomes sallow and bloated, the breathing is easily hurried, the teeth become loose, the gums are spongy, and bleed when slightly touched; and livid spots appear on different parts ofthe body. A very curious circumstance sometimes oc- curs in scurvy, old wounds which have been long healed, break out afresh; in Anson's ship, about 1740, a wound broke out in one of his marines, which he had re- ceived at the battle ofthe Boyne, fifty years before. If the disease is not checked, the joints become swelled and stiff, the tendons of the legs are stiff and contracted; blood issues from the nose, the ears, the anus, and other parts; fetid stools are discharged, and the patient dies with symptoms of diarrhoea or dysentery. The great predisposing cause which, when long continued, needs no other to excite the disease, is the being prevented r from having a due admixture of vegetable food with the diet; hence its frequent oc- currence in long voyages, where the peo- ple are compelled to live much on salt pro- visions, and in besieged towns, where the provisions are scanty and bad; and in cold, damp, and poor situations, where human life is with difficulty supported. Among other very powerful exciting causes, wet are to reckon want of cleanliness and venti- \ lation, a damp and cold atmosphere, and 4 above all, depressing passions. On the g large scale of observation afforded in fleets and armies, it is invariably found, that when- ever any thing occurs to damp the spirits of the men, the scurvy uniformly becomes worse; whereas, any thing that tends to in- ( crease their alacrity, has as conspicuous an effect in rendering it milder and less fre- ^j quent. P^ The destructive ravages of the scurvy in fleets and armies, render it an object of attention to the statesman and commander as well as to the physician; and it has been very properly remarked, that all the im- provements in navigatio'n and nautical as- t tronomy, by which a ship can keep the sea for so long a period, would have been utter- \ ly useless, had there not been found out some method of preserving the health of seamen during those long voyages. Happily I it has at length been ascertained, that by p keeping the^ ship perfectly dry, allowing fcv the men as much recreation and exercise ^ as possible, and by taking to sea a proper ' supply of lime or lemon juice, and distri- ! buting to the ship's company a portion of it every day, when their fresh provisions be- gin to fail, they may be kept from scurvy ' as effectually as any number of persons living on shore, and using fresh vegetables every day. This has for a considerable DISEASES. 425 ) i number of years been ascertained on a very fulness of mind. Various articles are to be extensive scale of experience. During the used in diet which counteract the perni- long voyages of Captain Cooke, he kept his cious tendency of a long continued use of men quite free from scurvy. In the nu- salt provisions, as spruce or treacle beer, merous and extensive armaments which sour crout, preparations of oatmeal occa- were made during the wars of the French sionally, parboiled vegetables and the like. revolution, and in the long voyages to But it is obvious, that the expense and trou- India and China, it was only in ships ble of all these expedients must, in some where the supply of lime juice was neglect- measure, hinder their universal adoption; ed, that any symptoms of the scurvy ap- it is satisfactory, therefore, to think, that in peared. From one to two ounces a day are the pleasant fruits of the tropical climates, a sufficient quantity for this salutary pur- we have a safe, an effectual, and a portable pose; and they may be given diluted with remedy,«easily applied, and easily provided, water, or mixed with the grog, so as to by every navigator. form a healthful and refreshing beverage. It is unnecessary to enumerate all the When iu any individuals, the tendency to vegetables to be used for the cure or pre- scurvy appears stronger than in others, as vention of scurvy. Water cresses, radishes, indicated by the spongy and easy bleeding scurvy grass, lettuces, and the like, which gums, by stiffness of the ham-string, by may be eaten raw; or cabbage, turnips, laziness and dejection of spirits, it will be spinage, cauliflowers, boiled; or ripe fruits, j proper to give an ounce, three or four times as oranges, melons, pine-apples, plantain, 7 a day, till the tendency is diminished. &c. when they come in the way, as they I Lime juice is apt to ferment and not to not unfrequently do in the long voyages to ^ keep properly, owing to the quantity of the Indian and Pacific oceans. It is indeed pulp and mucilage squeezed out along with a grateful vicissitude, when a crew, long it; to prevent this, it is proper to mix oxposed to dead calms and burning skies, • with it a little alcohod or carbonate of with scanty allowance of water, and with lime. their fresh provisions expended, arrive in Having said this much respecting the China, where abundance of fresh prdvi- ,. prevention of scurvy, we now proceed to sions, and a profusion of oranges and other say something concerning its cure. And fruits, accessible to every person on board, * happily, so far as our experience goes, the soon remove the spongy gums, the stiffened ^*, same powerful yet simple agent which pre- sinews, and the unhealthy look with which vents scurvy, is also fully able to cure it. they reached their desired haven. i When circumstances admit of it, and we are Scurvy Spots. This is a term popularly able to procure for a ship's company an applied to those scaly spots which appear I* abundant supply of fresh meat and vegeta- in different parts of the body; a large pro- \ bles, this is the natural and appropriate re- portion of the surface being free from any medy; but in the last stages of the disease, disease. They sometimes are troublesome ? when the debility is great, it is a matter of for a long time, and are with difficulty re- much danger to take the sick on shore, as moved by any medicine or external appli- they not unfrequently die in the boat that cation. carries them thither; and instances have The best remedies for scurvy spots, when even occurred of the land air being too op- they are thinly scattered and not in a state pressive for the lungs of those, who did not of active inflammation, or inclined to dis- previously show marks of so great feeble- charge matter, are washes slightly stimu- ness. It is by far the safest way to attempt lant, as sulphate of zinc in rose water, or the cure of the men on board their ships; and when the disease abates a little, and ) the strength is beginning to return, it may then be accelerated by a removal on shore, ointments of red precipitate, half a drachm to the ounce of lard; or the diluted citrine ointment, gradually using it of the full strength. These are to be applied night and by the usual diet and exercise to be and morning, and the greasy matter to be found there. Many auxiliary circumstances occasionally washed oft' with a little soap are to be called into action, both in the and water. The more extensive and formi- cure and prevention of scurvy; the greatest dable kind of spots will require general as attention to ventilation and cleanliness, well as local applications, the warm bath, frequently washing the ship in fine wea- rubbing with various ointments of which ther fumigation between decks by the va- some of the preparations of mercury are nours of the nitric or muriatic acid; atten- ingredients; accompanied by the use ofthe tion to increase the real comfort of the warm sea-water bath; attention being paid men and to check all intemperance; to to the state of the stomach and bowels, promote regularity of discipline and cheer- and of the health in general. PART VI. PREGNANCY AND PARTURITION, WITH THE DISEASES AND ACCIDENTS OF THOSE STATES. PREGNANCY. The state of pregnancy is that condition of the female constitution from the time of conception to that of delivery. Though it is a state the very reverse of disease, many changes take place, and various uneasy feelings arise, which in some constitutions are exceedingly troublesome, and incapa- citate the individual from the enjoyment of health, or the performance of the duties of life. It may not be superfluous to enu- merate the principal circumstances de- manding attention or medical aid, as also the proper management of women during pregnancy. Before proceeding to this, we may enumerate some of the signs which in- dicate a woman to be in that state, pre- mising at the same time, that no single symptom can be relied upon, and that even their combination does not ensure certainty. Signs of Pregnancy. It is an almost in- variable fact, that while the monthly flux is regular, the woman is not with child; and therefore one ofthe first signs of pregnan- cy is the cessation of that discharge. It is to be remembered, however, that obstruc- tion of the discharge may often happen from many other causes, and therefore it can not be depended on as a sign of preg- nancy unless other symptoms follow. Some derangement of the digestive organs takes place, sickness or vomiting, especially in the morning; heart-burn, costiveness, dis- turbed sleep, and in some cases, irritability of mind and fretfulness of temper. The dark circle round the nipple becomes of at deeper shade, the breasts afterwards be- come enlarged and harden, and towards the end of the period of gestation, a milky fluid is secreted in them. Sometimes the woman becomes pale, and has a livid line at the lower eye-lid. Some become rheu- matic, and are affected with headach, tooth- ach, or other kindred symptoms. There is a progressive increase of the size of the belly; but it has not unfrequently happened, that women have supposed themselves pregnant when they were not so, and yet that the belly has gone on increasing in size; sometimes from their getting fat by luxurious living and the want of exercise, at other times from dropsical or other dis- eases, and occasionally from causes quite undiscoverable. Towards the end of the fourth month, the woman perceives a flut- tering sensation, occasioned by the motion of the infant. In common language, the child is said to quicken,- but we are not to suppose, that this is the first moment of its becoming alive. It had been so, long be- fore, though the smallness of its size and its limited degree of motion had rendered the signs of life indistinct and impercepti- ble. This fluttering motion may be imi- tated by flatulence, which often causes mistake and disappointment. Fainting sometimes seizes the mother about this period. The appearance of the blood drawn from pregnant women, after it has PREGNANCY AND PARTURITION. 427 stood for a.time, in a degree resembles the blood drawn in inflammatory diseases; but this appearance is from many circumstan- ces rendered a fallacious test of pregnancy. It appears, therefore, that in the early monthsjrit is very difficult to ascertain, be- yond a doubt, whether a woman be preg- nant or not; and practitioners should al ways be extremely cautious in giving their opinion. A rash announcement that the woman has been deceiving herself, may give such a shock to the feelings, as to be productive of the most lamentable conse- quences; and with respect to the manage- ment of doubtful cases, it is always safest to treat them as if the woman were preg- nant, till time puts the matter out of ques- tion; as fatal consequences might result both to the mother and child, by an at- tempt to get rid of supposed tumours or any apparently morbid symptom, by violent medicines, or other means. 1. Disorders of the early months. Vo- miting, sickness, heartburn, and other symp- toms of indigestion very often require at- tention in the early months. When the woman is otherwise healthy, the sickness is not to be treated with any very powerful remedy; no brandy or laudanum should be allowed, but it must be moderated by abridging the diet, by taking little at a time, and by confining the patient to those articles of food which she has experienced to agree with her. If the heartburn is at- tended with a constant desire to hawk up phlegm, it may be adviseable for once to clear out the stomach by an emetic. After- wards, the bowels are to be carefully at- tended to; and a little bark and sulphuric acid to be taken twice a-day. When the heartburn is accompanied by a sour taste in the mouth, with sour belchings, it is to be palliated by magnesia, or prepared chalk, or lime-water, and the bowels are to' be kept easy by castor oil, by senna, rhu- barb, or other mild laxatives. Swelling and pain in the breasts. Some- times in the early months, the breasts be- come swelled and very painful, especially in those who are in good health, and of a full habit of body. Great care should be taken that no part of the dress be tight over the breasts, and that the corsets do not press upon them. The breasts are to be rubbed with a little warm oil, twice or thrice a-day, and they are to be covered with soft flannel. The bowels are to be kept open, and in those who are of a very full habit, a little blood may be taken from the arm. Longings. In the early stages of preg- nancy, the minds of women are often fret- ful and impatient, and can not bear any contradiction. Among the vulgar and self- indulgent, it is an opinion, that if they do not get whatever they desire, whether any article of food or other object of attention, something very bad will happen either to themselves or to the child, particularly that the child will bear the mark of the object longed for, however loathsome and dis- gusting; and hence they are at no pains to restrain their capricious fancies, but expect the most ready compliance on the part of all around them. It should be known that all fears of imparting any marks to their offspring are utterly groundless; and though no person of common good nature would think of thwarting any harmless inclination or longing women might happen to take, yet it ought to be their own care not to be discomposed by every trifle, and not to oc- casion unnecessary distress or trouble to those about them. There is no doubt that in the state of pregnancy, the nervous sys- tem is with many in so irritable a state, that the most prudent management is re- quired; and by neglect or harshness, such symptoms may be induced, as will occasion- both alarm and danger; and a prudent phy- sician or friend will therefore be always disposed to err rather on the side -of indul- gence than of opposition, and will rather suffer the harmless longings of women to be indulged in all their absurdity, than run the risk of hurting their health by an inju- dicious sternness. 2. Disorders in the latter months. Cos- tiveness ought to be most carefully guarded against; and in the state of pregnancy, no person should allow two days to pass with- out an evacuation. The bowels may be kept easy by attention to diet, using a con- siderable proportion of vegetable food; and by taking some laxative medicine. An oc- casional clyster, after long costiveness, may be useful, but women should never allow their bowels to get into this torpid state; as it is productive of much general derange- ment to their health, occasioning heat and flushing, feverishne.ss and irritability; and may demand very unpleasant manual inter- ference to break down the hardened mass. When laxative medicines are taken, their effect may be to increase the slimy dis- charge from the bowels, while the fecu- lent contents are not dislodged; this must be carefully looked after, and purgative medicines that act slowly but effectually, must be resorted to, such as aloes with soap, rhubarb, scammony, or colocynth; and these followed up by castor oil, neutral salts, senna, or the compound powder of jalap. Looseness. If the bowels are very loose, the appropriate remedies for diarrhoea must be used. It will be right to give a laxative medicine to clear the bowels of any irri- tating substance, and afterwards to give small doses of rhubarb or catechu; taking care that we do not bring on again the op- posite state of costiveness. Piles. Pregnant women not unfrequent- 428 PREGNANCY AND PARTURITION. ly suffer much inconvenience from piles. They are to be prevented and mitigated by avoiding costiveness, by the use of mild laxatives, as sulphur and cream of tartar, and by avoiding the standing posture, or much walking. An ointment made oftwo parts of litharge ointment and one of pow- dered galls, may be rubbed on the piles; and if there be much swelling, with great pain and feverish symptoms, leeches may be applied to the parts, and the bleeding encouraged by fomentations. The bleed- ing piles seldom require much attention, except when the discharge is too profuse. Such attentions are of very great impor- tance, as it not unfrequently happens, that some of the most troublesome symptoms after delivery, proceed from the irritation excited by piles, which have been much pressed upon duiing labour. Palpitation of the heart. When this af- fection occurs during pregnancy, it is gen- erally the effect of a disordered stomach. It is to be relieved by an emetic, when no cir- cumstance forbids this; by laxatives, by lowering the diet, and avoiding every arti- cle of food that is likely to cause flatulence or to overload the stomach. Hysterical symptoms occur chiefly about the period of quickening; they are alarming to those who do not know their nature, but they do not last long. The best treatment is to strengthen the body by diet, air, exercise, and attention to the state of the bowels; and to regulate the mind, and keep away any sudden impressions that may agitate or alarm it. When the fit is on, it is to be shortened by camphor, or valerian, or assa- foetida; but opium in all its forms is to be avoided. Cough and breathlessness, occurring at the latter periods of pregnancy, without fever or inflammation, are to be ascribed to the bulk of the enlarged womb and its con- tents, pressing on the diaphragm; thus di- minishing the space in which the lungs move, and irritating them in the exercise of their functions. A half-sitting posture gives some relief; but nothing will remove it but delivery; although, when it is particularly troublesome, small bleedings may give some mitigation. Blisters are not to be employed. Pains of the side, belly, back, and loins, are very frequent complaints of pregnant women. In some cases, they may arise from distentions and flatulence of the bow- els; such are to be treated by giving rhu- barb, castor oil, and other mild laxatives; or they may arise from the stretching of the muscles, when they are to be treated with anodyne balsams, by a bandage which gives some support to the parts, and by changing the posture ofthe body frequent- ly in the course of the day. When they are more severe, small bleedings may be ne- cessary. The bladder is sometimes in an irritable state,- in which case, the patient should use mucilaginous drinks and gruels, and be at- tentive to evacuate it frequently. Towards the end of pregnancy, there is sometimes an inability to retain the water, which is forced away by any exertion, especially by coughing. It is thought rather a good sign, of the head of the child being well down,- and therefore, though inconvenient, it need be no cause of alarm. Betention of urine is a symptom that should never be neglected at any period of pregnancy, especially at the latter part of it; as it might be productive of very bad consequences, were labour to come on while the bladder is full. Jaundice sometimes happens in preg- nancy, and in general there is no cure for it but delivery; the uneasy symptoms are to be palliated by attending to the bowels, giving infusions of chamomile to assist di- gestion, and aloes to stimulate the intes- tines. If the yellow colour of the skin is very deep, with violent pain in the side, and great sickness and vomiting, we judge the complaint to be owing to the formation of gall-stones, by some of which the en- trance of the bile into the bowels is pre- vented. Relief is to be attempted by blood- letting, by fomentations to the side, by opiates; and by laxatives to prevent the constipation arising both from the disease and from the opiate. Swelling of the legs, and enlargement of the veins of the lower extremities, are very frequent accompaniments of pregnancy. They are owing to the enlarged uterus pressing on the great blood-vessels; and but little can be done for the relief of these symptoms, which, without any measures of art directed to them, go off spontaneously soon after delivery. But when the swel- ling rises above the knee, or appears on the upper parts of the body, and does not disappear after some hours rest in the hori- zontal posture, it seems to indicate a too great fulness and inflammatory tendency in the system, and requires large bleedings, and repeated purgatives. If the swellings arise from a debilitated state of the consti- tution, and a dropsical habit, the strength of the patient is to be supported by diet and tonics, while we give what relief we can, by medicines that increase the flow of urine. Toothach. Some women during preg- nancy are much troubled with toothach. It is to be palliated by anodyne applica- tions externally, by small blisters behind the ears, and by fomentations; but very rarely by drawing any of the teeth; indeed it sometimes has happened, that abortion has been produced by drawing a tooth; and surgeons and dentists are not fond of per- forming this operation during pregnancy. Cramp is a common occurrence towards PREGNANCY AND PARTURITION. 429 the end of pregnancy. It is relieved by change of posture, and by rubbing with anodyne balsam; but delivery alone com- pletes the cure. Headach. This is never to be neglected in pregnant women, especially towards the later periods. If it proceeds from slight causes, as from disordered stomach, it will be the more easily removed; but if it pro- ceeds from previous mental agitation, or from peculiarity of constitution determining the flow of blood to the head, it may occa- sion apoplexy or convulsions of the most alarming nature. To remove it, bleed freely. Convulsions. When a woman complains of violent excruciating pain in the head, if she has swelling and redness of the face when in the erect posture, or cramps in the stomach with oppressive sickness, the ap- proach of a convulsion is to be suspected. When it does come on, there is violent agi- tation of the body and limbs, the face is flushed or bloated, the tongue is moved frequently backwards and forwards with a hissing noise, and there is a little bloody froth about the mouth. The duration of the fit varies from a minute or two to half an hour. The woman is quite insensible while the fit lasts, and when sensibility re- turns, she has no remembrance of what has happened. Sometimes, long after the fit, there is loud breathing and continued in- sensibility, from which the unhappy suf- ferer is roused by another convulsion. Sometimes the fits bring on labour pains. Convulsions of the above alarming de- scription are owing to circumstances both of mind and body, connected with the state of pregnancy. The greater quantity of blood then formed in the body, and the increased susceptibility of the nervous system, may be stated as the predisposing causes. In this state, many things that would have little effect at other times, give rise to con- vulsions; such are irritation of the stomach or bowels, of the urinary organs; fatigue, sudden agitation of mind. It is very fre- quently observed, that females who are very anxious about their situation, are those who are most liable to be seized with con- vulsions. When the threatenings of a fit have shown themselves, it is to be prevented by large bleedings; and if the fit has actually come on, the quantity of blood necessary to be taken, exceeds that which is required in the cure of any other disease. The head is to be shaved, and cold applied in the most effectual way, as by iced cloths, or vinegar and water, or muriate of ammonia dissolved in water. The feet are to be bathed in tepid or in hot water; and if the delivery has begun, it must be assisted by proper means, and accomplished as speedily as possible. Pregnant women often experience a de- gree of anxiety and despondency approach- ing to disease; more especially when they have been in the way of hearing untoward histories of other women in that state, or when there is much sickness in the place where they reside. Much depends on their natural temper and character, and on the prudent conduct of their friends, either by diverting their over-anxious thoughts from their own situation, or showing them that their fears are groundless. Wre may lay it down as a general maxim, with regard to the great variety of ailments which occur to women in the pregnant state, that they are all to be listened to with patience and attention; that they are never to be ridiculed as affected or capri- cious; that though we are not to have re- course to violent medical or surgical treat- ment on every trivial complaint, we are yet to examine carefully whether any mild and safe remedy can be applied, and to en- courage the patient by the assurance, that though art can in many cases do but little, these ailments have no tendency to make the delivery more difficult; and that they may confidently look forward to that event, as likely to put a period to all their annoy- ances. FLOODING. By flooding is meant a sudden and copi- ous discharge of blood from the vagina. It may take place at any period of pregnancy, but it is most commonly applied to those discharges which take place immediately either before or after delivery. It is an oc- currence of general and just alarm, and re- quires the most prompt and speedy assist- ance. When it occurs at the early periods of pregnancy, it is a symptom of threaten- ing miscarriage, and in the next article we shall give a full statement of the measures proper to be pursued. When it happens shortly before delivery, it is most commonly owing to the after-birth being situated near the neck of the uterus, and when this be- gins to expand, some of the large vessels by which the after-birth is there attached, are broken, and pour out blood in great quantity. As the after-birth is the con- necting substance between the mother and child, and as nearly the whole of the blood of the child is deposited in it, it is obvious that the child is exposed to the greatest hazard of bleeding to death, and that the mother also is in immediate danger of an irreparable loss of blood. If the woman be not come to the full time, we must try to suspend the action of the uterus for some time, by enjoining the utmost quietness, by taking a little blood from the arm, or by giving opiates. If this does not succeed, or if the patient is at the full time, the only means of safety to the mother and to the 430 PREGNANCY AND PARTURITION. child, (though to the child the probability of life is very small,) is to accelerate the delivery as much as possible; and the ac- complishment of this is, of course, to be entrusted only to an experienced practi- tioner. When flooding occurs after deli- very ofthe child, and before the after-birth has come away, this also is of dangerous tendency; and if it appears to go to too great an extent, it is to be checked by get- ting the after-birth expelled; and for ac- complishing this purpose, no rougher me- thods are to be used at first than very gentle rubbing of the belly with the hand, or soli- citing the extrusion of the placenta, by pulling very tenderly at the cord. When the after-birth is away, the uterus, in gene- ral, contracts into a small bulk; and by so doing, shuts up the bleeding vessels, and puts a stop to the flooding. This contrac- tion is to be assisted by again rubbing the abdomen, and putting a broad roller round the body to give a proper support and mo- derate pressure. Another and more alarm- ing kind of flooding is that which happens after the womb has been completely empti- ed. Instead of the proper contraction of the womb, by which the waste of blood is prevented, it retains a large size, and nu- merous vessels continue to discharge their blood. The patient's ears ring, the head becomes giddy, she is insensible to sur- rounding objects, and it is only by the alarming medium of a fainting fit, that the flow of blood is stopped for a short time, but only to return again when the powers of life begin to rally a little. When the gentle methods of obtaining contraction of the womb do not succeed, (and there is little time to lose in making the attempt,) we must have recourse to such as are more suited to the impending danger, however rough they may appear. The abdomen of the patient is to be more strongly com- pressed, and cold water is to be suddenly dashed upon it in large quantities, or wet cloths to be laid upon it. If still we do not succeed in stopping the flow of blood, it will be necessary to introduce the hand into the uterus, and by gentle but skilful pres- sure to solicit the uterus to contract upon the hand; which is to be withdrawn with the uterus pressing it, or as it were expel- ling it, and closing behind it. In some cases of flooding, the mouth of the womb being closed, there is no appearance of blood externally, but it is not the less lost to the patient, as it is out of its proper ves- sels, and fills up the internal cavity of the uterus. The occurrence of this accident is known by the same constitutional symp- toms as the former, by the dizziness, the fainting, and debility," and by the belly speedily rising to a size almost as large as before delivery. Means must be immedi- ately taken to empty the womb of the clot- ted blood which fills it, and to induce con- traction to stop any farther discharge. It is seldom that the womb can be properly emptied of that blood without the introduc- tion of the hand. When the coagulated blood has been removed, the same means of inducing contraction, as above described, are to be resorted to. Sometimes, the non- contraction of the uterus is owing to part of its fibres being seized with cramp, by which there is a contraction in the middle, while the upper and lower parts- are ex- panded, forming what is called the hour- glass contraction. To overcome thi» spasm, pretty large doses of opium are to be given, forty or fifty drops of the tincture, or a grain and a half of the solid opium repeated at a short interval, till it has been three times taken. The manag-ement ofthe patient after the flooding has ceased, is of a very delicate and difficult nature. The powers of the constitution seem nearly quite exhausted; and to attempt recovering them by stimu- lants, would be attended with considerable hazard. The best cordial that can be given in the first instance, is a dose of laudanum to the extent of forty or fifty drops; but sometimes the debility and feeling of sink- ing are so urgent, that stronger stimulants must be had recourse to, as hartshorn with spirit of wine and a little water, or wine, either alone, or mixed with water. If the collapsed state is thus counteracted, and if sleep comes on, we may hope that the fee- ble pulse will acquire a firmer beat, and the exhausted strength be recruited by de- grees. In the course of an hour or two, some nourishment of the simplest kind should be given, as a little calf's foot jelly dissolved in water, or a little panado with a small portion of wine, or very weak chicken broth; most particular care being taken, that the quantities given be very small and frequently repeated; and that thjere be nothing given indigestible or over seasoned. The patient must on no account be allowed to rise up hastily or to make any exertion; every occasion of alarm or agitation should be carefully kept from her; her diet must be light and nutritive, gradually increasing as the powers of digestion recruit; and a little wine and bark may be given. Much injuiy is often done to the female constitu- tion by flooding; and in many instances the debility and pallid countenance remain till the end of life, even though that is pro- tracted for many years. It is, therefore, an accident that should in every case be assi- duously guarded against. Even after a common and easy delivery, there should be as little disturbance of the woman as pos- sible for many hours; no shifting of her dress beyond what is absolutely necessary for her comfort; and even a degree of dis- comfort, which at another time would not PREGNANCY AND PARTURITION. 431 be tolerated, must now be suffered to re- main; and rather some dry clothes placed next the woman, than any part of her dress be removed, at the expense of her own ex- ertions in getting up and assisting in her adjustment. ABOIITION. The separation of the offspring from the mother, at any period before the seventh month is termed abortion; between which period »*id the full time, the same event is called premature labour. Abortion may be described as consisting of two sjages, the separation of the embryo from the inner surface ofthe womb, and its being thrown out ofthe body by the action of the womb and other expelling powers. For a longer or shorter period before abor- tion takes place, there is pain in the lower part of the belly or about the back and loins, which gives warning of something wrong being about to happen. Then there is a discharge of blood from the external parts, sometimes slight, at other times pro- fuse and alarming; accompanied or suc- ceeded by sharp pains in the back, the loins, and the lower part of the belly, not constant, but intermitting like those of re- gular labour. Often there is vomiting, sickness, or pains of the bowels, and head- ach; and from the quantity of blood lost, fainting fits frequently occur, and there is commonly a sense of weakness, much great- er than can be accounted for by the copi- ousness of the discharge. If, by the efforts of nature or the assistance of art, these symptoms abate or cease, the embryo is retained and continues to grow; but, in other cases, the discharge of blood conti- nues, and the signs of approaching expul- sion of the contents of the womb become more avident. Regular pains ensue, there is a feeling of bearing down, with a desire to make water, and at last, the foetus comes off, either surrounded with its membranes, if the whole ovum be small; or the mem- branes break, the waters are discharged, and the foetus comes away, leaving the after-birth behind. If this be long retained, the bleeding and other troublesome symp- toms continue, with the additional ones of fetid discharge and putrescency. Abortion may be caused, 1. By external violence, as kicks or blows, a fall, or violent action, as dancing, riding, jumping, or much walking. Women in the state of pregnancy should avoid many of the do- mestic operations so proper at other times for good housewives to engage in. As our aim is to be-practically useful, we venture, at the risk of exciting a smile, to mention some exertions that ought to be avoided, viz: hanging up curtains, bed-making, washing, pushing in a drawer with the foot, careless walking up or down a stair. 2. Straining of the body, as from coughing. 3. Costiveness. 4. Irritation of the neigh- bouring parts, as from severe purging, fall- ing down ofthe gut, or piles. 5. Any sud- den or strong emotion of the mind, as fear, joy, surprise. 6. The pulling of a tooth has been known to produce a miscarriage; and though toothach is occasionally very troublesome to women in the pregnant state, the operation of drawing teeth should, if possible, be avoided at that time. 7. Women marrying when rather advanced in life, are apt to miscarry. It would be ha- zardous to name any particular age at which it is too late to marry, but the general ob- servation is worth attending to. 8. Consti- tutional debility from large evacuations, as bleeding, or purging: or from disease, as dropsy, fever, small-pox. 9. A state the very opposite of this, is sometimes the cause of abortion, viz: a robust and vigorous ha- bit, with great fulness of blood, and activity of the vascular system. 10. The death of the child. Miscarriage is always an undesirable oc- currence, and is to be prevented by all pro- per means, as a single miscarriage may irre- trievably injure the constitution, or give rise to continual repetitions of the accident, Unless we have reason to believe that the child is dead, it is desirable that miscarriage should be prevented, and that the womait should go on to the full time, if possible, but if the motion of the child should cease, if the breasts ofthe mother should become soft after disease or great fatigue, and signi of miscarriage come on, it would be impro- per to endeavour to prevent the embryo coming away; and we must direct oui; efforts to relieve any urgent symptoms, and do what we can to conduct the patienf safely through the process. When we have determined to attempt checking the discharge and preventing the consequent expulsion, the patient must cease from all exertion in walking, or even sitting upright, and must lie on a bed or sofa; all heating food or liquors must be avoided; whatever is taken should be rather cool, and cold applications must be made to the back, the loins, and neighbouring parts. A lotion useful for this purpose, and generally easy to be had, is one part of vi- negar to three parts of cold water; cloths or towels dipped in this are to be applied as directed above. The fainting which so often occurs, requires to be relieved by a very moderate use of wine and water; but in this, much caution is required, lest fe- verishness or inflammatory symptoms be brought on, which in a weakened frame are apt to occur, from causes too slight to have the same effect in a healthy one. As abortion sometimes takes place from too great fulness of blood, and from that 432 PREGNANCY AND PARTURITION. state of the constitution well known by the name of high health, it is right in such cases to employ bleeding, to order a cooling diet, as light puddings, preparations of milk, or boiled vegetables; and to give gentle laxatives, as castor oil, senna, small doses of purging salts, magnesia and rhu- barb. If, under such treatment, the dis- charge from the womb stops, if the pains cease, and the sickness, headach, and con- stitutional symptoms are relieved, we may hope that the woman will not part with her offspring, but bring it to the full time. She must make up her mind to be in the reclining posture for some time, and must consider herself as liable to be affected by the same symptoms and the same danger if she uses the smallest liberty with herself. If the discharge, however, still continues, and if there is little likelihood of the preg- nancy going on, every thing must be done to assist the woman in the safe completion of the process. We must introduce a soft cloth dipped in oil, into the birth, so as to fill the lower part of it. By this means, the blood has time to form into clots, and the contraction of the womb throws down the embryo along with them. We should not hastily use any force by the hand to bring it away; but the time when this may be done is to be left to the judgment of the medical person in attendance. As the after- birth in the early months bears a larger proportion to the contents of the womb :han it does in the later months, it is often retained long after the child is expelled; out it must be remembered, that the womb will not contract till every thing is out of it, and therefore the bleeding will continue till the after-birth is off. It may happen to lie partly out of the womb, and if so, the practitioner is to attempt gently to remove ;t by the hand; but if it be wholly in the cavity of the womb, its expulsion is to be promoted by clysters of gruel, with the addition of salts, or with senna, or even a little of the tincture of aloes. Patients should be careful not to throw away any thing discharged, on the supposi- tion that they know what it is, but should uniformly show every clot to the practition- er, that he may be enabled to distinguish with certainty whether the child and after- birth are thrown off. When the womb is emptied, the belly is to be tied up with a binder, as after delivery at the full time; the same rest and quiet is to be ordered; the diet must be light and nourishing; heat- ing food, all spirits, wine and malt liquors, are to be avoided; the practitioner may judge it proper, however, to allow sulphu- ric acid and bark, subsequently, to assist in recruiting the strength, which in the event of abortion is generally greatly exhausted. A very strong reason for enjoining rest and quietness after a miscarriage is this, that when twins or three children have been conceived, the embryo of one of them may be thrown off, and the other may be car- ried to the full time. Any preaature ex- ertion might, therefore, endanger the life of more than one child. When the woman is in some degree recruited, her recover}' is to be completed by moderate exercise, by proper diet, by the use ofthe tepid bath or sea-bathing, and by taking* stomachic medicines, as the bark, preparations of iron, or the elixir of vitriol. Few incidents have so pernicious an effect as a miscarriage on certain constitutions; sometimes the health is irreparably injured, or a habit is begun which prevents the woman from ever carrying a child to the full time. In every future pregnancy particular caution is requisite, especially at the period when the miscarriage formerly happened, which is very generally between the eighth and twelfth week. For a considerable time be- fore and after this, the woman should lie in the reclining posture, should attend to keeping the bowels open by such mild lax- atives as have been already mentioned; and if too full, should lose a little blood. Sometimes, for wicked purposes, it is at- tempted to procure abortion, either by strong and acrid medicines, by violent ex- ercises, or by direct application to the parts concerned; but it should be generally known, that there is no medicine which directly and certainly acts on the womb it- self; and that to procure abortion by any drug or mechanical violence, is to run the risk of speedy death, of inducing madness, or causing irreparable injury to the consti- tution. LABOUR. The efforts of the womb, assisted by the abdominal muscles, to expel the foetus and after-birth, when the child is able to live in- dependently of the mother. The general period of labour is about nine calendar months, or from thirty-nine to forty weeks, or from 273 to 280 days, after conception. Occasionally labour may be a little sooner, and at other times, a little later, than the above-mentioned period. The time at which labour may be expected, is reckoned either from the time that the monthly dis- charge has been obstructed, or from the period of quickening. If the reckoning be taken from the obstruction, it should be from a fortnight after the last appearance of the discharge; and if from the period of quickening, five months from that may be allowed for the time of labour. The process of labour is far from being uniform in every instance; and from this circumstance, writers on midwifery have distinguished different classes of labours, of which the principal are, natural, laboribai. PREGNANCY AND PARTURITION. 433 reternatural, and complex. As child- earing is a function co-extensive with the species, it might be thought improper and unnecessary either to describe it with such variety and minuteness, or to interfere at all with the process; but experience shows that it is a subject demanding the most careful and discriminating investigation; and that on a proper management of women during labour, depends the future comfort and health, or even the life, of themselves and their offspring. I. Natural labour is that which takes place at the full time, the head ofthe child presenting properly, the pains being regu- lar and effective, the whole process being completed within twenty-four hours. La- bour consists of three stages; in the first, the mouth of the womb and the passages are opened and prepared; in the second, the child is expelled from the body and separated; and in the third, the after-birth and membranes are excluded. 1. First stage. The approach of labour is indicated by pain in the back and loins, occurring at irregular intervals, and giving many teasing and disagreeable sensations. When these have continued for some time, a discharge of slimy matter, tinged with blood, occurs, which is commonly known by the name of the show. After a number of hours, more or fewer in different cases, the uneasiness becomes considerable; there are alternate hot and cold fits; there is a desire to pass water, and the patient is restless and uncomfortable. The pains now inerease in regularity and force, returning every ten or twelve minutes, and leaving the woman comparatively easy in the inter- vals. In many cases, the woman is troubled for some time, even for days, with ineffec- tive pains, resembling those of labour, be- fore the true pains commence. These false pains are occasioned by the pressure of the enlarged womb on the neighbouring parts: they occur mostly towards the evening, and during the night; they are slight and irregular; they are not attended by a show, and they are generally mitigated by a change of posture. If they are occasioned by costiveness, this must be removed by laxttive medicines. When the pains occur every five or six minutes, and the opening of the mouth of the womb is pretty well advanced, the bag containing the child, with a little portion of the waters, is pushed forward, and this contributes in a gentle and easy manner to complete the opening, and to enlarge the parts sufficiently to ad- mit the progress ofthe child's head. After the passages are prepared, the membranous 1 bag bursts, the waters are discharged, and the pains commonly increase in violence. Sometimes the membranes burst when the womb is very little opened, and the water drains slowly off for one or two days; occa- sioning what is often called in the lying-in room, a dry labour. In favourable cases, this first stage is completed within twelve or fourteen hours from the time it fairly begins. 2. Second stage. In the second stage, the infant is expelled. The pains now are somewhat different; they are felt lower down, they continue longer, and are at- tended with a straining and bearing down. The pulse becomes quicker, the patient feels hot, and often strong perspiration breaks out. The head comes down and stretches the parts, till at length it is expel- led, with very severe pain, which common- ly ceases immediately afterwards. But it very soon returns, and the rest of the body is pushed forward, the proper turns being made during the whole process, so as to bring the broadest parts of the child to pass through the widest parts of the mother. The pressure made upon the head of the child by the contractions of the womb, de- prives it for the time of sensibility, so that it does not disturb the mother by any strug- gles of its own. In general the pains suc- ceed each other very rapidly in this stage, and their force is so great, as to complete the delivery in a period from a few minutes to half an hour. But various causes to be afterwards noticed, sometimes render this stage a great deal longer. 3. Third stage. There now only remains the after-birth with the membranes, to be thrown off; which constitutes the third stage of labour. Some time after the child is born, the patient rests a little, but by-and- by she feels pains, not quite so severe, but rather what may be termed grinding. These are occasioned by the contractions of the womb, by which the after-birth is expelled, the cavity of the womb greatly diminished, and the large blood-vessels by which the placenta was attached, are closed. The non-performance of this cont-action gives occasion to dangerous flooding's. If the after-birth is not thrown off within an hour, some assistance will be required. Having briefly stated some of the more common circumstances of natural and easy labour, we shall mention a few var'ations which sometimes occur. The alternate flushes of heat and sensations of cold are sometimes so strong, as to shake the body violently, and even the bed; they do not indicate any thing very bad. Vomiing is another occurrence, which, when it hap- pens alone, need not give any disquietude. Anxiety and fretfulness sometimes seize the patient's mind during the first stage, but these are to be dispelled by encouraging language and sympathizing attentions. Management of Labour. There are vari- ous particulars to be avoided, and several things to be done, in the management of women during labour. The good sense of 431 PREGNANCY AND PARTURITION. modern accoucheurs has swept away a great deal of useless and pernicious prac- tices, which really make it wonderful that so many women got over the process with safety. The crowds of gossips talking or regaling themselves in the patient's room; one group succeeding as another retires; the cordials and stimulants poured into the patient, are now scarcely tolerated amongst the most vulgar. A cheerful and prudent friend, with the practitioner and nurse, are all the persons proper to be in the room; a greater number only exhausts the woman's strength, and heats and contaminates the air of the apartment When the practi- tioner is called, if the pains are pretty fre- quent and regular, an examination should be made to ascertain the progress, but it should not be repeated frequently and un- necessarily. The woman need not be con- fined to one posture, but she should not use violent agitations of the body, nor bear down much in the early stage. No method should be tried to increase the force of the pains, as it is much better for the passages to be gradually enlarged. When the bow- els are known to be loaded, an injection is very proper, and the urine should be regu- larly passed. The bed is to be so prepared, that the moisture from the waters and other dischaiges, may not add to the discomfort ofthe woman. The mattiess is placed up- permost, and a dressed skin or oiled cloth, or folded blanket, is to be placed on that part on which the body of the woman is to rest. A. clean sheet should be laid on in the usial way, and another in the form of a roller, across the bed, having the ends folded in at the sides. A coarse blanket folded within a sheet ought to be laid immediately beneath the patient. This is to absorb the moisture, and is to be re- moved after delivery. The rest ofthe bed- clothes are to be put on in the ordinary way; but it is convenient to have the edge ofthe sheet at the side ofthe bed to which the patient's back is to be placed, pinned or sewed over the blanket and bed cover. The woman is to be on her left side, and the practitioner behind her. The bed ought to be placed in such a situation, that the room may be properly aired, without the patient being exposed to a current of air, at a lr.tle distance from the wall, when it can be done. The bed-curtains should be of cot:on or linen, and never drawn so close is to prevent the free circulation of air. The dress of women in labour slr>uld be light and simple, both to keep them- selves from being overheated, and to pre- vent any thing from being in the way of what assistance is necessary. The patient should be put to b.d when the first stage is nearly completed; the best posture is 1\ ing on the left side, and a pillow or small bundle i» to be put between the knees. The bearing down pains should be those of the womb alone, and should not receive any assistance from the voluntary efforts or forcing of the mother; as these violent ex- ex ions are apt both to injure the passages, and to wear out her strength. At the last pains, when the desire to force down is almost irresistible, the utmost attention on the part of the practitioner is necessary, to prevent laceration of the parts.- The pa- tient may be allowed to rest a Jittle after the head is expelled, and the body of the child should not be hastily drawn forth. In some cases, this may be necessary when the child seems livid and in danger of in- jur}, or when the cord is twisted lound its neck. When the child cries stoutly, the navel-string is to be tied at two parts, and separated by cutting between them. The child may then be lifted from the mother, and the proper attentions paid to it. The after-birth is not to be taken away till the pains return in a slight degree; to effect this, all rash or strong pulling is attended with the greatest danger. Neither should the woman use much exertion by straining, coughing, or the like, to hasten the throw- ing off of the after-birth. The belly may be gently rubbed with the hand. When no uiivoward symptoms take place, we may rest from a quarter to three quarters of an hour; but may occasionally, by gently pul- ling at the cord, try if the af;er-biith is dis- engaged. When more than an hour elapses, the assistance of a proper practitioner will be required; and at any time, if flooding takes place, assistance will be instantly ne- cessary. II. Laborious Labours. We now pi-oceed to mention some cases, in which matters do not go on so favourably as above detailed. The labour may be more tedious or difficult than usual, from various causes. The pains may be less effective from weakness Of' the system, but more frequently from weakness ofthe womb iiself. Sometimes, though less effective, they are severe enough; but generally they are slighter than proper pains, -and come seldomer. Sometimes this inefficient contraction is owing to the waters coming away too soon, or the womb being over distended, as by twins, or too great quantity of water; or it may be owing to debility, induced by fear or other depress- ing passions, or general weakness. This is a state of suffering and anxiety, and re- quires patience and fortitude on "the part of the patient, and tenderness and prudence on the part ofthe assistants. No measures must be taken for forcing matters, no sti- mulants, nor strong purgatives, nor vomits, as was too much the case in the times of ignorance, not very remote. Tranquillity of mind and body are to be enjoini*}, a little mild nourishment and drink may be allowed, and a saline clyster is oft«m of PREGNANCY AND PARTURITION. 43S service. When the pains are prevented from doing their office, by rigidity of the mouth of the uterus, accompanied by ful- ness of pulse, with heat of skin, thirst, and restlessness, drawing blood from the arm is often of very signal benefit. In cases of exhaustion and weakness, it must be obvi- ous, however, that bleeding would be quite improper. If the rigidity ofthe membranes be the cai^se of the delay, it is proper to break thy the use of instruments, or by al- lowing the child's head to be wedged too long in the bones. The disease may be mitigated if taken in time; but, when long delayed, the consequences are very de- plorable. Contrivances must be adapted to prevent the continual draining off of the urine. AFTEU-PAIXB. In the child-bed state, women are not unfrequently distressed with sharp pains in the belly, back, and loins, recurring at in- tervals for several days after delivery. These resemble the pains of labour, being, howeyer, somewhat slighter in degree. They rarely continue above two or three days, and are not attended with any dan- ger. They seldom are troublesome during a first in-lying, but afterwards they are more frequent, in proportion to the num- ber of children a woman has had. One great matter is, to be sure that the pains complained of are after-pains, and not the effect of some more serious disease, as in- flammation. After-pains are distinguished by being alternated with intervals of ease, and by being generally attended with the discharge of some coagulated blood from the womb; pain is not excited by pressure on the belly. Other symptoms, along with the pains, indicate the existence of some other disease. After-pains are alleviated by giving an opiate shortly after delivery, and repeating the medicine in smaller doses every six or eight hours, taking care not to injure the nervous system by too much opium, nor to bring on constipation of the bowels. Warm flannels may be applied to the lower part of the belly, and in some cases an opiate clyster may be required. LOCHIA. The cleansings, or the discharge which takes place from the uterus for some time after child-bearing. Immediately after de- livery, the discharge is of blood, which in a few days gradually diminishes, and is fol- lowed by a discharge of a greenish fluid of a peculiar odour. The flow of the lochia continues in different women from a week to a month; in some women, the red colour disappears and comes back again for some time, till the womb is reduced to its origi- nal size. It is a desirable thing that this flow should proceed with regularity, as many untoward symptoms take place, either when it is checked suddenly, or when the flow is greater than usual. Various circumstances occasion the suppression of the lochia, as passions of the mind, cold drink, or cold air applied; and the symp- toms consequent are very alarming. Great fever, heat, and restlessness, pain of the head, back, and loins, delirium, inflamma- tion of the uterus, colic pains, costiveness, are a few of those symptoms. The mea- sures to be pursued for counteracting them, and for restoring the flow of the lochia, are the warm bath, if the patient can bear it; fomentations to the abdomen, large emolli- ent clysters, and sudorific medicines, as antimony, or the acetate of ammonia, assist- ed by copious diluent drinks. When a profuse and general perspiration breaks out, the relief is very rapid and unexpected, and a practitioner will find a patient whom he left at his last visit in the most alarming distress, at his next in a great measure re- lieved and free from danger. When the patient too soon attempts to get up, there is great danger of renewing the flow of the red lochia, by which a great 438 PREGNANCY AND PARTURITION. degree of debility is induced, and the health in consequence is materially injured. It should be strongly inculcated on women in childbed, that it is highly imprudent to use any great exertion during the cleans- ings, and that they should not presume on their feeling soon well. When this immo- derate flow has occurred, it is to be check- ed by confining the patient to the horizontal posture, by keeping the bowels easy by mild laxatives, by giving dry diet, and some astringent julep, made with sulphuric acid. SORE NIPPLES. Women who are nursing are very subject to excoriation and chopping about the nip- ples, and the pain is often so severe when the infant is put to the breast, that it is with great difficulty they can continue to nurse. Something may be done before delivery to prevent this coming on, by a frequent use of astringent washes, as tincture of myrrh, or infusion of oak bark; and when it has come on, the same washes are to be applied; or a solution of white vitriol in rose water, taking care to wash off with a little milk and water, any foreign substance before the child begins to suck. Sometimes great pain is occasioned by the child capriciously or playfully, seizing the nipple often, and letting it go again. This is said to be pre- vented by sprinkling on the nipple, when the child has done sucking, equal parts of powdered gum arabic and sugar candy. The sweetness induces him to keep his hold; and the powder absorbs the sharp fluid which comes from the clefts, and also defends the part. In some cases, it may be necessary to suspend nursing for a short time, till the chops and excoriations are healed, drawing off the milk by nipple- glasses contrived for the purpose. Or the child may be made to suck through a cow's teat, properly prepared and adapted to the nipple of the mother. Some women have very small nipples, and such as scarcely project from the breast; and it is extremely difficult for a first child, especially if it be weakly, to perform the function of suck- ing. In such cases, the nipple is to be drawn out by the suction of an elder child, or of some adult who is capable of doing it; but if much violence be used in this way, inflammation may be induced. By -perse- verance, some unlikely nipples will be so formed as easily to nourish the child. PHLEGMATIA DOLENS. Phlegmatia dolens is a peculiar swelling of the leg which occurs to women after child-birth. It is a tense, clear swelling of one of the limbs, generally beginning at the upper part, and increasing pretty quickly; the pain is considerable, and accompanied with fever. It occurs a few days after de- livery, and commonly begins at the groin, the hip, or top of the thigh, being preceded by shiverings, and some feverish symptoms. There is pain, weight, and stiffness, and difficulty of moving either the body or lower limb. The part complained of is generally hotter than natural, a little swell- ed, but not discoloured; at length the pain and swelling increase, and exlfcnd to the leg and foot: at wliich time the pain dimin- ishes, except on motion. The whole ex- tremity is now swelled; but it does not, like a dropsical swelling, change its bulk by posture, nor does it pit upon toressure, being tense, elastic, and very paiiiml when touched. After continuing for some days, the pain and swelling abate; at first in the upper part of the limb, and afterward* in the leg and foot. When the acute svSjop- toms are over, the patient feels much weak- ened, and the limb is stiff, heavy, and weak. It seldom returns to its former size, but remains through life stiff and enlarged, and easily susceptible of cold. Phlegiiitia dolens is tedious in its progress, and diffi- cult of cure: but it rarely goes on to sup- puration or gangrene, though instafcees sometimes occur of these troublesome or fatal terminations. When this disease occurs, we are to» ob- serve whether it be alone, or accompanied with any feverish, or other affection, and to proceed accordingly. If the inflamma- tory symptoms are high, a general bleedipsj will be proper, as also purging, and ftnti- monials; but such evacuations would evi- dently be misapplied, if the patient be de- bilitated by floodings, or previous ilness. If the swelled leg be the primary object of our care, one of the best applicatftns at the beginning, is to foment the part* with flannels wrung out of hot vinegar, continu- ing this for many hours together; Assisting its effects by giving purgative medScines of considerable activity* Other fomentations may be used, as the muriate of ammonia, or solution of sugar of lead. Leeches sMould be applied in'considerable numbers, and their bites covered with an emollient poul- tice, to encourage the bleeding. When the acute symptoms are over, we are to at- tempt the diminution of the swelling by frictions with camphorated oil, or otheflsti- mulant liniments; and when the general health and strength will admit of it, a brisk purgative may be given, such as jalap, gam- boge, or scammony, which have a tendency ^ to act on the lymphatic system. When the swelling continues long and obstinately, . mercurial ointment may be rubbed on the A limb, both for the sake of the local effect, and to bring the system in some measure under the influence ofthe remedy. PREGNANCY AND PARTURITION. 439 i • STILL-BORN INFANTS. In general, the child, as soon as it is born, cries stoutly, giving proof that its respiration has fairly begun, and that it is capable of living, detached from its parent. But in other cases, no sign of life appears for some time, and the child is said to be still-born. *By proper means, it may some- times be ta-ought from that state. When there is aity pulsation felt in the navel- string, the child should not be detached from the mother, but warmth should be ap- plied tofts body by flannels; the nostrils should be touched with a little hartshorn, the brea|t should be rubbed with spirits, and the^ buttocks and soles of the feet should lie gently slapped with the open hand. If the after-birth should in the mean- whrfe be detached, which is known by the corfl becoming longer, the infant is to be separated entirely, and the cord being se- cured by a slip-knot, the child is to be put into water, warmed nearly to the heat of the human blood, keeping the head upper- most, and the mouth and nostrils out of the waKr. Artificial breathing is to be prac- tised by some person who understands the way of doing it, either by the mouth or by a proper syringe. If the pulsation of the heart be not restored, the infant is to be taken out of the water, placed before the fire, carefully rubbed, and wrapt in warm flarfnel. A clyster, made of a few table- spoonfuls of warm water with a tea-spoon- ful of spirits, is to be thrown up with mo- aerate force. The apparent death may arise from a cause analogous to that of apo- plexytin adults; and we therefore sometimes allow" a little blood to drop from the end of the lord. We do this the more freely, whenHhe shape of the head is altered from what is natural, when the colour ofthe face is dark and livid, and when the pulsation in the coVd is oppressed. The quantity of blood wliich we may allow to flow, is from one tabTe-spoonful to two. If the child does not breathe after this discharge, the cord is to f>e tied, and artificial breathing at- tempted. All stimulating and irritating means in these cases are to be avoided. Sometimes, though a child breathes and crie4 at first, it very soon becomes pale, and the pulsation of the heart becomes fee- bW Stimulants are then to be applied to the'surface, as brandy or hartshorn: occa- sionally we succeed by these means in re- sto - 372 JHieps, - - 22 Adhesive plaster, - - 163 Adipose membrane, - - 22 After-pains, - - 437 Ague\ and fever, - - 265 69 Albumen, - - 87 Alcohbl, - - 110 Alkalis? poisoning by the - 372 Alimentary canal, - - 25 Aliments, - - 85 Almonds, - - 101 Aloes, - - 163 Aloejic pills, - - 164 Alteratives, AluVi, . . 141 164 Alvine concretions, . - 214 237 AmBer, oil of - - 164 Ammonia, - - 165 Amrijoniacum, - - 165 Amsuos, - - 60 Arftomy and physiology, - 3 395 r^jfnasarca, - - Anchovy, - - 102 .Anchylosis, - - - - 252 Jlbcle and foot joints, - - 8 AnaSrson's pills, - - 164 Aneurism, - - 214 Anger, - - 124 Anesustura bark, - ■ 166 V PAGE Animal heat, 39 food, 36 Animation, suspended - 215 Anodyne clyster, 184,443 Hoffman's - 185 draught, - 444 drops, . 196 Anodynes, - - 142, 444 Antacids, ... - 141 Anthelmintics, . 142 Antidote, - . 142 Anti-emetics, - 142 Antimonial wine, - 166, 441 powder, - 166 - 166 Antiphlogistics, - 143 Antiscorbutics, - 144 Anus, ... 27 diseases of the - 218 Anxiety of mind, - 124 Apoplexy, . - - - 303 Appetite, ... 82 Apthae, ... - 327 Arabic, gum - 167 Ardent spirits, -_ - 111 17 pit, 17 - 144 Aromatic vinegar, - 160 Arrow root 92 - 167 poisoning from - 167,370 34 96 Articulations, 6 Artizans, diseases of - 134 Asarabacca, - 168 Asparagus, 97 Asphyxia, ... - 315 Assafoetida, - - 168, 443 Asthma, ... - 335 Astringents, - 144, 445 Astringent drops, - 445 mixture, - 445 Atlas, the - 6 Axilla, 17 Azederach, - 168 Azote, - 168 44S INDEX. PAGE Bacon, .....89 Baking, - - .- - - 103 Balsams,.....169 Bark, .....169 Barley,.....93 water, .... 93 Barytes, .... - 171 poisoning from - - 372 Basilicon, - - - - - 171 Basin or pelvis, - - - - 16 Bathing, - - - - 115, 144 Beds,......121 Bed chambers, .... 122 Beef,......88 tea,.....89 Bee sting,.....220 Beet,......97 Belladonna, .... 171 Belly, .....15 dropsy ofthe ... 397 Benne leaves, .... 171 Biliary organs .... 27 ducts, .... 28 Bilious fever, .... 269 colic, - 355 Biscuit,.....95 Bismuth,.....171 Bitters, .... 146, 445 Bitter-sweet, .... 172 Blackberry root, - - - 172 Bladder,.....41 inflammation ofthe - 298 Bleeding,.....128 from the nose, - - 391 from the lungs, - - 392 from the stomach, - 394 from the bladder, - - 374 from the womb, - 376, 429 Blisters, - - - - - 154 Blistering plaster, ... 172 Blood, - -" - - - 35 letting, .... 147 root,.....172 spitting of ... 392 vomiting of ... 394 Bloody urine, .... 374 Boil,......212 Boiling,.....103 Bones, .....5 of the head, ... 8 diseases of the ... 221 Boneset, - - - " - . 172 Borax, .....172 Bowels, care of the - 126,130,132 inflammation ofthe - 292 medicines to open the 150, 442 Brain, the.....42 nerves of the ... 44 injuries of the ... 222 inflammation ofthe - - 280 Dropsy ofthe ... 299 Bran, - - . . . . 92 Brandy,.....112 Bread, .....94 Breakfast.....104 Breast bone, ... Breast, the female pang Brocoli, .... Broiling, .... Bronchiae, - Bronchocele, Broth, .... Brown mixture, ... Bruise, .... Bubo, .... Buckwheat, ... Buckbean, ... Buckthorn, ... Bugle weed, ... Burdock, .... Burgundy pitch, Burgundy wine, ... Burns and Scalds, applications for Butter, .... milk, ... Butterfly weed, ... Butter nut, - Cabbage, .... Cajeput oil, ... Calamine, ... Calf's foot jelly, ... Calisthenics, ... Calomel, .... Canadian balsam, Cancer, .... ofthe eye, womb, ... Camphor, .... Canine madness, Cantharides, ... poisoning from Capillare, .... Capillaries, .... Caps, .... Carbon, - Carbonate of zinc, Carbonic acid, ... Carbuncle, ... Caries, .... ofthe Spine, Carminatives^ ... Carminative clyster, Carrots, - - . . Carrot seed, ... poultice, ... Cartilages, .... Cascarilla, .... Castor, .... Castor oil, .... Cataplasms, ... Cataract, .... Catechu, - Cathartics, .... Cattarrh, .... Caul,..... Cauliflower, Caustic, Lunar INDEX. 449 Cayenne pepper, Cellars, *- Celery, ... Cellular membrane, Chalk, Chalk mixtuflr, Chalybiates/ Chamomile* Champaigne, Chancre, ' - Charcoal poultice, Cheese, ... Cherries, - Cherry brandy, Cherry-tree bark, Chest, - - - dropsy of the Chestnuts, ... Chicken soup, i . pox» Chilblains, ... Childbed fever, Children, management of Chlorine, - Chlorosis, ... Chocolate, Cholera morbus, i malignant of infants, Chordee, . . - Chorda, ... Chorion, ... Q/der, ^tircocele, ... Osculation, Circulatory apparatus, Citric>acid, - Citrinte ointment, Claret, Clavicle, . . - Cleanliness, of infants, of children, Climate, . - - Clothing, - - of infants, of children, Clubfeet, Cljfsters, ... anodyne purgative Cocoa nut, - Cocj Coffee, Colchicum Coljj bath, asphyxia from Collar bone, Collyria, *T3Wocynth, Cologne water, Colombo, Coltsfoot, Coinparative anatomy, / PAGE 102,177 Compression of the brain, 71 Concussion of the brain, 98 Condiments, 21 Constipation, 177 Colic from 445 Consumption, 177 Contrayerva, 178 Contusion, ... 110 Convulsions in infants, 230 puerperal 175 Cookery, . . - 88 Copaiba, - 99 Copper, ... 112 poisoning from 178 Cordials, 13 Corn, - - 400 Cornea, opacity of the, - 101 Corns, - - - - 90 Corrosive poisons, - 415 sublimate, 230 poisoning 439 Cosmetics, - - - 132 Costiveness, - 178 Cotton, - - - - 377 Cough, - 108 Cow-itch, - 361 Cow-pox, ... 362 Coxe's hive syrup, - 365 Crabs and lobsters, 231 Cradles, - 315 Cramp, - - , - 60 Cranberry, - 108 Cravat, - - 231 Cream, - - - - 36 of tartar, 33 Cresses, ... 161 Cross births, ... 179 Croton oil, - 110 Croup, - - - 17 Crowfoot, . . - 114 Cubebs, 130 Cucumber, - - - 133 Cupping, 74 Currants, - 74 Curved spine, 130 Cutaneous exhalation, 133 Cuticle, - 231 Cutis, ---- - 151 444 Dalby's carminative, 443 Dancing, 101 Dance of St. Vitus, 16 Dandelion, ... 107 Dates, .... 179 Deglutition, - 72 Delerium tremens, 115,145 Delivery, precautions after, 216 injuries from, - 17 Deltoid muscles, 151 Demulcents, - - - 179 Denarcotized opium, 118 Dentition, 179 Dentrifices, - 180 Dewberry root, 4 Diaphoretics, PAGE . 222 - 222 - 101 . - 126 - 353 - 339 - 180 - 231 - 300 - 429 - 103 - 169 - 180 180, 371 - 112 93 - 235 - 232 - 369 - 180 from, 181, 371 - 118 - 126, 427 76 - 428 - 181 - 410 - 181 90 - 131 - 428 99 - - 77 87 - 181 98 - 435 - 182 - 327 - 182 - 182 98 - 151 99 - 255 23 22 23 - 182 80 - 315 - 182 99 25 - 325 - 436 - 437 17 - 152 - 182 12 - 119 - 183 - 152, 443 \ 450 INDEX. PAGE Diaphoretic fever powder, - 443 Diaphragm,.....14 Diabetes,.....373 Diarrhoea, - - - - - 356 Diet, -.....1^2 of children, .... 132 Digestion,.....29 Digestive apparatus, ... 24 Diluents,.....153 Dinner,......105 Dislocations, ----- 250 Diseases, ..... 265 surgical, - - - - 211 of tlie heart, ... 337 of menstruation, - - 376 of artizans, ... 134 Diuretic drops, .... 208 Diuretics, .... 153, 443 Diuretic powder, ... 443 Divided spine, .... 257 Dogwood, - - - - - 183 Doses and uses of medicines, - - 441 Douches, ..... 146 Dover's powders, - - - 183, 444 Dreaming, 62, 123 Dressings and plasters, - - 446 Drinks,......106 Dropsy, - - - - 395 external, - - - 395 ofthe eye, - - - 236 joints, ... 250 brain, - - - 299 belly, - - - 397 chest, - - - 400 Drowning, - - - - -215 Drunkenness, .... 113 Drunkards, delirium of, - - 325 Dyspepsia, ----- 342 Dyspeptic ley, - » - - - 183 Dysentery, ----- 360 Dysuria,.....375 Ear,......52 diseases of the, ... 238 Effervescing draughts, - - 183,445 Eggs,......88 Elaterium,.....183 Elbow joint, ----- 7 Elder,......183 Elecampane, ----- 184 Electricity,.....153 Elixir of vitriol, ... - 184 Elm,......184 Embrocations, .... 153 Emmenagogues, .... 154 Emetics, .... 153, 141 Emetic tartar, - - - - 166 poisoning from, - 371 Emollients,.....154 Empyema, ..... 233 Emphysema, - - - . . 232 Enemas, ..... 184 Enema, tobacco, .... 208 Epidemic catarrh, .... 287 cholera, .... 362 Epiglottis, - Epilepsy, - Epispastics, - Epsom salts, - - - . Ergot, Errhines, - - - ; - Erysipelas, • Escharotics, - Esophagus, - - - - Ether,..... Ethmoid bone, Excoriation, - . . . Exercise, ... of infants, of children, Exfoliation, - Exhalation, - - - . Expectorants, - Expectorant mixture, pills, Extensors of the arm, External senses, Extremity, the upper, the lower, Eye,..... diseases ofthe, inflammation ofthe, Eye-lids, diseases ofthe, Eye waters, - Face, the - Facial angle, - Fat,..... Fatuity, - - Fear,..... Feet, - - - _ - Female breasts, abscess of the, Female genital organs, - Femoral bone, Fern, male, - Fever, intermitting, bilious, yellow, typhus, scarlet, child-bed, - Fever powders, diaphoritic Fibula, the - Figs, - Fingers, the - - - . Fish, - Fistula, - lacrymalis, - Flannel, ... Flatulent colic, Flaxseed, - Y lexors of the arm, Flooding, ... Foetus, .... Food, .... of infants, Foot, .... and ankle joints, Foxglove, PAGE 54 313 154 184 184 154 415 155 11 184 9 339 78 130 133 221 41 444 444 4 17 46 16 18 46 83 82 238 185 > INDEX. 451 PAGE Fracture,.....221 Friction, 81, 156 Frontal bone,.....8 Fruits, ...... 98 Flying, -.....103 Gallbladder^ ..... 28 nuts,.....186 Game,......90 Ganglions* - - - - - 44 Gangrene^ ----- 240 G u-gles, .... 156,446 Gail.c,......97 Gartersi.....78 Gastric juice, ----- 26 Gastrocriemei muscles, 19 Gelati/e,.....86 Gesjleration, - - * * 58 organs of - - - 55 Geranium maculatum, ... 186 Gestation, .... 58, 80 Gin,......112 Ginger,......102 Gingerbread, 95 Glands,......40 Glahiber's salts, ... - 186 Gfeet,......241 Glottis,......54 GcM......187 -*>oseberry, . - 99 Gonorrhoea, ----- 241 G04H,......385 fii-apes, -.....100. •^ ravel and stone, - - . 243 **£reen sickness, .... 377 wegory's pov/ders, - - - 187 Grfef,......124 Griffith's pills, - 187 mixture, - - - 187 Gristle,......5 Gruel,......93 ,Guia»cum, ..... 187 Gullet,.....11, 25 affections ofthe - - - 242 Gum, '......92 boil,.....212 Gymnastics, . - - - , 82 Habit,......129 Hemoptysis*.....392 HaV the.....'23 * care of - - - - 124 HaVn,......89 Ha>d,......18 , articulations ofthe - - 7 Hanging, - - - - - - 215 Hafeh'p,.....246 cad, the.....8 and neck, articulation of the 6 dress,.....76 water in the - - - 299 lealth,......68 Hearing, ... . - 51 phenomena of - - - 53 Heart, the - diseases of Heat, - -( - - - - Heat, animal, - Hellebore, - " - - - - Hemlock, - - - - - Henbane, - - - Hernia, - - - - - • - Hip joint,..... disease, - - - - - Hive syrup, - - - - - Hoarhound, Hoffman's anodyne, - Honey,...... Hope,...... Hooper's pills, .... Hooping cough, - - - - Hops, - Horse-radish, - Hot bath,..... Humid tetter, - Hunger,..... Hydragogues, - - , - Hydrophobia, .... Hv driodate of potass, Hydrocele, .... Hygiene,..... Hypochondriasis, ... Hysterics,..... Ice,..... Iceland moss, .... Idiotism, ..... Iliac passion, .... Indian corn, .... tobacco, - turnip, .... Indigestion, .... colic from ... Infants, management of - convulsions in - sore mouth of - cholera of ... Still born, Inflammation of joints, - of the brain, eyes, iris, tonsils, - larynx, - stomach, intestines, liver, peritoneum, kidneys, urinary bladder, womb, pulmonary Influenza, Innominatabones - Insanity, Intemperance, Intercostal muscles, Intermitting fever, PAGE 33 337 71 39 187 187 188 246 7 253 181 188 185 92 123 188 332 188 102 145 419 31 156 312 188 248 68 308 307 188 188 319 366 93 189 189 342 352 129 300 327 365 439 249 280 282 283 283 284 291 292 293 295 297 298 298 288 287 16 317 112 14 265 3H 452 INDEX. PAGE Intestines, the .... 26 inflammation of - 292 Iodine, .....189 Ipecacuanha, - - 189, 441, 443 Iris, inflammation of the - - 283 Iron,......190 Itch, ------ 418 Jalap, .....190 compound powder of - - 190 Jaundice, .... 349,428 Jaw, articulations of the - . 6 Jaws, structure of the - - - 10 Joints, .....6 affections of the - - - 249" loose bodies in the - - 253 Joy,......123 Juniper, ..... 190 Kentish ointment, ... 190 Kidneys,.....41 inflammation of the - - 297 King's Evil,.....421 Kino,......190 Knee joint.....7 pan, ----- 8 Labour, management of - - 432 Labours, preternatural - 435 complex ... 435 Lactaels,.....29 Lamb, .....89 Larynx,.....37 inflammation of the - - 284 Laudanum, - - - - 191 poisoning from - - 191 Lauro-Cerasus, - - - - 191 Laxatives,.....442 Laxative clysters, ... 443 pills, ... 442 Lead, .....192 colic from - - - - 353 poisoning from ... 372 Leeches,.....156 Leek, .....97 Leg, the.....19 Leg, swelled - - - 428,438 Legumen,.....98 Lemon,.....100 Lenitive electuary, - - - 192 Lettuce, 98, 192 Leucoma, ..... 235 Lichen, - - - - - 188 Ligaments,.....6 Lime water,.....193 Linen, .....76 Liquorice, .... 193 Lisbon diet drink, - - - 193 wine, .... HO Lithontriptics, .... 157 Liver, the.....27 inflammation of - .- 293 Lobelia,.....189 Lochia,.....437 Locked jaw, .... 311 Logwood, ... Longings, ... Looseness, - - - Love, - Low spirits, Lumbar abscess, Lunar caustic, poisoning from Luncheon, Lungs, the - - - inflammation of consumption of bleeding from V f PAGK 193 427 427 123 308 213 193 372 105 37 288 339 392 Madeira wine, Magnesia, ... Magnolia, . . - Maize, ... Malt liquors, ... Mammae, - Mammary abscess, Mania, - - Marrow, - . - Marshes, Marsh mallow, Mastication, Materia Medica, May apple, Meals, ... Measles, ... Mediastinum, Medicated baths, Medicines, - uses, and doses of Meadow saffron, Medulla oblongata, Melancholia, Melons, - - - Membranes, Menstruation, diseases of Menses, - - -. suppressed immoderate difficult cessation ofthe Mercury, ... Mesentery, the Mental diseases, Mezeceon, ... Milk, - - - - Mineral waters, poisons, Molasses, .... Morphia, .... Mortification, ... Mouth, the - sore, of infants, Moveable articulations, Mucous membrane, body, . - - Mumps, 7 - - - Muriate of tin, poison from of ammonia, poison from SJ 110 193 194 93 08 4 2 17 70 94 4 It 146 139 441 17* '43 £'319 aoo 21 57 *.376 ■ J 57 - f 376 - 376 - 377 -^377 -^194 - * 15 1 60, 106, 158, 6 21 $72 - U65 - \2 INDEX. 453 PAGE Muriatic acid, ..... 161 Pains after delivery, Muscles,.....20 ofthe side, &c. Mushroom, .... 98 Painters' colic, - Musk, - / • ... 196 Palate, the Mussels,.....91 Palsy,..... Mustard, > - 102, 197 Palpitation ofthe heart, Mutton, '.....89 Panada, - Myrrh,- ----- 197 Pancakes, - mixture, - - - 187 Pancreas, - - - - * Parietal bones, . . - Nails, the>.....24 Parsnip, .... Narcotiog,.....158 Parsley, - Narcotic poisons, - - - 369, 372 Parturition, - - - - Navel string, the - - - - 60 Passions, ; management of - 129 Pastry, .... falling of - - 436 Patella, the - Necfe*, the.....11 Pear,..... Necrosis, - - - - - 222 Peach, . - - - N>rvous system, 42 Pectoral muscles, - flferves, '.....43 Pelvis, the - "> of the brain, 44 Penis, the t spine, 45 Pepper, - Nerve pan?, .... 310 Peritoneum, the - N*itral mixture, - - - - 197 . inflammation of Night air.....70 Perspiration, Nipple, the ..... 14 Pertussis, - - - - Ripples, sore • - 438 Peruvian bark, l^trate of potass, - - 197,443 balsam, - / silver, --- - 193 Pharynx, - poisoning from - 372 P hlegmatia dolens, Nitre - - - - - 197 Phosphate of Soda, j poisoning from - - - 372 Phosphorus, ^itro-muriatic acid, - - - 161 Phrenology, Nitric Ether, - - - - 184 Phymosis, - - - - 1 Node, .....222 Physiology, - Noli me tangere, - 254 Piles, - - N3se, the.....51 Pills purgative - - - bleeding from - - 391 laxative Nurses .....I33 pine aPPle» - - - - Nursing,.....134 Pink root - - - - Nutmegs,.....102 P.psisseva, - - - - Nutrition,.....33 Pitch, - Nu\s I.....101 Placenta, the ... Nux Vomica, - - - 198 Plasters and dressings, - - Pleura, the .... •Oak bark.....198 Pleurisy, .... ^J b_'.....93 Plummer's pills, - - - Opcipital bone, the _ - - - ^ g^*0.^ ner^f ' \ 2wn.l.....198 Pneumonia notha, t f1'.....102 Poison oak, - - - X *,m - - 16 Poisons, - Omentum, - - _ _ ^ pQ^..... 7P1Umdenarcotized - - 182 Polypi of the womb, - v -noisonine from - - 201, 372 Polypus, - - ^nodeldoc ... 201 Pomegranate bark, - - Sges.....100 Pork, . - Organs whose office is unknown, - 6°^™' [ [ "_ '_ / OxydeofZinc, - - - - J10 Potass . . . . / Oxalic acid, " * 0 av V^ poisoning from - lo-s "*> ^*- „ , p & 20 Poultry, - - - - -Oxymei, - ' _ _ _ 201 Powder, purgative Oysters, - - - - - 91 Precipitate, red - - - PAGE . 437 . 428 - 353 11 . 305 . 428 95 95 15,29 8 97 - 201 - 426 - 123 95 8 - 100 - 100 14 16 56 - 102 15 - 295 23 - 327 - 169 - 169 21 - 438 - 201 - 202 66 - 254 4 219, 427 - 442 - 442 - 100 - 202 . 202 - 202 60 - 446 14 - 288 - 202 - 100 44 - 290 - 202 - 368 97, 203 - 381 - 254 - 203 89 - 110 - 203 96 - 203 90 - 442 - 203 <, 454 INDEX. Preserves, ... Prolapsus of the anus, womb, Pregnancy, management of Prostate gland, Prunes, ... Prussic acid, Puddings, - - - Pueiptral fever, Pulmonary inflammation, Pulse, the Punch, - - Pupil, closed Purgatives, - - - Purgative clysters, pills, draught powder, Purging of infants, Purpura, ... Puti id sore throat, Pylorus, the Pyroligneous acid, Quack medicines, Quarantine, Quassia, Quinine, - Radishes, ... Raisins, Raspberry, Renal glands, Repose, time for Respiratory apparatus, Kespiration, Rhatany, ... Itheumatism, Rhubarb, ... pills, Ribs, the Rice, - . - - Rickets, ... Ring-worm, Roasting, Rochelle Salts, Rubefacients, Rum, Rupture, ... Rye, .... PAGE . 102 - 218 - 379 58 - 426 56 . 100 . 162 95 - 439 - 288 34 - 112 - 235 - 442 184, 443 442 - 442 - 442 130, 441 - 417 -' 407 26 - 162 - 140 74 - 203 171, 203 98 100 100 61 120 37 38 204 382 204 165 13 93 423 420 103 204 158 112 382 93 Sacrum, Sago, Sailing, Salads, Salep, Saliva, Salivary glands, Salt, Salted meat, Sarcocele, Sai-saT::::! :a, Sas:.i.i:as, Sausages, 16 96 81 98 96 24 24 102 90 255 204 205 89 Savine, • Scalled head, ... Scalds and burns, applicationslpr Scalp, wounds of the Scabby tetter, ... Sc:immony, - Scapula, the - - - , Scarlet fever, - - - « Scrophula, - - - - k Scrotum, the - - - \ Scurvy, .... spots, Sea air, .... bathing, - - - - water, - Sebaceous glands, Secretion, . - - - Sedatives, . - - - Seidlitz powders, Seltzer water, ... Seminal reservoirs, Senega, .... Senna, - tea, .... Sensation, . - . - Serpentaria, ... Serous membrane, Sherry wine, ... Shingles, .... Shoulder joint, - bones of the Sialagogues, ... Sight, preservation of the Skeleton, the ... Skin, the - Sleep, .... of children, Sleep walking, ... Small pox, .... Smell, .... Snake root, ... Sneezing, - - - - Soap, - - . - - liniment, - , - Soda,..... powders, ... water, ... Softening of bones, Somnambulism, - Sore nipples, ... throat, ... putrid, mouth of infants, Soups, .... Sourcrout, Specifics, .... Sphenoid bone, ... Spermatic cord, the » Spinage, .... Spinal marrow, ... Spine, articulations of the structure of the - nerves of the affections of the \ INDEX. 455 Spitting of blood, Spleen, the Sprain, - .-> - .Spruce beer, ... Squill, - Staphyloma^ ... Starch, .... Stewing, .... Still-born infants, . - - Stimulant^ ... Stomach, the - inflammation of ? complaints, discharge of blood from Stone, ,' .... Strampnium, - Strangury, .... StiCwbeny, ... Strengthening plaster, s/rictures, - - - - Strychnine, ... St. Vitus' dance, ... Sudorifics, - - - - Sugar, - - Silgar plums, ... Sugar of lead, ... Sulphate of zinc, ... Sulphur, - Sulphuric acid, - - poisoning from Sulphate of zinc, ... poisoning from Supper, - Suppositories, ... Surfeit, - Surgical diseases, Siftures, .... Sweet spirits of nitre, Swelled leg, ... Svqimming, ... Sympathetic nerve, Sympathy, .... Synovia, .... Tamarinds, - Tansy, .... Tar,..... water, . - - - ointment, ... Tartar emetic, . . - ointment, Tartaric acid, ... Taste, - Tea,..... Teeth, the - Teething, - Temperaments, ... Temporal bones, the Tendons, . - - - Testicles, the - Tetanus, . - - - Tetter, - Thigh, the - Thirst, - - - " Thoracic duct, PAGE . 392 61 . 257 . 108 206, 443 . 236 91 . 103 . 439 . 159 25 - 291 - 342 the 394 - 243 . 206 - 375 . 100 . 207 . 258 . 207 . 315 • 443 92 92 . 192 - 210 - 207 - 162 -"' 372 . 441 - 372 . 105 - 159 34 - 211 9 - 443 428, 438 80 - 45 45 6 . 100 . 207 - 208 . 208 - 208 166, 444 - 167 - 163 53 - 107 12 12 67 9 28 56 - 311 - 419 18 32 29 Throat, sore ... Thrush, the Thymus gland, the Thyroid gland, the Tibia, the .... Tic doloreux, ... Tin,..... Toast,..... water, - . - - Tobacco, - - - - Tobacco poultice, salve, - - - injection, Tolu, balsam of Tongue, the Tonics, - Tonsils, the inflammation of - Tooth ache, ... Training, - - - Turner's cerate, - - - Turnips, .... Turpentine, - Turtle, .... Twin cases, - - - - Typhus fever, ... Ulcers, .... Ureters, the ... Urethra, the ... stricture of Urinary apparatus, Urine, the .... bloody incontinency of • retention of - - suppression of - Uterus, inflammation ofthe Uvse ursi, .... Vaccination, ... Valerian, .... Vapour bath, ... Veal,..... Vegetable food, ... gluten, poisons, Veins, .... Venereal disease, the Venison, - Ventilation, - - - - Vertebrx, - Vinegar, .... aromatic, Vision, phenomena of - Vitriol, oil of - Voice, the - Vomiting of blood, medicines to produce Walking, .... Warm bath, /■ - - • Warming plaster, - Warner's cordial, - paos . 283 . 327 61 61 19 31 . 208 95 - 104 127, 208 - 208 - 208 - 208 - 169 53 - 159 11 - 283 . 428 . 128 - 208 - 97 . 208 91 - 435 - 276 - 257 41 42 . 258 41 -~ 42 - 374 374, 428 375, 428 - 375 . 298 . 209 - 410 . 209 - 146 89 85 91 - 372 35 - 259 89 71 10 101 2,160 . 160 49 - 162 54 - 394 441 79 116, 145 - 209 - 209 456 INDEX. PAGE PAGE Warts, ... . . - 261 Womb, the ... . 57 Washing of infants, . - . 129 inflammation, of - . 298 Wasp sting, - - - - 261 falling down of - - 379 Water, . . - 106 inversion of - * - 380 Water brash, . . . 349 polypi in - 381 in the head, . - - 299 cancer of - - 381 131 Worm seed, - - 209 Wen, - - - 261 wood, - - 209 Wheat, . . . 92 Worms, ... . 1 - 367 Whev, - - - 107 Wounds, - . - 262 Whiskey, - . . 112 Wrist, the - < 7 White swelling, - - . 252 articulations of - 18 vitriol, - - - 210 Wry neck, ... - - 263 poisoning from - - 372 Whites, the - - . . 378 96 Whitlow, - . - 261 Yeast, --.. . V 209 -V273 Windpipe, - - - 37 Yellow fever, - Wine, - - - 109 Wolfsbane, - - - 163 - ?09 t ( ( i m&zm