. V; f* * ■-.'::!».-r. m KM £»«?,'■:*. 44 9 ■ # 2,h Surgeon General's Office "ccftcn '*•■*. I., 4* '♦ vw >■ ^e, C^ y-1 ^/ff/*/y * S////s:is PHYSICIAN'S VADE-MECUM: CONTAINING THE SYMPTOMS, CAUSES, DIAGNOSIS, PROGNOSIS, AND TREATMENT or DISEASES. ACCOMPANIED EV A select Collection of Formula ■" % AND A ^. V , c>~ ■ '■"■ ■ ' 'V'Y ' > GLOSSARY OF TERMS. ■,,-/->' w ~..... By ROBERT HOOPER, M. D. Licentiate in Physic of the Universitj' of Oxford, and the Royal College of Physicians of London; Physician to the St. Mary-le-bone Infirmary; and Lecturer on Medicine in London. With a translation of the Formulae, and additions and alterations, adapted to the American climate, &c. By a Practitioner of the State of New-York. ALBANY: PUBLISHED AND SOLD BY E. F. BACKUS, Albany Book-Store, 45, State-street. 1809. District of New-York, ss. BE IT REMEMBERED, That on the eighth day of Sep-- tember, in the thirty-fourth year of the Independence of the United States of America, Eleazer F. Backus, of the said district, hath deposited in this office, the title of a book, the right whereof he claims as proprietor, in the words following to wit: THE PHYSICIAN'S VADE-MECUM: CONTAINING The Symptoms, Causes, Diagnosis, Prognosis, and Treat- ment of Diseases. Accompanied by a select Collection of Formula:, and a Glossary of terms, by ROBERT HOOP- ER, M. D. Licentiate in Physic of the University of Ox- ford, and the Royal College of Physicians of London; Physician to the St. Mary-le-bone Infirmary ; and Lecturer on Medicine in London. With a translation of the For- mulae, and additions and alterations, adapted to the Amer- ican climate, &c. By a Practitioner of the State of New- York. In conformity to the Act of the Congress of the United States, entitled " An Act for the encouragement of learning " by securing the Copies of Maps, Charts, and Books to the " Authors and Proprietors of such Copies during the time " therein mentioned," and also an Act, entitled an Act, sup- plementary to an Act, entitled " An Act for the encourage- " ment of learning by securing the Copies of Maps, Charts, " and Books to the Authors and Proprietors of such Copies " during the times therein mentioned, and extending the " benefits thereof to the arts of Designing, Engraving and " Etching Historical and other Prints." CHARLES CLINTON, Clerk Of the District of New-York. E. & E. Hosford, Printers'. TO FRANCIS KNIGHT, ESQUIRE, INSPECTOR GENERAL CI ARMY HOSPITALS, &C. &C. THIS WORK IS RESPECTFULLY INSCRIBED, AS A TESTIMONY 01 GREAT RESPECT AND ESTEEM, BY HIS SINCERE FRIEND, THE AUTHOR. I PREFACE. The following concise account of the several diseases that fall under the province of the Physician has been committed to the press, with the hope of its proving useful to students, and those practitioners in medicine who, from their professional occupations, or other cir- cumstances, may not have it in their power to consult the more voluminous works that have contributed so much to the improvement of medicine. It has been the author's object to compress, within a smaller compass than has hitherto been done, con- sistently with utility, every thing which more espe- cially deserves attention with a view to the treatment of diseases. In pursuing this, he has discarded all theory, and retained only those leading facts which it is absolutely necessary for a practitioner to be acquaint- ed with when he approaches the bedside of his patient. He has arranged under distinct heads*, 1. The characteristic symptoms by which diseases are known. * In this arrangement the order of the Cullcnian nosology is adopted, with the exception of placing Pulmonary Con- sumption amongst the Cachexia:. A :3 vi PREFACE. 2. The causes from which they most frequently have their origin. 3. The ^circumstances that more especially point out the difference between diseases which re- semble one another. 4. The signs which influence the judgment in form- ing a prognosis of their event. 5. That mode of treatment, which, in the present improved state of medicine, is deemed most appropriate, and which experience has sanc- tioned- The select collection of Formulae, and the accom- panying Glossary of terms, will, he trusts, combine to render it more extensively useful, 21, Savii.e Row, January 180P. PREFACE, TO THE FIRST AMERICAN EDITION. The advantages of a concise manual, such as the one offered to the public by Doctor Hooper, will be read- ily acknowledged, even by the more experienced members of the profession; but it is principally the student and junior practitioner, who will fully estimate its importance. The " Vade-Mecum" of Dr. Hooper, will complete- ly supersede all other works of that title, as it contains the most recent discoveries, both in the history and method of treating diseases. It has the merit of de- tailing with sententious brevity, the symptoms, causes, diagnostics, prognostics, and method of treating, most of the diseases which come under the care of the phy- sician. The great variety of elegant Formulas subjoined to the method of treatment in each disease, will greatly enhance its value to the tyro in practice ; while vete- rans in the art, may derive some advantage from a choice of prescriptions. viii PREFACE. To render this edition more extensively useful, the original recipes, are accompanied with translations in English, so that those who choose, may write their prescriptions in latin, while those who are unacquaint- ed with that language, may use the more familiar one of the translation. It will be perceived that Dr. Hooper has retained in most of his Formulae, the language of the older chemists ; whereas, the translator has employed the more scientific nomenclature of modern chemistry. Every article specified in the English Formulae may be found by referring to the index of " Murray's Ma- teria Medica," the best work in our language on that subject, and one that will form a necessary appendage to this little volume. As the translator has not ventured to mutilate the prescriptions of his author, the latin Formulae of this, will be found the same as those of the London edition ; but sensible that the physician, -who, in this climate, trusts to the quantities specified in many of the recipes, will be frequently disappointed, he has ventured in the translation to make alterations, and to state the dose that will generally be found necessary in this country. These deviations from the original will be found principally in the class of cathartics, more particularly where the submuriate of mercury is used for that pur- pose. The translator has also added, by way of appendix, three or four other cases, which frequently come un- der the care of physicians in this country, and they are fREFACE, IX scarcely of less importance than those contained in the table of Dr. Hooper. The greatest pains has been taken in correcting the whole of this volume ; but especially the' Formulae, and it is presumed that not a single error will be de- tected in that part of this edition. A&BA.r,r, Octobss. 16, ISO?. X The following Table is intended to show the doses of Medh cines proper for persons of different ages : thus, supposing one drachm of any medicine a sufficient dose for an adult, that is, for one of twenty-one years of age, then other ages will require as follows : Ages. Weeks.....7 Months Years -31 5 7 U 21 63 77 100 Common Dose. 3J- 1 x Proportionate Doses gr. iv. gr.v. gr. viij gr. xij. gr. xv. - 9j- - 3SS- - 9ij- - 3J- gr. lv. - 9yss - 9ij- CONTENTS. PYREXIJR . . Page 1 EXANTHEMATA Page 91 FEBRES . . . . ib. Variola . . . ib. Intermittent Fevers . 2 Varicella . . • . 97 Remittent Fever . 13 Rubeola . . . . 98 Synocha . . . 14 Scarlatina . . . 104 Typhus . . . 19 Erysipelas . . . 109 ■■ mitior . . ib. Miliaria . . . . 113 ; 30 Urticaria . . . . 116 Synochus . 35 Pemphigus . . . ib. PHLEGMASIA . 35 Aphtha . . . . 118 Phrenitis . . . . 36 HEMORRHAGIC . 121 Cynanche tonsillaris . 40 Epistaxis . . . ib. . 44 . 50 . 53 . ib. . 54 . 60 . 62 . 65 . 70 Haemoptysis . 124 Menorrhagia . 127 i pharingea Hxmatemesis Hematuria PROFLUVIA . Catarrhus Dysenteria . . NEUROSES . . COMATA . . . 129 . 130 Pneumonia Gastritis . . Enteritis . . Hepatitis . . Nephritis . 132 . ib. . 135 . 144 . ib. Cystitis . 72 Apoplexia . . . ib. Rheumatismus . 74 Paralysis . . . 148 Podagra . . . 84 xii CONTENTS. ADYNAMIC . Page 153 VESANIC . Page 215 Syncope . . . . ib. Melancholia . ib- Angina Pectoris . 155 Mania , . . . . 217 Dyspepsia . . . 157 CACHEXIM . . 220 Hypochondriasis . . 163 MARCORES . . ib. Chlorosis . . . .165 Phthisis pulmonalis . ib. SPASMI . . . . 170 INTUMESCENTIC . 225 Tetanus . . . ib. Emphysema . ib. Epilepsia . . . 174 Tympanites . 226 Chorea Sancti Viti . 181 Anasarca . 230 Asthma . . . 182 . 187 238 Pertussis . . Hydrothorax . 240 Pyrosis . . . . 190 Hydrocephalus . 243 Colica . . . . 192 . 201 Rachitis . . 246 Cholera Morbus . IMPETIGINES . 248 Diarrhrea . . . 203 Scrofula . . . ib. Diabetes . . . . 209 Scorbutus . . . 250 Hysteria . . . Hydrophobia . . . 211 252 . 214 APPEI *DIX. dancer ... I age 257 1 Worms . . . Page 262 •Burns..... . 259 1 Tinea Capitis . . . 265 THE. PHYSICIAN'S VADE MECUM, CLASS I. PYREXIAE; OR, FEBRILE DISEASES. CHARACTER. INCREASED heat and frequency of pulse, after a shiver- ing, accompanied with a disturbance in many of the functions, and diminution of strength, especially in the limbs. ORDER I. FEBRES, OR FEVERS. CHARACTER. Pyrexia, without any primary local affection, preceded by languor, lassitude, and other symptoms of debility. B 2 INTERMITTENT FEVERS. GENERA. Febris intermittens, or Intermittent fever. ----- remittens, — Remittent fever. Typhus, • — Nervous fever. Synocha, —. Inflammatory fever. Febris hectica, — Hectic fever. INTERMITTENT FEVERS. Generic character. Fevers consisting of paroxysms, or periods of fever ; be- tween each of which there is a distinct and perfect intermis- sion from febrile symptoms, or an apyrexial period. A paroxysm consists of three stages : a cold, a hot, and a sweating stage. Species. < n. The quotidian—having an interval of 24 hours. The tertian;" — — — 48 hours. The quartan ; — — — 72 hours. SYMPTOMS. Of the cold stage.—Languor and sense of debility ;—listless- ness ;—yawning and stretching ;—an aversion to motion. The face and extremities become pale ; the features shrink; the bulk of every external part is diminished ; and the skin over the whole body appears constricted as if cold had been applied to it.—Sensibility is greatly impaired ; the secretions and excretions diminished j the pulse small, frequent, and irregular ; and the respiration short and anxious.—At length the patient himself feels a sensation of cold ; first arising in the back, and thence diffusing itself over different parts of the body : though sometimes it is confined to a particidar part, as to the extremities, side of the bead, &c. This is sue- INTERMITTENT FEVERS. 4 ceeded by rigors, which terminate in an universal and conr vulsive shaking. Of the hot stage.—After a longer or shorter continuance cf shaking, the heat of the body gradually returns ; at first irre- gularly by transient flushes, soon however succeeded by a steady, dry, and burning heat, rising much above the natural standard.—The skin, before pale and constricted, is now swollen, tense, and red ; and possesses an unusual tenderness and soreness to the touch.—The sensibility, which in the cold stage was diminished, now becomes preternaturally a- cute ; pains arise in the head, and flying pains are felt over different parts of the body. The pulse is quick, strong, and hard ;—the tongue white ;—there is great thirst;—the urine is high coloured. Of the sweating stage.—At length a moisture is observed to break out upon the face and neck, which extending soon be- comes an universal and equable perspiration.—The heat now descends to its usual standard ;—the pulse is diminished in frequency, and becomes full and free ;—The urine deposits a sediment; the bowels are no longer constipated ; respira- tion is free and full; and all the functions are restored to their natural order. After a specific interval (vide Species) of intermittent fe- ver the paroxysm again returns, commencing as above descrL. bed. CAUSES. 1. Predisposing.—Debility, however induced;—by a watery, poor diet;—great fatigue ;—long watching;—grief;—anxiety; —the suppression of accustomed evacuations;—the repul- sion of eruptions;—preceding disease ; cold united with moisture in whatever way applied to the body. 2. Exciting.—Marsh miasma ; or the effluvia arising from stagnant water, or marshy ground, impregnated with vege- table matter in a state of putrefactive decomposition. 4 INTERMITTENT FEVERS. PROGNOSIS. 1 When the paroxysms are of short duration ; when they are regular in their recurrence, and leave the intervals quite free, the disease, at least in our climate, is unattended with dan- ger. The circumstances giving rise to an unfavourable prognosis are— 1. The paroxysms being of long continuance, violent, and attended with much anxiety and delirium : 2. The disease being combined with others ;—or other dis- eases being induced by a protracted state of the original inter- mittent. These are most frequently dysentery, cholera, en- largements of the liver and spleen, ultimately inducing drop- sy and jaundice ;—swelling of the tonsil glands : 3. The presence of unfavourable symptoms, as convul- sions occurring during the paroxysm, preceded by great co- jna ;—obstinate costiveness ;—hiccup with vomiting and pain upon pressure in the hypochondriac and epigastric regions ; —depraved sense, as double vision ;—great prostration of strength ;—vertigo ;—dry, black tongue ;—foetid excretions. TREATMENT, In the paroxysm. i. During the cold stage—to endeavor to induce the hot. k ii. During the hot stage—to promote a per- spiration. 1. By artificial warmth ;—the pediluvium ;—fomentations to the feet;—the warm bath ;—warm diluent liquids ;—cor- dial diaphoretics ;—and opiates. INTERMITTENT FEVERS. 5 R. Aquae ammoniae acetatse 5UJ ■ —— cinnamomi, —— distillatae, aa Jv. Syrupi corticis aurantii Jj. Miscc ut fiat haustus quavis hora sumendus. R. Aquae ammonia acetatae Jij. Misturaecamphorae £x. Vini antimonii gutt. viij. Syrupi simplicis Jj. M. f. haustus quavis hora su- mendus. HAUSTUS SALINUS COMMUNIS R. Kali preparati ^j. Succi limonis §ss. vel q. s. ad ejus saturationem. Aqua: cinnamomi JIj. ----distillatse 3V"J Syr. corticis aurantii Jj- M. pro haustu. Take of Water ofacetite of am- monia 3uj- —— of cinnamon, • distilledeach^v. Syrup of orange peel Ji, Mix and make a draught, to be taken every hour. Take of Water ofacetite of am- monia Jij. Camphorated mixture Jx. Antimonial wine drops x. Simple syrup %\.—Mix. Make a draught to be taken ev- ery hour. COMMON SALINE DRAUGHT. Take of Carbonate of potash ^i. Lemon juice §ss. or as muck as may be sufficient to sat- urate the alcali. Cinnamon water Jij. Distilled Water 5vijj- Syrup of orange peel £i. Mix.—Make a draught. This may be taken every half hour, or every hour. R. Spiritus aetheris nitrosi Jss. Misturx camphorae 3X\J- Aquae ammoniae acetatae Jij. Syrupi rosae Jj. M. f. haustus quavis hora su- mendus, Take of Nitrous tether ^ss. Camphorated mixture Jxij. Water ofacetite of ammo- nia 3ij. Syrup of roses Ji.—Mix. Make a draught to be taken ev- ery hour. B 6 INTERMITTENT FEVERS. R. Spiritus aetheris vitriolici compositi Zss. Misturae camphorae Jxij. Syrupi simplicis Jj. M. F. haustus quavis hora sumen- dus. Take of the Compound spirit of sulphuric aether 2Jss. Camphorated mixture 3xy* Simple syrup Xi.—Mix. Make a draught, to be taken every hour. R. Pulverisantimonialisgr. vj. ----- opiati ^ss. Sacchari purificati J^j. M.et divide in partes quatuor, quarum capiat unam quavis hora. Take ofAntimonia I powder gr .vi Opiated powder ^ss. Purified sugar ^i. Mix and divide into four doses, one of which may be taken every hour. R. Pulveris ipecacuanhae com- Take of the Compound powder positi gr. x. of ipecacuanha gr. x. —— tragacanthae com- Compound poivder of traga- positi ^ij. canth ^ij. M.et divide in partes quatuor Mix and divide into four equal zequales, quarum sumat u- doses, one of which maybe nam quavis hora. taken every hour. 11. By the use of cold acidulated liquids, and continuing the remedies recommended during the cold stage. If coma supervene— Adplicetur emplastrum can- Let the head be shaved, and an tharidis capiti raso. epispastic applied. Emplastrum cantharidis inter Let an Epispastic be applied scapulas applicandum. between the shoulders. Admoveantur cataplasmata Let draughts of mustard be sinapeos pedibus. applied to the feet. Should there be a congestion of blood in the external ves- sels of the head, or delirium ; cupping from the temples, or leeches, are to be applied, and opiates laid aside. INTERMITTENT FEVERS. T If there be any inflammatory diathesis, nitre is to be added to the medicines ; and if any imflammation exist, it must be treated in the usual way. Vide Phlegmasia. In the intermission. r 1. To excite a new action in the system by certain remedies, administered at the commencement, or immediately before the accession of the cold fit; and thereby to destroy the morbid concatenation in- duced by the cause of the disease. 11. To prevent the return of the paroxysms Indications. ^ L by invigorating the body. 1. By emetics, by aether, or by opium. yULVISEMITICUS COMMUNIS R.Pulveris ipecunacahaegr .xv. Antimonii tartarisati gr. j. Misce ut fiant pulvis. COMMON EMETIC POWDER. Takje of Powder of ipecacuan gr. xx. Tartrite of antimony gr. i. Mix and make a powder. HAUSTUS EMETICUS COM- COMMON EMETIC DRAUGHT. MUNIS. R.Pulverisipecacuanhaegr.xv. Take of the Powder of ipecacw an gr. xx. Antimonii tartarisati gr. j Tartrite of antimony gr. i. Aq. menthae sativae 3xij. Water of spearmint 3xij- Syr. croci Jj- ' Syrup of saffron Q. M. pro haustu. Mix for a draught. R. Mistur x camphor x 3xiij. Take of the Camphorated mix- ture 3xiij' Tincturrc opii gutt. e. Tincture of opitim drops e. Syrupi simplicis 3J- M. Simple syrup Ji. F. haustus. Mix and make a draught. R. Ctheris vitriolici Jj. Take Sulphuric tether ^i. The patient is to take this undiluted: it deprives him of his breath for a short time, and excites great distress. * INTERMITTENT FEVERS. 11. By nutritive diet;—regular exercise, if the state of the patient render its use practicable ; and one of the follow- ing tonics : 1. Cinchona officinalis:—The Peruvian bark. This heroic medicine is to be given in substance, and in large dos- es ; if the interval be long, its exhibition should be delayed till within six or eight hours of the time of the accession of the cold fit; should there be any inflammatory diathesis, this ought first to be reduced during the hot stage of the prece- ding paroxysms, by saline diaphoretics ; where there is great debility, the bark may be joined with wine and aromatics ; if it occasion purging, with opiates and astringents ; if cos- tiveness, with rhubarb. R. Pulveris cinchonae |j. Divide in partes xij aequales, quarum capiat unam in ho- ras vel secunda vel tertia quaquehoraexcyatho parvo lactis vaccini, absente febre. Take ofthePowder of cinchona § i Divide into twelve equal doses, one of which let the patient take every second or third hour, in a small glass of cows milky when the fever is absent. R. Pulveris cinchonae Jj. aromatici Jss. M. et divide in chartulas xij. Take ofthePowder of cinchona gi Aromaticpowder 3 ss.—Mix and divide into twelve equal doses. R. Pulveris cinchonae §j. Confectionis opiatae $j. M. et divide in partes xij. aequales. Take ofthePowder qfcinchona^i Opiate confection Z'\.—Mix and divide into twelve equal parts. R. Pulveris cinchonae |j. rhoei J^ij. Take of the Powder of cinchona^ i ---- Rhubarb^ij. M. et divide in partes xij. Mix and divide into twelve equal sequales. doses. Of each of the above formulas the dose is one part every mie, two, three, or four hours. INTERMITTENT FEVERS. I R. Pulveris cinchonae |j. ——- aromatici ^ss. Conservac rosae gjss. Syrupi rosae q. s. ut fiat electuarium, cujus capiat ad magnitudinem nucis moscha- tae quavis hora. R. Decocti cinchonae 3xij- Tincturae ejusdem ^ij. Pulveris cinchonae ^j. Syrupi zingiberis 3J- f. haustus quavis vel se- cunda vel tertia vel quarta quaque hora sumendus. M R. Extracti cinchonae gr. xv. Decocti cinchonae 3xnj- Tincturae cinchonae comp. 3JSS- Syrupi corticis aurantii 3J- M. f. haustus quavis vel se- cunda vel tertia vel quarta quaque hora sumendus. SYRUPUS CINCHONA. R. Extracti cinchonae 3lb Syrupi corticis aurantii 3xiv- M. ut fiant syrupus. Take ofthePowder ofcinchona\\ —— Aromatic 3ss. Conserve of roses §iss. Syrup of roses q. s. Make an electuary of which let the patient take the size of a nutmeg every hour. Take of the Decoction of Cin- chona 3xrj' Tincture of-----Jij. Powder of ------Qi. Syrup of ginger 31-—Mix and make a draught, to be ta- ken every, or every second, third or fourth hour. Take of the Extract of cincho- na gr. xv. Decoction of cinchona ^^j- Compound tincture of — 3iss. Syrup of orange peel Q.—Mix- Make a draught to be taken Hke theformer. SYRUP OF CINCHONA. Take of the Extract of cincho- na 3ij. Syrup of orange peel ^siiv. Mix and make a syrup. This syrup is to be given to children when they refuse oth- er forms of bark ; it may be acidulated with sulphuric acid, which makes it vary grateful to the palate. The dose is one tea-spsonful or more, every one, two, three, or four hours. 10 INTERMITTENT FEVERS. Take of the Extract of cinchona with resin "^i. Make a mass and divide into twelve pills, of which let two be taken every second, third or fourth hour, in any conven- ient drink. R. Extracti cinchonae cum resina 3j- F. massula in pilulas xij div- idenda, quarum capiat duas secundis vel tertiis vel quartis horis, superbibendo haustulum alicujusliquoris idonei. 2. Salix fragilis. The craci-willow .-—The bark of this species of willow is given in the same way and the same doses with the Peruvian bark, but not with equal advantage. 3. Cascarilla :—Cascarilla bark is occasionally service- able in the cure of intermittents. It is given in the same doses as Peruvian bark. 4. Angustur.e cortex:—This medicine is also adminis- tered in the same doses as the Peruvian bark. It is often ser- viceable when there is a weakness of the bowels producing diarrhoea, and especially when the cinchona officinalis cannot he made to agree with the bo. As. 5. Swietenia febrifuga. Febrifuge Swietenia. R. Swieteniae in pulverem tritae gj. Aquae distillatx Sjxviii. Coque per horx sextam par- tem et cola. R. Hujus colaturae §jss. Tincturae cinchonae 3jss. Syrupi corticis aurantii *j. M. f. haustus secunda vel ter- tia vel quarta quaque hora sumendus. 6. Cinchona Jamaicensis vel Caribjea :—Dr. Wright ef Jamaica gives the bark of this tree in the same way and doses with the common bark, and with the greatest success. 7. Quercus robur. The oak .—The bark and excrescen- ces of this tree, called gall-nuts, are sometimes employed. Take Swietenia rubb'd to poia- derV]- Distilled water gxviij. Boil for ten minutes and strain. Take of this strained liquor % iss. Tincture of cinchona .^iss. Syrup of orange peel $1.- Mix. Make a draught to be taken eve- ry second, thirdorfourth hour. INTERMITTENT FEVERS. i\ R. Corticis quercus exterioris Take of the exterior bark of the contusi §jss. Oak bruised §iss. Aquae ferventis gxx. Boiling water %xx.—Mace- Macera per horam et cola. rate for an hour and strain. R. Kujus colaturae gjss. Take ofthis strained liquor §iss. Pulveris gallae gr. x. Powder of galls gr. x. Tincturae cardamomi com- Compound tincture of carda. positae, mon. Syrupi corticis aurantii aa Syrup of orange peel, each 3i. M. f. haustus secunda vel Mix—Make a draught to be tertia vel quarta quaque ho- taken every second, third or ra sumendus. fourth hour. 8. Bitter tonics, especially the following: Carduus benedictus, - - - - The blessed thistle. Gentiana, ------- Gentian. Absynthium vulgare, - - - - Wormwood. Chamtemelum, — — — - - Chamomile. Quassia, ------- Bitter wood, Colomba, ------- Colombo. Faba Sancti Ignatii, - - - - St. Ignatius' bean, Ctntaurium minus, - - - - Lesser centaury. Arnica, _______ Mountain arnica. 9. Kali arsenicatum :—This forms the basis of the tasteless ague-drop. It cures the most obstinate intermit- tents, but must be used with the greatest circumspection. SOLUTIO ARSENICALIS DR. ARSENICAL SOLUTION OF FOWLEIl . DR. FOWLER. R. Arsenici albi, Take of the white oxyd of At. senic. Kali preparati, au gr. lxiv. Carbonate of potash each gr. lxiv. Aquae distillatae g viij. Distilled water § viij. Boil until the arsenic is dissolved in a Florence flask placed in a sand b;ith : then add as much compound tincture of lavender as will increase the solution to one pound. *2 INTERMITTENT FEVERS. R. Solutionis arsenicaUs gutt. VJ- Aq. cinnamomi §xij. Tincturae cardamomi, Syr. zingiberis, aa 3j. M. f. haustus quarta vel sex- ta quaque hora sumendus. R. Solutionis arsenicalis gutt. v. Tincturae opii gutt. viij. Confectionis aromaticae ^j. Misturae camphorae 3x\i- Syrupi croci 3J- M. f. haustus ter in die su- mendus. R. Zinci vitriolati gr. £. Decocti cinchonae §jss. Tincturae cinchonae 3JSS- Syrupi corticis aurantii 5J. M. f. haustus quartis horis sumendus. R. Zinci vitriolati gr. iij. Extracti gentianae 3j. M. f. massa in pilulas xviij dividenda, quarum capiat duas ter quaterve die. Take of the Solution of arsenic drops vi. Cinnamon water 3xy- Tincture of cardamon. Syrup of ginger each "£\—Mix. Make a draught to be taken ev- ery fourth or sixth hour. Take of the Arsenical solution drops v. Tincture of opium---viij. Aromatic confection ^i. Camphorated mixture 3xij> Syrup of saffron Ji.—Mix. Make a draught to be taken three times a day. Take Sulphate of zinc gr. \. Decoction of cinchona §iss. Tincture of ------ 3iss» Syrup of orange peel ^i. Make a draught, to be taken every four hours. Take Sulphate of zinc gr. iij. Extract of'gentian^i.—Mix. Make a mass and divide into xviij pills, of which take two, three or four times a day. 10. ZlNCUM VITRIOLATU R. Zinci vitriolati gr. j. Infusi quassiae §vij. Tincturae colombae §iij. Syrupi corticis aurantii ^ij- M. f. mistura, cujus capiat coch. iij secunda vel tertia vel quarta quaque hora. Take of Sulphate of zinc gr. i. Infusion of quassia §vij. Tincture ofcolumboZiij. Syrup of orange peel jij. Make a mixture, of which three spoonfuls are to be ta- ken every second, third or fourth hour. REMITTENT FEYEK. 13 11. Hydrargyrus :—Mercury is always necessary in the cure of intermittents when there is any visceral obstruction : a small dose should be given every night so as just to affect the mouth, and the tonic medicines are to be continued. R. Calomelanos gr. j. Confectionis opiatae gr. vj. M. f. pilula omni nocte su- menda. R. Pilulae ex hydrargyro gr.iij. -------opiogr. ij. M. pro pilula omni nocte su- menda. R. Hydrargyri calcinati gr. j. Pulveris opiati ^j. M.f. pulveres quatuor aequales quorum capiat unum omni nocte. R. C amphorae ^j. Unguenti hydrargyri forti- oris ^iv. M. f. unguentum cujus illi- natur gr. x omni nocte in cxtremitates inferiores. Take Sub-muriate of Mercury yr. i. Opiate confection gr.v'i.-Mix. Make a pill to be taken every night. Take of the Mercurialpillgr.iij. Opium pill gr. ij. Mix.—Make a pill to be taken every night. Take of Red oxyd of quicksil- ver gr. i. Opiate powder $\.—Mix. Make iv equal powders, of which take one every night. Take of Camphor ^i. Strong mercurial ointment Mix and make an ointment.— Let x grains of it be rubbed in every night on tJie inferior extremities. REMITTENT FEVER. A fever arising from the same causes as the intermittent; but in which, although evident and distinct exacerbations and remissions can be perceived, there is no complete interval or r. 14 INFLAMMATORY FEVER. apyrexia: one exacerbation appearing not entirely to go off, before a fresh attack ensues. The symptoms vary according to the situation and constitu- tion of the patient, and the season of the year. Sometimes they are those pointing out a redundancy of bile ; sometimes the nervous are most prevalent; at others the putrid. TI12 protraction of the exacerbations generally arises from some cause which keeps up an irritation in the system, and thereby prevents the disease assuming its regular form ; or it depends upon fever of another type having been accident- ally superinduced. The prognosis will be drawn from the presence, or absence, of those circumstances which indicate danger in that partic- ular form of fever which the disease assumes ; and which are pointed out under the heads of the different species of typhus, synocha, or synochus. In warm climates it is often fatal. TREATMENT. The treatment will entirely depend upon the concomitant fever or other cause which prevents the state of apyrexia, and gives to the disease the remitting form. Should it have a tendency to either of the following genera, the treatment will be such as is there laid down ;—if it depend upon some cause of irritation, as diseased viscera, this is to be removed by the appropriate means .elsewhere enumerated. SYNOCHA, OR INFLAMMATORY FEVER. SYMPTOMS. Lassitude and general anxiety, succeeded by rigors, alter- nating with transient flushes, and terminating in a violent and continued heat;—the countenance is flushed ;—there is a suffused redness of the eyes and skin ;~the pulse is frequent, strong, and regular;—great thirst;—white tongue j—scanty and high-coloured urine ;—costiveness ;—morbid sensibility, . INFLAMMATORY FEVER. 15 and intolerance of usual impressions ;—hurried respiration ; ■—extreme anxiety, CAUSES, Predisposing.—Plethoric habit of body, with a strong mus- cular system. Exciting.—Sudden alternations of temperature, as the ap- plication of cold to a heated body ;—violent exercise ;—in- temperance ;—the suppression of usual evacuations ;—repul- sion of eruptions ; strong passions cf the mind ;—the too free use of vinous or spirituous liquors. DIAGNOSIS. From typhus, by the more sudden accession of the disease, by its arising from the common causes above enumerated, and not from contagion ;—by the strength and hardness of the pulse ;—the whiteness of the tongue j—by the high colour of the urine. PROGNOSIS. Favourable symptoms.—About the seventh day a moisture appearing upon the skin, succeeded by an universal and nat- ural perspiration ;—haemorrhage from the nose ;—the appear- ance of scabby eruptions about the mouth and ears ; suppu- ration of glandular parts ;—the formation of abscesses ;—di- arrhoea j—the urine depositing a furfuraceous or lateritious sediment;—diminished sensibility;—the pulse becoming more slow and soft. Unfavourable symptoms.—Intense pain in the head, with fe- rocious delirium ;—extremely laborious respiration ;—strong, hard pulse, and other symptoms indicating excessive action ; by the inordinacy of which the disease usually proves fatal;— or by a determination to internal organs when the disease ceases to be synocha, and runs into phrenitis, pneumonitis., hepatitis, or an inflammation of some other viscus ;—picking the bed-clothes ;—hiccup ;—subsultus tendinum; involuntary evacuations. 16 INFLAMMATORY FEVER. TREATMENT. Indication.—To lower excessive action. 1. By diminishing or removing certain natural impressions, which in the febrile state become morbid stimuli; such arc impressions upon the senses,—stimulating operations of the mind,—aliment,—the effects of motion,—the contents of the intestinal canal,—sound. 2. By diminishing the quantity of the circulating fluids, and lowering the tone of the vascular system : this is to be effected by bleeding,—purging,—laxative clysters,—diapho- retics. Mittatur sanguis e brachio ad Let blood from the arm to X § x. et repetatur pro re nata. ounces and repeat according to circumstances. At the commencement a copious and rapid evacuation of blood is absolutely necessary, and subsequent smaller bleed- ings are to be instituted according to the strength and hard- ness of the pulse and the urgency of the symptoms. Admoveantur hirudines tres Let three Leeches be applied to singulis temporibus si adsit each temple, if there should dolor capitis. be pain of the head. R. Natri vitriolati 3viij. Take of Sulphate ofsoda 3viij. Infusi sennae §vij. Iifusion of senna §vij. Syrupi corticis aurantii ^i'j. Syrup of orange peel -^i ij. M. f. mistura, cujus sumat Mix.—Make a mixture, of cochleariatriamgna quavis which let the patient take hora donee alvus bis terve three large spoonfuls every respondeat. hour till it operates twice or thrice. R. Magnesias vitriolatae ^vj. Take of Sulthate of Magnesia 3vi-' Infusi sennae §jss. Infusion of senna, 3'iss. Syrupi corticis aurantii gj. Syr.ip of orange peel 7,i. Mix M. f. haustus aperiens. «-:J make an a'^rkr.i draught. INFLAMMATORY FEVE&. \t R. Cremoiis tartari jjss. Pulveris rhabarbari ^j- M f. pulvis purgans. R. Magnesiae vitriolatae jjj, Aceti communis 3-iij. Aquae tepidae §vj. M. f. enema purgans. R. Pulveris antimonialisgr. iij. Cremoris tartari gr. vj. M. f. pulvis sexta quaque hora sumendus ex euovis vehi- culo crasso. R.Pulveris antimonialisgr.iij. Nitri purificati pulverisati gr. y. M. f. pulvis quarta vel sexta quaque hora sumendus ex quovis vehiculo crasso. R. Antimonii tartarisati g. ss. Nitri purificati J5J. Aquae distillatae §vj. Syrupi rosae g ss. M. f- mistura cujus capiat aeger partem quartam quar- ta quaque hora. R. Aquae ammoniae acetatae |jss. Nitri purificati ^ij. Misturae camphorae §vj. Syrupi simplicis §ss. M. f. mistura de qua capiat cochlearia tria magna quar- ta quaque hora, Take of Supertartrite of Potash 3ss. Powder of rhubarb "^'l.—Mix and make a purging powder. Take cf Sulphate of magnesia § i Common vinegar §iij. Warm water %A.—Mix and make a purging injection. Take of'Antimonialpowder gr iij Supertartrite of potash gr. vi. Mix—Make a powder to be ta- ken every six hours in any kind of jelly. Take of Antimonialpowder griij Nitrate of potash pulverized gr. v. Mix and make a powder, to be taken every iv or vi hours. Take of Tartrite of antimony gr. ss. Nitrate of potash Q. Distilled water jlvi. Syrup of roses § ss.—Mix and make a mixture of which let the patient take the fourth part every iv hours. Take of Water of acetite of am- monia §:ss, Nitrate of potash ^ij. Camphorated mixture §vi. Simple syrup |ss.—Mix and make a mixture of which let iij large spoonfuls be taken every four hours, 2 13 INFLAMMATORY FEVER. R. Kali preparati ^j. Succi limonis §ss. Nitri purificati gr. vj. Misturae camphorae 5*ij> Syrupi simplicis ' j. M. f. haustus quarta quaque hora sumendus. R. Natri tartarisati ^ss. Lactis amygdalae §vij. Syrupi simplicis ^iij. M. f. mistura cujus sumat aeger cochlearia quartuor magna quartis horis. Take of Carbonate of potash ^'u Lemon juice §ss. Nitrate of potash gr. vi. Camphorated mixture 3XU- Simple syrup 3;-—Mix. Make a draught, to be taken every hour. Take of the Tartrite of potash, and soda §ss. Milk of almonds §vij. Simple syrup 3'ij'—Mix. Make a mixture, of which let the patient take four large spoonfuls every four hours. Bibat aeger cyathum aquae Let the patient drink after that sodae supercarbonatae su- a cup 0f the supercarbonated bmde. soda water. Infusum rosae pro potu ordi- Infusion of Roses for ordinary nario. drink. R. Cremoris tartari 3j. ITitri purificati ^jss. Aquae pvirae j^ij, Sacchari purificati §ij. M. pro potu communi. Take of Supertartrite of pc'.ash Nitrate of potash 3iss. Pure water t^yj. Purified sugar %\y—Mh:for a common drink. it. Sacchari purificati §ij. Acidi tartari %ss. Aquae purae § xviij. M pro potu ordinario. Take of Purified sugar gij. Tartarous acid §ss. Pure water § xviij.—Mix for ordinary drink. 3. By abstracting heat;—by cool air ;—sprinkling the floor of the room with vinegar and water ;—agitating the surround- ing atmosphere;—regulation of clothing ;—occasionally re- NERVOUS FEVER. 19 moving the bed-clothes, or taking the patient out of bed ; by frequent draughts of cold acidulated liquors, or of common water;—by the affusion of cold or tepid water ;—or by spong. ing the body with a mixture of vinegar and water, when the heat of the body is above the natural standard; and when there is no general or profuse perspiration. If there be delirium, or determination to any viscus—top- ical bleeding,—blisters,—fomentations,—pediluvium, and the treatment elsewhere laid down for the inflammation of the or- ganaffected. VldcPhrenitis, Pneumonitis, Hepatitis, &c.&c. &c. If the pulse sink, and the extremities become cold, sina- pisms to the feet, cordials, especially camphire and ether. If at the commencement of the disease there be muchnau- aea, a gentle emetic is by some practitioners judged proper. TYPHUS, OR NERVOUS FEVER. Generic Character. Contagious pyrexia ; heat but little increased ; pulse weak and small, and in general quick; urine little changed the animal functions much disturbed j great prostration of ' .rength. f" Typhus mitior, or Low nervous fever. Species. J —__ gravior, — Pufid fever. _ -----icterodes, — Yellow fever. TYPHUS MITIOR, OR LOW NERVOUS FEVER. SYMPTCMS. General languor and lassitude,—dejection of mind,—loss of appetite,—alternate chilliness and flushing,—dullness and confusion of thought,—in a few days giddiness and pain in the head, with aching pains over the whole body,—nausea and vomiting,—short anxious respiration,—frequent, weak, and often intermittent pulse,—at first the tongue is moist, 23 NERVOUS FEVER. and covered with a whitish mucus, but afterwards becomes dry, brown, and tremulous ;—there is little thirst,—the u- rine is pale and watery,—low muttering delirium, arising from the torpid state of the sensorium, inducing indistinct or ill-associated ideas. As the disease advances the heat often becomes intense, ri- sing several degress above the standard ;—the tongue dry and brown, or morbidly red ;—delirium, now from deter- mination of blood to the head, indicated by the suffused red- ness of the ey-^s, the flushed countenance, the throbbing of the temporal arteries ;—scanty, high-coloured, and foetid u- rine ;—sometimes a disposition to immoderate sweating ;— diarrhoea;—subsultus tendinum,—coma,—involuntary excre- tions,—cold extremities,—convulsions,—death. CAUSES. Predisposing. Weak and delicate habit of body, accompa- nied with much sensibility and irritability;—studious and se- dentary life ;— depressing passions of the mind ;—poor liv- ing;—too free indulgence in the use of enervating liquors ; —excess in venery;—profuse evacuations ;—warmth of cli- mate. Exciting. Intemperance ;—exposure to cold united with moisture;—grief,— fear,—anxiety;— those causes which in constitutions so predisposed would induce synochaj—conta- gion. DIAGNOSIS. From typhus gravior.— At the commencement, by the at- tack being more gradual, and the symptoms much more mild (vide Typhus gravior).—In the progress of the disease by the absence of those symptoms of putreacency enumerated in typhus gravior ; and by its being accompanied with less heat and thirst, less frequency of pulse, and no bilious vom- itings. NERVOUS FEVER. 21 PROGNOSIS. Favourable symptoms.—About the seventh, fourteenth, or twenty-first day, the tongue peeling and becoming moist, first at its edges, afterwards on the surface ;—a moisture break- ing out upon the skin ;— a gentle diarrhoea;— salivation (not unfrequently accompanied with aphthae, which, if they be of a light colour, are not unfavourable, and the contrary) ;—the pulse become fuller and more slow ;— the ceasing of delirium, with some return of sleep and appetite ;—the appearance of scabby eruptions about the mouth, or of phlegmonous tumors in different parts of the body ;—the urine increasing in quan- tity, and depositing a sediment. Unfavourable circumstances.— All those indicating extreme debility ;—as diminished energy of the brain, marked by a continued state of insensibility, or confusion of intellects, with low muttering delirium ;— muscular debility, indicated by the presence of convulsions, subsultus tendinum, tremu- lous motion of the lips, tongue, and other parts; impeded deglution, by the patient lying prostrate on his back, with ex- tended arms, or insensibly gliding down to the bottom of the bed ;— falling of the lower jaw ;—involuntary evacuations; —small, rapid, intermittent pulse ;— hiccup ;—partial sweat- ing about the breast and head;—a peculiar yet indescribable expression of anguish in the countenance ;—picking of the bed-clothes ;—catching at imaginary objects in the air. TREATMENT. f 1. To excite anew and general action in the system, and thereby to check, or mode- t j rate, the effects of the morbid impression Indications. •{ made by the cause of the disease. j 11. To support the strength of the patient, where the fulfilment of the first indication t. has been found impracticable. 1. By the operation of an emetic administered at the com- mencement of the disease ;—by diaphoretics;—by cold affu- 32 NERVOUS FEVER. sion or immersion (admissible only when the hot stage is ful- ly formed; when there is no sense of chilliness present; when the heat of the surface of the body is steadily above the natural standard; and when there is no general or profuse perspiration: Currie, Med. Reports). Pulvis emeticus communis. Common emetic powder—See Page 7. page 7. Haustus emeticus communis Page 7. R. Vini ipecacuanhae ^vj. —— antimonii 3J- M. pro haustu emetico. R. Aquae ammoniae acetatae Misturae camphorae 3xij Vini antimonii gutt. xx. Syrupi simplicis 3J- M. f. haustus diaphoreticus quartis horis sumendus. Common emetic draught—See page 7. Take of Ipecacuan wine £vi. Antimonial wine "Zf\—Mix for an emetic draught. Take of the Water of acetite of ammonia 3"j- Camphorated mixture 3XVJ> Antimonial wine drops xx. Simple Syrup Q.—Mix- Make a diaphoretic draught, to be taken every four hours. Take ofAntimon ialpowder gr. iv Nitrate of potash in powder gr. v. Purifiedsugar inpowder gr. vi. R. Pulveris antimonialis gr.iv. Nitri purificati pulverisati gr. v. Sacchari purificati pulveris- ati gr. vj. M-f.pulvis diaphoireticus quar- Mix—Make a diaphoretic paw- tis horis sumendus ex quo- der, to be taken every four vis vehiculo crasso. hours, in any kind of jelly. 11. By the exhibition of tonics, previous to which if the skin be hot and dry, the tongue dry and crusted, the pulse hard, and the bowels constipated, mild aperients, gentle cor- dial diaphoretics should be given. R. Pulveris rhabarbari ^j. Take of Powder of Rhubarb ^i. Cremoris tartari 5J Supertartrite of potash %i. Pulveris aromatici gr. v- Aromatic powder gr.v.-Mix M. f. pulvis aperiens. and make an aperient powder. NERVOUS R. Kali tartarisati 3JSSi Pulveris rhaei gr. x. Infusi sennae 3xrj. Syrupi corticis aurantii, Tincturae cardamomi, a_3J- M. pro haustu aperiente. R. Pulveris rhabarbari gr. xij. Calomelanos gr. iij. M. f. pulvis aperiens expaux- illo mellis sumendus. R. Calomelanos gr. v. F. pulvis pro re nata sumca- dus. R.Extracti colocy nthidis com- positi J^ss. Calomelanos gr. iij. M. f. bolus aperiens : vel pil- ula; tres pro dosi. R. Pulverisipecacuanhaeccm- positi gr. v. F. pulvis diaphoreticus sexta quaque hora sumendus. R. Misturae camphorae 3x'j- Aqux ammoniae acetatae 3:'j. Spiritus ammoniae compos- iti 3SS- Syrupi simplicis 3J. M. f. haustus sexta quaque hora sumendus, FEVER. 23 Take of Tartrite of potash 3'iss. Powder of Rhubarb gr. x. Infusion of senna 3xli- Syrup of orange peel. Tincture ofcardamoneachXi. Mix for an aperient draught. Take of Powder of Rhubarb gr. xij. Submuriate of mercury gr. viij.—Mix and make a laxitive powder, to be taken in a little honey. Take of submuriate of mercury gr. x. Make a powder, to be taken according to circumstances. Take of Compound extract of Colocynth ^ss. Submuriate of mercury gr.viij Mix—-Make an aperient bolus, or three pills to be taken for a dose. Take of Compound powder of ipecacuan gr. v. Make a diaphoretic powder, to be taken every six hours. Take of Camphorated mixture 3xiJ- Water ofacetite efammonia^'ij Compound spirit of ammonia 3ss. Simple syrup fyj.—Mix. Make a draught to be taken ev. try six hours. 24 NERVOUS FEVER. R. Mistura: camphorae 3*ij. Vini antimonii gutt. xx. Pulveris contrayervae com- positi ^ss. Syrupi corticis aurantii 3J- M. f. haustus sexta quaque hora sumendus. MISTURA CAMPHORJE FOR- TlOR. R. C amphorae gr; xxv. Amygdalarum dulcium de- corticatarum sex. Sacchari purificati 3iij- Optime contere, dein adde Aquae menthae sativae gvijss. Ut fiaht mistura. Sit dosis cochlearia tria magna. Vel, R. Camphorae gr. xxv. Spiritus vini rectificati gutt.v. Fiat pulvis, dein adde Pulveris arabici 3JSS- Syrupi corticis aurantii 3iij. Aquae menthae sativae §vij. Ut fiant mistura. Sit dosis cochlearia tria ordinaria. R. Misturae camphorae fortio- ris 3X- Aquae ammoniae acetatae ^iij- Vini antimonii gutt. xv. Syrupi simplicis 3j. M. f. haustus quartis horis sumendus. Take of the Camphorated mix* ture 3xij. Antimonial wine drops XX. Compound powder of contrst- yerva ^ss. Syrup of orangepeel"£\.--Mix. Make a draught to be taken ev- ery six hours'. STRONG CAMPHORATED MIXTURE. Take of Camphor gr. xxv. Sweet almonds, blanched vi. Purified sugar ^iij. Rub them well, then addwater of spearmint gvijss. Make a mixture. The dose is three large spoonfuls. or, Take Camphor gr. xxv. Alcohol drops v.—Make a powder. Then add Gum. arabic in powder 31SS. Syrup of orange peel 3bj. Water of spearmint §vij. Make a mixture, the dose three ordinary spoonfuls. Take of strong camphorated mixture Xts.. Water ofacetite of ammonia 3liJ- Antimonial wine drops xv. Simple syrup "Zfx.—Mix. Make a draught, to be taken every four hours. NERVOUS FEVER. 25 R. Camphor* gr. iv. Pulveris contrayervae com- positi J^ss. ——— antimonialis gr. j. Mucilaginis arabicae q. s. Take of Camphor, gr. Lv. Compound powder of contra- yerva ^ss. Antimonial powder gr. i. Mucilage of gum arable, as much as sufficient. F. bolus sexta quaque hora Make a bolus, to be taken every sumendus. six hours. These being premised—tonics :— cinchona,— angustura,— columba, serpentaria virginiana ;— acids :—acidum vitrioli- cum, acidum nitricum, acidum muriaticum, &c— wine : — red port, Madeira ^-antispasmodics :—camphor,—musk and castor, and spirit, aether, vitriol.;— the allusion of cold water, as before directed. R. Decocti cinchonx^xiij. * Elixir vitrioli acidi gutt. vj. Syrupi rosae Jj. M. f. haustus quarta quaque hora sumendus. R. Decocti cinchonae S^'i* Tincturx ejusdem 5JSS- Syrupi rosae 3JSS- Spiritus aetheris nitrosi ^ss. M. f. haustus quartis horis sumendus. R. Radicis serpentariae Vir- ginian ae, Corticis cinchonae, aa jjss. Aquae ferventis 5XVJ. Macera per horam et cola. Take of the Decoction of cin- chona 5x'ij- Sulphuric aciddiluteddrops\'i. Syrup of roses ^'i.—Mix. Make a draught, to be taken every four hours. Take of the Decoction of cin- chona 3xiy- Tincture of----- 3iss- Syrup of roses 3iss- Nitrous tether Xss. — Mix. Make a draught, to be taken every four hours. Take of Virginia snake root, Cinchona, each^as. Boiling '^ater jjxvi. Macerate for an hour and strain. D 26 NERVOUS FEVER. R. Hujus infusionis ~xiv. Tincturae colombx $j. Syrupi corticis aurantii Jjss M. f. haustus quartis hoi is capiendus. Take of this infushn 3X'7. Tincture of columbo £i. Syrup of orange peel ^JS3- Mix—Make a draught, to be taken every four hours. R. Decocti angusturae 3xiij. Tincturae cinchonae 3JSS- Confectionis aromaticae ^j. Syrupi simplicis 3J- M. f. haustus quarta quaque hora sumendus. Take of Decoction of Angustura ^xiij. Tincture of Cinchona $iss. Aromatic confection ^i. Simple syrup ^i.—Mix. Make a draught, to be taken every four hours. As the disease advances recourse may be had to the stimu- lating operations of blisters,—-nutritive diet,—the lighter kinds of animal food ; as chicken and veal broth, calf's foot jelly, &.c.; recent and acescent fruits. Sleep should be procured by opiates united with an anti- monial. R. Mithridati Sj. Misturx camphorae ^xiij. Vini antimonii gutt. xx. Syrupi rosae 3JSS- M. pro haustu. R. Tincturae opii gutt. xx. Misturae camphorae 3xilj. Spiritus aetheris nitrosi, Syrupi simplicis, aa 5J- M. pro haustu. R. Pulveris antimonialis gr.iij. ------opii gr. j. ——. tragacanthae com- positi^ss. M f. pulvis. Take of Mithridaie^i. Camphorated mixture 3xi'j- Antimonial wine drops XX. Syrup of roses 3'ss. Mix for a draught. Take of Tincture of opium drops xxx. Camphorated mixture 3xiij. 'Nitrous tether, Simple Syrup each X\. Mix for a draught. Take of Axtimonialpowdergr.il] Powder of opium gr. i. Compound powder of traga- canth ^ss. Mix for a powder. NERVOUS FEVER. 27 If there be delirium arising from a determination of blood to the head, as indicated by a suffused i-edness of the eyes, -•-dilated pupil and inordinate sensibility and irritability, Imponatur, nuchae capitis, vel Let an Epispastic be applied to suris externis, emplastrum the back of the neck, or on cantharidis. the outside of the legs. Cataplasmata ex farina lini Let a poultice of flaxseed be ap- pedibus imponenda. plied to the feet. R. Spiritus aetheris vitrioliei compositi gss. Misturae camphorae ^xij. M. pro lotione temporibus fre- quenter admovenda. Take of Compound spirit of sul- phuric tether §ss. Camphorated mixture |xij. Mix—Make a lotion, with which let the temples be fre - quently bathed. R. Aceti communis |iij. Camphorae gr. v. Aquae purae §ix. M- pro lotione toto capiti su- binde applicanda. Take of Common vinegar §iij. Camphor gr. v. Pure water §ix.-« Mix for a lotion, with which let the whole head be frequently washed. If it be low muttering delirium, or incoherence of ideas above mentioned,—opium,—musk,—camphire,—and blisters to the head. Six drops of laudanum may be added to each tonic draught ; or a proportional dose of the pulvis opiatus, or confectio opi- ata. R. Misturae e moscho gvj. Take of the Musk mixture §vi, Cujus sumat aeger cochlearia Of which let the patient take two duo magna secundis horis. large spoonfuls every two hours. 28 NERVOUS FEVER. R. Misturae e moscho § vij. Spiritus aetheris vitriolici compositi 3'j- Syrupi rosae 3'uj. M. f. julapium de quo capiat cochleare magnum sub/nde. R. Misturae e moscho, ------camphorae fortio- ris, aa 3-iij. Spiritus aetheris nitrosi 3'j. M. f. mistura cujus suman- tur cochlearia duo magna tertia quaque hora. R. Pulveris opiati ^ss. ------ ipecacuanhae gr. j. M. f. pulvis octavis horis su- mendus. R. Misturae e creta. § vij. Vini ipecacuanha iij. Tincturae zingiberis ?ss. M. f. mistura. R. Misturae e creta §vij. Confectionis aromatkae'z.jss. Tincturae opii gutt. xx\. M. pro mistura. R. Misturae e creta ^vij. Confectionis opiatae X). M. f. mistura. Take of the Musk mixture § vij, ici Compound spirit of sulphuric tether ^ij. Syrup of roses Zfi'y—Mix. iat Make a julep, of which let the Le. patient take a large spoonful frequently. Take of the mixture of musk, o* Strong camphorated mixture each §iij. j. Nitrous tether "^'ij.—Mix. 1- Make a mixture of which let la the patient take two large spoonfuls every three hours. Take of the Opiate powder 2)ss. Powder of ipecacuan gr. i. Mix—Make a powder, to be taken every eight hours. Take of the Chalk mixture g vij. Ipecacuan wine ^iij. Tincture of ginger §ss. Make a mixture. Take of the Chalk mixture % vij. Aromatic confection%\ss. Tincture of opium drops xxx. Make ,i mixture. Take of the Chalk mixture 5 vij. Opiate confection ^i. Make a mixture. A diarrhoea, not critical, should be checked by the exhibi- tion of opium,—of ipecacuanha in small doses, alone or join- ed with opium,—by cordials,—astringents ;— catechu,— kino. NERVOUS FEVER. 2? Take of the Chalk mixture §vi. Tincture of cardamon §i. Syrup of ginger §ss. Tincture of opium 3SS. Make a mixture. Take of the Electuary of cate- chu (P.E.)3iij. Decoction of angustura ^vij. Tincture of • 3iij. Make a mixture. R. Misturae e creta §vj. Tincturae cardamomi §j. Syrupi zingiberis gss. Tincturae opii 3ss. M. f. Mistura. R. Electuarii catechu (P. E.) Decocti angusturae §vij. Tincturae ejusdem 3'iij. M. f. mistura. Three table spoonfuls of any of the above mixtures may be given every two, three, or four hours, or after every purging stool. Bibat aejer vinum rubrum Let the patient drink freely of generosissimum frequenter. the best Port wine. Profuse sweats are to be restrained by aciduh.ted drinks, and by the use of the vegetable and mineral acids. R. Misturae camphorae forti- Take of the strong Camphorated oris § vij. Elixir vitrioli acidi 33s. M. f mistura cujus capiat cochlearia tria subinde. mixture 5vij. Sulphuric acid diluted Jss. Mix—Make a mixture of which let the patent take three spoon* fulsfrequently. Take of the Infusion of roses, Port wine, each equal parts. For ordinary drink. R. Infusi rosae, Vini rubri, aft p. ae. M. pro potu ordinario. Should the extremities become cold, sinapisms to the feet3 blisters to the inside of the ancles, camphire and aether. R. Misturae camphorae forti- Take of the strong Camphora- oris |vij. Spiritus aetheris vitriolici compos iti 31J. M. f- mistura cujus sumantur cochlearia duo magna quaque hora. D2 ted mixture |vij. Compound spirit of sulphuric tether 3'ij. Mix—Make amixturenfwhich let two large spoonfuls be ta- ken every hour, 30 PUTRID FEVER. TYPHUS GRAVIOR, OR PUTRID FEVER. SYMPTOMS. The attack of this disease is much more sudden than that of the preceding, and its progress more violent and rapid ; — the rigors are extremely severe,—the prostration of strength greater and more early, and the expression of anguish and horror more acute ;—the heat of the skin is often moderate, though in some instances it soon rises to a degree greater than in any other fever, to 108° of Fahrenheit, and is pecul- iarly acrid and burning to the touch ;—the pulse is quick, small, and possesses considerable hardness ; nausea and bil- ious vomiting,—intense pain in the head,—tinnitus aurium,--- preternatural throbbing of the temporal and carotid arteries, -—ferrety redness of the eyes,—extreme anxiety,—ferocious delirium,—the tongue is dry and covered with a brown or black crust,—the breath is hot and offensive, foetid sordes ac- cumulate about the teeth, the urine, at first pale, then be- comes extremely high-coloured and foetid, and in the last stage of the disease often deposits a black sediment. In the advanced stages haemorrhages breakout from differ- ent parts of the body,—blood is effused under the skin, form- ing petechiae, maculae, and vibices. The excretions become involuntary, and extremely offensive,—gangrenous aphthae appear about the mouth and throat,—the pulse sinks, and in- termits ; the extremities grow cold ; hiccups ensue ; and be- fore dissolution the patient exhibits a most complicated scene of misery. CAUSES. Predisposing. Al} those causes inducing debility already enumerated under Typhus mitior ;—want of cleanliness- confined air—close and humid state of the atmosphere—con- tagion. PUTRID FEVER. 21 DIAGNOSIS. From typhus mitior. Vide Typhus mitior. From synocha. By the sudden and great prostration of strength which ensues on its first attack ;—by the constitu- tion of the patient;—by the brown or black tongue ;—the liv- id flush of the countenance ;—the black and foetid sordes a- bout the teeth;— the less degree of strength, yet greater quickness and hardness of pulse ;—the acrid and more in- tense heat of the skin ;«-the symptoms of putrescency above mentioned. PROGNOSIS. Favourable. A crisis accompanied with any of the symp- toms mentioned under Typhus mitior ;—an abatement of fe- brile heat and thirst; a gentle moisture diffused equally over the whole surface of the body, succeeded by a rising of the pidse j—the absence of delirium and stupor ;—the prostration of strength not great;—the petechiae or haemorrhages being of a florid, red colour. Unfavourable. In addition to those already enumerated as marking extreme debility fvide typhus mitior J, the peculiar appearance of the patient; his eyes inflamed and staring, his speech quick, the sound of his voice altered;— extreme anx- iety and perpetual watchfulness,—high delirium,—loss of sight,—dry, black tongue,—nausea, or constant vomiting,— foetid and involuntary excretions,—-passive haemorrhages,— dark-coloured, livid, petechial eruptions,—yellowness of the skin,---tension of the abdomen,—black and gangrenous aph- thae,—gangrene of blistered places,—partial cold and clammy sweats,—cadaverous smell of the whole body. TREATMENT. C 1. To moderate the excessive febrile action, j and to support the strength of the patient. S' "j 11. To obviate the putrid tendency in the flu- C ids. 32 PUTRID FEVER. 1. Bv the means recommended for the eure of the prece- ding disease ;—great reliance is placed by some practitioners on the frequent affusion of cold water, employed under the restrictions there mentioned. Great benefit has been deriv- ed from the use of the spirit, aetheris vitriolici compositi. R, Spiritus aetheris vitriolici compositi jiij. Misturae camphorae |vijss. M. f. mistura cujus capiat seger coch. iij. magna tertia quaque hora. Take of compound spirit of sul- phuric tether Xuj. Camphoratedmixture §vijss. Mix—-Make a mixture of which let the patient take three large spoonfuls every hour. R. Spiritus aetheris vitriolici compositi 3;ij. Misturae camphorae fortior- is SviJ- M- f, mistura cujus capiat aeger cochlearia tria mag- na tertia quaque hora. Take of Compound spirit of sul- phuric tether 2,iij. Strong camphorated mixture | vij.—-Mix. Make a mixture, let the patient take three large spoonfuls ev- ery hour. 11. This is partly to be done by fulfilling the first indica- tion :— by the utmost cleanliness ;—frequent change of linen j —ventilating and fumigating the apartment of the patient; —frequently sprinkling the room with vinegar or camphor- ated spirits ;—the use of acid and acescent fruits, such as currants, grapes, oranges. The exhibition of antiseptics, especially cinchona, in com- bination with acids : R. Decocti cinchonae ^xij. Tincturae cinchonx ?ij Elixir vitriol acidi gutt. x. M. f. haustus, Take of Decoction of cinchona 5xiJ- Tincture of ■ jij. Sulphuric acid diluted drops X. Mix—Make a draught. PUTRID FEVER. R. Decocti cinchonae 3xij. Tincturae ejusdem 3JSS- Acidi muriatici gutt. v. M. f. haustus. R. Decocti cinchonae 3xij. Tincturae ejusdem 3jss. Acidi nitrici gutt. viij. M. f. haustus. R. Extracti cinchonae mollis 9ss. Decocti cinchonae 3xlj- Tincturae ejusdem XY$. Acidi muriatici gutt. vj. M. f. haustus. One of these draughts to be taken every two, three, or four hours. The decoction of angustura, quercus, serpentaria, or cas- carilla may be used, made in the same way as the decoction of the cinchona, and employed in the same dose, combined with tincture and acid. The intestinal canal should be assiduously cleared from any accumulated faeces, by the occasional use of gentle laxatives, as rhubarb and cream of tartar, calomel, and mild clysters. R. Aceti communis giij. Take of common Vinegar giij. Infusi florum chamaemeli §v. Infusion of Camomile flow- ers J v. M. pro enemate. Mix for an injection. R. Natri muriatici §ss. Aceti communis §jss. Infusi chamaemeli ^vj. M. f. enema. Take of Decoction of cinchona 3xiJ- Tincture . 3'SS- Muriatic acid drops v. Mix—Make a draught. Take of decoction of cinchona 3xiJ- Tincture of ----1---X\ss. Nitric acid drops viij. Mix—Make a draught. Take of the soft Extract o cinchona ^ss. Decoction of----— 3xy- Tincture of ■ Xij. Muriatic acid drops vi. Mix—Make a draught. Take of Muriate of soda §ss. Common vinegar §iss. Infusion of camomile §vi. Mix for an injection. 34 PUTRID FEVER. R. Nitri purificati 3'iij. Take of Nitrate of potash 3'iij. Infusi chamaemeli § j. Infusion of camomile £vi. Aceti communis §ij. Common vinegar §ij. M. f. enema. Mix for an injection. Acids vegetable and mineral, and carbonic acid in every form ;— fermenting liquors ;--yeast has been successfully us- ed ;— infusion of malt;— aerated waters ;— clysters of carbon- ic acid gas, or of acidulated waters j—oxygen gas ;—oxy- genated muriate of potash. R. Muriatis potassae oxygen- Take of the oxygenated muriatt ati 3SS> of potash^ss. Tincturaecardamomi 3ij- Tincture of cardamonXfi. Syrupi corticis aurantii 3 j- Syrup of orange peel Xf\. Aquae cinnamomi §jss. Cinnamon water §iss. M. pro haustu secunda vel Mix for a draught, to be taken tertia quaque hora sumendo. every second or third hour. Phosphorus dissolved in aether or oil, and made into an e- mulsion with mucilage of gum Arabic,has been employed with beneficial effect in the last stages of typhus by Drs. Mentz, Wolff", Leroy, and others ; but the difficulty of obtaining and mixing it, and the great caution that is requisite in the exhi- bition, are such as prevent its general use. If aphthae appear, the garglea recommended for cynanche maligna may be employed. Should hemorrhages arise—the acidulated infusion of roses, in addition to other antiseptics ; but more especially the oxy- genated muriatic acid. R. Acidi muriatici oxygenati Take of oxygenated muriatic gutt. xx. acid drops xx. Decocti cinchonae ^xiij. Decoction of cinchona 3xiij, Tincturae ejusdem 3iij- Tincture-------3'iij. M. f. haustus tertia quaque Mix—Make a draught, to be hora sumendus. taken every three hours. MIXED FEVER.—INFLAMMATIONS. 33 SYNOCHUS, OR MIXED FEVER. This is a compound of synocha and typhus. It commences with the symptoms of the former, and terminates in those of the latter.—At first the pulse is strong and hard, the tongue white, the urine high-coloured;— soon however the tongue becomes yellow, then brown; the pulse loses its strength, yet retains its hardness, and becomes more quick; prostra- tion of strength supervenes ; and the disease assumes the form of typhus mitior, or gravior, as certain predisponent circumstances of constitution, or cause, may happen to be present.. The usual and almost universal cause of this fever is cold; —the. morbid effects of which are promoted by its union with moisture, or by a debilitated state of constitution however previously induced. The treatment has been already fully described.—In the commencement it will be that laid down for the cure of in- flammatory fever : the utmost caution must however be em- ployed in the use of those means which lower the tone of the system, especially bleeding, so that sufficient strength may be left to combat the succeeding stage, in which the treat- ment will be that proper for typhus. ORDER II. PHLEGMASIA, OR INFLAMMATIONS. CHARACTER. Synocha fever, with inflammation Or topical pain ; the func- tion of an internal part being at the same time injured; the blood upon venesection exhibiting a huffy coat. GENERAL CAUSES. All the causes inducing local inflammation ; viz. All mechanical, chemical and nervous stimuli; as external 36 INFLAMMATION OF THE BRAlNi injuries by bruises, wounds, compression, &c. Irritation produced by the presence of extraneous bodies of whatever kind. The application of cold. Any cause that determines ah increased or irregular impet- us of blood to the part—as violent exercise, certain diseases, an inordinate influx of nervous energy. All the causes inducing inflammatory fever. Vide Synocha. GENERAL TREATMENT. f 1. To remove the remote causes when they are evident, and continue to operate. 11. To lower the tone of the vascular sys- tem in general; by abstracting those nat- Indications. -( ural agents or stimuli, by which it is sup- ported. 111. To lowrer the tone, diminish the sensi- bility, and reduce the inflammatory ac- V. tion of the part in particular. PHRENITIS, OR INFLAMMATION OF THE BRAIN, OR ITS MEMBRANES. SYMPTOMS. Horror ;—immense anxiety and sense of tension referred to the breast;—loss of memory ;—frightful dreams ; nausea and oppression at the stomach ;—excruciating pain in the head ;—extreme sensibility to impressions of light and sound; —peculiarly wild expression of the countenance ;—constant watchfulness.—The face becomes flushed, and turgid ;__the eyes stare, and seem as if starting from their sockets ;—fero- cious delirium ;—tears sometimes burst from the eyes ;— sometimes there is profuse sweating from every pore, at oth- ers the skin is dry and burning ;—parched tongue ; at first INFLAMMATION OF THE BRAIN. 37 fiery red, afterwards becoming white, yellow, or bluek •— peculiarly hard and rapid pulse. Phrenitis generally terminates in stupor and insensibility ; and if protracted, in great prostration of strength, and symp- toms of debility. CAUSES. Exposure to excessive heats, or to vicissitudes of temper- ature ; as subjecting the head uncovered to the rays of a ver- tical sun ;—violent exercise ;—stimulant passions of the mind; —intense study;—the presence of irritating matter in the stomach;— external violence ;—the abuse ofspirituous liquors. DIAGNOSIS. From mania.—By the one being accompanied with violent fever,—the other not;—by the speedy termination of the one, and longer duration of the other. From the delirium of synocha.—In phrenitis, the delirium is the primary affection,—in synocha it is consequent upon the general fever ;—in synocha the pulse is strong and full,—in phrenitis small, hard, and more rapid ;—phrenitis terminates when protracted in symptoms of typhus, true inflammatory fever most frequently in visceral inflammation. From the delirium of typhus.—By the mode of the accession : the affection of the head in phrenitis comes on suddenly, and is extremely violent;—the delirium of typhus is preceded by the characteristic marks of that disease, and is more mode- rate in degree ;—it is distinguished from the low muttering delirium, often accompanying nervous fever, by there being in this no symptoms of inflammation :—the face is pallid ; the eyes are dull; and all the features shrunk ; the contrary is the case in phrenitis. PROGNOSIS. Favourable.—The appearance of a warm and equable per- spiration, when the skin has been before constricted ;—diarr- E 38 INFLAMMATION OF THE BRAIN. hcca ;—sediment in the urine ;—hemorrhage from the nose ;— the pulse diminishing in frequency, and becoming more full and soft,—the return of sleep and consciousness,—inflamma- tion attacking a less important part. Unfavourable.—After ferocious delirium and constant watch- fulness—the pupil of the eye becoming dilated,—frothing at the mouth,—grinding of the teeth,—profound insensibility,— tremors,—convulsions,—involuntary evacuations,—the face, from being flushed, suddenly becoming pale ; suppression of urine,—involuntary tears,—the urine of a dark red or yellow colour, or covered with a pellicle ;—the faeces either bilious or white and very foetid ;— profuse sweats without affording relief,—paralysis of the tongue or other parts,—inflammation of other viscera, without diminishing the symptoms of the original disease ;—delirium changing to coma, while the poise becomes weaker. TREATMENT. C To diminish the quantity of circulating flu* T ,. ,. j ids, and lessen the tone of the vessels, in Indication. < , . ' 1 the system in general, and in the head in (^ particular. 1. By Heeding.—A copious and sudden evacuation of blood from the temporal artery, the jugular vein, or the arm, which should be repeated frequently, proportioning the quantity to Uie age, sex, temperament, and habits of the patient : Mittatur sanguis, pleno rivo, Take away gxvi of blood in a ad §xvj, et repetatur pro full stream, and repeat it ac- re nata. cording to circumstances. Topical bleeding also, from the head, neck, or feet: Admoveantur singulis tern- Let four or six Leeches be ap- poribus hirudines quatuor plied to each temple. vel sex. INFLAMMATION OF THE BRAIN. 39 2. By purging:—with neutral salts, or calomel in strong doses, so as to keep up a counter irritation, and not to excite vomiting. R. Natri vitriolati §j. Aqurc purse §vj. Syrupi croci 3'ij- M. f. mistura de qua capiat acger cochlearia iv quavis hora donee alvus bis terve respondeat. R. Calomelanos gr. x. Sacchari purificati ^j- M. fiat pulvis catharticus. Take of Sulphate of soda §i. Pure water |vi. Syrup of saffron X^ny—Mix. Make a mixture, of which let the patient take four spoonfuls every hour till two or three stools are produced. Take of Submuriate of mercury gr. xij. Purified sugar ^i.—Mix. . Make a cathartic powder. R. Pulveris e scammonio cum calomelane gr. xv. F. pulvis catharticus. Take of the Powder of scammo- ny with submuriate of mer- cury gr. xv. Make a cathartic powder. R. Gambogiae gr. x. Pulveris jalapii gr. xij. M. f. pulvis catharticus. Take of Gamboge gr. x. Powder of jalap gr. jay—Mix. Make a cathartic powder. 3. By saline diaphoretics and refrigerants. Capiat aeger haustum salinum Let the patient take the common communem (page 5) tertia saline draught (page 5,) ev- quaque hora. ery three hours. R. Nitri purificati gr. x. Aquae ammoniae acetatae31 j- —— distillatae 3x'j- Syrupi rosae 3J- M. pro haustu diaphoretico quarta quaque hora sumendo- ery three hours. Take Nitrate of potash gr. x. Water ofacetite of ammonia 3u- Distilled water 3XU- Syrup of roses X\.—Mix and make a diaphoretic draught to be taken every four hours. 40 INFLAMMATORY SORE THROAT. R. Aquae ammoniae acetataegss. Take of Water ofacetite of am- monia §ss. Misturae camphorae fortior- Strong camphorated mixture is3x. _ 5x. Vini antimonii tartarisati Wine of tartrite of antimony gt. vj. drops vi. Syrupi simplicis Jj- Simple syrup Xf\.—Mix. M. f. haustus diaphoreticus Make a draught, to be taken quartis horis sumendus. every four hours. 4. By the application of vinegar and water to the bead, pre- viously shaved;—pediluvium and semicupium. 5- By the application of blisters to the head, neck, and legs. Applicetur toto capiti raso, Let a large Epispastic plaistcr vel nuchae capitis, velsuris be applied over the whole externis, emplastrum can- head (~shavedj to the back tharidis amplum. of the neck, or on the outside of the legs. The most perfect tranquility should be observed in the pa- tient's room, all sounds and light excluded, and no food what- ever be allowed during the inflammatory period, except bar- ley-water, rennet-whey, gruel, sago, panada, arrow-root, or the like. CYNANCHE TONSILLARIS, OR INFLAMMATORY SORE THROAT. SYMPTOMS. Rigors and flushing, succeeding each other, and termina- ting in the hot stage of an inflammatory fever ; during which inflammation is found upon the tonsils, uvula, and adjacent parts,—difficult and painful deglutition,—the voice becomes hoarse, sometimes almost lost ;—sense of burning heat and lancinating pain in the tliroat,—copious excretion of viscid INFLAMMATORY SORE THROAT. 41 mucus and saliva,—in more severe attacks the eyes are inflam- ed and the cheeks swollen and florid,—pain in the ear, and not unfrequently deafness ;—sometimes the inflammation from being extremely florid becomes of a dusky rose colour, and is soon interspersed with little whitish specks, which be- come small sloughs. It terminates in resolution—in suppuration, or in gangrene. CAUSES. All those causes which induce inflammation in general,— the application of cold to the neck,—wearing damp linen,— sitting in damp rooms,—getting wet in the feet, violent exer- tions of voice,—blowing wind instruments,—suppression of customary evacuations,—acrid substances irritating the fau- ces, DIAGNOSIS. From cynanche maligna.—By the fever, which in the one is inflammatory, in the other typhoid ;—by the absence of ulcer- ation. From scarlatina anginosa.—See Scarlatina anginosa. PROGNOSIS. Favourable.—Those circumstances indicating resolution or suppuration,—little fever,—free respiration,—deglutition not much impeded,—the inflammation being of a vivid red coloui', —copious salivation about the fifth day. Unfavourable.—Those circumstances indicating gangrene ; which are, after unusual violence of pain, a sudden abate- ment ;—the tonsils, before turgid, moist, and shining-, sud- denly appearing dry, flaccid, unequal, and of a pale brown or livid colour;—the inflammation becoming of a dull red, and interspersed with specks of a dark colour (as long as the specks continue white, little is to be apprehended from them) ;—the pulse, from being strong, becoming small, weak, and irregular;—the face, before flushed, now s,ssum- E 2 42 INFLAMMATORY SORE THROAT. ing a cadaverous appearance ;—clammy cold sweats and cold extremities ;—foetid breath,—great anxiety,—subsultus ten- dinum,—foam in the mouth,—coma, or slight delirium ;—the tonsils enlarging to such a size as to threaten suffocation. TREATMENT. The Indications are those for the treatment of inflammation in general. Emetics are extremely useful in the beginning, before the Tcbrile symptoms are very violent. The timely exhibition of y.n emetic often checks the complete formation of the disease. R. Antimonii tartarisati gr. ij. Sacchari albi ^j. M. fiat pulvis in partes qua- j.uoi" aequales dividendus, quarum capiat unam quavis hora donee probe vomat. Take of Tartrite of antimony ^ 'j- Purified sugar ^i.—Mix. Make a powder, which divide into four equal parts, let the patient take one every hour till he vomits copiously. When the disease is not checked, the antiphlogistic regi- men and diet must be enforced, and the inflammation attacked: 1. By blood-letting-, general and local. Mittatur sanguis ex veno jug- uhiri ad §viij. Take away § viij. of blood from the jugular vein. Admoveantur hirudines tres Let three Leeches be applied to parti ail'ectae. the part affected. Applicentur cucurbitulae cum Apply the scarificator and cup. ferro sub aurem lateris af- ping Glass under the ear of fecti, et mittatur sanguis the side affected, and take adgiv. away §iv. of blood. 2. By blisters to the throat and back, and rubefacients. INFLAMMATORY SORE THROAT. 43 Illinatur linimentum ammo- niac vel linimentum cam- phorae compositum in par- tem affectam, sextis horis. Emplastrum cantharidis collo qua dolet. Let the ammoniated or com- pound camphorated linament be rubbed in on the part af- fected every six hours. Let an Epispastic be applied over the painful part of the neck. 3. By purging, with either of the recipes page 16. 4. By diaphoretics, such as recommended, page 17, against inflammatory fever. 5. By inhaling the steams of warm water, alone, or im- pregnated with vinegar, camphor, or aether. 6. By sedative or slightly stimulant gargles : R. Nitri purificati 3ij. Take Nitrate of potash X\y Aquae hordei §vij. Barley water §vij. Mellis acetati 3v'j- Acetated honey Xy\y—Mix. M. f. gargarisma saepe uten- Make a gargle, to be frequent- dum. ly used. R. Infusi rosae §vij. Tincturae myrrhae 3hj. M. f. gargarisma. R. Acidi muriatici 3ss. Aquae hordei §vij. M. f. gargarisma. Take Infusion of roses §vij. Tincture ofmyrrhXf\y—Mix, Make a gargle. Take Muriatic acid 3ss. Barley water $viy—Mix. Make a gargle. If suppuration ensue—emollient cataplasms—warm emol- lient gargles,—frequently inhaling the steams of warm wa- ter,—early incision. R. Caricarum incisarum |iv. Aqux distillatx §xij. Coque per sextam partem ho- rae, dein cola pro gargaris- mate tepide utendo. Take of Figs, cut fine §iv. Distilled water §xij. Boil for ten minutes, then strain for a gaigle to be used tepid 44 PUTRID SORE THROAT. If a tendency to gangrene—the means enumerated under the head Cynanche maligna are to be used. If danger of suffocation—scarifications of the tumefied parts,—inhalation of aether—bronchotomy. The strength of the patient should meanwhile be support- ed'by nutritious clysters of animal broths, thick gruel, or a solution of starch. CYNANCHE MALIGNA, or PUTRID SORE THROAT. SYMPTOMS. Cold shiver in gs,--anxiety,—nausea,—vomiting,—heat,— restlessness,—debility,—oppression at the chest,—the face is flushed,—the eyes red,—sense of stiffness in the neck, with hoarseness of voice, and sore throat; when upon inspection, the whole internal fauces appear of a fiery red colour.—This soon changes to a dark red, and becomes interspersed with a number of specks, of some shade between a light ash, and dark brown.—In some cases the first appearance which the fauces assume, is that of a large whitish-coloured stain, sur- rounded by a florid margin: the stain soon becoming an ex- tensive slough.—The tongue is covered with a thick brown fur,—the inside of the lips are beset with vesicles, and a thin acrid matter distils from the mouth and nostrils, excoriating the neighbouring parts ;—there is often a diarrhoea, and sometimes a constant discharge of an excoriating fluid from the anus ;—considerable fever with an obvious evening exa- eerbation ; small, frequent, irregular pulse ;—prostration of strength ; coma or delirium ; yet often, even when the dis- ease terminates fatally, the patient is free from these symp- toms, and continues to walk about until a few hours before bis death. About the second or third day large patches or stains appear about the neck and face, of a scarlet, or fiery red colour $ FUTRID SORE THROAT 45 Which, upon inspection, are composed, of small prominent papulae.—These, by degrees, become dispersed over the whole body, and after continuing for about four days, depart with a desquammation of the cuticle. In bad cases the sloughs in the throat corrode deeper and deeper, and spread throughout the whole alimentary tube, or to the trachea; the symptoms of irritation continue to in- crease, gangrene supervenes, a severe purging comes on, and the patient expires ; usually before the seventh, often as early as the third or fourth day. CAUSES. Predisposing.—Weak and relaxed habit of body,—debility, however induced,—autumn and the commencement of win- ter,—long-continued humid state of the atmosphere,—it most frequently attacks children. Exciting.—A specific contagion. DIAGNOSIS. It is distinguished from the preceding species of cynanche by the concomitant fever : in the one it is inflammatory, in the other putrid.—By the inflammation in the throat, in one disease terminating in resolution, or suppuration;—in the other, in gangrene.— Cy the absence of an eruption in the one ; by its presence in the other. From Scarlatina.—See Scarlatina. PROGNOSIS. Favourable circumstances.—The fever moderate, and suffer- ing a remission upon the appearance of the eruption ;—about the fifth or sixth day, the skin, from being parched, becom- ing moist and soft; and this followed by a diminution of fe- brile symptoms ;—the eruption of a florid red colour, and diffused equally over the whole surface of the body ;—swel- ling of the tonsils has sometimes been attended with relief. 46 PUTRID SORE THROAT. Unfavourable. At the commencement of the disease severe headaches, especially acute pain in the crown of the head ;.— diarrhoea,—coma,—delirium,—the eyes heavy and watery ;— the countenance either full and bloated, or pale, shrunk, and dejected;—early prostration of strength ;—small irregular tremulous pulse, whether frequent or not; or full and une- qual ;—small hurried anxious respiration, interrupted by sighs;—the urine quite limped, or very high coloured, and turbid ;—the fauces of a dark rose colour, with brown spots; an eruption of red pustules, or purplish blotches, forerun the worst cases.—Sores or issues assuming an ill appearance,— the absence of an eruption, or its early appearance ;—the eruption suddenly becoming livid, or changing from a dark red to a pale colour ; or altogether disappearing ; when the countenance assumes a cadaverous hue, and convulsions su- pervene.—Dropsical swellings,—the ulcers, left after the separation of the sloughs, of a fiery red colour, or suddenly becoming covered with a black crust;—the ceasing of the discharge from the mouth and nose,—the evacuation of faeces of a dark or black colour,—the inflammation spreading to the stomach and intestines, and producing symptoms of gastri- tis or enteritis ; to the brain inducing phrenitis ; to the trach- ea, followed by a change in the voice, and other symptoms of angina trachealis.—Hemorrhages from the mouth, nose, or ears ;—foetid breath,—cold extremities,—clammy sweats,— hiccup. TREATMENT. C 1. To check the tendency to gangrene by i supporting the strength of the system in general. Indications. -{ 11. To promote the separation of sloughs ; I and to preserve a healthy state of the fau* J ces. LH1. To allay urgent symptoms. PUTRID SORE THROAT 4V 1. By the liberal administration of antiseptics, especially bark, joined with spices and wine ; it is more effectual when given in substance R. Pulveris cinchonas ^j. ------aromatici gr. iij. Confectionis aromaticae 5ss. Tincturae cinchonae ^j. Decocti ejusdem jxij. Syrupi zingiberis Xy M. f. haustus quarta quaque hora capiendus. Take of Powder of cinchona ^j. Aromatic powder gr. iij. Aromatic confection 3SS- Tincture of cinchona Xi. Decoction ———- Jxij. Syrup of ginger Xj.—Mix. Make a draught, to be taken every four hours. The formulae prescribed at page 32 against putrid fever are also proper. If the skin be hot and dry, the bark should be joined with _ diaphoretic. R. Aquae ammoniae acetatae X.\y Decocti cinchonae tz xij. Tincturae cinchonae %jss. Confectionis aromaticae tss. Take of water of acetite of am- monia T\y Decoction of Cinchona ^xij. Tincture •---------^iss, Aromatic confection ^ss. Fiat haustus tertia vel quarta Make a draught, to be taken quaque hora sumendus. every third or fourth hour. R. Ammoniae preparatae ^j. Succi limonis, q. s. ad ejus saturationcm. Decocti cinchonae 3ix. Tincturae ejusdem 5j. Confectionis aromaticae Jss. Take of Carbonate of ammonia 9i- Lemon juice, q. s. to satu- rate it. Decoction of cinchona %\x, Tincture —_——_ ^i. Aromatic confection ^ss. F. haustus tcitia vel quarta Make a draught to be taken eve- cjuaque hora sumendus. ry third or fourth hour. Tiic diet should be thick gruel,—barley-water,—prepara- •jons of tapioca,—Indian arrow-root,— rice,—sago,—panado, 4S PUTRID SORE THROAT. with red wine or brandy.—The ordinary drink wine-whey,-- negus, acidulated with the juice of oranges or lemons. The chamber of the patient should be kept cool,—the floor often sprinkled with vinegar,—free ventilation,— fumigations, by casting pulverized nitre over a chafing-dis,h containing live charcoal, or with oxy-muriatic acid gaz ;—all sources of pu- trid effluvia should be removed, and the patient's linen often changed. Great attention ought to be paid to the state of the bowels ; and irritating faeces should be prevented from accumulating by the occasional use of laxative enemas. 11. By stimulant, tonic, and astringent gargles ;—such are —an infusion of capsicum, of roses acidulated, solutions of myrrh, of marine acid, of a watery extract of bark in port wine : R. Seminis capsici annui con- tusi Jss. Aquae ferventis §vij. Mellis rosae 3iij. Tincturae myrrhse 3V. Fiat gargarisma. Take qf Long pepper bruised 3SS- Boiling water §vij. Honey of roses X\\j. Tincture of myrrh Xv. Make a gargle. R. Infusi rosae gvj. Tincturae myrrhae |j. Acidi sulphurici diluti 5J- M. pro gargarismate. Take infusion qf roses §vi. Tincture of myrrh §i. Diluted sulphuric acid Xi. Mix for a gargle. P.. Extracti cinchonae mollis3J. Take soft Extract of cinchon* Vim rubri generosissimi Best port wine % vij. Bvij. Fiat gargarisma. . Make a gargle. Should these be insufficient, the parts may be touched with mel aeruginis, with powdered myrrh or allum, by means of a camel-hair pencil, with marine acid mixed with honey. PUTRID SORE THROAT. 49 R. Acidi muriatici 3ij. Take Muriatic acidX.iy Mellis rosae 3xiv. M. Honey of roses X.xiv.—Mix. Quo partes gangrenosa saepe, Touch the gangrenous partsfre- ope penicilli, tangantur. quently with it by means of a pencil or soft rag. The inhalation of the steams of hot water, impregnated ■with myrrh, camphor, or vinegar, may be had recourse to. 111. Diarrhoea—by opium—and astringents—such as are ordered against diarrhoea in nervous fever at page 28. Violent vomiting—by the saline medicine in an effervescing state,—mild laxative enemas,—opium joined with camphor. HA.USTUS SA.T.INUS EFFER- VESCEKS. R. Kali praeparati £)j. Aquas cinnamomi ^ij. -----distillatae 3viij. Syrupi corticis aurantii % jss. Fiat haustus cum cochleare magno succi limonis, in ac- tu effervescentiae, sumen- dus. SALINE EFFERVESCING DRAUGHT. Take Carbonate of potash ^i. Cinnamon water X\'y Distilled water X\'\\]. Syrup of orange peel 3 i s s. Make a draught to le taken with a large spoonful of le- mon juice, in the act of ef- fervescence. Take of strong Camphorated mixture Xv. Spirit of nutmeg or mace X\. Water of acetite of ammonia 3' F. mistura cujus capiat coch- leare magnum pro re nata. Infusion of senna XiLi'y Syrup of roses X\'y 3'ake a mixture, of which let the patient take a table spoon- ful according to circumstances. R. Calomelanos gr. ij. Pulveris antimonialis gr. iij. Fiat pulvis catharticus exmel- le sumendus. Take Submuriate of mercury gr. iv. Antimonial powder gr. iij. Make a cathartic powder to be taken in Honey. 4. Blisters to the neck, kept open by the use of the un- guentum cantharidis, or unguentum sabinae. 5. Calomel so administered as to excite salivation, has been successfully employed. THE MUMPS. ,53 R. Calomelanos gr\ iij. Take Submuriate of mercury gr. iij- Sacchari purificati gr. vj. Purified sugar gr. vi. £. pulvis tertia vel quarta vel Make a powder, to be taken ev- sexta quaque hora, ex quo- ery third, fourth or sixth vis vehiculo crasso, sumen- hour, in any thick vehicle. dus. If the bowels be soon purged, and the motions be green, the calomel must be discontinued, and mercurial ointment rubbed into the thigh, or elsewhere, if the inflammation ber not abated. 6. Strong decoction of seneka, frequently taken into the mouth in small quantities, has been successfully used to pro- mote a separation of the films or coagula. R.Radicis senekae contusae | ij. Take Seneka root bruised g ij. Aqrae purae foj. pure water ffci. Coque per horam dimidiam, Boil forhalf'an hour, th^n strain dein cola pro collutorio. for a wash. CYNANCHE PHARYNGyEA, OR INFLAMMATION OF THE PHARYNX, Differs from cynanche tonsillaris in the seat of the inflam- mation only. It is of the same nature, produced by the same causes, and requires the same treatment. CYNANCHE PAROTID/-A, OR THE MUMPS. After slight symptoms of inflammatory fever, a swelling of the parotid and maxillary glands appearing externally ^-re- spiration and deglutition little impeded ;—sometimes a meta- stasis of the inflammation takes place to the breast in the fe- F2 54 PNEUMONIA. male, and to the testes in the male ; and the recession is noC unfrequently followed by delirium. Cause.—Specific contagion. The treatment will be the same as in cynanche tonsillaris. Emetics are especially beneficial.—Should inflammation of the breast or testes supervene, with delirium or stupor, blis- ters to the head, sinapisms to the feet, fomentations to-the parts affected. PNEUMONIA. r Pleuritis, er inflammation of the pleura. Species. < Peripneumonia, or inflammation of the substance C of the lungs. SYMPTOMS. Pleuritis commences with the usual symptoms of inflamma- tory fever, accompanied, or followed, by a sense of weight in the chest, which in a few hours becomes acute pain, refer- red to the side, about the sixth or seventh rib, and thence lancinating to the sternum or scapula.—The breathing is ex- tremely anxious, and the pain is increased during inspiration ; —incapacity of lying upon the affected side ,-—frequent, hard, contracted pulse, vibrating under the finger like the tense string of a musical instrument;—white tongue,—high colour- ed urine, and other symptoms of synocha. In peripneumonia, the pain is more obtuse and attended with greater sense of weight, and oppression ;—the pulse is more soft;—the difficulty of breathing more constant,—the face is flushed, and sometimes of a purple hue. The disease terminates either In resolution.- marked by the gradual subsidence of the symptoms. In adhesion : which is very frequents "When protracted beyond the seventh day. not unfrequently PNEUMONIA. 55 by suppuration: indicated by severe rigors, the pain becoming more fixed, by a remission of previous febrile symptoms, and the accession of hectic, by the respiration becoming less pain- ful but more oppressed ; the patient lying with greater ease on the affected side, and these followed by the subsequent symptoms of Empyema or Vomica. In effusion: when a sudden remission takes place, of fever, and pain, without preceding rigor ; the breathing becomes more anxious, and the symptoms of hydrothorax ensue. By hemorrhage :— at the acme of the disease, instant faint- ing and sense of suffocation, followed by immense anxiety and oppression at the chest, and an oppressed, and sometimes scarcely perceptible pulse. CAUSES. Remote and predisposing.—Sanguineous temperament,—vig- orous and plethoric habit,—winter and spring seasons.—vi- cissitudes of temperature,—all the causes inducing inflam- mation,—violent exercise of body,—or exertions of voice. Exciting.—All the causes inducing inflammation in general —vicissitudes of temperature—violent exercise of body, or exertions of voice. DIAGNOSIS. From hepatitis.—See Hepatitis. PROGNOSIS. Favourable.—An early and copious mucal expectoration, or tinged with blood of a florid red colour ;—spontaneous he- morrhage from the nose,—warm, equable, and free diaphor- esis,—diarrhoea,--- the appearance of inflammation on an ex- ternal part,—the urine depositing a sediment. Unfavourable.—The duration of the disease beyond the four- teenth day, when suppuration or phthisis are to be apprehend- ed :— violent symptoms of fever with delirium ;—no expecto.- ration, or the expectorated matter tinged with blood* or of ?> dark or black colour;— sudden cessation of pain, followed 5fi PNEUMONIA. by a change of countenance, and a sinking or irregularity of the pulse ;—the symptoms indicating suppuration or effusion, TREATMENT. Indications.—See the general treatment of inflammation, which is to be conducted : — 1. By general and local bleeding. Copious and sudden evacuations of blood from the arm, ac- cording to the urgency of symptoms : Extrahatur sanguis,jb/eno rivo, Take away §xvi. of blood as ad §xvj. quamprimum, repetetur pro re nata. et soon as possible in a large stream, and repeat it ac* cording as the case may de- mand. Admoveantur cucurbitulae cum scarificatione ad par- tem thoracis dolentem pro re nata et exsugatur san- guis ad § viij. 2. By a brisk purge at the commencement, and then by oc casional aperients. Apply the Scarificator and cup. ping Glass over the part af- fected, and draw g viij. of blood, as may be necessary. R. Calomelanos gr. v. Conservae rosae gr. v. M. fiat pilula statim sumenda, superbibendo haustum se- quentum. R. Kali tartarisati 3J- Infusi sennae 3XV- Syrupi simplicis 3J- Fiat haustus. The opening medicines, prescribed at page 18 against in- flammatory fever, are also proper. Great caution is requisite not to exhibit a drastic purge when the expectoration is go« ing on freeh/i Take Submuriate of mercury gr. x. Conserve of roses gr. v.--Mix. Make a pill to be taken imme- diately, after which take the following draught. Take Tartrite of potash £i. Infusion of senna 3XV- Simple syrup Xj. Make a draught. PNEUMONIA. &r 3. By nauseating diaphoretics and expectorants. R. Aquae ammoniae acetatae3'ij Take Water ofacetite ofammo' via 3iij. ——- distillatae Z.X.. Nitri purificati gr. viij. Syrupi simplicis 3J> Vini antimonii tartarisati St. x. Fiat haustus. Distilled water X,x. Nitrate of potash gr. viij. Simple syrup X\. Wine of tartrite of antimony drops x. Make a draught. R. Kali praeparati 9j. Succi limonis recentis. q. s. ad ejus saturationem. Misturae c^mphoratae3x. Pulveris ipecacuanhae gr.jss. Syrupi croci Xj. Nitri purificati gr. vj. Fiat haustus. Take of Carbonate of potash ^i Fresh lemon juice q. s. To saturate it- Camphorated mixture X>x. Powder of ipecacuan gr. iss. Syrup of saffron 31. Nitrate of potash gr. vi. Make a draught. One of these draughts is to be given every four hours ; and, if they fail to produce a perspiration, one of the following should be given with each dose : R. Calomelanos gr. £. . Pulveris Jacobi gr. iij. --------scillae gr. £. Conservae rosae gr. iij. -M. pro pilula. R. Pulveris ipecacuanhae gr.j. ■ ■ - antimonialis gr.iij. Calomelanos gr. £ Sacchari purificati gr. vj. Fiatpulvis ex melle capiendus- Take Submuriate of mercury gr. i. yames powder gr. iij. Powder of squills gr. ^. Conserve of roses gr. iij. Mix—Make a pill- Take of Powder of ipecacuan gr. i. Antimonial powder gr. iij. Submuriate of mercury gr. i. Purified sugar gr. vi. Make a powder to be taken i* honey. 58 PNEUMONIA. Should these means neither produce a perspiration nor ex- pectoration, the dose must be increased and assisted by pe- diluvium of warm water, or decoction of chamomile-flowers. The following juleps and emulsions will also tend to promote the same effect, and will palliate the cough : R. Aceti scillae 3j. Mellis acetati ^vj. Aquae menthae sativx Sjvj. M. cujus sumat aeger coch- leare unum magnum subinde. R. Aceti communis §jss. Syrupi tolutani §j. Aquae distillatae §v. Vini antimonii tartarisati 3ss. M. cujus sumantur cochlea- ria duo magna frequenter. R. Nitri purificati J}j. Lactis amygdalae §vj. Syrupi rosse §j. M.cochleare magnum subinde. R. Decocti hordei compositi ftj- Nitri purificati ^ss. Solve et sumat aeger cyathum parvum subinde. Take Acetite of squills Xi. Acetated honey 3vi. Water of spearmint.—Mix. Of which let the patient take a large spoonful frequently. Take of Common vinegar §iss. Syrup of tolu gi. Distilled water |v. Wine of tartrite of antimony 3ss.—Mix. Of which let two large spoonfuls be taken frequently. Take of Nitrate of potash ^i. Milk of almonds gvi. Syrup of roses %i.—Mix. Take a large spoonful frequently Tate Compound decoction of bar. ley fti- Nitrate of potash 3s s. Dissolve, and let the patient take a small glass of it frequently' When the violence of febrile action is somewhat abated, and the pulse continues very frequent, digitalis is of great use: it may be added to the common saline draught. 4. By the application of blisters, fomentations, and cata« plasms, to the chest. iPNEUMONIA. 59 When the symptoms of suppuration, or effusion, super- vene, the strength must be supported, 1. By farinaceous food, mixed with mild and dilute wine. 2. By cordial diaphoretics and bitters. R. Ammoniae praeparatae ^ss. Aquae ammoniae acetatae §j. Mistuiae camphorae £v. Syrupi croci 3 V. M. cujus capiat aeger coch- learia tria ordinaria secun- da vel tertia quaque hora. Take Carbonate of 'ammonia^SB Water ofacetite of-----§i. Camphorated mixture §v. Syrup qf saffron Xy.—Mix. Of which let the patient take three ordinary spoonfuls every second or third hour. R. Ammoniae praeparatae gr. v. Infusi gentianae compositi Aquae menthae sativae 3X. Fiat haustus quartis horis su- dus. Tate Carbonate of ammonia gr. v. Compound infusion of gentian 3»J- Water of spearmiiit 3X. Make a draught to be taken ev- ery four hours. If the pulse sink, and cold and partial perspirations appear, and the countenance becomes sunk and cadaverous, aether and camphire will be proper, and wine must be given more liber- ally ;- R. Spiritus aetheris vitriolici compositi "—^iij. Misturae camphorae fortio" ris §vjss. Syrupi croci §ss. M. cujus sumantur cochlearia duo magna secunda quaque hora. Take Spirit of sulphuric tether compound Xny Strong camphorated mixture gviss. Syrup of saffron §ss.—Mix. Two large spoonfuls to be taken every two hours. It sometimes happens that the febrile symptoms soon be- come typhoid ; in such cases large doses of camphire with ather, or ammonia—seneka, and serpentaria virginiana, have been found useful, and blood-letting prejudicial. 60 INFLAMMATION OF THE STOMACH. GASTRITIS, OR INFLAMMATION OF THE STOMACH -^ . ^ Phlegmonous. Species, -s _ ° , C Erysipelatous. SYMPTOMS. Of the phlegmonous.—An acute fixed pain and sense of burning heat in the region of the stomach ;—sudden and great prostration of strength ;—small, hard, contracted, and rapid pulse ,—extreme anxiety ;—frequent hiccup ;—violent and painful vomiting—the pain is aggravated by the taking in of food, and by pressure ;—great thirst. Of the erysipelatous.—Loss of appetite,—-great anxiety; — symptoms of typhus fe'ver ;—heat and pain in the epigastric region ;— unusual irritability of the stomach upon the taking in of aliment or other substances ;-— vomiting;—sometimes an erysipelatous eruption in the fauces, extending along the alimentary canal. The disease terminates either In resolution:—when the pulse becomes more soft and full, and the other symptoms gradually disappear. In gangrene .--—marked by a violent exacerbation of the symp- toms, followed by a sudden cessation of heat and pain ; the pulse becoming more rapid and intermitting; the utmost pros- tration of strength, flaccidity and coldness of the praecordia, delirium, hiccup, cold extremities ; death. In suppuration .-—-preceded by a remission of pain ; increas- ed sense of weight and anxiety ; severe rigors. The sudden application of cold to the body in general, to the extremities, or to the stomach, as in drinking cold li- quors while the body is preternaturally warm ;--the repulsion of eruptions ;—the operation of poisons taken into the stom- ach ;—the translation of gout and other diseases ;—-indigest- ible food;— violent passions of the mind. INFLAMMATION OF THE STOMACH. 61 DIAGNOSIS. From enteritis.—TZy the seat of the pain ascertained by pres- sure ;—by the peculiar sense of burning heat in' the epigastric region;— by the more severe vomiting and hiccup. PROGNOSIS. Favourable.—About the third or fourth day, the pulse b&- coming more soft and full, and diminishing in frequency ;— the pain gradually ceasing;—the urine depositing a sediment; —diarrhoea. Unfavourable.—The disease continuing after the expiration of a week, with severe rigors, followed by a sense of weight in the region of the stomach. The symptoms marking the accession of gangrene. TREATMENT. Indications.—To reduce the inflammatory action in the sto- mach, and diminish its irritability: 1. By general and topical blood-letting. 2. The use of the warm bath ; even until fainting come on. 3. Fomentations to the abdomen. 4. Blisters to the region of the pain. 5. By keeping the bowels open with large emollient clysters. 6. By mucilaginous diluents in very small quantities and often, especially linseed-tea, barley-water in which gum Ara- bic is dissolved. 7. By saline diaphoretics. R. Nitri purificati gr. vj Take Nitrate of potash gr. vi. Pulveris tragacanthae com- Compound powder of traga. positi gr. xij. canth gr. xij. Aquae distillatae gvij. Distilled water 3vij. Syrupi simplicis 3J- Simple syrup xi. Fiat haustus. Make a draught. G 62 INFLAMMATION OF THE INTESTINES. R. Kali praeparati gr. xx. Take Carbonate of potash gr.XX, Succi limonis recentis, q. s. Fresh lemon juice, q. s. Aquae distillatae 3vj. Distilled water ^vi. Nitri purificati gr. viij. Nitrate qf potash gr. viij. Fiat haustus. Make a draught. R. Infusi rosae 3*. Take Infusion of roses %x. Nitri purificati gr. viij. Nitrate of potash gr. viij. Fiat haustus. Make a draught. One of these may be given every three or four hour*. The saline draught, in the act of effervescing, every tw» or three hours. The acidulated soda water is also very proper. Should there be any difficulty in keeping the bowels open, R. Natri tartarisati Sjvj. Take of Tartrite of potash and soda 3vi. Lactis amygdalae §vj. Milk of almonds %vi.—Mix. M. cujus capiat aeger cochle- Let the patient take three spoon- aria iij. pro re nata. fids when necessary. When symptoms indicating suppuration take place, opium may be given in small doses, to allay the irritability and pain of the stomach, and mild farinaceous nourishment. If gangrene take place ;—diluted wine must be adminis- tered frequently; then diluted brandy, aether, and campho- rated medicines, as recommended in pneumonia. ENTERITIS, OR INFLAMMATION OF THE INTESTINES. f Phlegmonous. Species. 1 ° ( Erysipelatous. SYMPTOMS. Acute pain in the abdomen, increased upon pressure, and shooting in a twisting manner around the umbilicus j—obsti- INFLAMMATION OF THE INTESTINES. 63 nate costiveness ;—tension of the abdomen;—tenesmus, or vomiting, as the inflammation happens to be in the superior, or inferior portion of the intestine ; the vomiting is generally bilious, or dark, fetid, and in some instances stercoraceous 5 —pyrexia,—quick, hard, contracted pulse,—great prostra- tion of strength, high-coloured urine. Its terminations are In resolution,—known by a gradual diminution of the symp- toms, and a free evacuation of the bowels. Ulcer at ion,—which is very uncommon, and only known by the febrile symptoms remitting, by occasional pains and shi- yerings, and purulent evacuations from the bowels. Gangrene,—marked by sudden cessation of pain and anxie- ty, the patient becoming calm and collected, while the coun- tenance assumes a livid, and indescribably cadaverous hue ; —suppression of urine,—hiccup,—subsultus tcndinum,—de- lirium,—convulsions,—death. CAUSES. All the causes inducing gastritis,—incarcerated hernia,— volvulus,—colic,—indurated faeces,—long-continued obstinate costiveness. DIAGNOSIS. From gastritis.—See Gastritis. From colic.—By the one being accompanied with fever,— the other not;—by the peculiar pulse described;—by the pain in enteritis being increased by pressure,—in colic allevi- ated. From hepatitis.—See Hepatitis. PROGNOSIS. Favourable.—Gradual remission of pain and other symp- toms;—the abdomen becoming less tender to the touch ;— the pain changing its seat, and not confined to a particular 64 INFLAMMATION OF THE INTESTINES. part ;-~the belly no longer obstructed,—a warm equable sweat,—the urine depositing a sediment,—the pulse losing its frequency, and becoming natural. Unfavourable.—The symptoms indicating mortification.— See Symptoms. Indications. TREATMENT. To allay the inflammatory action in the bowels. To keep the bowels open. 1. By general and topical blood-letting. 2. By the warm bath and fomentations. 3. By the frequent exhibition of purges. R. Olei ricini §j. Take Castor oil §i. Aquae hordei gij. Barley water §ij. Fiat haustus. Make a draught. U. Olei recini §jss. Vitellum ovi unius. His rite terendo subactis, ad- de paulatim Aquae menthae sativae §v. Syrupi simplicis §ss. Ut fiant mistura aperiens de qua capiat aeger cochlearia quaque omni trihorio donee alvus sit soluta. H. Magnesiae vitriolatae 3vj. Mannae optimae 3"j- Aquae distillatae 3X\J. Fiat haustus. R. Kali tartarisati 3bj. Mannae optimae gj. Aquae distillatae §vj. M. cujus sumantur cochlearia tria magna tertia quaque hora Yel pro re nata. Take Castor oil §iss. The white of one egg. These being fully incorporated by rubbing, add by degrees Spearmint water §v. Simple syrup Sss. Make a mixture of which let the patient take a spoonful every three hours, 'till it op- erates. Take Sulphate of magnesia 3vi. Best manna Xf\y Distilled water 3XU' Make a draught. Take Tartrite of potash 3iij. Bat manna §i. Distilled water %vi.—Mix. Let the patient take three large spoonfuls every three hours or when necessary. INFLAMMATION OF THE LIVEK. 6S R. Antimonii tartarisati gr.j. Magnesia: vitriolatae |j. Aquae distillatx §vjss. Syrupi simplicis j§ss. Solve ut fiant mistura cathar- tica:—sumantur cochlearia tria magna quolibetbihorio donee alvus rite soluta fue- rit. Take Tartrite of antimony gt.'u Sulphate of magnesia 3ji. Distilled water gviss. Simple syrup §ss. Dissolve and make a cathartic mixture. Three large spoon- fuls to be taken every two hours 'till it operates freely. If these purges fail of opening the bowels, the more active must be employed, & also purging clysters in large quantities. R. Calomelanos gr. ij. Extracti colocynthidis com- positi gr. x. Fiat pilulae duae secunda qua- que hora sumehdae cum do- si misturae aperientis donee alvus respondeat. R. Magnesiae vitriolatae §jss. Decocti avenae tenuioris §xxx. Fiat enema. Take Submuriate of mercury gr. iv. Compound extract qf colo. cynth gr. x. Make two pills, to be taken ew- ery second hour with a dose of aperient mixture, till they operate. Take Sulphate of magnesia § iss. Thin oatmeal gruel §xxx. Make an injection. 3. By saline diaphoretics, with mucilaginous drink similar to those ordered in gastritis. HEPATITIS, OR INFLAMMATION OF THE LIVER. „. . C Acute. Species. < C Chronic. SYMPTOMS. Of the acute.—'Pain in the right hypochondrium, increased by pressure, often extending high in the chest, and resembling G2 66 INFLAMMATION OF THE LIVER. pleurisy;—incapacity of lying upon the left side ;—dry cough; —difficulty of breathing, and shooting pains in the chest re- sembling pleurisy ;—sympathetic pain in the right shoulder ; —sallow countenance,—sometimes a yellow tinge of the tu- nica conjunctiva, and actual jaundice ;—high-coloured urine, —either costiveness or diarrhoea.—In some instances there is a deficiency of bile in the intestines, when the faeces are of a clay colour ;—sometimes a superabundance, which is then ejected by vomiting and stool. When the concave surface of the liver is affected, the pain is more obscure, and is referred to the back ;—the breathing is less anxious,—the functions of the stomach more distur- bed, producing vomiting, hiccup, and other symptoms of gas- tritis. Of the chronic—Its attack is in general so gradual, andthe symptoms, at its commencement, so obscure, that it is long unattended to.—It is marked by symptoms of dyspepsia,— loss of appetite,—flatulence,—sense of fulness and distention of the stomach,—at length the health becomes impaired,— weight, and obtuse pain, in the region of the liver, or more frequently referred to the back ;-.—the countenance becomes sallow ; —torpor and inactivity ;— dejection of mind ;—the functions of the primae viae greatly disturbed ;—obstinate cos- tiveness ;—clay-coloured stools,—scirrhus,—dropsy,—jaun- dice. Hepatitis terminates either in resolution, about the 4th, 7th, or 11th day;—or in suppuration and abscess. CAUSES. All the causes inducing inflammation,—biliary concretions, —irritation of acrid bile,—the violent operation of emetics, —external injury,—passions of the mind,—intense heat,—in- temperance in the use of spirituous liquors. DIAGNOSIS. From pneumonia.—By the pleuritic pains being less violent, and chiefly confined to the course of the phrenic/ nerve (a$- INFLAMMATION OF THE LIVER. 6/ tending to the top of the shoulder) ;—by the pain in hepati- tis being increased by pressure, in pneumonia unaffected by it; —by the difficulty, in pneumonia, of lying upon the affect- ed side, while in hepatitis pain is occasioned by lying upon the opposite;—by the sallowness of countenance; by the cough being generally unaccompanied with expectoration. From gastritis and enteritis.—By the seat of the disease, dis- covered by tenderness upon pressure—by the symphathetic pains of the clavicle and shoulder ;—by the less prostration of strength, and greater fulness of pulse ;—by the colour of the stools and urine. From dyspepsia.—See Dyspepsia. PROGNOSIS. Favourable.—About the 3d, 5th, or 7th day, bilious diarr- hoea ;—universal and free perspiration,—copious sediment in the urine,—inflammation appearing upon an external part, —hemorrhage from the haemorrhoidal veins,—these followed by an abatement of fever, and of other symptoms. Unfavourable.—Intensity of pain and fever,—the pain con- fined to a point;—continual hiccup,—cold extremities, while other parts are extremely hot;—obstinate constipation ;—se- vere rigors—succeeded by transient flushes, and hectic fever ; —the symptoms of mortification ; already often mentioned.— In the chronic form ; an enlargement, and preternatural hard- ness of the organ, obvious to the feel;—the constitution im- paired by previous excesses. TREATMENT. Of the acute. Indications. The same as in all visceral inflammations* The indications are best fulfilled by : 1. General and topical blood-letting» 2. Blisters. 3. Cathartics, especially calomel. 6S INFLAMMATION OF THE HYER. R. Calomelanos gr. v. Pulveris antimonialis Ph. L. gr.iij. Fiat pulvis catharticus, ex melle sumendus. Take Submuriate of mercury gr. x. Antimonial powder gr. iij. Make a cathartic powder to be taken in honey. 4. Saline and antimonial diaphoretics.—See page 17. When the antiphlogistic plan has been continued for five or seven days, and the symptoms do not abate, calomel must be given frequently. R. Calomelanos gr.j. Conservae rosae q. s. Fiat pilula sexta quaque hora sumenda. Take Submuriate ofmercurygri. Conserve of roses q. s. Make a pill, to be taken every six hours. Should suppuration take place, and an abscess form exter- nally, it must be brought forward as quickly as possible by poultices and fomentations ;—a generous diet;—the use of cinchona and bitters ; and an early incision is to be made when it points. Of the chronic.—Mercury, both internally and externally ap- plied, in small quantities. R. Camphorae gr. v. Unguenti hydrargyri forti- oris gr. xxv. Fiat unguentum in regionem hepatis alterna quaque noc- te illinendum. R. Calomelanos, Sulphuris antimonii praeci- pitati, aa 3J- Terantur simul in mortario perhoram unam integram ut fiant pulverem subfus- cum. Take Camphor gr. v. Strong mercurial ointment gr. xxv. Make an ointment, to be rub- bed in, on the region of the liver, every other night. Take Submuriate of mercury, Prepared sulphuret of anti- mony each 7f\. Rub them together in a mortar- for an hour till they make & brownish powder. INFLAMMATION OF THE LIVER. 69 R. Hujus pulveris gr. j. Conservae rosae gr. v. Fiat pilula ter in die sumenda. Take of the above powder gr. i. Conserve of roses gr. v. Make a pill to be taken three times a day. R. Calomelanos gr. ss. Take Submuriate of'mercurygf.i Succi cicutao spissati gr. iij. Dry extract qf cicuta gr. iij. Fiat pilula ter in die sumenda. Make a pill, to be taken three times a day. A continued course of bitter tonics and aperients, as tar- axacum, gentiana, quassia, or Colombo with soda. R. Radicis taraxaci recentis Take the Fresh root of the dan- Aqux distillatae fj^jss. Coque ad libram unam. R. Hujus decocti 3xi'J* Natri ppt. gr. v. Fiat haustus ter in die sumen- dus. R. Extracti taraxaci gr. vj. Pulveris rhabarbari gr. iv. Fiat pilulae duae ter in die ca- piendae,superbibendo haus- turn sequentem. R. Infusi gentianas compositi 3UJ- Aquae menthae sativae Xx. Natri praeparati gr. iv. Fiat haustus. R. Qitassiae incisae ^ij. Corticis exterioris aurantii Hispalensis 3>>j- Aquae ferventis jj|xvj. Per horam integrant macera in vase clauso, dein cola. delion §iij. Distilled water J^iss. Boil to one pound. Take of this Decoction Xx\\y Carbonate of soda gr. v. Make a draught to be taken three times a day. Take the Extract of dandelion gr. vi. Powder of rhubarb gr. iv. Make two pills to be taken thret times a day in the following draught. Take Compound infusion of gen- tian X\\y Spearmint water X^x. Carbonate of soda gr. iv. Make a draught. Take Shtassia cut small ^ij. Outer bark of Seville orange 3nJ- Boiling water §xvi. Macerate in a close vessel fw an hour and strain. yO INFLAMMATION OF THE KK&NET. R. Hujus colaturae Jxijv Take of this strained liquor^xij. Tincturae colombae 3J- Tincture of columbo 3*." Fiat haustus. Make a draught. The nitric acid of modern chemistry has been frequently of great use. R. Acidi nitrici gutt. viij. Take Nitric acid drops viij. Aquae distillatae 3XVJ. Distilled water 3x'j- Syrupi simplicis 3>j> Simple syrup X\y Fiat haustus ter quaterve die Make a draught, to be taken capiendus. three or four times in a day. R. Acidi nitrici 3J- Take Nitric acid Xji. Aquae distillatae |xij. Distilled water §xij. Syrupi corticis aurantiigjss. Syrup of orange peel §iss. Fiat mistura quotidie sumen- Make a mixture, to be taken in da, partitis haustibus. the course of the day in divi* ded doses. Removal from a warm to a cold climate is useful, and a sea voyage. NEPHRITIS, OR INFLAMMATION OF THE KIDNEY. SYMPTOMS. Pyrexia;—pain in the region of the kidney—the pain ex- tends along the course of the ureter, and is accompanied with numbness of the leg and thigh on the affected side ;— retraction of the testicle,—nausea and vomiting,—high-col- oured, sometimes mucous, or bloody urine ;—micturition,— dysuria. It terminates in resolution ; in abscess ; or in gangrene ; known by the ordinary symptoms that accompany these ter- minations of inflammation in other parts. CAUSES. The common causes of inflammation;—acrid diuretics ;— calculi in the kidney j—external injury;—long-continued and INFLAMMATION OF *HE KIDNEY. 7 X violent exercise on horseback ;—collections of hardened fa- ces in the colon ;—retrocedent or atonic gout;—violent exer-i tions,—strains, &c. DIAGNOSIS. From lumbago.—By the seat of the complaint, discovered upon pressure;—by the pain following the course of the an- terior crural nerve ;—by the dysuria and micturition ;—by the pain not being increased upon motion of the muscles. From gastritis.—By the seat of the pain, &c,—See symp- toms of gastritis. PROGNOSIS. Favourable.—Remission of pain, fever, and tension, follow* ed by a very copious excretion of high-coloured, mucous, or purulent urine ;—universal equable perspiration ;-—haematu- ria; if succeeded by a remission of symptoms ;—haemorrhoids. Unfavourable.—'Pale urine, secreted in small quantity ;— great micturition;—dysuria;—sudden cessation of pain ;—■ hiccup,—delirium,—cold extremities,—severe rigors,—and supervening hectic fever. TREATMENT. Indications.—The same as in the other phlegmasia. They are to be fulfilled by— 1. General and local blood-letting j the latter either by the use of cupping-glasses, or by the application of numerous leeches to the region of the kidney. 2. Oleaginous cathartics of castor oil, manna, or oil of al- monds : frequent emollient clysters. 3. Mild diaphoretics, especially frequent and copious draughts of mucilaginous and diluent liquids, as barley wa- ter, decoction of marsh-mallows, linseed tea, with a little nitre. 4. Opiate clysters when the pyrexia is somewhat abated and the pain excessive. 73 INFLAMMATION OF THE BlADDtll" R. Decocti marantae (Arrow Take of Decoction of arrom root) §vj. root gvi. Tincturae opii 3J. Tincture of opium %i. Fiat enema. Make an injection. ■ ' 5. The warm bath, repeated according to the violence of the pain ; and fomentations to the region of the kidney. Blisters are very prejudicial, inducing strangury. CYSTITIS, OR 1NFLAMMATIONOFTHE BLADDER, Species. 1 Acute. Chronic. SYMPTOMS. Of the acute.—Pyrexia, acute pain, tension, and tumour, in the region of the bladder j—pain and soreness, increased upon pressure above the pubes, or in the perinaeum ;—mictu- rition,—painful discharge of urine, in small quantities; or complete obstruction to its passage ;—tenesmus;—vomiting. Of the chronic—In this case the mucous membrane of the bladder, by repeated or continued irritation, produced by calculus, by stricture, by the disease of the prostate, or oth- er cause, has become thickened, indurated, ulcerated; and pours out a large quantity of mucu&.and pus ; which, added to the urine, gives to it the appearance of whey.—Often there is a discharge of blood. Mechanical injury;—local irritation by calculus;—the in- flammation of gonorrhoea extended along the urethra;—spas- modic or permanent stricture ;—all the usual causes of in- flammation. TREATMENT. Indications.—The same as in the other phlegmasia, and arc to be fulfilled nearly in the same way ;— INFLAMMATION OF THE BLADDER. 73 1. By general and topical blood-letting, the application of leeches to the perinaeum and region of the pubes. 2. By oleaginous purges and emollient clysters. 3. The warm bath and fomentations. 4. The exhibition of opium with diaphoretics. 5. The other means recommended in nephritis, The chronic species. By stimulants, and injecting the bladder with emollient de- coctions. R. Balsami copaivas §ss. Vitellum unius ovi. Sacchari purificati |j. M. dein adde paulatim Aquae menthae sativae §vj. Ut fiant emulsio cujus capi- at aeger cochlearia tria mag- na ter in die. R. Terebinthinaede Chio gr.iij. Saponis Hispanici gr. iv. Pulveris columbae q. s. Fiat pilulae duae ter in die su- mendae. R. Saponis Hispanic i gr. v. Extractilactucae virosae gr.iij Pulveris rhaei q. s. Fiat pilulae duae ter in die su. mendae. R. Resinx flavae gr. vj. Succi cicutaespissati gr. iij. Balsami Canadensis q. s. Fiat pilulae duae ter in die su- mendae. Take of Balsam ofcopaiva%s9. The white of one egg. Purified sugar %\.—Mix. Then add by degrees, Water qf spearmint §vi. Make an emulsion of which let the patient take three large spoonfuls, three times a day. Take qf Turpentine gr. iij. Spanish soap gr. iv. Powder ofcolumbo q. s. Make two pills, to be taken three times a day. Take of Spanish soap gr. v. Strong scented lettuce gr. iij. Powder of rhubarb q. s. Make two pills, to be taken three times a day. Take of Yellow resin gr. vi. Extract of hemlock gr. iij. Canada balsam q. s. Make two pills, to be taken three times a day. H 74 RHEUMATISM. R. Olei lini recentis §ss. Aquae calcis giv. M. pro injectione. R. Amyli 5ij. Aquae ferventis gv. Tincturae opii 3j> Fiat injectio. R. Aquaelythargyri acetati 3j. -----distillatae §iv. Tincturae opii Jj. Fiat injectio. Take Fresh linseed oil §ss. Lime water |iv.—Mix. For an injection. Take of Starch 31 j-. Boiling water |v. Tincture of opium X\. Make an injection. Take Water qf acetite of lead Distilled water § iv. Tincture of opium Xj., Make an injection. R. Aquaelithargyri acetati3Jss Take Lead water X^isa. Olei lini recentis 3jss. Fresh linseed oil §ss. Aquae calcis giv. Lime water giv. Fiat injectio. Make an injection. RHEUMATISMUS, OR RHEUMATISM, Species, -i , Acute. Chronic. SYMPTOMS. Of the acute.—Lassitude and rigors, succeeded by heat, (hirst, anxiety, restlessness, a hard, full, and quick pulse, and all the usual symptoms of synocha;—sense of weight, and coldness of the extremities ;—great restlessness ;—obsti- nate costiveness ;—after a short time, (in the course of one, tw®, or three days,) inflammation, with acute pain, tumor, and tension, makes its appearance in one, or more, of the larger joints of the body.—The pain is transitory, shifts from joint to joint, and leaves the part it occupied, swollen, rf d; RHEUMATISM. 75 and extremely tender to the touch.—The pulse is full, and hard ;__the blood, when drawn from a vein, exhibits the in- flammatory surface ;—the tongue preserves a steady white- ness;__the body is usually obstinately costive ;—the urine high-coloured ;—sometimes there i6 profuse sweating, unat- tended by relief. Of the chronic.—The chronic form of rheumatism may be either a consequence and termination of the acute; or it may be independent of it.—In the first case, the parts which were affected with inflammation are left weak, rigid, in some in- stances (Edematous, and the pain, before moveable, is now usually confined to particular parts :—sometimes, however, it still shifts from joint to joint, but without occasioning any inflammation or fever.—In the latter, from exposure to cold, or other cause, pains arise in the head, shoulders, knees, loins, wrists, or other parts ; which often continue for a con- siderable time, and at length go off, leaving the seat they oc- cupied in a state of debility : not unfrequently of paralysis. CAUSES. Obstructed perspiration; occasioned either by wearing wet clothes, lying in damp linen, or damp rooms, or by being exposed to cold air, after having been much heated by exer- cise. DIAGNOSIS. The pathognomonic symptoms are, synocha, with pains and inflammation in the larger joints, under which the inte- guments become distended, smooth, and of a particularly pale red colour. From, podagra.—By its generally attacking the larger joints only;—by the pain shifting its seat; and following the course of the muscles in its translation to other parts ;—by the dis- ease not having been preceded by symptoms of dyspepsia; by its occurring at any period of fife ; whereas gout is usually confined to the adult period. 78 RHEUMATISM. PROGNOSIS. Favourable symptoms.—A general, but not unnaturally pro« fuse, perspiration ;—the deposit of a lateritious, orfurfurace- ous, sediment in the urine ;—eruptions on the skin ;—moder- ate haemorrhage of florid blood from the nose or other parts. Unfavourable.—The inflammation becoming erysipelatous, and assuming a dark red, or rose colour ; and this followed by vesications,—delirium,—pale urine,—metastasis of the in- flammation to the head, chest, abdominal viscera, diaphragm ; producing the symptoms of the idiopathic diseases of these organs. TREATMENT. Of acute rheumatism. The indications are the same with those of the phlegmasia, and are to be fulfilled :— 1. By general and topical blood-letting. General bleeding is to be had recourse to in all cases where the vascular action is strong, the heat considerable, the con- stitution robust, and the patient not advanced in years. It should be repeated according to the violence of the symp- toms, the firmness of the coagulum, and the appearance of the blood previously drawn. The reduction of vascular action is more particularly to regulate the repetition than the buffy appearance of the blood, Which in many cases continues to increase, notwithstanding the abstraction of blood, and is not diminished by bleeding. Topical blood-letting by leeches, and cupping, is useful, when the disease produces considerable pain and tumefaction about a joint or limb. 2. By occasional purgatives of castor oil, magnesia vitriola- Ja, natron vitriolatum, kali tartarisatum, rhubarb, and cream of tartar or calomel, or laxative clysters : those recommend- ed at pages 16 and 17. ftHEUMATISM. 77 3. By diaphoretics.—The antimonial sudorihcs with opium are in general the most effectual in promoting perspiration and allaying the pain ; but in mild cases the saline diaphoret- ics are sufficient, such as are recommended for the cure of synocha : see p. 17 and 18. To these opium is a useful addi- tion when the pain is considerable ; or one of the following may be exhibited: R. Opii purificati gr. j. Pulveris antimonialis Lon- dinensis gr. iij. Conservae rosae gr. iv. Fiat pilula quarta vel sexta quaque hora sumenda cum haustu salino communi. R. Opii purificati pulverisati Sr-j- Calomelanos gr. ss. Pulveris antimonialis Lon- dinensis gr. iij. Sacchari purificati gr. viij. M. pro pulvere sexta quaque hora sumendo ex quovis ve- hiculo crasso. R.Pulveris ipecacuanhaegr.viij Sacchari purificati gr. x. Fiat pulvis sextis horis capi- endus ex pauxillo mellis, superbibendo haustum com- munem salinum. Take purified opium gr. i. Antimonial powder gr. iij. Conserve of roses gr. iv. Make a pill, to be taken every four or six hours, with the common saline draught. Take Purified opium powdered gr. i. Submuriate of mercury gr. ss Antimonial powder gr. iij. Purified sugar gr. v'ny—Mix for a powder, to be taken every six hours in any thick vehicle. Take powder of ipecac gr. viij. Purified sugar gr. x. Make a powder, to be taken ev- ery six hours in a little honey —drinking after it the com- mon saline draught. 4. By narcotics.■—The opiates already prescribed. Cicuta, hyosciamus, aconitum, digitalis, are sometimes employed with success, especially the first, with small doses of calo- mel, after haying freely evacuated the bowels. H2 7"8 RHEUMATISM. R. Succi cicutae spissati gr. v. Take Extract of hemlock gr. V. Calomelanos gr. }. Submuriate of 'mercury gr. $. Fiat pilula quarta quaque ho- Make a pill, to be taken every ra sumenda. four hours. R. Succi hyosciami spissati Take Extract of black henbane gr. v gr. v. Fiat pilula quarta quaque hora Make a pill to be taken every capienda. four hours. R. Succiaconitispissatigr. ij- Take Extract of Monk's-hood gr- ij- Fiat pilula ter in die adhiben- Make a pill, to be given three da. times a day. R. Pulveris ipecacuanhae com- positi gr. v. ——— tragacanthae compo- siti gr. xij. Tincturae digitalis gutt. x. Misturx camphorae ^xiij. Syrupi simplicis 3J- Fiat haustus sextis horis ad- hibendus. Take Compound powder of ipecac gr. v. ■ qftragacanthgr.xij. Tincture of purple Foxglove drops x. Camphorated mixture ^xiij. Simple syrup X^i. Make a draught, to be repeated every six hours. S. By fomentations of bitter herbs with poppy-heads, or any narcotic herb, as cicuta, lactuca virosa, hyosciamus or belladonna, and camphorated liniments, which are more use- ful when a limb or joint is principally affected. R. Camphorae gss. Olei olivae optimi §ij. Fiat embrocatio camphorata. Take Camphor |ss. Best olive oil §ij- Make a camphorated embroca* tion. As soon as any remission can be perceived; or where there has been much perspiration accompanied by a deposit or aed« RHEUMATISM. 79 iment in the urine; or where the exacerbations of the disease have been from its commencement strikingly periodical, Pe- ruvian bark is serviceable, either alone or with ammonia or guaiacum. R. Decocti cinchonae 3xiy. Extracti ejusdem gr. x. Tincturae cinchonae compo- sitae3J. Syrupi corticis aurantii 3J- Fiat haustus quartis horis, in apyrexia, sumendus. R. Spiritus ammoniae compo- siti 3j. Tincturae cinchonae compo- siti 3Jss. Decocti cinchonae 3xi"j- Syrupi Simplicis 3J- Fiat haustus quarta quaque hora capiendus. R. Tincturae guaiaci 3J- Vitelli ovi q. s. Syrupi corticis aurantii 3J. Decocti cinchonae 3XUJ- Fiat haustus quartis horis ad- hibendus. Take Decoction of cinchona 3xiv. Extract of — gr. x. Compound tincture —— X\. Syrup of orange peel X\. Make a draught to be taken ev. ery four hours, when the fever is off. Take Compound spirit of am- monia 51 • Compound tincture of cinchona 3iss. Decoction qf cinchona x,xi'iy Simple syrup X}. Make a draught, to be taken. every four hours. Take Tincture of guaiac x\. White of eggs q. s. Syrup of orange peel X\. Decoction of cinchona 3xnj. Make a draught, to be given every four hours. The mineral alkali has also been found useful, under sim- ilar circumstances, in combination with the tonic barks or bitters. The dose is five grains of the prepared natron eve- ry four or six hours, with two ounces of the decoction of cin chona or cascarilla; or the same quantity of an infusion of CO" iombo, gentian, granatum, chamomile, &c. so RHEUMATISM. Of the chronic. A great variety of remedies are exhibited against this spe« cies of rheumatism. 1. Stimulants.- as guaiacum, ammonia, terebinthina, sina- pis, raphanus rusticanus, arum, pyrethrum.. R. Tincturae guaiaci 3J- Pulveris arabici ^ij. Misturae camphorae %xiiy. Syrupi corticis aurantii 3J- Fiat haustus ter in die sumen- dus. Take Tincture qfguaiae Xi. Gum: Arabic in powder ^ij. Camphorated mixture 3xiij' Syrup of orange peel %i. Make a draught, to be taken three times, a day. R. Guaiaci pulverisati gr. vj. Pulveris antimonialis Lon- dinensis gr. iij. Syrupi zingiberis q. s. Fiat bolus ter indie capiendus- R.Terebinthinaede Chio gr.vij Guaiaci pulverisati gr. iv. M. secundum artem ut fiant bolus ter in die sumendus. R. Spiritus terebinthinae recti - ficati, ■i >- aetheris nitrosi, 5a p. ae. Sumat aeger cochleare mini- mum ter in die ex quovis yehiculo idoneo. Take gum guaiac in powder gr.vi Antimonial powder gr. iij. Syrup qf ginger q. s. Make a bolus to be taken three times a day. Take Chi an turpentine gr. vij. Gum guaiac in powder gr. iy. Mix, according to art, and make a bolus to be taken three times a day. Take Rectified spirits qf turpen- tine, Nitrous tether, each equal parts. Let the patient take a teaspoon- ful three times a day in any convenient vehicle. RHEUMATISM. 8! R. Spiritus terebinthinae recti- cati 3SS. ■ aetheris nitrosi 3J. Vitellum ovi unius. Syrupi simplicis 5J. Aquae cinnamomi 5xij. M. pro haustu ter in die su- mendo. Take Rectified spirits ofturpen* tine 3ss. Nitrous tether X,\. The white of one egg. Simple syrup X,i. Cinnamon water 3xij- Mix for a draught, to be taken three times a day. The best way of exhibiting the sinapis or mustard, and raphanus rusticanus or horse-radish, is as they come to the table; they may be taken very freely. R. Pulveris radicis ari gr x. Fiat pulvis ter in die sumen- dus ex parvo cyatho vini al- bi Hispanici. Take the Root of wake robin in powder gr. x. Make a powder, to be taken three times a day in a glass of Spanish white wine. R.Pulveris radicis pyrethri^j. Take the Root of Spanish pelli- tory in powder ^i. Fiat pulvis ter in die, ex vino Make a powder to be taken three albo Hispanico, sumendus. times a day in Spanish white 2. Alteratives »• especially sulphur, mercury, sarsaparilla, mezereon, dulcamara, and the narcotics. R. Sulphuris antimonii prae- cipitati, Calomelanos, aa gr. ss. Guaiaci pulverisati gr. iv. Syrupi zingiberis q. s. M. ut fiant pilula ter in die su- menda. Take prepared Sulphuret of an- timony, Submuriate of mercury, each gr. ss. Gum guaiac in powder gr. iv. Syrup of ginger q. s—Mix. Make a pill, to be taken three times a day. *2 RHEUMATISM. R. Calomelanos, Sulphuris antimonii praecip- itati, aagr. ss. Succi cicutae spissati gr. iij. Fiat pilula ter in die sumenda. R. Pulveris antimonialis Lon- dinensis gr. iij. Calomelanos gr. ss. Succi cicutae spissati gr. iv. Fiat pilula ter in die capienda. Take Submuriate of mercury, Prepared sulphuret of anti- mony, eachgr. ss. Extract of hemlock gr. iij. Make a pill, to be taken three times a day. Take Antimonial powder gr. iij. Submuriate of mercury gr.ss. Extract of hemlock gr. iv. Make a pill, to be taken three. times a day. With either of these, the simple or compound decoction of sarsaparilla may be taken in the quantity of half a pint daily, or the decoction of dulcamara. R. Stipitum dulcamarae contu- sarum §j. Radicis glycyrrhizae contu- sae jfiij. Aquae distillatae H^jss. Coque per quadrantem horce, dein cola. Bibat aeger li- bram dimidiam quotidie, partitis haustibus. 3. External applications. The simple warm bath, or tepid sea water bath. A tepid bath with marine acid, in the proportion of one ounce to each gallon of water. Friction with salt brine, so as not to excoriate. Stimulating liniments. Take the Tops of woody night- shade §i. Liquorice root, bruised §iij. Distilled water J^iss. Boil for a quarter of an hour and strain.—Let the patient drink half a pound daily, in divided doses. R. Spiritus terebinthinae recji- ficati, Olei olivae optimi, aa Jj. Aquae ammoniae jjss. Tinctui* opii Xn'y M. f. linimentum quod ssepe Utatur, Take rectified spirit* of turpen- tine, Best oil qf olives, each 0i. Water of ammonia §ss. Tincture of opiumXv].--MiM. Make a linament, to be vied frequently. RHEUMATISM. 83 R. Liniment! camphorae forti- ons |jss. Tincturae opii 3iij. M. fiat embrocatio, bis quoti- die applicanda. Take strong Camphorated lina- ment §iss. Tincture of opium $'ni. Mix^ Make an embrocation, to be ap- plied twice daily. R. Linimenti saponis §jss. Aquae ammoniae trij- M. pro embrocatione. R. Pulveris sinapeos 3iij. Aceti communis ^xiv. Fiat embrocatio. R. Pulveris sinapeos 3'ij. Olei olivae £vj. Spiritus aetheris terebinthi- nae 5vij. Take soap liniment §iss Water qf ammonia Xij. Mix for an embrocation. Take Mustard seed in powder 3UJ- Common vinegar X^x'w. Mix, for an embrocation. Take Mustard seed in powdir 3y- Oil of olives £vi. Etherial spirit qf turpentine 3viJ- utendo. M. pro linimento ter in die Mix, for a liniment, to be used three times a day. Take Tartrite of antimony pul- verized 3L Wax ointment %i.—Mix. Make an ointment.—Of which let the patient rub in a little twice a day on the part af- fected. Take Tartrite of antimony Xfu Soap liniment 3XV- Make an embrocation, to be used twice a day. R. Antimonii tartarisati opti- me pulverisati 3J. Unguenti cerae Sjj. M. f. unguentum cujus illina- tur aeger q.. n. m. bis quoti- die in partem affectam. R. Antimonii tartarisati 3J- Linimenti saponis 3xv. Fiat embrocatio bis in die u- tenda. The tartar emetic ointment and embrocation have the pro- perty of producing a crop of pustules wherever they are rub- bed, and when this effect is produced they must of course be discontinued. 84 COUT. Blisters are likewise very serviceable. Warm opiate plaisters also. Electricity, Galvanism, and fomentations. Warm clothing and a stimulating diet. Covering the part with oilskin. These are the principal remedies that are used in the pres- ent day; it would be an endless task to enumerate all that have been selected. Many were formerly employed that are now fallen into disuse, and others are frequently starting up which have their run, and are then laid aside. In all cases where there are any suspicions of the disease being connected with a syphilitic taint, the mercurial altera- tives should be continued a long time, or mercury should be so administered as to affect the gums. Whatever remedies are used, it will be absolutely neces- sary to persevere with them for a considerable length of time, in order to obtain from them the desired advantage. PODAGRA, OR THE GOUT. C The regular. . J The atonic. pecies. < „,^e retrocedent. £ The misplaced. SYMPTOMS. Of the regular gout.—Dyspepsia, with its usual attendants- lassitude, torpor, and dejection of spirits ;—unusual coldness, and numbness, of the extremities, alternating with sense of pricking, or formication;—frequent cramps ;—unusual tur- gescence of the veins of the leg.—The paroxysm most fre- quently comes on about two o'clock in the morning, with ex- cruciating pain, in the articulations of the great toe ; suc- ceeded by rigor, horror, and pyrexia.—The pain continues to increase in violence, and having attained its acme towards GOUT. 85 the following evening, gradually ceases ; a general moisture breaks out upon the skin, and the patient, freed from his tor- ment, falls into a sound sleep ; upon awakening from which, he finds the parts, before painful, now swollen and inflam- ed.—In several succeeding evenings, there is a return of pain, and fever ; which continue, with more or less violence, du- ring the night, and go off' at break of day. Of the atonic gout—When the gouty diathesis prevails in the system, but, from certain causes, does not produce the usual inflammatory affection of the joints, it often appears in the form of an atonic affection of some internal part.—If it be in the stomach, there is pain, nausea, vomiting, eructations, dejection of mind, and other symptoms of dyspepsia, and hy- pochondriasis ;—these are frequently accompanied with cramps in several parts of the trunk and upper extremities ; —sometimes there is obstinate costiveness—sometimes diarr- hoea.—If in the viscera qf the thorax, it produces palpitation ; sjneope; asthma.—When the head is affected, there is ce- phalalgia—vertigo ;—and apoplectic and paralytic affections arc sometimes the consequence. The retrocedent gout is where an inflammation of the joints has, in the usual manner, come on, but without arising to the ordinary degree ; or, without continuing for the customary time, it suddenly and entirely ceases, while the disease is transferred to some internal part.— To the stomach; when great anxiety,—sickness,—violent pain, and vomiting, with peculiar sense of cold in the epigastric region, are induced.— To the heart; occasioning syncope.— To the lungs ; asthma.— To the head; apoplexy, or palsy. The misplaced gout is when the gouty diathesis, instead of producing the inflammatory affection of the joints, produces an inflammation of some internal part; and which appears with the same symptoms that attend the inflammation of those parts, arising from other causes. I ^ gout. CAUSES. Predisposing and remote.—The adult age, more especially the middle period of life ;—hereditary predisposition ;—mel- ancholic-sanguine temperament;—full plethoric habit of body'; —indulgence in the use of animal food, fermented liquors; and venery ;—sedentary and studious life ;—the large use of acids and acescents ;—tartareous wines ;—dyspepsia. Exciting.—The application of cold to the extremities ;—fa- tigue ;—anxiety of mind ;—excessive evacuations ;—sprains ^ —intemperance of whatever kind ;—the ceasing of usual la- bour ;—the sudden change from a very full to a very spare diet. DIAGNOSIS. From rheumatism.—By the previous dyspeptic symptoms \ —by the pains, in the one disease attacking the smaller, in 4he other the larger joints.—By the peculiar mode of its at- tack (see Symptoms) ; by its not being preceded, or accom- panied at its commencement, with symptoms of synocha ;— by the age of the patient. PROGNOSIS. Favourable.—Youth, and an unimpaired constitution ;—the more severe the paroxysm, the shorter its duration ; the long- er the intermission, the more effectual, is it in removing va- rious anomalous diseases, to which the patient had been be- fore subject;—its not being hereditary. Unfavourable.—Impaired constitution ;—concomitant vis- ceral affections ;—hereditary predisposition to the disease ;— the deposition of chalky matter on the joints ;—the disease .mddenly receding from the extremities, and attacking an im- portant internal organ, as the stomach, heart, brain, &c. TREATMENT. Of the regular gout. C 1. To alleviate pain, and shorten, the Indications. < duration of the paroxysms. / 11. To prevent their return. GOUT. 87 The first indication is best fulfilled by diaphoretics and opi- ates. R. Ammoniae preparats: gr.xij. Take Carbonate of ammonia gr. xij. Succi limonis q. S. Lemon juice q. s. Misturae camphorae ^x. Camphorated mixture 3*. Syrupi corticis aurantii 3J. Syrup of orange peel Xi. Tincturae opii gutt. x. Tincture of opium drops xv. Fiat haustus quarta vel sexta Make a draught to be taken ev- quaque hora sumendus. ery fourth or sixth hour. R. Pulveris antimonialis gr.iij. Take Antimonial powder gr. iij. Ammoniae preparatae g. iv. Carbonate of ammonia gr.iv- Pulveris ipecacuanhae com- Compound powder of ipecac positi gr. v. gr- v- Conservae rosae q. s. Conserve of roses q. s. M. ut fiant bolus quartis ho- Make a bolus, to be taken every ris sumendus. four hours. In a regular fit of the gout the assistance of medicines is not so great as is generally supposed ; all that is required is to keep the inflamed part moderately warm with flannel, wool, or fleecy*hosiery ; to confine the patient, if young, to a spare regimen ; if advanced in life, or a high liver, to en- force a more moderate one ; carefully abstaining from every thing that might add to the irritation,—keeping him as quiet and still as possible, and taking care that his mind be not ruffled, but on the contrary soothed and calmed. Some practitioners have been induced to adopt an antiphlo- gistic mode of treatment, which, in a few instances, has soon removed a regular fit of the gout; in others, it has in- duced an alarming and serious train of symptoms. Many topical remedies have been recommended ; pediluvi- um of simple water; a tepid bath of water and muriatic acid, in the proportion of one ounce to a gallon of water ; leeches ; very cold water ; ice ; blisters ; stinging with nettles ; burn- ing with moxa ; covering the part with oilskin, and the like ; 83 GOUT. but the less the part is interferred with the better, for the consequence of their use is often the translation of the in- flammation to an internal organ. Exciting a perspiration on the part by fleecy hosiery or flannel is sometimes attended with the most beneficial effects. The second indication is effected :— By regularity of life ;—avoiding the exciting causes of the disease :—abstinence from the use of animal food and. fer- mented liquors ;—milk and vegetable diet;—exercise ;—fric- tion with the flesh-brush ;—tonics and stomachic bitters and chalybeates, such as are recommended for the cure of dy- spepsia ;—Bath waters ;—the regular use of mild cathartics. R. Pulveris rhabarbari jij. Aquae ferventis Sjviij. Macera per horam integram in vase idoneo et liquorem cola, dein adde Tincturae jalapii 3VJ. Magnesiae ustae 3j- Sumantur cochlearia tria pro re nata. R. Pulveris rhabarbari gr. xij. fa£e Mhubarb in powder gr. xij, ———— aromatici gr. iij. Aromatic powder gr. iij. Fiat pulvis, ex syrupo, mane Make a powder, to be taken in sumendus. the morning in jsyrup. Take Rhubarb in powder X\y Boiling water gviij. Macerate for an hour in a prop' er vessel and strain: Then add Tincture of jalap X^'x. Calcined magnesia XS.. Let three spoonfuls be taken oc- casionally. R. Pilulae gaibani compositae gr. iij- Extracti colocynthidis com- positi gr. ij. Fiat pilula omni mane capien- do Take Compound pills qf gaU banum gr. iij. Compound extract of colo- cynth gr. ij. Make a pill, to be taken every morning. GOUT. a£ R. Pulveris aloes cum guaia- Take Powder of aloe* with guai- co gr. iv. tic gr. iv. Olei essentialis cinnamo- Essential oil of cinnamon mi gutt. j. drop i. Fiat pilula quotidie sumenda. Make a pill, to be taken daily. The long-continued use of the mineral alkali. R. Natri preparati gr. vj. Take Carbonate of soda gr. vi. Saponis Hispanici gr. iv. Spanish soap gr. iv. Pulveris colombae q. s. Powder qf columbo q. s. Fiatpilulaeduxnoctemaneque Make two pills, to be taken sumendae. night and morning. The double acidulated soda-water, in the quantity of half * pint daily ;—lime water ;—ginger. The atonic gout is to be treated by :— Carefully avoiding all the causes inducing debility; mode- rate exercise ;—cold bathing;—the moderate use of animal food, and the least acescent wines, as Madeira;—tonics, stomachics, and chalybeates, such as are recommended against indigestion ;—guarding against the effects of cold, by wearing flannel next the skin :—in severe attacks, blisters to the extremities are serviceable. Of the retrocedent gout. If the stomach be the seat of the disease, the liberal ad- ministration of warm brandy and water, or wine and aromat- ics ; aether;—ammonia, assafoetida, camphire, musk. R. Spiritus aetheris vitriolici Take Compound spirit of sul-. compositi jiij. phuric tether X}'\]. Misturae camphorae fortioris Stt ong camphorated mixture Jvijss. §vijss. M. sit dosis cochlearia triaom- Mix. The dose is three spoon- ni hora. fuls every hour. R. Spiritus ammoniae succina- Take succinated spirit of am- - 3'J* mania X\y Misturae camphorae ^vj. Camphorated mixture § vi. M. sumantur cochlearia tria Mix. Dose, three spoonfuls#*. m&gna omni hora. ery hour. 12 90 GOUT. R. Lactis asaefoetidae §iij. Misturae camphorae giv. Ammoniae preparatae^j. Syrupi zingiberis §ss. M. capiat aeger cochlearia tria omni hora. Take Milk of aseefcetida^'uy Camphorated mixture § iv. Carbonate of ammonia ^i. Syrup of ginger |ss.—Mix. Three spoonfuls every hour. R. Camphorae, Moschi, Asasfcetidae, singulorum gr. "j- Syrupi zingiberis q. s. F. bolus omni bihorio adhi- bendus. Take Camphor, Musi, Astefatida, each gr. iij. Syrup of ginger q. s. Make a bolus, to be given every two hours. Warm stimulating plaisters are to be applied externally. R. Emplastri labdani compo- siti §j. Olei essentialis sassafras3j. Fiat emplastrum regioni epi- gastricae imponendum. Take compoundplaister of lab- danum §i. Essential oil of sassafras Xi, Make a plaister to be applied over the epigastric region. Fomentations of bitter aromatic herbs are also proper. If the head be the seat of the gouty action, vertigo, apo- plexy, or paralysis, comes on ; then blisters must be applied to the head and extremities, and aromatics, aether, and warm cathartics, given internally. When the chest is affected, a similar mode of treatment is proper. 91 ORDER III. EXANTHEMATA, OR ERUPTIVE FEVERS. CHARACTER. Contagious diseases, beginning with fever, and followed by an eruption on the skin. VARIOLA, OR SMALL-POX. The small-pox is distinguished into two species ; the dis- tinct and confluent ,• implying that in the former the pustules. are perfectly distinct and separate from each other, and that in the latter they coalesce, and the eruption is continuous. SYMPTOMS AND PROGRESS OF THE DISTINCT SMALL-POX. The eruption of the variola discreta, or distinct small-pox, is ushered in by a fever of the inflammatory type, character- ized by considerable pains in the back and loins, nausea, vom- iting, pain in the epigastrium upon pressure, disposition to drowsiness, and in infants often one or more epileptic fits. Towards the end of the third day from its commencement, the eruption makes its appearance on thence and hairy scalp, in the form of small red points not dissimilar to flea-bites. During the fourth, it extends itself successively to the neck, breast, upper extremities, and at length occupies the whole body. About the fifth, a little vesicle, appearing depressed in the middle, containing a colourless fluid, and surrounded by an inflamed areola or margin, perfectly circular, may be observ- ed on the top of each little point or pustule.—The eruptive fe- ver now disappears. About the sixth, the saliva becomes increased in quantity, and viscid ; at the same time that there is a degree of swell- ing of the throat, difficulty of deglutition, and hoarseness. 92 SMALL-POX. On the eighth day, the pustules are completely formed and spherical, or prominent and appearing almost terminated in a point; and the contained matter has assumed the appear- ance of pus.—The face swells, and the swelling extending to the eyelids, these often become so much enlarged as to close the eyes. About the eleventh, the pustules have gained their full size (which differs in different epidemics, but is generally that of a pea), the matter has changed from a white to an opake yel- low, and a dark spdt appears on each.—At this time the tu- mefaction of the face subsides, and the hands and feet begin to swell.—The secondary fever now also, usually, makes its appearance. After the eleventh day, the pustules from being smooth be- come rough, break, and discharge their contents ; which dry- ing on the surface, a small crust is formed over each of them. These in a short time fall off, and leave the part they covered of a dark brown colour, which often remains for many days ; and in cases where the pustules have been large, or late in becoming dry, deep indentations of the skin. The swelling of the hands and feet gradually subsides, and about the se- venteenth day the secondary fever disappears. SYMPTOMS AND PROGRESS OF THE CONFLUENT SMALL-POX. Both in its symptoms and progress, the confluent kind dif fers materially from the distinct or benign. The eruptive fe- ver often early shews a tendency to the typhoid form ; and besides possessing the characteristic symptoms above men- tioned, which are usually present in a more marked degree, it is frequently attended with coma or delirium; in infants with diarrhoea; in adults, salivation. The eruption is irregular in its appearance, and in the suc- cession of its stages. It is usually preceded by an erythe- matic efflorescence upon the face, from which the pustules emerge on the second day in the form of small red points ; ma- ny of which soon coalesce and form clusters greatly resent- SMALL-POX. *3 blingthe measles.—Maturation is more early; but the pustules do not retain their circular form, are of an irregular shape, often flattened, and appear like thin pellicles fixed upon the skin, instead of true pus, containing a brownish ichor ; nor are they surrounded by an inflamed margin, the intermediate spaces between the clusters appearing pale and flaccid.—The swelling of the face and salivation appear earlier, and rise to a much greater height, than in the distinct form of the dis- ease.—The fever, though it generally suffers a slight remis- sion, does not cease upon the appearance of the eruption, and about the ninth day it suffers a remarkable exacerbation ; and in some instances all the worst symptoms of typhus super- vene : the eruption assumes a livid hue, petechiae and passive haemorrhages make their appearance, and the patient is often carried off on the night of the eleventh day from the com- mencement of the disease. CAUSES. Variola is the effect of a specific contagion.—It is produced either by subjecting the body to the effluvia arising from those who already labour under the disease, or by the intro- duction of a small quantity of the variolous matter into the system by inoculation. PROGNOSIS. Variola, in its regular and benign form, seldom proves fa- tal, unless in consequence of improper management; but it often leaves behind it a predisposition to inflammatory com- plaints, particularly to ophthalmia and visceral inflammation, more especially of the thorax ; and they not unfrequently ex- cite scrofula into action, which might otherwise have lain dormant in the system. The circumstances which lead to the apprehension of dan- ger are, 1. The appearance of symptoms announcing the approach of the confluent form of the disease (vide symptoms), or the disease in its progress approaching to the malignant caarac= 94 SMALL-POX. ter before described ; the fever assuming the form of typhus,, and the pustules becoming flattened, livid, or interspersed with petechiae. 2. A sudden disappearance of the eruption, subsidence of tile swelling of the face or extremities, suppression of sali- va, or depression of the pustules, followed by great prostra- tion of strength, universal pallor of the skin, great anxiety, oppression at the chest, syncope, convulsions, coma or delir- ium. 3» Complications with visceral disease, as inflammatory af- fections of the lungs or the alimentary canal. In general the fate of the patient is determinable from the eleventh to the seventeenth day. The crisis of the seconda- ry fever is generally accompanied with a diarrhoea, or sedi- ment in the urine. DIAGNOSIS. Difficult at the commencement of the disease.—The pain in the stomach, increased upon pressure; and the drowsi- ness ; are the chief pathognomonic symptoms.—The regular succession of appearances, and changes in the eruption, af- terwards render the distinction easy. The distinct may be often distinguished from the conflu- ent, before the eruption appears, by the mildness of its at- tack ; by the synochal type of the fever ; the late appearance of the eruption ; and the want of typhoid symptoms. TREATMENT. Of the distinct. C To moderate the fever, when violent. I To support the strength, when deficient. Indications. < To obviate a11 th°se circumstances that j may produce any irregularity in the ap- I pearance, or in the progress, of the dis- . v. ease. SMALL-POX. 9? In cases of violent action, in full and plethoric habits, bleed- ing has been had recourse to, and is recommended by ma- ny ; but it is a practice mostly replete with danger, and to be avoided, if possible ; for the subsequent debility generally overbalances the temporary advantage that may be gained by this remedy. Purging is ©ften successful in diminishing the violence of febrile action without inducing much weakness. An emetic has been given with advantage at the accession of the disease, except in cases where there is much pain of the stomach. During the eruptive fever, when this is pure synocha, the febrile symptoms, if considerable, are to be moderated by exposing the body of the patient to a cool atmosphere, by fre- quently administering cold diluent fluids, as lemonade, im- perial saline draughts, nitre; at the same time administering Saline aperients, so as to keep the bowels loose. If there be great irritability and restlessness, opium in small quantities, with a saline draught, will be serviceable, or with a small quantity of antimony. R. Pulveris ipcacuanhae com- positi gr. ijss. antimonialis Lon- dinensis gr. ij. Conscrvae rosae q. s. Fiat pilula sexta quaque hora sumenda cum haustu sali- no communi. R. Pulveris opii gr. ^. Calomelanos gr. $. Pulveris antimonialis Lon- dinensis gr. iij. Fiat pulvis, bctava quaque ho- ra capiendus, ex pauxillo mellis. Take compound powder of ipecac gr. ijss. Antimonial powder gr. ij. Conserve of roses q. s. Make a .pill to be taken every six hours, with the common saline draught. Take Powdered opium gr. ^. Submuriate of mercury gr. \. Antimonial powder• gr. iij. Make a powder, to be taken ev- ery eight hours in a little honey. 96 SMALL-POX. Small doses of mercury are often serviceable in moderating the febrile action of variola, even when exhibited so as slightly to affect the gums ; no inconvenience is likely therefore to arise from the administration of the above. If the febrile symptoms indicate a tendency to typhus, the mode of treatment recommended for typhus fever should be resorted to. When the eyelids swell much, and are inflamed, a blister may be applied behind the ears, or a leech to the temples. If the throat be much affected, and there is difficulty in (swallowing, a blister is to be applied to the neck, and gargles of infusion of roses directed. As debility comes on, recourse must be had to cinchona, wine, and nourishment not so antiphlogistic as in the com- mencement. Determination to the head or chest, or other viscera, re- quires blisters, pediluvium, and sinapisms to the feet. Obstinate vomiting, which in this disease often proves both a troublesome and dangerous symptom, is most effectually al- layed by saline remedies, in the act of effervescence, with opium. R. Kali aerati Qj. Take Carbonate of potash ^i. Misturae camphorae Xx. Camphorated mixture Xx. Tincturae opii gt. iv. Tincture of opium drops iv. Syrupi corticis aurantii 3J- Syrup of orange peel XJi. Fiat haustus quarta quaque Make a draught, to be taken ev hora sumendus in actu ef- ery four hours, in the act of fervescentiae cum cochleare effervescence, with a large uno magno succi limonis. spoonful of lemon juice. R. Camphorae gr. vj. Opii pulverisati gr. ss. Saponis Hispanici gr. iv. Fiat pilulae duae sexta quaque hora sumendae. Take Camphor gr. vi. Pulverized opium gr. ss. Spanish soap gr. iv. Make two pills, to be taken ev- ery six hours. THE CHICKEN-POX. 97 In all cases where there is a great propensity to sweating after the eruptive fever has passed by, a cool regimen will be particularly necessary. Diarrhoea is to be checked only when it is excessive and in- creases debility. When the eruption suddenly recedes, or the pocks sink and become very much dimpled, and any alarming symptoms su- pervene, as rigors, convulsions, or delirium, recourse must be had to wine, opiates, aether, camphor or musk, blisters and sinapisms. Upon the accession of the secondary fever, if this preserve the character of synocha, and be not attended by any debility, recourse must be had to the same means of moderating it employed at the commencement of the disease. If, on the contrary, the secondary fever be typhoid, the means recommended for the cure of typhus gravior must be enforced. VARICELLA, OR THE CHICKEN-POX. SYMPTOMS. After slight symptoms of fever, as lassitude, loss of sleep, wandering pains, loss of appetite, &c. an eruption appears; first on the back, consisting of small reddish pimples, much resembling the first appearance of the small-pox.—On the se- cond day the red pimples have become small vesicles, contain- ing a colourless fluid; and sometimes a yellowish transpa- rent liqnor.—On the third, the pustules arrive at their full maturity, and, in some instances, very much resemble the genuine sraall-pox.—Soon after, the fluid becomes extravasa- ted by spontaneous, or accidental, rupture of the tender ve- sicle, and a thin scab is formed at the top of the pock ; with- out pus ever being formed, as in the true variola.—Generally before the fifth day the whole eruption disappears, and no ci- catrix or mark is left behind. K 9* THE MEASLES* DIAGNOSIS. From variola.—By the small degree of fever; by the pim- ples first appearing in the back ;—by no suppuration taking place ;—by the pustules falling off, in scales, about the fifth day ; at which period the eruption in variola is only just com* pleted. PROGNOSIS. It is entirely free from danger, unless the eruption be of the confluent kind, when it is to be appreciated from the de* gree of violence of the concomitant fever. TREATMENT. This complaint is of so trivial a nature, as seldom to re- quire the aid of medicine.—Gentle cathartics are all that are in general necessary.—Should there be accidentally much fe- ver, the means may be employed for moderating it that are recommended in small-pox. RUBEOLA, OR THE MEASLES, „. . f Benign. Spectes. < * c Malignant. SYMPTOMS. Of the benign.—Synocha;—cough ;—hoarseness ;—difficul- ty-of breathing;—sneezing;—sense of weight in the head; —nausea or vomiting ;—dulness of the eyes ;—drowsiness; epiphora;—coryza;— itching of the face. On the fourth day, small red points or papulae appear, first on the face and afterwards successively on the lower parts of the body.—They are generally in clusters, do not rise into visible pimples, but by the touch are found to be a httle prominent. On \he fifth or sixth day, the vivid red i* changed to * THE MEASLES. 99 brownish hue j and in a day or two more the eruption entire-- ly disappears, with a mealy desquammation of the cuticle. The febrile symptoms are not diminished upon the appear- ance of the eruption, but rather increase, and become attend- ed with much anxiety and oppression of the praecordia, and symptoms of pneumonia.—At the period of desquammation of the papulae, a diarrhoea frequently comes on, and contin- ues for some time. Of the malignant.—This form of the disease is accompani- ed with typhus-fever, and the symptoms of putrescency, that are enumerated under the head of typhus.—The eruption ap- pears more early ; and all the symptoms above described are in an aggravated form.—The fauces often assume the same appearance as in cynanche maligna, probably from a combina- tion of the two diseases. CAUSE. Specific contagion. DIAGNOSIS. The pathognomonic symptoms, which distinguish the erup- tive fever of measles from variola and other diseases, are the dry cough and hoarseness ;—the heaviness of the head and drowsiness ;—sneezing;—coryza ;—the appearance of the eyes, which are red, swelled, itchy, very sensible to hght, and frequently loaded with tears. PROGNOSIS. Favourable.—The febrile and other symptoms light;— mo- derate diarrhoea;—early, and free, expectoration ;—a moist- ure on the skin at the appearance of the eruption. Unfavourable.—& high degree of fever ;—hot and parched skin ;—hurried and difficult breathing;—flushed countenance; —unusually hard pulse. The fever increasing after the appearance of the eruption ; —great pain in the head, and eyes ;—shooting pains in the chest;—symptoms of pneumonia or cynanche i—no expecto- 100 THE MEASLES. ration before the fourth day;—the pulse rapid and small ;— delirium ;—extremely anxious respiration. The sudden disappearance of the eruption, succeeded by delirium;—acute pains in the chest, or violent diarrhoea.— The eruption becoming of a livid hue.—A pallid appearance of the pimples, with great prostration of strength,—small intermitting pulse,—petechiae,—and other marks of putres- cency. Continued diarrhoea or vomiting. TREATMENT. Of the inflammatory. r ,. . C To diminish the inflammatory action. indications, -s C To relieve urgent symptoms. The first indication is to be attempted :— 1. By abstinence from animal food, and strict adherence to the antiphlogistic diet. 2. By placing the patient in a moderately cool atmosphere, the temperature of which should be regulated in a great measure by his own feelings, carefully guarding against any sudden change. 3. By the common diaphoretics and refrigerants ; more es- pecially the saline ones. See page 17. 4. By the occasional exhibition of saline aperients. 5. When the synocha-febrile symptoms run high, and more especially when symptoms of local inflammation are present* recourse must be had to general and local bleeding. Practitioners differ much with respect to the time at which blood-letting may be employed with the most advantage. Dr. Morton thinks it requisite as soon as the eruption is comple- ted. Sydenham recommends it after the eruption has disap- peared. Dr. Mead judiciously observes, that our practice in this respect should be regulated by the degree of the ac- companying pneumonic symptoms, without attending to the particular period of the disorder, or the state of the erup- tion -, and this is the generally approved practice in the pre- sent day. THE MEASLES. lOi Where the inflammatory symptoms become urgent, with much anxiety, pain, and oppression at the chest, general bleeding cannot be dispensed with, unless there be a septic tendency in the system. Topical bleeding, under less urgent symptoms, may suffice. 6. By the application of blisters to the chest, in cases where the fever is violent, with delirium or pneumonic in- flammation. The second indication regards symptoms. 1. If the disease be accompanied by inflammation of the lungs, general and topical blood-letting must be enforced ; with occasional purges and nauseating diaphoretics, as re- commended for the cure of pneumonia. 2. Hoarseness, cough, and inflammation of the fauces, will be palliated by barley-water, with gum Arabic ; thin arrow- root ; orgeat and water; the compound decoction of barley or capillaire and water, taken in very small quantities and fre- quently, not cold, but with the chill just removed. The ad- dition of a little nitre, or of a small quantity of lemon-juice, will render them more palatable. Inhaling the steam of warm water is also useful. Mild opiates are occasionally useful against these symp- toms, after the febrile action is abated ; but when given be- fore, they neither procure rest, nor an abatement of the cough. R. Lactis amygdalae gv. Take Milk of almonds |v. Nitri purificati gr. xv. Nitrate of potash gr. xv. Syrupi papaveris albi §ss. Syrup of white poppies gss. M- cujus sumat aeger coch- Mix.—Let the patient take a leare medium urgenti tussi. moderate spoonful when the cough is urgent. An opiate, given at bed-time, should always be combined with a saline diaphoretic. 3. When diarrhoea does not take place towards the resolu- tion of the disease, a calomel purge or two should be admin* istered. K2 102 THE MEASLES. 4. Where the diarrhoea is excessive, astringents and opi- um are necessary. R. Misturae e creta §vj. Fiat mistura cujus capiat aeger cochlearia duo magna post singulas sedes liquidas. R. Confectionis aromaticae^j. Misturae e creta 3X1J- Pulveris ipecacuanhae gr. j. Fiat haustus quartis horis su- mendus. R. Confectionis aromaticae^j. Extracti haematoxyli gr. x. Misturae e creta 3xy- Fiat haustus quartis horis ca- piendus. R. Catechu contusi3Jss. Aquae ferventis §xij. Macera et liquorem frigefac- tum cola. R. Hujus colaturae 3xij- Pulveris tragacanthae com- positi gr. xv. Confectionis aromaticae 3j. Syrupi papaveris albi 3J. F. haustus quartis horis su- mendus. Take chalk mixture §vi. Let the patient take two large spoonfuls after each liquid stool. Take Aromatic confection ^i. Chalk mixture 3XVJ- Powder of ipecacuanha gr. i. Make a draught to be taken ev- ery four hours. Take Aromatic confection ^i. Extract of logwood gr. x. Chalk mixture 3x'j- Make a draught to be taken eve- ry four hours. Take Catechu bruised X\$a. Boiling water gxij.—Mace- rate and strain the liquor when cold. Take of this strained liquor 3x\j • Compound powder qf traga- canth gr. xv. Aromatic confection ^i- Syrup of white poppies XA. Make a draught to be taken ev- ery four hours. To either of the above five drops of laudanum maybe added. Should the diarrhoea continue, and threaten great exhaus- tion, recourse must be had to the opiate confection, astrin- gent clysters, and the more powerful astringent remedies re- commended against diarrhoea. 5. If the symptoms manifest a tendency to a malignant form of disease, they must be treated accordingly, as directed ia typhus. THE MEASLES. 103 Of the malignant. The treatment of malignant measles is similar to that of typhus fever : it requires the exhibition of mineral acids, cin- chona, and red port wine. Delirium, pneumonic symptoms, cough, &.c. must be treated as before recommended. When the eruption of measles disappears before the pro- per period, and convulsions, or great anxiety, or delirium, take place, the indications will be to restore the eruption to the skin. To effect this, recourse must immediately be had to the warm bath, blisters to the chest and feet, the admin- istration of warm dilute wine, camphor and aether, or anti- mony. R. Pulveris antimonialis Lon- Take ofAntimonial powder gr.vi dinensis gr. vj. Make a powder to be taken every F. pulvis tertia vel quarta vel tnree orjour or six hourSf sexta quaque hora adhiben- dus. R. Spiritus aetheris nitrosi 3ij. Aquae ammonix acetataejvj. ——- mcnthae sativae ?v. Syrupi croci 3iij. M. cujus capiat aeger cochle- aria duo magna frequenter. R. Aquae ammoniae acetataegjss Spiritus aetheris vitriolici compositi 3'ij. Misturae camphorae fortio- ris gv. Vini antimonii tartarisati 3ss. F. mistura cujus adhibeantur cochlearia duo magna in ho- ris, vel secunda vel tertia quaque hora. Take Nitrous tether XVy Water of acetite of ammonia 3vi. ---- of spearmint % v. Syrup of saffron Xfiy—Mix. Let the patient take two large spoonfuls frequently. Take water of acetite qf am- monia §iss. Compound spirit of sulphuric cether X\y Strong camphorated mixture Antimonial wine 3ss. Make a mixture and the patient take two large spoonfuls every hour, or every second or third hour. 104 SCARLET FEVER. SCARLATINA, OR SCARLET FEVER. Specie*. $ Scarlatina simplex. C Scarlatina cynanchica, vel anginosa. SYMPTOMS. j) Of the scarlatina simplex.—Synocha or synochus.—-About the fourth day, the face begins to swell, and maculae, of a florid red colour, appear scattered throughout the skin, which at length coalesce, and after three days disappear, leaving a desquammation of the cuticle, which falls off in branny scales, and is occasionally succeeded by anasarca. Of the scarlatina cynanchica.—Lassitude;—dejection of mind; —pain in the head, followed by soreness, with sense of strait- ness in the muscles of the neck and-sbqulders ;—rigor ;—hor- ror ;—and other symptoms of typhus pyrexia. On the second day, difficulty of swallowing;—loss of appe- tite ;—nausea, and often vomiting;—hurried respiration, in- terrupted by frequent sighs ;—the breath is hot and burning to the lips ;—great thirst;—hot and dry skin ;—small pun- gent pains, as if occasioned by the point of a needle ;—quick, weak, sometimes hard pulse. On the third day, the face, neck, and breast, appear red- der than usual;—or scarlet stains, or patches, are observed about the mouth and nose ;—the submaxillary glands are en- larged and painful to the touch ;— the velum pendulum palati, the uvula, the tonsils, and pharynx, as far as the eye can reach, partake of the general redness.—Collections of thick mucus, and specks, are often observed, much resembling the sloughs in angina maligna; yet real ulceration seldom takes place.—The redness in a few hours becomes universal over the body, and increases to a great degree of intensity.— It disappears upon pressure ; is perfectly smooth to the touch j nor is there the least appearance of pimples or pustules. SCARLET FEVER. 105 On thefifth or sixth day, the intense scarlet gradually abates; a brown colour succeeds ; when the skin, becoming rough, peels off in small scales ; and the patient begins to recover strength and appetite.—Not unfrequently, however, after a few days amendment, an unaccountable languor and debility is felt;—stiffness in the limbs ;—accelerated pulse ;—distw- o«n£.—Cholerico -sanguine temperament,-—plethora* habit;—previous affections of the same nature. Exciting.—Cold;—excessive heats, or vicissitudes of tem- perature ;—abuse of fermented liquors -,—suppressed evacu- ations, or other causes, inducing plethora ;—the presence of irritating matter in the primae viae ; more especially of acrid bile.—Contagion! PROGNOSIS. Favourable.—The fever purely inflammatory ;—the erup- tion of a bright scarlet or red colour ;—not extending over a large surface ;—no vesications ;—the fever and coma dimin- st. Anthony's fire. 1U ishing upon the appearance of the efflorescence; and this, soon after, assuming a yellowish hue, with an abatement of the swelling. Unfavourable.—The fever assuming the typhoid form ;—its being protracted to the seventh, ninth, or eleventh day, with increase of coma, and delirium ;—the inflammation becoming of a dark rose colour ;—its suddenly receding from the sur- face, and attacking an internal part;—its extending over a large surface, without leaving the part itoriginally occupied ; —livid vesications ;—weak, rapid, irregular pulse ;—great prostration of strength ;—early coming on of coma ;—the dis- ease being epidemic j—the constitution of the patient origin- ally weak, or emaciated by previous illness.—The disease be- ing combined with dropsy, jaundice, or other affections, ori- ginating in a depraved organ, TREATMENT. 1. To reduce the phlogistic diathesis, if the fever be of the inflammatory kind. 11. To support the strength of the patient, Indications. -^ if it assume the typhoid form. And 111. To obviate the tendency to a determinar tion to the head or other important or- L gans. The phlogistic diathesis is to be reduced, 1. By bleeding.—This operation is, however, to be adopt- ed with the greatest care, for it seldom happens that the fe- ver is purely inflammatory, but mostly mixed, having strong synochal symptoms in the beginning, and running soon into typhoid. Local blood-letting is never serviceable, for gangrene most- ly takes place where the skin is penetrated. 2. By cooling or mercurial purges.—These are extremely serviceable : calomel is to be administered in doses of from three to ten grains, with rhubarb or any aperient. 112 st. Anthony's firk- 3. By nauseating diaphoretics : especially tartarized anti- mony, acetated ammonia, and camphor. R. Misturae camphorae gjss. Take camphoratedmixture^iss Aquae ammoniaeacetat„3iij. Water of acetite of ammonia 3»J- Vini antimonii tartarisati Antimonial wine drops x. gutt. x. Syrupi simplicis 3J- Simple syrup X}. Fiat haustus quarta quaque Make a draught, to be given hora adhibendus. every four how s. When the synochal symptoms are degenerating into ty* phoid, large doses of camphor are highly beneficial. R. MistuMfc camphorae fortio- Take Strong camphoratedmix- ris 3*. ture X^x. Aquae ammoniae acetatae3iij. Water ofacetite of ammonia 3ui- Vini antimonii tartarisati Antimonial wine drops _. gutt. x. Syrupi corticis aurantii 3j- Syrup of orange peel ji. Fiat haustus quartis horis su- Make a draught, to be taken ev- mendus. ery four hours. 4. By diluents : as acidulated soda-water, lemonade, tam- arinds with water and the like. To support the strength of the patient, when erysipelas assumes the typhoid character, recourse must be had to wine, Peruvian bark, opium, and mineral acids. These remedies are to be exhibited in the same way as re- commended in the cure of typhus. The treatment of erysipelas will vary, therefore, according to the type of the fever with which it is attended. If it be well-marked synocha, which it seldom is, the usual means of diminishing inflammation are to be resorted to (see Sy» MILIARY FEVER. 113 tiochaj ; and, above all others, the frequent exhibition of ca- lomel purges. If, on the contrary, it possess the character of typhus, and manifest symptoms of malignancy, Peruvian bark, wine, mineral acids, and other remedies of the invig- orating kind, enumerated under typhus, are to be relied on. In cases of coma and delirium, much relief will be afford- ed by the semicupium, together with the application of sina- pisms to the feet, or a blister between the shoulders. The topical applications resorted to by surgeons are vari- ous. 1. Dry absorbent powders, to take up any acrimonious flu- id that may be oozing out, as starch, meal, chalk, litharge. 2. Warm spirituous fomentations. 3. Cold spirituous applications to young habits, where the inflammatory action is strong. MILIARIA, OR MILIARY FEVER. SYMPTOMS. Synochus ;—oppression, and sense of tightness about the pr_cordia;—the breathing becomes laborious, and is inter- rupted with frequent sighs, or teasing cough, while the spir- its are oppressed with unusual sadness and timidity.—As the heat increases, there is a sense of pricking or itching in the skin, which Vogel says is also sometimes felt in the bowels ; —numbness in different parts of the body;—profuse sweat, of a sour, rank odour, during which there is often a contracted pulse.—On an uncertain day, a number of small red papulae, about the size of millet-seeds, are observed, first upon the neck and breast, and thence gradually extending to the trunk and extremities ;—their prominence is imperceptible to the sight, yet evident to the touch;—they often loose their red- ness, and appear of the ordinary colour of the skin.—After L 2 114 MILIARY FEVER. ten or twelve hours, a small vesicle appears upon the top of each; this at first is of a whey colour, but afterwards be- comes white.—At other times the pustules retain their red colour, which has given rise to the division into the white and red eruptions ;—they generally appear separately ; some- times, however, they are intermixed ;—in both, the matter, contained in the vesicles, has a peculiarly offensive smell.— In two or three days the vesicles break, and are succeeded by small crusts, which fall off in scales. CAUSES. Predisposing.—Lax habit of body ;—sanguine temperament j —childhood ;—the female sex ;—the period of child-birth ;— old age ;—preceding affections of the same disease ;—debil- ity, however induced ;—excessive evacuations ;—long-con- tinued and copious menstruation ;—fluoralbus ;—the presence of irritating matter in the primae viae (Van Swieten) ;—abuse of tea-drinking (Hoffman). Exciting.—Immoderate sweating, produced by excessive heat, or by heating medicines. DIAGNOSIS. The uncommon anxiety, and dejection of mind ;—the pro- fuse sweating;—its peculiarly fetid, rank smell.—Afterwards, the appearance of the eruption. PROGNOSIS. Favourable.—The fever inclining more to the nature of sy- nocha than typhus;—remission of the symptoms upon the appearance of the eruption;—the papulae of a florid red colour. Unfavourable.—The sweating obstinately continuing after the eruption of the papulae, with increase of fever;—great unxicty;—flaccklity of the parts covered by the eruption;— profound coma;—difficulty of breathing;—dejection of mind ; MILIARY FEVER. 113 —the sudden disappearance of the eruption, followed by great prostration of strength, anxiety, difficult respiration, violent vomiting, delirium, convulsions ;—the appearance of petechias, interspersed among the papulr;—the symptoms of putrescency elsewhere enumerated;—rapid, wealc, and intermitting pulse ;—anasarcous swellings. TREATMENT. {1. To diminish the immoderate heat and' sweating, 11. To support the strength of the patient, where there are concomitant symptoms of great debility. The first indication.will be accomplished, 1. By the cautious application of cold ;—the air of the bed-. room should be cooled, and part of the bed-clothes removed ; —the patient desired to lie with his arms exposed.. 2. By gentle cathartics, if the. debility be not great; neuT tral salts are to be preferred. Where these are inadmissible, the union of rhubarb with calomel; 3. By mineral acids : especially the sulphuric. The second indication requires:— Bark and wine ;—opium.',—blisters ;—and the other means proper for typhus fever. Should a retrocession of the eruption take place, followed by the alarming symptoms above mentioned,—musk;—cam- phor ;—opium ;—blisters, and frictions to the skin ;—endea- vouring, by every means, to bring out and support a copious diaphoresis;—external warmth;—powerful diaphoretics, &c- 116 NETTLE-RASH.—-VESICULAR FEVER. • UTICARIA, OR NETTLE-RASH. CHARACTER. An eruption resembling that produced by the stinging of nettles ; whence its name.—These little elevations often ap- pear instantaneously, especially if the skin be rubbed or scratched, and seldom stay many hours, sometimes not many minutes, in the same place ; but vanish, and again make their appearance in another part of the skin.—The parts af- fected with the eruption are often considerably swelled.—In some persons they last a few days only, in others many months, appearing and disappearing at intervals.—Long weals sometimes are observed, as if the part had been struck with a whip.—The little eminences always appear solid, not hav- ing any cavity, or head containing either water, or any other liquor.—Intolerable itching is their invariable concomitant.—■ They generally disappear in the day time, and in the even- ing again break forth, accompanied with slight symptoms of TREATMENT. Frequent cooling aperients ;—small doses of calomel;—ni- trous acid ;—sudorifics ;—the antiphlogistic regimen ;—but remedies are seldom needed in so trivial a complaint. PEMPHIGUS, OR VESICULAR FEVER. SYMPTOMS. The usual symptoms of the cold stage of fever; lassitude, headache, sickness, oppression, frequent pulse, in some in- stances delirium. VESICULAR FEVER. H? On an uncertain day an eruption of small pellucid blisters, similar to those produced by burning; varying in size, some- times as large as walnuts, more frequently about the size of almonds; surrounded by an inflamed margin or areola, and distended with a faintly yellow serum.—They appear on the face, neck, trunk, arms, mouth, fauces, and sometimes ex- tend along the whole alimentary canal; producing great diffi- culty of deglutition ; pain referred to the stomach ; nausea ; frequent vomiting; sense of soreness in the abdomen ; often bloody stools. After the blisters have remained from one to several days, they either break, and discharge a yellowish, bland, or sharp ichorous fluid, or they begin to shrink, and in a short time disappear. DIAGNOSIS. The peculiar appearance of the eruption. PROGNOSIS. Favourable.—The vesicles few in number, and confined to external parts ;—the fever inclining more to the inflammatory than to the typhoid character. Unfavourable.—The disease attacking the alimentary canal, attended with a rapid, small pulse ;—symptoms of confirmed typhus ;—the vesicles becoming livid, with sudden and great prostration of strength ; delirium. TREATMENT. Added to the treatment proper for the concomitant fever, Which is very generally an approximation to typhus, An emetic at the commencement. Calomel, in small and frequent doses. Saline purges. Antimonium tartarisatum, in small and frequent doses.. The larger veticles should be opened, and kept clean. lid THE THRUSH. Demulcent and detergent gargles when the mouth and fau- ces"become the seat of the disease.—See Aphtha. To diminish the effects of irritation ; opium combined with vitriolic aether. APHTHA, OR THE THRUSH. SYMPTOMS. The mouth becomes redder than usual;—the tongue swel- led and rough;—small whitish escars or pustules invade the uvula, fauces, palate, tonsils, the inside of the cheeks, the gums, and lips.—They generally commence at the uvula; are sometimes few and distinct, at others numerous and conflu- ent ; sending forth a glutinous mucus, which forms a thick whitish crust, adhering most tenaciously, and which falls off when the pustules have arrived at maturity, without indu- cing an escar on the parts beneath.—The disease sometimes extends to the oesophagus, stomach, and throughout the whole alimentary canal; when mucus is evacuated, in large quantities, by stool and vomiting;—at others, to the trachea and broncliiae, when it is brought up by coughing:—aphthae sometimes fall off in the space often or twelve hours, at oth- ers they remain attached for several days, and often a separa- tion and reproduction takes place a great number of times before the final solution of the disease. CAUSES. Predisposing.—Cold and moisture ;—debility. Exciting.—Most frequently a derangement of the intestinal canal. PROGNOSIS. Favourable.—The aphthae appearing of a white, pearly co- lour ; falling off early, and leaving the parts they occupied THE THRUSH. 119 elean, red, and moist.—Salivatioil, or moderate diarrhoea, at the period of separation.—When the disease is long protract- ed, repeated, crops are more favourable than, the permanence of the original. Unfavourable.—The disease affecting internal parts; pro- ducing violent hiccup, oppression, pain referred to the sto- mach, vomiting, and sense of suffocation ;—the aphthae being, from the first, of a brown colour, or becoming so in the course of the disease ;—their sudden disappearance ;—the mouth and fauces unusually pallid previous to the eruption; — violent diarrhoea;—coma;—great prostration of strength ;— any of the symptoms of putridity, accompanying cynanche maligna. See Cynanche. TREATMENT. f 1. To remove or moderate the concomitant Indications. < _ fever. (_11. To produce a separation of the aphthae. The first indication must be fulfilled, By the means laid down for the treatment of synocha, ty- phus fever, and cynanche maligna. The second— 1. By emetics, when other means are resisted. 2. Gentle laxatives, as manna, rhubarb, and castor-oil). R. Matmae optimae gss. Aqux anethi gj. Solve : capiat infans cochleare medium subinde. R. Olei amygdalae $v. Syrupi rosae Jx. M. cujus de]tur cochleare mi' nimum pro re nata. Take best Manna gss. Aniseed water %i-—Dissolve, Let the child take a pap-spoon- ful frequently. Take Oil of almonds 3 v. Syrup of roses Xx.—Mix. Give a tea spoonful when neces* saryi iso THE THRUSH. R. Manna optimae 3vj> Take best Manna %Vi. Pulveris rhabarbari 3SS. Powder of rhubarb 3SS. Infusi sennae 3'ix. Infusion of senna Xfx.—Mix M. sit dosis cochleare medi- The dose is a pap-spoonful. wax. S. Copious emollient clysters. R. Decocti avenae tenuioris Take oatmeal gruel giij. Olei olivae gss. Olive oil gss.—Mix. M. pro enemate octava qua- For an injection, to be admin- que hora adhibendum. ittered every^ eight hours. Veal broth also, with turnip radishes boiled in it. 4. By tonic and stimulant gargles. R. Decocti cinchonae gij. Elixir vitrioli acidi Jss. Fiat gargarisma. R. Decocti quercus gij. Pulveris Arabici3j. Boracis purificati 3J- F. gargarisma. R. Boracis purificati 3Jss. Aquae florum sambuci gvj Tincturae myrrhae, Mellis rosae, aa gss. F. gargarisma. R. Mellis aeruginis gss. —-—rosae gjss. M. partibus affectis, ope pe nicilli, quarta quaque hor admovendum. Take Decoction of cinchonain. Sulphuric acid diluted 39s. Make a gargle. Take Decoction of oak barki'ij; Gum Arabic in powder "Xi. Borate of soda X}. Make a gargle. Take Borate qfsoda jiss. Water of elder flowers gvi. Tincture qf myrrh, Honey qf roses, each gss. Make a gargle. Take Honey of verdigrease gss. ■ of roses giss. Mix. Let a little of it be applied to the parts affected, with a soft pencil, every four hour*. HAEMORRHAGE FROM THE NOSE. 121 ORDER PV. HEMORRHAGIC, OR INVOLUNTARY DISCHARGES OF BLOOD. CHARACTER. Pyrexia, with a profusion of blood, without any external violence ; the blood drawn from a vein having the same ap- pearance as in the phlegm asiae. GENERAL CAUSES. External heat;—sudden diminution of the weight of the atmosphere ;—whatever increases the force of circulation; as, violent exertions of the body in general, or violent action in a particular part;—particular postures of the body;—liga- tures producing local congestion;—exposure to cold;—exter- nal violence. GENERAL TREATMENT. To put a stop to the discharge of blood. To prevent its recurrence, by removing the the causes by which it was excited. To destroy the inflammatory diathesis. EPISTAXIS, OR HEMORRHAGE FROM THE NOSE, SYMPTOMS. Sense of weight, and obtuse pain in the head ;—redness of the cheeks ;—inflation of the face, and of the vessels of the neck and temples ;—tinnitus aurium ;—heavy pain, promi- nence and dryness of the eyes ;—vertigo j—itching of the M 1. . 11. Indications. 111. 122 HEMORRHAGE FROM THE NOSE. nostrils, and sense of weight about the root of the nose ;—in some instances, disturbed sleep and dreadful dreams ;—cos- tiveness ;—diminished secretion of urine ;—coldness of the extremities ; tension of the right hypochondrium ;—these succeeded by a profusion of blood from the nostrils. CAUSES. Predisposing.—A certain age ; i. e. the period of puberty, and the decline of life ;—plethoric state of the system ;—pe- culiar weakness of the vessels of the part. Exciting.—External heat;—violent exertion ;—cold applied to the body ;—particular postures of the body ;—external vi- olence. TREATMENT. The indications mentioned in the general treatment of Hae- morrhage will be answered :— 1. By the local means recommended in surgical works ;— erect position of the body, with the head somewhat reclined backwards ;—free exposure to cool air ;—cold applied to the neck, or immersion of the head in water impregnated with ammonia muriata;—affusion of cold water over the genitals; —and astringent injections :— R. Zinci vitriolati 3J. Take Sulphate qfzinc £i. Aquae distillatae gx. Distilled water gx. Fiat injectio. Make an injection. R. Tincturae ferri muriati 3 j. Take Tincture of muriate of iron Xj.. Aquae distillatae gvj. Distilled water gvi. Fiat injectio. Make an injection. R. Aluminis gij- Take Super-sulphate of alum and potash Xjiy Aceti dlstillati gj. Distilled vinegar gi. Aquae distillatae gvj. -------water gvi. Fiat injectio. Make an injection* HAMORRHAGE from THE NOSE. 123 The second and third indications will be fulfilled by, 1. The means that obviate plethora, as the antiphlogistic diet, general and local blood-letting, purging, and diaphor- etics.—These remedies are more particularly required when the fever is considerable and the pulse strong. 2. Refrigerants and diaphoretics ; as, nitre and antimoni- um tartarisatum. R. Nitri purificati gr. vj. Vini antimonii tartarisati gutt. x. Aqua distillatae 3xij- Syrupi croci 3J- Fiat haustus sextis horis su- mendus. Take Nitrate of potash gr. vi. Antimonial wine drops X. Distilled water 3xij- Syrup of saffron X^. Make a draught to be taken ev- ery six hours. 3. Astringents ; especially vitriolated zinc, alum, acetated ceruse with opium. R. Zinci vitriolati gr. £. Aluminis purificati gr. x. Infusi rosae Xxi'iy Syrupi ejusdem 3J- Fiat haustus sextis horis capi- endus. Take Sulphate of zinc gr. &. Super-sulphate of alum and potash gr. x. Infusion of roses 3XUJ- Syrup of ----3i. Make a draught, to be taken ev- ery six hours. R. Cerussae acetatae gr. j. Tincturae opii gutt. x. Aquae cinnamomi Jv. -----distillatae X,x. Syrupi simplicis 3J- Fiat haustus octavis horis su- mendus. Take Acetite of lead gr. i. Tincture of opium drop* X. Cinnamon water Xv. Distilled-----3x. Simple syrup X\. Make a draught to be taken ev- ery eight hours, 124 SPITTING OF BLOO&. 4. Sedatives ; especially digitalis and nitre. R. Tincturae digitalis gutt. Take Tincture of purple foxglove x—xxx. drops from x to xxx. Nitri purificati gr. vj. Nitrate of potash gr. vi. Aquae menthae sativae gxiij. Water of spearmint 3xiij. Syrupi croci 3j. Syrup of saffron X\. Mix— M.pro haustu sexta quaque For a draught to be taken every hora sumendo. six hours. HEMOPTYSIS, OR SPITTING OF BLOOD. SYMPTOMS. Sense of weight and oppression in the chest;—dry tickling cough ;—peculiarly hard jerking pulse ;—difficulty of breath- ing;—sense of pain and heat, referred to the sternum;— Saltish taste in the mouth ;—flushed countenance ;—constant irritation at the top of the larynx, which excites hawking and coughing, during which the profusion of blood takes place. Predisposing.—A certain age ; 5. e. from the period of pu. berty to the thirty-fifth year ;—sanguineous temperament j— great sensibility and irritability;—suppression of usual evac- uations ;—narrow conformation of the chest;—previous affec- tions of the same disease;—hereditary predisposition;__pleth- ora. Exciting.—Excessive heat of the atmosphere ;—violent ex- ercise ;—inordinate exertion of the organs Of respiration;.« external violence. DIAGNOSIS. The blood being brought up by hawking and coughing ;-« of a florid red colour; and mixed with a little frothy mucus j —reference to the predisposing causes. SPITTING OF BLOOD. 125 From hxmatemesis.—The blood thrown up in haematemesis is usually in much more considerable quantity;—of a darker colour;—more grumous ;—mixed with other contents of the stomach ; and usually unattended with cough. PROGNOSIS. Favourable.—The disease arising from common causes on- ly, and not from hereditary predisposition, or malconforma- tion of the pulmonary system.—The blood being small in quantity, and of a bright red colour.—Its not being followed by cough, dyspnoea, pain or other affection of the lungs. Unfavourable.—The reverse of the above. TREATMENT. Indications.—See general treatment of Haimorrhagy. The indications will be answered by, 1. Carefully avoiding heat, and every kind of bodily exer- tion. 2. Making use of a light vegetable diet. 3. Bleeding, where symptoms of inflammatory diathesis are indicated by the hardness and peculiar jerk of the pulse ; the constitution of the patient; the florid colour of the blood evacuated from the lungs. On the contrary, where there are marks of debility and laxity, and the blood is of a dark colour, depletion is impro- per. Dr. Percival. 4. Cooling purges, of magnesia vitriolata, or natron vitrio- latum, in infusion of roses. R. Infusi rosae gvij. Take Infusion of roses gvij. Magnesiae vitriolatae 3vj. Sulphate of magnesia ^vi. Spiritus pimento gss. Spirit of Jamaicapepper^ss. M. cujus capiat aeger cochle- Mix—Let the patient take foU>- aria iv sexta quaque hora. spoonfuls every six hours. M 2 126 SPITTING OF BLOOD. 5. Refrigerants ;—nitre ;—sulphuric acid;—ammonia mu- riata. R. Infusi rosae gij. Nitri purificati J^ss. Tincturae opii gutt. v. M. fiat haustus tertia vel quar- ta quaque hora sumendus. R. Acidi sulphuric! diluti 3ss. Aquae distillatae 3XV- Tincturae opii gutt. x—xv. Syrupi rosae 3J- Fiat haustus tertia vel quarta quaque hora capiendus. Take Infusion of roses gij. Nitrate of potash ^ss. Tincture qf opium drops v. Mix—Make a draught to be ta- ken every third or fourth hour. Take Sulphuric aciddilutedX.ss. Distilled water X.XV. Tincture qf opium drops from x to xv. Syrup of roses X}. Make a draught to be taken ev- ery third or fourth hour. R. Cremoris tartari 3iij. Take supertartrite of potash triij. Nitri purificati 3\j. Nitrate of potash X,'\y Mix— M. capiat aeger 3ss. pro dosi Let the patient take ^ss for a ex cyatho parvo aquae hor- dose in a glass of barley-wa- dei. ter. Draughts of cold water acidulated with lemon-juice. 6. Astringents ;—vitriolic acid ;—cerussa acetata;—tinc- tura saturnina. 11. Cerussae acetatae gr. vj. Take Acetite of lead gr. vi. Opii purificati gr. iij. Gum opium gr. iij. Conservae oynosbati q. s. ut Conserve of hips q. s. to make fiant pilulae numero sex. six pills. Sit dosis una vel altera bis, The dose may be one or t%vot ter, quaterve in dies. three or four times a day. The 'cerussa aceUtu draught, page 123. MENORRHAGIA. 12? R. Tincturae saturniae gutt. Take Saturnine tincture, drops xx—xl. xx to xl. Aquae distillatae 3xij. Distilled water 3xij. Syrupi simplicis 3J- Simple syrup X}- Fiat haustus ter in dies su- Make a draught to be taienthree mendus. times a day. • 7. Sedatives ;— digitalis ;— hyoscyamus, 8. Emetics are recommended by Dr. Darwin. 9. Nauseating medicines ;—antimonium tartarisatum in small and repeated doses. 10. Inhaling sedative airs ;—hydrocarbonate. 11. Limited use of liquids. 12. Cold lotions externally applied ;— vinegar and water, —a solution of ammonia muriata. Where symptoms of debility prevail—blisters to the chest; —bark j—opium ;—chalybeates. MENORRHAGIA, OR IMMODERATE FLOW OF THE MENSES. A flow of the menses is to be considered as immoderate, when it cither returns more frequently than what is natural, continues longer than ordinary, or is more abundant than is usual with the same person at other times. It may be the effect of two different and opposite states of the system : plethora with inordinate arterial vigour; and general relaxation or debility. SYMPTOMS. An immoderate flow of the menses, arising from plethora, is usually preceded by rigors, acute pains in the head and loins, thirst, turgid flushed coimtenance, universal heat, and 128 MENORRHAGIA. a strong, hard pulse : on the contrary, where the symptoms of debility are prevalent in the system, the pulse is small and feeble, the face pallid, the respiration small and hurried on the slightest effort; the general leucophlegmatic appearance of the patient indicates a laxity of every muscular fibre ; the pains of the back and loins are rather aching than acute. CAUSES. The causes which predispose to the disease are plethora; —a laxity or debility of the organ, arising from frequent child- bearing ;—difficult and tedious labours, or repeated miscar- riages ;—a sedentary and inactive life, indulging much in grief and despondency;—living upon a poor low diet; — drinking freely of warm enervating liquors, such as tea and coffee ; and living in warm chambers. The exciting causes of menorrhagia are, violent exercise, more especially in dancing;—strokes or concussions on the belly ;—strains ;— passions of the mind ;—violent straining at stool;— excess in venery, particularly during menstruation ; —the application of wet and cold to the feet;—organic affec- tions of the uterus, such as scirrhus, polypus, &c. PROGNOSIS. Menorrhagia, when it is the effect of plethora, rarely proves Fatal; but when it occurs inhabits much reduced by previous disease, or is produced by a laxity of the vessels of the organ, is profuse, long-continued, or of frequent recurrence ; if the lips, nails, and other parts, be pale ; if the extremities be- come cold, and with these symptoms the patient fall into syn- cope, especially if there be any convulsions of the limbs, the danger is very great. When it arises from an organic affec- tion of the part, which is frequently the case after the age of forty-five, it is usually incurable. • VOMITING OF BLOOD. 133 TREATMENT. The cure of menorrhagia consists in:— 1. Strictly confining the patient to an horizontal posture ; especially avoiding every exertion both of body and mind. 2. Keeping the body gently open with laxative medicines that have but little stimulus. R. Kali tartarisati gss. Take Tartrite of potash gss. Mannae optimae Xy'y Best manna Xy'i. Aquae ferventis gvj. Boiling water gvi. Tincturaelavendulaecompo- Compound tincture oflaven« sitae gss. der gss. Fiatmisturae cujus capiat aeger Make a mixture of which let cochlearia tria pro re nata. tne patient take three spQQ^ fuls when necessary. R. Magnesix vitriolatae 3iij. Take sulphate of 'magnesiaXiiy Aquae frigidae gx. Cold water gx. Fiat enema. Make an injection. 3. Administering draughts of acidulated cold liquors fre- quently, as infusion of roses, lemonade, and the like. 4. The internal use of styptics, especially cerussa acetata, as directed against haemoptysis, page 126. 5. When symptoms of debility are present, tonic astrin- gents : cinchona, cascarilla, kino, quercus, and wine. 6. The constant application of astringents to the vagina and hypogastric region; especially ice, very cold water, vinegar and water. H£MATEMESIS, OR VOMITING OF BLOOD. An haemorrhage of dark-coloured, grumous blood from the stomach, in considerable quantity, mixed with alimentary 130 VOIDING BLOOD BT URlNE. matter, and preceded by a sense of weight and obtuse pain or anxiety in the region of the stomach. CAUSES. The general causes of haemorrhage, as plethora—suppres- sion of evacuations, &c.;— tumors compressing the liver or spleen {—external violence ;— obstructions in any neighbour. ing viscue. TREATMENT. Indications.—Set the General Treatment of Hsemorrhagy. If accompanied by symptoms indicating inflammatory dia- thesis,—bleeding, and the antiphlogistic regimen, with di- gitalis.—If not,—tonics and astringents ; vitriolic acid with opium. Opium in large doses is recommended by Dorffmuller. Cerussa acetata, as directed in haemoptysis, Tinctura ferri muriati gutt. xx. ad xxx. omni hortV The union of decoctum cinchonae with acidum vitriolicum. Alum, in the dose of ten grains every four hours. Epispastics to the abdomen. If the existence of scirrhous tumors can be ascertained,— hydrargyrus; —cicuta ;—and other remedies elsewhere re- commended. HEMATURIA, OR VOIDING OF BLOOD BY URINE. CHARACTER. An evacuation of urine, mixed with blood, preceded, when not the effect of injury, by pain, and sense of weight, in the loins ;—pain and heat in the region of the kidney. CAUSE. It is most frequently symptomatic of other renal affections. VOIDING BLOOD BT URINE. »Si See Nephritis, and Calculus Renali*.—Or it arises from e_« ternal violence, or great exertion.—It may be produced by any of the causes of haemorrhage before enumerated. PROGNOSIS. It is distinguished from the high-coloured urine, attendant on many diseases, by the deposit of a coagulum to the bottom of the vessel, and by its staining linen of a red colour. TREATMENT. If the disease be the consequence of injury, or the patient be of a full plethoric habit,—bleeding,—refrigerants,—as ad- vised under the head of haemoptysis. Saline purges of magnesia or natron vitriolatum. Astringents;—infusion of roses with an additional quanti» ty of vitriolic acid. Uva ursi, in powder ; one scruple three times a day. The double acidulated Boda-water for a common drink. Opium, in small doses, every four or six hours. Decoction of peach-leaves. If it arise from irritation of the kidney by calculus, together with the remedies proper for that disease, frequent draughts of mucilaginous liquids ; as thick barley-Water, solution of gum Arabic, decoction of marsh-mallows sweetened with honey.—Opium ;—copious emollient clysters. Should there be concomitant symptoms of debility, power- ful astringents ; alum ;—tinctura ferri muriati;—terebin- thina, &c. 132 CATARRH. ORDER V. PROFLUVIA, OR FLUXES WITH PYREXIA: CHARACTER. Pyrexia, with an increased secretion, not naturally bloody, CATARRHUS, OR CATARRH. „ . C Catarrhus a frigore, common cold, v . contagiosus, the influenza. An increased secretion of mucus from the mucous mem- brane of the nose, fauces, and bronchise, attended with py- rexia. SYMPTOMS. Pyrexia;—weight and pain in the head;—oppression of the chest, and impeded respiration ;—sense of fulness and stopping up of the nose ; watery inflamed eyes ;—coryza ;— cold shiverings, succeeded by transient flushes of heat ;— soreness- of the fauces and trachea ;—cough ;—pains about the chest;—rheumatic pains in the neck and head ^—increas- ed secretion of mucus from the mucous membrane of the nose, fauces, and bronchiae. CAUSES. Remote.—Cold applied to the body ;—contagion. Proximate.—An inflammation of the mucous membrane of the nose, fauces, bronchiae, &c. CATARRH. 133 PROGNOSIS. It is seldom attended with danger, when in a mild form, and arising from common causes. Unfavourable.—Predisposition in the constitution to phthi- sis ;—tendency to asthma, or peripneumonia. TREATMENT. Indications. {To reduce the febrile action of the system. To allay the irritation of the affected parts. General bleeding may be necessary, if the type of the fe- ver be synochal, and the symptoms are violent: in such cases purges will be beneficial, saline diaphoretics, and the anti- phlogistic diet, as recommended against synocha, or inflam- matory fever. When the system evinces typhoid actions, the contrary must be observed. The second indication requires, 1. Frequent use of tepid diluents, mucilaginous and oily demulcents. R. Spermatis ceti 3'j. Vitellum ovi unius. Syrupi simplicis gss. Aquae cinnamomi gij. -----distillatae giv. Fiat misturacujus capiat aeger cochleare magnum frequen- ter. R. Olei amygdalae Xyy Syrupi tolutani gj. Aquae distillatae gv. —— kali preparati q. s. Fiat emulsio cujus sumantur cochlearia duo secunda qua- que hora, vel urgentitusse. N Take Sperma ceti Xyy The white of one egg. Simple syrup gss. Cinnamon water gij. Distilled-----§iv. Make a mixture of which let the patient take a spoonful frequently. Take Oil of almonds Xy\. Syrup oftolu gi. Distilled water gv. Water of carbonate of potash q. s. Make an emulsion of which let the patient take two spoonfuls every two hours, or when the cough is urgent, 134 CATARRH. R. Mucilaginis Arabicigjss. Aquae cinnamomi gv. Syrupi mori gj. M. cujus sit dosis cochleare medium urgenti tusse. Take Mucilage of gum Arabic giss. Cinnamon water gv. Mulberry syrup gi. Mix— The dose is a small spoonful whenthe cough is troublesome' % Mild expectorants and diaphoretics. R. Aceti scillae xfy Aquae menthae sativae gv. Syrupi croci gj. M. cujus sumat cochleare magnum quando raucedo urget. R. Oxymellis scillae gss. Spiritus aetheris nitrosi 3'j- Aqux menthae sativae gv. Syrupi corticis aurantii3iij. Fiat mistura de qua capiat ■seger cochleare magnum su- binde. Take Acetite of squills Xfi. Water of spearmint gv. Syrup of saffron gi. Mix- Let a large spoonful be taken when the hoarseness is trou- blesome. Take Oxymel qf squills gss. Nitrous tether Xij. Water of spearmint gv. Syrup of orange peel 3iij. Make a mixture of which a large spoonful is to be taken frequently. Take Nitrate of potash ^i. Milk of almonds gvij. Tincture of squills Xfi. Syrup oftolu gss.—Mix— The dose a large spoonful fre. quently. .3. Mild opiates and diaphoretics when the inflammatory di- athesis is reduced. R. Nitri purificati 3j. Lactis amygdali gvij. Tincturae scillae ^j. Syrupi tolutani gss. M. sit dosis cochleare mag num subinde. 1. Syrupi papaveris albi gj. Nitri purificati 3j- Aqux menthae sativae gvj. Fiat mistura. Take Syrup of white poppies gi. Nitrate of potash X\. Water qf spearmint gvi. Make a mixture. DYSENTERY. 135 R. Syrupi papaveris albi gj. Oxymellis scillae gss. Aqux menthae sativx gvj. Fiat mistura cujus sumantur cochlearia duo magna tertia quaque hora. R. Pulveris ipecacuanhae com- positi gr. ijss. Conservae rosae q. s. Fiat pilula quarta quaque ho- ra sumenda. The trochisci glycyrrhizac cum opio. R. Decocti hordei compositi gxivss. Syrupi papaveris albi gjss, M. cujus capiat aeger cyathum vinosum parvum secunda quaque hora. Take syrup of white poppies gi. Oxymel of squills gss. Water of spearmint gvi. Mix—Let the patient take two large spoonfuls every three hours. Take Compound powder of ipe- cacuan gr. ijss. Conserve of roses q. s. Make a pill to be taken every four hours. The troches of Liquorice with opium. Take Compound decoction qf bar- ley gxivss. Syrup of white poppies giss. Mix—Let the patient take a small wine glass full every two hours. 4. Blisters to the breast, if there be uneasiness there, or pain, or difficult expectoration, or sense of oppression. 5. Inhaling the steam of warm water. DYSENTERIA, QR DYSENTERY. SYMPTOMS. The disease sometimes comes on with cold shiverings and Other symptoms of fever ; at others, the local affection is first perceived.—Costiveness ;—unusual flatulence in the bowels ; —severe griping;—frequent inclination to go to stool ^--te- nesmus ;—loss of appetite ;— nausea;—vomiting;—febrile Re at, and frequency of pulse j—frequent discharge of a pet 136 DYSENTERY. culiarly fetid matter from the anus, varying in appearance ; being sometimes pure mucus, or mucus mixed with blood j pure unmixed blood; pus, or a putrid sanies, proceeding from ulcerated or gangrenous parts ; and often films of a membranous appearance, or small sebacious masses, floating in a large quantity of liquid matter.—Masses of indurated faeces are likewise sometimes passed by stool.—Great emaci- ation and debility ;—quick and weak pulse ;—sense of burning heat, and intolerable bearing down of the parts (—hiccup j— and not unfrequcntly a fatal termination ensues. CAUSES. Remote.—A specific contagion.—All those causes capable of inducing spasm and ulceration;—much moisture, succeed- ing quickly to intense heat,—unwholesome and putrid food; —noxious exhalations and vapours. Proximate.—Spasmodic constriction and ulceration of thjg colon. PROGNOSIS. Favourable.—A gentle diaphoresis ;—the stools becoming yellow, and less frequent;—the strength little impaired ;— sediment in the urine ;—the disease arising from common causes. Unfavourable.—The disease having become habitual by long continuance ;—violent and distressing tenesmus and tormina; —vomiting ;—hiccup ;—aphthae ;—difficult deglutition;—con- vulsions ;—cold extremities ;—delirium ;—cold and partial sweats;—the tongue preternaturally red and dry ;—the pain suddenly ceasing ;—great prostration of strength ;—the faeces extremely fetid;—petechiae;—involuntary evacuations;—in- termitting pulse ;—the disease being complicated with oth- ers ; as with affections of the liver, with intermittent fever, &c. DYSENTERY. li? TREATMENT. f 1. To remove the concomitant fever. j 11. To evacuate the matter contained in the Indications.-^ intestines. 111. To lessen irritation, and to restore the tone I. of the intestines. To fulfil the first indication, the type of the fever must be ascertained. If it be synocha, and the inflammatory diathesis prevail, blood-letting and the antiphlogistic regimen must be resorted to, but this will seldom be necessary, for the fever mostly assumes a putrid tendency, when the treatment proper for typhus will be required. If it assume the intermittent form, cinchona and tonics must be resorted to. The second indication requires, 1. An emetic of ipecacuanha or vitriolated zinc. The haustus emeticus communis, page 7. R. Zinci vitriolati £j. Take sulphate of zinc ^i. Aquae distillatae g ij. Distilled water g ij. Fiat haustus emeticus. Make an emetic draught. 2. Cathartics.—Of this class of medicines rhubarb ha3 been very much preferred : calomel has also been highly approv- ed ; and where there is a tendency to inflammation, or the dejections manifest a total absence of bile, no other cathartic will be so effectual. R. Olei lini, Take Linseed oil. Tincturae rhabarbari, aa^ij- Tincture of rhubarb each X\], M. fiat haustus semel vel bis Make a draught to be taken quotidie sumendus. once or twice daily. N2 138 DYSENTERY. R. Pulveris rhabarbari 3SS. Take powder of rhubarb jss. Confectionis aromaticae 3J- Aromatic confection ^i. Tincturae rhabarbari 3jss. Tincture ofr.hubarb 3iss. Aqua menthae piperitidii Peppermint water giss. gjss. Syrupi croci 3J- Syrup of saffron Xi. Fiat haustus. Make a draught. The refrigerant cathartics alone, or conjoined with manna» have been long employed, especially by the army physicians, with the greatest advantage. R. Magnesiae vitriolatae 3vj. Take Sulphate of magnesia jvi. Infusi rosae gvj. Infusion of roses gvi. Syrupi zingiberis gss. Syrup of ginger §ss> Fiatmistura cujus capiat aeger Make a mixture, let the patient cochlearia quatuor pro re take four spoonfuls when ne. nata. cessary. R. Magnesiae vitriolatae 3vj. Take Sulphate of magnesia Jvi. Mannae optimae gj. Best manna gi. Aquae menthae piperitidis Peppermint wafer gvi.--Mix. 3VJ- M. cujus sit dosis cochlearia The dose is four spoonfuls. quatuor. The natron variolation, and sodaphosphorata, maybe used :n the same doses as the vitriolated magnesia. The oleum ricini is a very excellent purge. Ipecacuanha, administered in such doses as not to prove emetic, but to act on the bowels, is perhaps the most effec- tual cathartic in dysentery. 3. Large emollient clysters :— R. Amyli $xij. Take iff Starch 3xij. Aquae ferventis gxvj. Boiling water gxvi. Fiat enema bis terve die in- Mate an injection to be given jiciendum. *-"* or thrice a day. Clysters of mutton broth and arrow-root. DYSENTERY. l& 4. Emetic and purgative medicines combined. R. Magnesiae vitriolatx gj. Antimonii tartarisati gr.iij. Infusi sennae gvj. Syrupi rosae gss. Fiat mistura cujus adhibean- tur cochlearia tria magna pro re nata. Take Sulphate of magnesia gi, Tartrite of antimony gr. iij. Infusion of senna gvi. Syrup of roses gss. Make a mixture, give three large spoonfuls, when neces- sary. To fulfil the last indication, several remedies are used. 1. Mucilaginous demulcents ; as, solutions of gum Arabte in milk; preparations of barley, arrow-root, linseed, salop,. and the like : the wax emulsion :— R. Cerae flavae £iij. Saponis Hispanici jj. Aquae distillatae gss. Lcni calore, post solutionem, adde— Aquae distillatae Jj^jss. Syrupi ex althaea gij. Ut fiat emulsio, cujus sit do- sis cyathum parvum subin- de. Take Yellow wax 3iij- Spanish soap X}- Distilled water gss. After solution with a gentle heat, add, Distilled water H51SS. Syrup.of marsh-mallows gij, Make an emulsion—The dose is a small glass frequently. R. Gummi Arabici in pulve- Take Gum Arabic in powder gij, rem triti gij. Decocti hordei jfeij- Decoction of barley Jfcij. Succi limonis gij. Lemon juice ^ij. Bibat aeger pro potu ordinario. Let the patient take it for com- mon drink. 2. Fomentations and embrocations to the abdomen. A strong decoction of poppy-heads. 140 DYSENTERY. R. Camphorae tjvj. Opii optime pulverisati 2Jij- Olei palmae vel macis giij. Fiat unguentum cujus illinen- dum sit quantitas nucis mo- schatae ter quotidie. R. Linimenti saponis 3xij. Tincturae opii 3iij. Olei essentialis caryophyl- lorum aromaticorum 3J- Fiat embrocatio subinde uten- da. Take Camphor jvi. Best opium powdered 3ij< Palm, or mace oil 5iij. Make an ointment, of which rub in the size qf a nutmeg three times a day. Take Soap liniment Xxij. Tincture ofopium^ij. Oil of cloves 3!- Make an embrocation to be used frequently. 3. Mucilaginous clysters with opium :— The starch clyster, with a drachm of laudanum, every six or eight hours. 4. Diaphoretics; especially Dr. Dover's powder. R. Pulveris ipecacuanhae com- positi gr.iij- Conservae rosae q. s. Ut fiat bolus quarta quaque hora adhibendus. Take Compound powder qf ipe- cacuan gr. iij. Conserve of roses q. s. Make a bolus, to be taken every four hours. R. Pulveris ipecacuanhae com- Take Compound powder of ipe- positi gr. x—xx. cacuan gr. x—xx. Conservae rosae q. s. Conserve of roses q. s. Fiat bolus singulis noctibus Make a bolus, to be taken every sumendus. night. 5. Opium ; alone, or united with antimony or nitre. 6. Antimonials :—the vitrum antimonii ceratum, as recom- mended by Sir John Pringle. 7. Tonics and astringents, at a more advanced period of the disease, when the frequency of the dejections seem ra- DYSENTERY. 141 ther to proceed from a weakened and relaxed state of the bowels than from any remains of malignancy; especially quassia, angustura, Colombo, cascarilla, simarouba, verbas-. cum, catechu, kino, nux vomica, arnica, haematoxylum, lime- water, bignonia capriolata, baked bread, nitrous acid with opium. R. Corticis angusturae contu- se 3y- -------exterioris aurantii Hispalensis, Radicis colombae, aa 3J- Aquae ferventis Jj^j. Macera, et liquorem frigefac- tum cola. R. Infusi colati 3*uj* Tincturae cardamomi com- positae 3j. Tincturae opii gutt. x. Fiat haustus octava quaque hora capiendus. Take Angustura btuised X}\. Spanish orange peel, Columbo root, each ^i. Boiling water Jfji.--Macerate Strain the liquor when cold. Take of the strained infusion 3xiiJ- Compound tincture of carda- mon "x\. Tincture of opium drops X. Make a draught to be taken c«- ery eight hour*. The cascarilla and other tonics above mentioned may be made into an infusion in like manner. R. Acidi nitrosi jij. Opii purificati gr. ij. Aquae distillatae "$xvy M. capiat aeger cochleare mi- nimum quater in die, ex cyatho parvo aquae hordei. Take nitrous acid $iy Opium gr. ij. Distilled water "Xxyu—Mix. Let the patient take a teaspoon- ful three times a day in a small glass of barley water. 142 DYSENTERY. R. Extracti haematoxyli 3J, Take extract of Logwood xi. Misturae cretaceae 5iv. Cretaceous -mixture ?iv. Tincturae catechu 3ij. Tincture of catechu 31J. Spiritus nucis moschatae Z; Spirit of nutmeg ±i-—Mix. M. cujus sit dosis cochlearia The dose is three large spoon- tria magna tertia vel quarta fuls every three or four hours. quaque hora. R. Confectionis aromaticx 3ij. Take Aromatic confection X\y Aquae cinnamomi gv. Cinnamon water 5v. Spiritus pimento |j. Spirit 0f Jamaica pepper %i. Tincturae kino 31J. Tincture of kino •zjy—Makc Fiat mistura singulo dosi cu- a mixture—To each dose addx jus adde guttas x. tincturae drops of tincture of opium, ae- opii pro re nata. cording to circumstances. There has been much difference in opinion with respect to the propriety of administering cinchona in dysentery. Its use is more particularly serviceable in those cases where the at- tendant fever assumes the remittent form, or where the dig- ease is complicated with typhus, or with intermitting or re- mitting fevers. Sir John Pringle recommends the cinchona to be joined with serpentaria Virginiana, and Dr. Akenside gave it combined with a cathartic. On the continent, the nux vomica, arnica montana, bigno- nia capriolata, and sulphur, in large and frequent doses, are the favourite remedies. Dr. Thomas informs us, in his Practice of Physic, that, during a residence in the West Indies, he was in the habit of recommending a strong decoction of Logwood, with the bark of the pomegranate and cherry-tree, as an astringent drink, from which his patients seldom failed to experience a good effect. Tbe means above mentioned will be found totally inade- quate to the cure of chronic dysentery, if a dusky sallow hue $f countenance, tenderness upon pressure in the region cf DYSENTERY. 143 the liver, and a clayey appearance of what faeces happen oc- casionally to be voided, manifest the presence of a diseased or obstructed state of the liver. In such cases -mercury is the only remedy ; and this should be pushed to such an extent, as to keep up a gentle affection of the mouth until the symp- •toms begin to be mitigated. Every kind of food which tends to putridity should be avoi- ded, also spirituous liquors; and the strength should be sup- ported by light preparations of barley, rice, sago, Indian ai> row-root, flour, panada, and gelatinous broths. H4 CLASS II. KEUROSES\ OR, NERVOUS DISEASES. CHARACTER. Injury to sense or motion, without any idiopathic fever, of primary local affection. ORDER I. COMATA. CHARACTER. Diminution of voluntary motion, with sleep, or a privation of sense. APOPLEXIA, OR APOPLEXY. Species, f Sanguineous. *£ Serous. SYMPTOMS. Of the sanguineout.—Abolition of all the powers of sense and motion, accompanied with noisy or stertorous breathing; —flushed, and sometimes hvid countenance ;—prominence APOPLEXY. 145 and immobility of the eye, with dilated pupil;—foaming at the mouth ;—grinding of the teeth;—often a resolution of the sphincter muscles ;—the strength of circulation remaining unimpaired.—The attack is sometimes sudden, at others it is preceded by various symptoms denoting an affection of the brain ; such as—giddiness ;—head ache ;—haemorrhage from the nose ;—interruption of sight, or of hearing;—false asso- ciation of ideas,—faltering in speech,—loss of memory,— drowsiness,—numbness of the extremities.—It often termi- nates in paralysis, or the patient is seized with vomiting, and recovers after a profuse sweat. Of the serous.—The attack of serous apoplexy is, in gene- ral, more gradual than that of the sanguineous ; and is prece- ded by languor, debility, disposition to sleep, and often par- tial loss of sense. In the fit the pulse is weak, the face pale, and there is a diminution of natural heat. CAUSES. Predisposing.—A certain age: from the 50th to the 60th year.—Great obesity; especially if occurring in persons hav- ing a short neck and large head ;—indulgence in the luxuries of the table ;—suppression of usual evacuations ;—intense study ;—sedentary life ;—plethora, however induced. Exciting.—Violent exercise ;—passions of the mind; sud- den exposure to cold;—intense heat;—long stooping;—de- rangement of the stomach, or intestinal canal;—violent pas- sions of the mind ;—long-continued inspiration ;—excess in venery ;—overloading the stomach ;—the application of the fumes of certain narcotic and metallic substances; such as opium, alkohol, charcoal, mephitic airs, &c. • Proximate.—Pressure upon the brain by extravasated blood, distended vessels, tiimor, or other cause.—In many instan- ces dissection discovers no obvious cause. O 146 APOPLEXY. ©/ the serous. Predisposing.—The leucophlegmaticconstitution. All those causes inducing a debilitated state of the body ; such as de- pressing passions of the mind,—much study,—watching,— poor living, &c. Proximate.—The pressure of effused serum upon the brain. PROGNOSIS. Favourable.—The senses little impaired ;—The function of respiration not much affected;—haemorrhagy from the nose or haemorrhoidal vessels ;—diarrhoea.—The sanguineous is more dangerous than the serous ; the latter has often been removed by supervening fever. Unfavourable.—Protracted beyond the third day ;—the pulse becoming quick and hard ;—febrile heat;—redness of the eyes ;—dribbling of saliva from the mouth ;—deglutition con- tinuing impeded;—cold extremities ;—cold and clammy sweats. TREATMENT. *. ,. S To remove the cause producing pressure Indications. < . r ° * < t upon the brain. In the sanguineous. 1. By bleeding from the jugular vein and temporal artery. 2. The application of cupping-glasses to the neck. 3. Blisters, first to the back, afterwards to the head; then to the extremities. 4. Drastic purges. R. Extracti colocynthidis com- positi ^j. Calomelanos gr. iv. Fiat pilulae quatuor vel bolu3. Take Compound extract ofcolo- cynth 3'- Submuriate qf mercury gr. vi. Make four pills, or a bolus. APOPLEXY. Uf R. Tincturx sennae, Vini aloes, aa gss. Tincturae jalapii 3^- M. fiat haustus purgans. R. Gambogiae gr. v. Tincturas sennae composite Si- -------jalapii 3j. Fiat haustus catharticus. R. Vini aloes giij. Aquae purae g x. Fiat enema. R.Extracticolocynthidis com- positi 9j. Aqux ferventis gx. Coque per sextam horae par- tem, et liquori colato ad- huc tepido admisce Syrupi spinae cervinse gj, Fiat enema statim injicien- dum. R. Terebinthinae communis gss. Ovi unius vitellum. Decocti lini gx. Tere terebinthinam cum ovi vitello donee in misturam perfectam coeant; turn sen- sim adde decoctum,ut fiant enema. Take Tincture of senna, Aloeticwine, each gss. Tincture of jalap trij. Make a purging draught. Take Gamboge gr. v. Compound tincture of senna gi, ----- of jalap 31, Make a cathartic draught. Take Aloetic wine giij. Pure water gx. Make an injection. Take Compound extract of cola- cynth ^i. Boiling water gx. Boil for ten minutes—and to the strained liquor, while yet warm, add Syrup qf Buckthorn gi. Make an injection, to be ad' ministered immediately. Take Common turpentine gss. The white qf one egg. Decoction of flaxseed |x. Rub the turpentine with the white of the egg 'till perfect' ly incorporated—then gradu- ally add the decoction, and make an injection. 148 PALSY. 5. Sudorifics of antimonials and acetated ammonia. 6. If the disease take place soon after a full meal, an emetic, 7. Erect position of the body. Should this plan prove ineffectual, recourse should be had to the diffusive stimuli, recommended for the serous apoplexy, and for paralysis. In the serous. 1. By emetics of ipecacuanha and tartarized antimony, 2. By blisters applied to the head. 3. Sinapisms to the extremities. 4. Drastic purges. See Sanguineous Apoplexy. 5. Diffusive stimuli; as ammonia preparata, castor, assa* fcetida, valerian. 6. Electricity; the electric spark passed through the head ! 7. Errhines ; helleborus, pulvis asari compositus I 8. Mercury, rubbed on the extremities. PARALYSIS, OR PALSY. ' f Paralysis partialis; or paralysis of a certain mus- Icle, or set of muscles, only. ——— hemiplegia ; or total paralysis of one side of the body. I—----paraplegica; or paralysis ol one nali ol the body, taken transversely. . - i . venenata; from poisons. SYMPTOMS. An abolition of voluntary motion, or sensation, or both, in certain parts of the body only; often with sleep, and slow and soft pulse;—preceded, when not the consequence of FALSI'. 149 ipoplexy, by universal torpor; vertigo; sense of weight and pain in the head; loss of memory; sense of creeping, of numbness, of pricking, sometimes of heat, in the part after- wards to be paralyzed. CAUSES. Compression of the brain, from whatever cause ;—impair- ed nervous energy ; either in the part itself, or in its source, the sensorium commune ;—determination of fluids to the head, by the suppression of usual evacuations ;—certain poisons ; of which the most frequent is lead;—compression of the nerves in their course ;—apoplexy, and all the causes inducing it; see Apoplexy ;—irritation of the primae via;—rheumatism. DIAGNOSIS, From apoplexy.—It is distinguished from apoplexy by the loss of sense and motion being partial only; by the absence of stertor ; by the sunk pulse -, and other symptoms above mentioned. PROGNOSIS. Favourable.—Sense of pain and itching in the paralyzed parts;—returning sensation and motion.—A fever and diarr- hoea have restored sensation to parts paralyzed from causes acting upon the nerves only.—Youth, and previous strength of constitution. Unfavourable.—The parts being deprived of both motion and sensation ;—gradually wasting, and becoming dry and withered ;—convulsions ;—the paralysis of the left side is more dangerous than a similar affection of the right; and of the upper extremity than of the lower.—When the conse- quence of apoplexy, the disease usually proves difficult of cure. 01 150 PALSY. f To remove causes that are obvious, and the re- Indications. < by to restore sensation and motion to the par- / alyzed parts. If the accession of the fit be sudden, the patient of a ple- thoric habit, and the head much affected, bleeding from the jugular vein, and the treatment recommended for apoplexy. —If the disease occur in a debilitated constitution, in a pa- tient advanced in age, and where the head is little affected, the use of powerful stimuli will be proper; as, mustard-seed, —horse radish,—volatile alkaline salts, or spirits,—guaiacum, -r-electricity,—aether,—arnica flowers,—rhus radicans,—and toxicodendron. R. Seminis sinapeos albse 3j. Capiat aeger cochlearia duo minima bis terve die excy- atho aquae frigidae. R. Radicis raphani contusaegij. Seminis sinapeos albae, Radicis Valerianae, aa 3'j- ——rhabarbari incisae gss Infunde in Vini albi Hispanici ffoij. Saepe agitetur et coletur.usus tempore : cochlearia duo magna quarta quaque hora sumenda. R. Spiritus ammoniae compo- siti 3j. Tincturae cardamomi com- positae 3'ij. Aquae pimento 3XU- Fiat haustus sextis horis capi- endus, Take white -mustard seed gi. Let the patient take two tea- spoonfuls twice or thrice a day in a glass of cold water. Take Horse radish root bruised _ij- White -mustard seed, Valerian root, each Qy Rhubarb.—Sliced. Pour on jfjij. of Spanish white wine. Shake frequently, and strain for use, two spoonfuls every four hours. Take Compound spirit of am,' monia Xf\. Compound tincture of carda* monXfxy Water of Jamaica pepper 3xiJ- Make a draught to be taken en* ery six hours. PALSY. 151 R. Spiritus raphani composi- ti 3J. -------ammoniae foetids gutt. xx. Tincturae valerians volati- lis 3$s. Fiat haustus quarta quaque hora sumendus. R. Salis volatihs cornu cervi gr. vj. Spiritus aetheris vitriolici compositi 3SS- Misturae camphorae 3X1V- Syrupi zingiberis gj- Fiat haustus quartis horis ad- hibendus. R. Guaiaci pulverisati gr. vj. Tincturae guaiaci 3J- Pulveris Arabici^ij. Syrupi croci 3JSS' Aquae pimento 3xi'j- Fiat haustus sextis horis ca- piendus. R. Floris avnicae montanx gj. Aqux ferventis gx. Macera per horam in vase clauso et cola. R. Colati liquofls3xiij. Tincturx zingiberis 3'j- Syrupi ejusdem jj. Fiat haustus quartis horis su- mendus. Take Compound spirit of horse radish gi. Foetid ammoniacal spirit drops xx. . Volatile tincture of valerian 3ss. Make a draught, to be taken ev- ery four hours. Take Carbonate of ammonia gr. vi. Compound spirit of sulphuric tether 3SS- Camphorated mixture %x\v. Syrup of ginger Xf\. Make a draught, to be given every four hours. Take gum guaiac inpowdergr.vi. Tincture of---- Xi. Gum: Arabic in powder J^ij. Syrup of saffron 3'ss- Water of Jamaica pepper 3xiiJ- Make a draught, to be taken every six hours. Take flowers of Leopard's bane Boilingwater %x.—Macerate for an hour in a close vessel and strain. Take of this strainedHquorXfXii^. Tincture qf ginger 3lj. Syrup of------ 3i. Make a draught to be taken ev- ery four hours. 152 PALSY. The external application of stimulants. Friction with flour of mustard, or with the volatile lini- ment, Spanish flies, or turpentine. R. Farinx seminis sinapeos Take Flower of white mustard albx gj. Aceti communis gss. Aqux ferventis gj. Fiat embrocatio nocte mane- que applicanda. R. Linimenti ammonix miti- oris 3xij. Spiritus terebinthinx recti- ficati 3iy- Fiat embrocatio sxpe utenda. secd%i. Common vinegar gss. Boiling water gi. Make an embrocation, to be ap- plied night and morning. Take mild ammoniated Lini- ment Xxiy Spirits of turpentine "Xvr, Make an embrocation, to be used frequently. R. Linimenti ammonix forti- oris 3xrj- Spiritus terebinthinx recti- ficati 3iv. Fiat embrocatio nocte mane- que applicanda. Take strong ammoniated Lini- ment 3x'j- Spirits of turpentine 3.1V. Make an embrocation, to be applied night and morning. R. Linimenti saponis £x. Take Soap liniment "Xx. Tincturx cantharidis 3vj- Tincture of cantharides 'xy'i. Fiat linimentum sxpe uten- Make a liniment, to be usedfrs- dum. qutntly. R. Linimenti camphorx ^xij. Aqux ammonix jj. Fiat linimentum^ nocte mane- que utendum. Take Camphorated liniment 3xiJ- Water of arfemonia X)- Make a liniment, to be used night and morning. PAINTING. 153 The frequent and continued use of the flesh-brush. Blisters, in the direction of the nerves. Warm fomentations. Urtication ; or the irritatiHg the limb with nettles. Regular exercise. The warm and salt-water baths. Bath waters. Light, nutritive, and warm aromatic diet. In the paralysis arising from lead, Peruvian balsam, and balsam of copaiva;—mercury, as an alterative. ORDER II. ADYNAMI2E. CHARACTER. A diminution of the involuntary motions, either vital or natural. SYNCOPE, OR FAINTING. r- Syncope accidentalis. " Species, •s-------cardiaca. *- anginosa. SYMPTOMS. Remarkable anxiety about the heart, followed by a sudden deprivation of all the animal and vital powers and actions :. of pulse, of sense, and motion.—Sometimes the loss of sense is incomplete (~leipothymiaj, when the patient turns cold and pale, yet the pulse continues to beat, or rather to tremble, and respiration is just perceptible ;—at others ("asphyxiaJ not the smallest sign of life can be perceived; the face hath 154 FAINTING. a death-like paleness, the extremities are cold, the eyes shut, the mouth sometimes shut and sometimes open, the limbs flaccid, and the strength quite gone.—A recovery is announ- ced by deep and heavy sighs ; and is frequently accompanied with vomiting.—It sometimes terminates in epilepsy and con- vulsions. CAUSES. Predisposing.—Nervous irritability and delicacy of constitu* tion;—debility, however induced;—profuse evacuations, es- pecially of blood ;—violent passions of the mind ;—surfeits j —excessive pain;—organic diseases of the heart or large ves- sels. Proximate.'-Diminished action of the heart and arteries; or their total quiescence. TREATMENT. f 1. During the paroxysm, to excite the return j of the action of the heart and arteries. Indications, -s ^ In ^ interval t0 prevent the recurrence (. of the disease. The first indication requires, 1. Bleeding, when the disease has arisen from any other than adebiUtatingcause ;—-in that instance evacuations would be prejudicial. 2. Emetics, if the patient be capable of swallowing ;— more especially indicated in syncope arising from any cause of saburra.—Vomiting may be sometimes excited by tickling the fauces with a feather dipped in some stimulant liquor. 3. Acrid stimuli applied to the nose ; and taken internally,1 as soon as the capacity of swallowing returns ;—such as the ammonia preparata, and liquor volatilis cornu cervi. When syncope is induced by large evacuations of blood| diffusive stimuli are prejudicial. ANGINA PECTOniS. \5$ To fulfil the second indication, 1. The causes must be removed by which it was induced. —If debility, by tonics ; as bark, steel, &c.—antispasmodics. 2. Other remedies, adapted to the several causes above enumerated. When fainting fits are produced by organical affections of the heart, or neighbouring viscera, all that can be done is to palliate symptoms of fainting, and endeavour to remove the primary disease. Of Syncope Anginosa^ or Angina Pectoris, SYMPTOMS. Upon exercise, especially when walking up an ascent, and after a full meal, a sudden and violent pain across the chest, extending down the arm as far as the insertion of the deltoid muscle, accompanied with a sense of stricture, so acute as to threaten immediate destruction.—The patient is instantly obliged to stand still, and the moment he does so, all the symptoms vanish.—After repeated attacks of the disease, it is excited by slighter causes, and the paroxysms become more violent.—The pulse sinks, and becomes weak and irregular; —the countenance pale ;—cold sweats ;—constant cough ;— expectoration of viscid mucus ;—the patient becomes incapa- ble of lying down ;—at length a fit more violent than usual puts an end to his miserable existence. Jtt CAUSE. Ossification of the coronary arteries ,- yet many dissections have shown this not to be invariably attendant.—Ossification of the valves of the heart ;—morbid accumulation of fat;— incapacity of action in the heart; excited by every tiling l-5« ANGINA PECTORIS. which hurries the circulation, and accelerates the passage of the blood to the depraved organ ; as violent exertion, certain passionsof the mind, sneezing, coughing, strainingat stool, &c. Treatment. r 1. In the paroxysm, to alleviate the distressing , .-. . i symptoms above described. Indications. J ... , , P.. ,. 211. In the interval, to prevent the return of thedis- ^ ease. The symptoms are sometimes relieved, 1. By bleeding. Dr Parry recommends the patient to be laid in a recumbent position, and a small quantity only of blood drawn away. 2. Antispasmodics were employed by Dr. Heberden;— spiritus xtheris vitriolici;—opium. The combination of opium with vitriolic xther. 3. Emetics were administered by Dr. Pcrcival. 4. Carminatives, 5. Blisters. The return of the paroxysm is to be prevented, !. By removing all the exciting causes. 2. Diminishing plethora by abstemious living, and vegeta- ble diet. 3. Abstinence from every thing heating ; as spices, wines, and all fermented liquors. 4. Guarding against vehement emotions of the mind. 5. By issues, recommended by Drs. Smyth and Mtcbride. 6. Blisters to the chest. 7. Argentum nitratum, given by Dr. Cappe. 8. Arsenic, by Dr. Alexander. 9. Zincum vitriolatum, by Dr. Perkins. INDIGESTION. 15? DYSPEPSIA, OR INDIGESTION. SYMPTOMS. Want of appetite ;—distention of the stomach;—flatulent eructations ;—general debility, languor, and aversion to mo- tion ;—dejection of spirits ;—spasmodic pains in the region of the stomach ;—nausea ;—acid eructations ;—sometimes ru- mination ;—sense of oppression and sinking after eating ;— heart-burn;—irregularity of appetite ;—either obstinate cos- tiveness, or diarrhoea;—small slow pulse, quickened upon the slightest exertion ;—palpitation ;—flushed countenance, after a meal;—the tongue dry, and generally white in the morning ;—pale urine ;—cold extremities ;—sallow counte- nance ;—various affections of the senses ;—depraved vision, &c.;—pain in the head and breast;—dry skin ; sometimes, however, profuse diaphoresis or salivation ;—disturbed sleep, —frightful dreams,—hectic fever,—symptoms of hypochon- driasis. CAUSES. Every thing which debilitates the system in "general, or the stomach in particular;—narcotics ; as opium taken in immoderate quantities, spirituous liquors, tea, tobacco, &c. .—the frequent use of warm relaxing liquids ;—sedentary life ; —imperfect mastication ;—certain depressing affections of the mind;—too flatulent or farinaceous a diet;—excessive evacuations,—the too powerful operation of emetics and pur- gatives ;—diseases of the liver;—hysteria,—hypochondria- sis ;—aliment taken into the stomach in too large quantities ; excess in venery ;—exposure to moist and cold air;—defi- ciency in the secretion of bile, saliva, or gastric juice. DIAGNOSIS. From hypochondriasis.—See Hypochondriasis. P ^58 INDIGESTION. TREATMENT. f 1. To remove those causes which are obvious, and continue to operate. Indications.-^ 11. To palliate urgent symptoms. 111. To restore the tone of the stomach, and V, prevent the recurrence of the disease. The first and most important step to be taken in the cure of dyspepsia is to point out to the patient the indispensable necessity of removing such habits and pursuits as may have tended to give rise to the disease, and continue to aggravate it: until this has been effected, remedies will be found of no avail. The cure will then consist, 1. In the occasional exhibition of a gentle emetic, to re- move crudities from the stomach, indicated by nausea, sense of weight and oppression, and eructations of imperfectly di- gested food. 2. In correcting morbid acidity, by alkalies and absorbents alone, or united with laxatives. R. Aqux kali puri 3ij. —— calcis gvjss. M. cujus capiat xger coch- leare magnum bis indie ex poculo jusculi bovini. R. Misturx cretacex gjss. Spiritus myristicx 3'j- Syrupi zingiberis 3J. Hat haustus mane seroque sumendus. Take Water of carbonate *>f potash 3ij- Lime water gviss.—Mix. Let the patient take a spoonful twice a day in a bowl qf beef- broth. Take Cretaceous mixture giss. Spirit of nutmeg 3'ij. Syrup of ginger 51 ■ Make a draught, to be taken morning and evening. INDIGESTION. 159 R. Kali preparati ^jss. Myrrhx contusx X). Aloes socotrinx 3JSS- Croci ^ss. Aqux distillatx fly. Coque ad gxij. et liquori CO. lato adde— Tincturx cardamomi com- positx giv. Sit dosis cochlearia duo mag- na bis die. R. Rhabarbari in pulverem triti, Magnesix ustx, utriusque Corticis cinnamomi contusi 3J- Aqux ferventis gx. Magnesia et rhabarbaro prius rite contritis, in vase ido- neo macera, et liquorem cola, dein adde— Tincturx corticis aurantii Si- Sumanter cochlearia tria sin- gulis auroris. R. Aloes socotrinx, Pulveris rhabarbari.aa 3Jss Saponis Veneti 3ss. Syrupi zingiberis q. s. Fiat massa in pilulas l divi- denda, quarum sumat duas vel tres pro re nata. Take Carbonate of potash 3iss. Mytrh bruised ^i. Socotrine aloes X^ss. Saffron X^s. Distilled water f{=ji. Boil to gxij. and to the strained liquor, add Compound tincture of Carda- -mon giv. The dose is two table spoonfuls twice a day. Take Rhubarb in powder, Calcined magnesia, each tiij,, Cinnamon bruised 3i, Boiling water gx. Let the Rhubarb and magnesia be welfirubbed together, then macerate in a proper vessel —strain the liquor and add Tincture of orange peel gi. Let three large spoonfuls be ta- ken every -morning. Take Socotrine aloes, Powder of Rhubarb each X\ss. Venetian soap X^ss. Syrup of ginger q. s. Make a mass—divide into fif- ty pills, let two or three be taken when necessary. 3. In obviating costiveness by warm and gentle laxatives. 160 INDIGESTION. R, Pulveris rhabarbari gr. xij. Calomelanos gr. iv. Pulveris zingiberis gr. iv. Fiat pulvis aperiens. R.Extracti colocynthidis com- positx 9'ij. Pilulx galbani composite Fiat pilulx xviii. quarum su- mat tres pro re nata. Take Powder qf rhubarb gr. xij. Submuriate of mercury gr.x. Powder of ginger gr. v. Make an aperient powder. 'hake Compound extract of cslo- cynth ^i. Compound pills of galbanum 9y- Make xviij. pills. Let three be taken when necessary. R. Pilulx ex aloe cum myrr-i ha 3J. Extracti gentianx 3SS. Fiat pilulx xviij. quarum su- mat tres" pro re nata. Take pills of aloes with myrrh Si- Extract of gentian 3SS. Make xviij. pills. Let them be taken occasionally. R. Pulveris aloes cum ferro3j Take Powder of aloes with iron Extracti taraxaci 3Jss. Extract of dandelion 3iss. Fiat pilulx xxx. quarum su- Make xxx. pills.—Dose iij. mat tres pro dosi. 4. In relieving pain by demulcents, carminatives, antispas- modics, and opiates. R. jEtheris vitriolici 3SS- Tincturx opii gutt. xv. Aqux cinnamomi 3X- M. pro haustu in dolore su- mendo. Take Sulphuric nether 3ss. Tincture of opium drops XV. Cinnamon water 3X-—Mix- For a draught, to be taken du- ring the pain. INDIGESTION. 161 R. Pulveris tragacanthx com- positi 3J. Tincturx cardamomi com- positx gss. Confectionis aromaticx 3J- Aqux menthx piperitidis 3vlJ- Syrupi zingiberis gss. M. cujus sumat xger cochle- aria tria magna urgenti fla- tu vel dolore. R. Magnesix ustx 3j. Aqux calcis gvij. Tincturx cardamomi gss. Fiat mistura cujus sumat xger cochlearia tria magna in do- ' lore. R. Confectionis aromaticx^; Spiritus aetheris vitriolici compositi gss. Misturx camphorx gvij-. Syrupi zingiberis gss. M. sumantur cochlearia tria magna in do.lore. Take Compound powder oftra- gacanth Xf\. Compound tincture of cafda- mon gss. Aromatic confection 3i- Peppermint water gvij. Syrup of ginger |ss.—-Mix. Let the patient take three large spoonfuls when the flatus or pain is urgent. Take calcined magnesia x\. Lime water §vij. Tincture of cardamon gss. Make a mixture, of which let the patient take three large spoonfuls during the pain. Take aromatic confection Xi. Compound spirit of sulphuric tether gss. Camphorated mixture gviij■ Syrup of ginger gss.—Mix. Let three large spoonfuls, be taken during the pain. 5. In removing diarrhoea, should it accidentally occur, by absorbents ; and if the faeces be of an unnatural clay-like or whitish colour, by mercury, especially calomel. R. Confectionis aromaticx3ss Take Aromatic confection 3ss, Misturx cretacex 3x. Cretaceous mixture 5x. Tincturx opii gutt. x. Tincture of opium drops x. Fiat haustus urgenti diarrhoea Make a draught, to be taken Qapiendus. when the diarrhea proves troublesome, P2 162 INDIGESTION. R. Hydrargyri cum creta gr. x. Take Mercury with chalk gr. x. Fiat pulvis bis terve die su- Make apowder to be taken twice mendus. or thrice a day. 6. In restoring the tone of the stomach by bitters combi- ned with astringents and aromatics ; the mineral acids ; cha- lybeates ;—by universal temperature ; cold bathing;—by the use of mineral waters, more particularly those of Buxton and Seltzer;—by a diet consisting of light animal food, carefully avoiding the more indigestible foods and farinaceous vegeta- bles ;—by abstaining from malt liquor, and employing soda- water and toast and water, weak brandy and water, or water mixed with the least acescent wines, as Madeira or sherry, as common drink ;—and, lastly, by warm clothing, more es- pecially about the feet and legs. R. Quassix rasurx Xy Corticis aurantii Hispalen- sis 5JSS- Aqux ferventis jfoy Stent in vase aperto per horx spatium et cola.—Infusi co- lati capiat xger cochlearia quatuor bis quotidie. R. Radicis colombx, -------gentian x, -------calami aromatici, Corticis aurantii Hispalen- sis, aa x)'y Vini albi Hispanici j^ij. Infundantur per dies octo : hujus infusi capianturcoch- learia tres ter in die. Tate shavings qf quassia 3'. Rinds of Spanish oranges 3iss Boiling water J^i. Let them stand in an open ves* selfor an hour and strain.— The dose is four spoonfuls twice a day. Take Co\umbo root, Gentian — Sweet flag —— Rinds of Spanish orange;, each X\y Spanish white wine f[jij. Infuse for eight days.—Let the patient take three spoonfuls three times a day. VAPOURS, OR LOW SPIRITS. 163 R. Infusi gentianx compositi 3X- Natri preparati gr. v. Spiritus pimento, Tincturx colombx, aa 3J- Fiat haustus bis quotidie, je- jund ventriculo, sumendus. R. Elixir vitrioli acidi 3JSS- Tincturx cinchonx compa- sitx py M. capiat xger cochleare u- num vel alterum minimum bis in dies ex cyatho parvo. aqux purx. R. Vini ferri Jij. Tincturx colombx ^j. Infusi quassix xx. Fiat haustus ter in die sumen- dus. Take Compound infusion of gen- tian 7X> Carbonate of potash gr. v. Spirits of Jamaica pepper, Tincture ofcolumbo, each 3i. Make a draught, to be taken twice a day on an empty stomach. Take Sulphuric acid dilutedxAs* Compoundtincture of cinchona: liy—Mix. Let the patient take one or two tea-spoonfuls twice a day in a small glass of water. Take Wine of iron 3'j- Tincture of Columbo Xj. Infusion of quassia X,x. Make a draught to be taken three times a day. HYPOCHONDRIASIS ; VAPOURS, ORLOW SPIRITS. SYMPTOMS. Dyspepsia,—sense of heat and pain in the hypochondria ;__ languor,—listlessness,—want of resolution and activity,—dis- position to seriousness, sadness, and timidity as to future events ; an apprehension of the worst, and most unhappy state of them, and therefore upon slight grounds a dread of great evil.—Particular attention to health ; and, upon any un- usual feeling, a fear of imminent danger, and even death it- self.—In respect to all these feelings and apprehensions, the most obstinate belief and persuasion. 164 YAPOUjRS, OR LOW SPIRITS. Predisposing.—The melancholic temperament. Exciting.—All the causes of dyspepsia (see DyspepsiaJ ;— every sedative impression upon the mind. Proximate.—A torpid state of the brain and nervous sys- tem. DIAGNOSIS. From dyspepsia.—By the affection of the mind being great- er, that of the stomach less, than in idiopathic dyspepsia.— H)'pochondriasis occurs only in the melancholic tejnperament, at the middle period of life, and is increased as age advan- ces ;—dyspepsia chiefly occurs in the sanguineous tempera- "ment, at an early period of life, and is diminished by time. PROGNOSIS. Unfavourable.—The melancholic temperament exquisitely formed, as indicated, previously to the disease, by the usual mental and corporeal characteristics, when, not unfrequent- ly, it terminates in confirmed melancholia ;— combined with other diseases, which are aggravated by a diminished energy of the brain and nervous system ;—the long continuance of the disease often inducing scirrhus of the viscera, and vari- ®us cachectic affections. TREATMENT. f 1. To restore the energy of the brain and I nervous system ; and to obviate the morbid association of ideas, by which j the disease is characterized. [ 1L To remove the dyspepsia and other con- l^ comitant symptoms. The first indication can alone be accomplished by diverting the attention of the patient from his own feeling by change of scene ;—engaging his attention by new and interesting ob- jects ;—convival society;—various amusements and rusal CHLOROSIS. 165 Sports ;—moderate and regular exercise ;—gaining his confi- dence ; condoling with him rather than ridiculing his foibles; —and persuading him of a gradual recovery from his ideal illness, by some innocent medicaments regularly administer- ed. The second by: 1. The treatment laid down for the cure of dyspepsia. 2. Chalybeate mineral waters. 3. Tonics and antispasmodics ; particularly Peruvian bark^ —preparations of steel,— castor,—camphor,—valerian,—as.i safoetida,—opium. 4. Blisters, and sinapisms. 5. Mercurial purges. 6. Mercury, even carried so far as to effect the mouth, has been attended with much success. 7. Warm and cold bathing. 8. The mineral waters recommended for dyspepsia, and also Harrowgate water. 9. Light nutritive diet;—as common drink, wine and wa- ter, or brandy and water, should be substituted for malt li- quors. The violent pain in the head and stomach, to which hypo- chondriacs are subject, may be reheved by aether, musk, and opium, separately or combined. CHLOROSIS, OR RETENTION OF THE MENSES. SYMPTOMS. Heaviness;—listlessness to motion and fatigue on the least exercise ;—palpitations of the heart;— pains in the back, loins, and hips ;—flatulency and acidity in the stomach and bowelSj And many symptoms of dyspepsia. fiid chlorosis; The appetite is singularly depraved;—lime, chalk, and other absorbents, are greedily eaten, when the accustomed food is rejected. As the disease advances, the lips lose their colour ; the eyes are encircled with a livid areola ; the face becomes pale, assumes a yellowish hue, and the whole body has a leucophlegmatic appearance, with every indication of want of power and energy in the constitution. The feet are affected with oedematous swellings ; the breathing is hurried by the slightest exertion ; the pulse is quick but small; the patient is affected with various symptoms of hysteria, cough, and sometimes confirmed hectic fever. CAUSES. Debility or laxity of the constitution in general, and of the Uterine system in particular. TREATMENT. Indication*, f 1" To inviSOTate **« system in general. ill. To excite the action of the uterine vessels. To fulfil the first indication, 1. A nutritive diet, and the moderate use of wine ; regu- lar exercise on horseback, taking care not to induce fatigue j cheerful society. 2. An emetic of ipecacuanha, or white vitriol. 3. A gentle aperient, of aloes, myrrh, and bitters. R, Pilulx ex aloe cum myrrha 5J- Calomelanos gr. iij. Fiat pilulx xii. quarum su- mat xgra unam vel duas pro re nata. Take Pills of aloes with myrrh 5*- Submuriate of-mercury gr. x. Make xij. pills. Let the pa- tient take one or txto, ishen necessary. chlorosis. 167 R. Pulveris aloes cum ferro 3J- Saponis Hispanici ^ij. Syrupi zingiberis q. s. Fiat massa in pilulas xxiv. dividenda, quarum suman- tur dux alterna quaque noc- te. Take powder of aloes with ir&n Spanish soap ^ij. Syrup of ginger q. s. Make a mass to be divided inte xxiv pills. Let two be ta- ken every other night. R. Extracti gentianx, —----colocynthidis com- positi, aa Jss. Fiat pilulx xii. sit dosi dux pro re nata. Take Extract of gen tian, Compound —— of colocynth, each 3ss. Make xij. pills. Th e dose may 'be two when necessary. 4. Tonics, especially preparations of iron, either alone or joined with myrrh, quassia, gentian, and aromatics ; adding an alkali, where it is chemically admissible, to obviate cardi ■ algic symptoms : the best chalybeates are, the vitriolated iron, the muriated iron, ammoniacal iron, and tartarized iron. R. Myrrhx 3ij- Ferri vitriolati gr. xxiv. Kali preparati 3J. . Mucilaginis Arabici gss. Decocti glycirrhizx ferven- tis gxiv. Tincturae pimento gj. Myrrham et ferrum vitriola- tum cum kali preparato et mucilagine tere donee per- fecte commisceantur, dein gradatim adjice decoctUm et denique tincturam. Take Myrrh X,\y Sulphate of iron gr. xxiv. Carbonate of potash "x\. Mucilage of Gum Arabic g ss. Decoction of liquorice, ("boil- ingj gxiv. Tincture ofjamaicapepper gi_ Rub the myrrh, sulphate of iron and carbonate qf potash, with the mucilage, till they are perfectly incorporated, then gradually add the decoc- tion, and lastly the tincture. This mixture is an improved recipe on that of Dr. Moses Griffith ; and the following pills are the best substitutes when it cannot be taken in the fluid form : 16* chlorosis. R. Ferri vitriolati ^j. Myrrhx optimx, Natri preparati, aa ^ij. Fiat massa in pilulas xxiv. (vel mediocres) distribuen- da, quarum sit dosis dux ter in die. R. Ferri vitriolati gr. vj. Kali preparati gr. xij. Pulveris myrrhx 3ss. Aqux pimento gjss. Syrupi zingiberis gij. Fiat haustus ter in die sumen- dus. R. Ferri vitriolati gr. xij. Extracti gentian x cluri 3J- Pulveris aromatici 3ss. Fiat massa in pilulas xviii. dividenda, quarum capiat xgra duas ter in die, su- perbibendo haustulum infu- si alicujus amari. R. Ferri tartarisati 3j. Extracti chamxmeli 3JSS- Balsami Peruviani q. s. Fiat massa in pilulas xxxvi. dividenda, e quibus capiat xgra quatuor bis terve in dies. R. Tincturx feri muriati 3j. Cujus adhibeantur guttx sex ter quaterve die ex poculo alicujus liquoris idonei. Take Sulphate of iron ^i. Best myrrh, Carbonate qf soda, each 9'ij. Make xxiv pills, and let the patient take two three timet a day. Take Sulphate of iron gr. vi. Carbonate of potash gr. xij. Powdered -myrrh 3ss. WaterofJamaica peppergisB Syrup of ginger gij. Make a draught to be taken three times a day. Take Sulphate of iron gr. xij^ Hard extract of gentian "Xj.. Aromatic powder 3ss. Make a mass, to be divided in^ to xviiypillt. Let the pa- tient take two, three times a day, and drink some bitter infusion after them. Take Tartrite of potash and iron 3'. Extract of camomile 3'iss. Balsam qf peru q. s. Make a -mass, to be divided in- to xxxvi. pills. Let the pa- tient take four, twice or thrice a day. Take Tincture of muriate of iron Xji. Let six drops be given three or four times a day in a cup of any proper liquor. chlorosis. 169 R. Ferri ammoniacalisgutt. iv. Aqux cinnamomi 3X1J- Fiat haustus ter in die su- mendus. Take tincture of muriate of ammonia and iron drops iv. Cinnamon water 3Xlj- Make a draught to be taken three times a day. 5. Sea bathing, cold bathing, and the internal use of the Bath, Tunbridge-well, Pyrmont, or Spa waters. The other indication is best fulfilled, 1. By walking, jumping, dancing, frequent friction; pe- diluvium ; heat applied by steam, or otherwise, to the region •f the uterus. 2. By electric shocks through the pubic region. 3. By purges that act especially upon the rectum ; as aloes and scammony. R. Aloes socotrinx sj. Lactis communis gvj. Solve pro enemate bis in sep- timanis adhibendo. Take Socotrine aloes X\. Commonmilk^vi.—Dissolve For an injection, to be admin- istered twice a week. R. Scammonii pulverisati 3ss. Saponis Hispanici 7Jss. Aqux ferventis gviij. Fiatenema quartaquaque noc- te injiciendum. R. Tincturx aloes compositx gss. Pro dosi alternis auroris. R, Pulveris e scammonio cum calomelane jj. Syrupi zingiberis q. s. Fiat massa in pilulas xii. div- idenda, quarum tres pro dosi sumendx. Take Scammony in powder 3ss. Spanish soap 3iss. Boiling water gviij. Make an injection, to be used every fourth night. Take Compound tincture of aloes gss. To be taken every other morning. Take Powder of scammonywith submuriate of mercury X\. Syrup of ginger q. s. Make a mass, to be divided in- to xij. pills.— The dose is three. iro TETANUS. 4. By Spanish flies, hellebore, and savine. R. Tincturx cantharidis 3ij. Take Tincture ofcantharidcs%i} --------cardamomi Xfv. M. cujus sumat xgra guttas ex. vel cochleare minimum ter in die ex quovis vehicu- lo idoneo. cardamon "xyr. Mix.—Let the patient take _X drops three times a day in any proper drink. R. Extracti hellebori nigri Qj. Take Extract of black hellebore -------gentianx^ij. gentian ^ij. M. fiat pilulx xii. qauarum Make xij pills. Let two be ta* sumantur dux nocte mane- ken night and -morning. que. R. Pulveris myrrhx composi. Take Compound powder of ti 9ss. myrrh ^ss. Balsami PeruViani q. s. Balsam of peru q. s. Fiat bolus ter in die sumen- Make a bolus, to be taken three dus. times a day. 5. By inhaling two gallons of oxygen gas three times a day. ORDER III. SPASMI, OR SPASMODIC DISEASES. CHARACTER. Irregular motions of the muscles, or of the muscular fibres, TETANUS. SYMPTOMS. Sense of stiffness in the back part of the neck, rendering the motion of the head difficult and painful j—difficulty of TETANUS. 171 9wallowing j—pain, often violent, referred to the sternum, and thence shooting to the back ;—spasm of the muscles of the neck, pulling the head strongly backwards ;—rigidity of the lower jaw, which increasing, the teeth become so close- ly set together, as not to admit of the smallest opening, when the disease is called Trismus, or Locked yaw. If the disease proceed further, a great number of muscles become affected ; as those of the spine, bending the trunk of the body forcibly backwards ; in this state the tetanus is term- ed Opisthotonos ;—or forwards, when it constitutes the Emprosthotonos. At length every organ of voluntary motion partakes of the disease ;—the extremities are rigidly extended;—the abdo- minal muscles are strongly retracted ; hence costiveness and suppression of urine are generally produced ;—the eyes are immovable in their sockets ;—the tongue often protruded be- yond the teeth ;—the forehead is drawn up into furrows ; — the cheeks backwards towards the ears, and the whole coun- tenance exhibits the most shocking distortion.—The stiffened parts are affected with violent contractions, which occasion the most excruciating pain.—A remission of these occasion. ally takes place every ten or fifteen minutes, but they are re. newed, with aggravated torture, from the slightest causes, even the least motion of the patient, or the touch of an atten- dant.—At length one universal spasm puts a period to a most miserable state of existence. CAUSES. Remote.—The male sex;—robust and vigorous constitu- tion ;—warmth of climate. Exciting.—Vicissitudes of temperature ;—exposure to cold, united with moisture ; or to excessive heat;— injuries of nerves or tendons, by puncture or laceration ;—the presence of irritating substances in the stomach or alimentary canal ; — irritation of the extremities of the nerves j—affections of the mind. 172 TETANUS. PROGNOSIS Will ever be most unfavourable ; more so when the disease arises from injury of nerves than when proceeding from cold; __when it comes on suddenly, and quickly advances to a vio- lent degree, than when slow in its progress;—when the spasmodic contractions quickly succeed each other, and are excited by very slight causes, than when there is a consider- able interval, and the rigidity forms the chief of the disease. TREATMENT. To remove causes that are obvious. To allay the inordinate action of the brain and nervous system ; or to excite a new and powerful action, and thereby super" sede the original and morbid one. When the disease is the consequence of a puncture or small wound, it has been supposed to arise from the partial division of a nerve. In this case a free dilatation of the wound should be made.—If arising from local irritation, the nervous communication with the brain should, if practicable, be cut off. The second indication requires, 1. The most powerful antispasmodics, as opium with musk, camphor, and xther. R. Camphor*, Take Camphor, Moschi, aa 3SS. Musk, each 3ss. Fiat pulvis ex quovis vehiculo Make a powder, to be taken ev- idoneo capiendus omni tri- ery three hours, in any pro- horio. Per vehicle. Indications, i 1. 11. TETANUS. 173 R. Camphorx gr. viij. Moschi gr. vj. Pulveris opii gr. ij. Fiat pulvis secunda vel tertia vel quarta quaque hora su- mendus. Take Camphor gr. viij. Musk gr. vi. Powder of opium gr. ij.=vi.=_ xij. Make a powder, to be taken ev- ery two, three or four hours. R. Misturx camphorx fortio- ris gvij. Spiritus xtheris vitriolici compositi, Syrupi simplicis, aa gss. Tincturx opii 3J- M. sit dosis cochlearia tria magna. Take strong camphorated mix- ture gvij. Compound spirit of sulphur- ic tether, Simple syrup, each gss. Tincture of opium $i. =iij. = vi.—Mix. Let the dose be three tablespoon. fil*- _____ Take Sulphuric tether Xiy Strong camphorated mixture SviJ- Simple syrup gss. Make a mixture—The dose is three ordinary spoonfuls. 2. The cold bath, or affusion of cold water; successful ca- ses of the use of which are related by Dr. Cochrane, in the Medical Commentaries ; Dr. Wright, in the London Med- ical Observations ; Dr. Currie, in his Medical Reports ; and by others. 3. Mercury ; administered both externally and internally, so as to excite salivation.—It was also successfully employed by Dr. Clarke, as a. preventive after wounds and punctures. Peruvian bark; and wine in large quantities. This plan was found successful by Dr. Rush, in the Transactions of the American Philosophical Society; Dr Hossack, in the New-York Repository; and Dr. Currie, in his Reports. 0,3 R. i_theris vitriolici 3'j- Misturx camphorx fortio- ri s gvij. Syrupi simplicis gss. Fiat mistura:—dosis cochle- aria tria ordinaria. il74 THE EPILEPSY. 5. Alkalies and alkaline bath; a hot bath impregnated with kali or quick lime. Dr. Stutz, Medical and Physical Journal. 6. Meadow narcissus. Dr. Dufresnoy. 7. The tinctura ferri muriati has been successfully used, and the petroleum or oleum petrolei. EPILEPSIA, OR THE EPILEPSY. SYMPTOMS. Sudden loss of sense, and power of motion, so that, if the patient be standing, he immediately falls, or with convulsions is thrown to the ground, frequently with a violent ^y.—Dur- ing the fit there are strong convulsive motions of the limbs and trunk of the body, and spasms of the muscles of the face and eyes, producing various distortions of the countenance. —After a longer or shorter continuance of the convulsions, they cease altogether, and leave the patient motionless, still in a state of absolute insensibility, and under the appearance of a profound sleep.—The fit is frequently preceded by pain in the head,—lassitude,—some disturbance of the senses,__ unquiet sleep,—unusual dread,—noise in the ears,—palpita- tion of the heart,—coldness of the joints j—sensation of a cold air, the aura epileptica, arising in some part of the ex- tremities, and gradually creeping upwards, until it reaches the head, when the patient is instantly deprived of his sen- ses, and falls as above described. CAUSES. Predisposing.—Great irritability of the nervous system ;— hereditary predisposition. Exciting.—Mechanical, chemical, or mental stimuli; espe- cially the effects of joy and surprise ;—sudden fright;—fits of passion, or any vehement emotion of the mind;—plethora of the vessels of the head;—worms;—dentition;—acute pain 5 THE EPILEPSY. ItS —excessive evacuations;—suppression of accustomed dis- charges ;—tumors compressing the brain, or any part of the nervous system. DIAGNOSIS. From convulsion.—By its terminating in profound sleep ;— by the total abolition of the senses. From apoplexy.—By the voluntary motions in the one dis- ease being increased ; in the other, totally suspended. From hysteria.—-See Hysteria, PROGNOSIS. Favourable.—The disease being sympathetic, occurring be- fore the age of puberty, and arising from causes easy of re- moval;—there being no hereditary predisposition ;—an inter- mittent fever, or cutaneous eruption, has sometimes effected a cure. Unfavourable.—The reverse of the above. When the dis- ease comes on after the age of puberty, when it has arisen from an hereditary predisposition, or by frequent repetition has become confirmed, the probability of cure is slight; es- pecially where the memory and judgment have become im- paired. TREATMENT. f 1. To abate the violence and shorten the du- Indications.3 ration of the paroxysm. /ll. To prevent its recurrence. If there be symptoms of determination of bloodto the head, or if the patient be of a full plethoric habit, bleeding from the arm, jugular vein, or from the temporal artery. If, on the contrary, the presence of debility is obvious, the most powerful antispasmodics ;—sinapisms to the lower extremities;—anodyne and antispasmodic clysters—In gener- al little else can be done, during the paroxysm, than to use 176 EPILEPST. the necessary precautions to prevent the patient injuring him- self in the violence of the convulsions. R. Tincturx asafcetidx |ss. Take Tinctureqfasqfcetida%$s, --------opii3J. ------ opium 5L Aqux distillatx gviij. Distilled water gviij,. Fiat enema. Make an injection. The recurrence of the paroxysm is sometimes prevented, 1. By removing causes that continue to operate ; as worms, dentition, &c. &c. 2. By avoiding the occasional or exciting causes ; as, over- distension of the vessels of the head, however induced ;—fits of passion, or other violent emotions of the mind, &c. 3. If the paroxysm be preceded by the aura epileptica, it has been advised to apply bhsters or caustic to the part from which the sensation arises: to destroy the communication with the brain, by dividing the nerve, or by means of a liga- ture applied round the limb, will often be successful. 4. If the patient be of a plethoric habit, by occasional bleed- ing ;—abstemious diet;—issues or setons in the neck;—fre- quent purges, &c. 5. If weak and irritable, by tonics ; as cinchona,—zincura calcinatum arfd zincum vitriolatum,—cuprum ammoniatum, —cuprum vitriolatum ;—argentum nitratum. R. Pulveris cinchonx 3ss. Take powder of cinchona 3-ss. -------valerianx £)ss. ------ valerian ^ss. Fiat pulvis ter in die sumen- Make a powder, to be taken dus. three times a day. R. Tincturx cinchonx compo- sitx, —---- valerianx ammo- niatx, aa *j. Infusi quassix (3j. ad ffej.) 5xiJ- Fiat haustus ter in dies capi- endus. Take compound tincture of cin- chona, Volatile tincture of valerian, each X\. Infusion of quassia (~Xl. te the ib J 3x5i Make a draught, to be takej) three times a day. EPILEPSY. \Tt R. Zinci calcinati gr. vj. Extracti gentianx gr. iv. Syrupi zingiberis q. s. Fiat pilulx dux ter in die ca- piendx cum haustulo infusi chamxmeli. R. Zinci vitriolati gr. £. Extracti chamxmeli gr. x. Fiat pilulx dux ter in die su- mendx. R. Zinci vitriolati gr. j. Extracti cascarillx gr. viij. Olei essentiallis caryophyl- lorum aromaticorum gr .ij. Fiat pilulx dux ter in die su- mendx. R. Cupri ammoniati gr. ij. Conservx rosx gr. v. Fiat pilula ter quotidie capi- enda. R. Cupri vitriolati gr. ij. Conservx rosx 3J. Pilulx ex opio _)j. Optime misceantur inmassam in pilulas xxiv. dividendam, quarum capiat xger unam vel duas ter in die. R. Argenti nitrati gr. j. Conservx rosx gr. v. Fiat pilula ter in die deglu- tenda. Take oxyd of zinc gr. vi. Extract of gentian gr. iv. Syrup of ginger q. s. Make two pill*, to be taken three times a day, in a little camomile tea. Take Sulphate of zinc gr. \. Extract of camomile gr. x. Make two pills, to be taken three times a day. Take Sulphate of zinc gr. i. Extract ofcascarillagr. viij. Essential oil of cloves gr. ij. Make two pills, to be taken three times a day. Take Sulphate of copper and ammonia gr. ij. Conserve of rose* gr. v. Make a pill, to be taken three times a day. Take Sulphate of copper gr. ij. Conserve of roses X\. Opiate pill $i When well incorporated in a mass, divide into xxiv. pills. Let the patient take one or two, three time* a day. Take Nitrate qf silver gr. i. Conserve of roses gr. v. Make a pill, to be swallowed three time* a dayy m THE EPILEPSY. 6. By regular exercise. 7. By cold bathing. 8. By antispasmodics; as valerian, castor, musk, xther, Oleum animale, opium. R. Pulveris valerianx ^j> Take Powder of valerian'^u Tincturx valerianx ammo- Volatile tincture qf—— niatx, Syrupi corticis aurantii, a£ Syrup of orange peel, each gij. 3U- Aqux pimento 3xij. Water of Jamaica pepper 3xij- fiat haustus ter quotidie ad- Make a draught, to be given hibendus. three time* a day. Radicis valeriansincisxgj. Canellx albx contusx ^jj. Aqu x ferventis f^j. Macera per horas duas, dein cola. R. Hujus colaturx 3x1}. Tincturx valerianx 3J. Fiat haustus ter in die su- mendus. R. Castorei, ■'<■'' Moschi, aa gr. iv. Olei animalis gutt. ij. Fiat pilulx dux ter in die deg- lutendx,superbibendo haus- tulum aUcujus Uquoris ido- aei. Take Valerian root, cut%i. Canella alba, bruised Xj\\. Boiling water J^i. Macerate for two hour* and strain. Take ofthi* strained liquor 3 xij. Tincture of valerian Xf\. Make a draught, to be taken. three times a day. ^ake Castor, Musi, each gr. iv. Animal oil drop* ij. Make two pills, to be taken three times a day—drinking after them a draught of any proper liquor. THE EPILEPSY. 179 R. jEtheris vitriolici 3ss. Tincturx opii gutt. xv. Misturx camphorx 3x1]. Syrupi croci 3J. Fiat haustus ter in die sumen- dus. Take Sulphuric tether 33s. Tincture of opium drops xv. Camphorated mixture Xf&y Syrup qf saffron X}. Make a draught to be taken three times a day. 9. When the attack of the disease can be foreseen by cer- tain well-known feelings of the patient, an emetic given an hour before its approach has been known to prevent the fit; a large dose of opium also, or other powerful antispasmodic, administered in the same manner. Haustus emeticus communis. Common emetic draught. R. Tincturx opii gutt. xx-xl. Misturx camphorx 3xij. Syrupi rosx 3J. Fiat haustus. Take Tincture of opium drop* XX—XL. Camphorated mixture 3x*j" Syrup qf roses gi- Make a draught. R. Spiritus xtheris vitriolici compositi 3J- Tincturx opii gutt. xx—xl. Misturx camphorx 3xij. Syrupi croci 3j- Fiat haustus ineunte paroxys- mo capiendus. 10. By digitalis, particularly if there be an accelerated pulse, when it should be given in doses, gradually increased* until the pulse is influenced by it. 11. The rhus radicans, in the praise of which Dufresnoy and Hufeland have written, has occasionally cured epilepsy. 12. By the cicutaria, which is said by Dufresnoy to be use- ful. Take Compound spirit qf sul- phuric ather 31. Tincture of opium drop* xx-» XL. Camphorated mixture %xiy Syrup of saffron 3L Make a draught to be taken when the fit is coming on. 180 THE EPILEPSY. 13. The carbonate of potash is recommended by Dra. Mi< ehaelis and Wiedemann. 14. By mercury, as an alterative :— R. Calomelanos gr. £. Conservx rosx gr. v. Fiat pilula ter in die sumen- da. Take Submuriate of mercury gr. I—i. Conterve qf roses gr. v. Make a pill, to be taken three times a day. R. Pilulx ex hydrargyro gr. v. Take Mercurial pill gr. V. Fiat pilulx quavis nocte capi- Make a pill to be taken every enda. night. R. Calomelanos, Sulphuris antimonii precip- itati, singulorum gr. ss. Conservx rosx q. s. Fiat pilula ter in die sumenda. Take Submuriate of mercury, Prepared sulphuret of anti- mony, each gr. ss. Conserve of roses q. s. Make a pill, to be taken three times a day. £15. By the nux vomica, which has often been successful. R. Nucis vomicx contusx gj. Aqux ferventis Jj-y. Macera per horam, dein cola. R. Hujus infusi jxij. Tincturx cardamomi 3J- M. pro haustu ter quotidie oapiendo. Take Nux vomica, bruited 31. Boiling water Jfoi. Macerate for an hour and strain. Take of this infusion Xxiy Tincture qf cardamon 3L Make a draught, to be taken daily. R. Pulveris nucis vomicx gr. "j« Conservx rosx gr. v. Fiat pilula ter in die deglu- tenda. Take Powder qf nux vomica £*• "j- Conserve of rose* gr. v. Make a pill, to be taken three times a day. 16. By the internal use of arsenic. THE DANCE OF ST. VITUS. 181 R. Solutionis arsenicalis Di. Take Arsenical solution ("of Dr. Fowler gutt. iv.—vj. Fowler) drops iv—vi. Tincturx cinnamomi 3j. Tincture of cinnamon 31. Syrupi simplicis 3J. Simple syrup Xi. Aqux pimento 3xij. Water of Jamaica pepper 3xiJ- M. fiat haustus ter in die su- Make a draught to be taken mendus. three times a day, 17. By electricity. 18. By the viscus quercinus, or missletoe, recommended by Dr. Frazier. 19. By oxygen gas, extolled by Dr. Girtanner. 20. The gratiola officinalis, praised by Dr. Sommer, in his treatise De Virtute Gratiolx. 21. By change of climate and mode of life. CHOREA SANCTI VITI, OR THE DANCE OF ST. VITUS. SYMPTOMS. The disease is marked by convulsive motions, somewhat varied in different persons, but generally affecting the leg and arm of one side only.—The lower extremity is mostly first affected ;—there is a kind of lameness and imbecility in one of the legs ; and, though the limb be at rest, the foot is often agitated by involuntary motions, turning it alternately outwards and inwards.—In walking, the affected leg is sel- dom lifted as usual, but is dragged along, as if the whole limb were paralytic ; and when it is attempted to be lifted, that motion is unsteadily performed, the limb becoming ir- regularly and ludicrously agitated.—The motions of the arm likewise are variously performed, or it is drawn by convul- sive retractions in a direction contrary to that intended. R 182 ASTHMA. CAUSES. General weakness and irritability of the nervous system ; occurring between the tenth and fifteenth years of age.—It is induced by various irritations ; as teething, worms, offen- sive smells, poisons, affections of the mind, fright, horror, anger. PROGNOSIS. It is never attended with danger, unless very violent in de- gree, when fever supervenes, and it often kills : it passes not unfrequently into epilepsy. TREATMENT. location \ ^° *ncrease tne tone °f *ne muscular sys- ' tern. After the administration of an emetic and mild aperient, Tonics ; especially zincum vitriolatum,—cuprum ammoni- atum,—argentum nitratum, as recommended against epilepsy. Cold bathing, and electricity. Terror has sometimes effected a cure. The antispasmodics, and other remedies enumerated under 'ibe head Epilepsy. ASTHMA. SYMPTOMS. The attack is usually preceded by sense of fulness about the stomach,—lassitude,—depression of spirits,—drowsiness, smd pain in the head ; little, however, regarded by the pa- tient.—On the approach of the succeeding evening, a sense oftightness and stricture is perceived across the breast, with distressing straitness of the lungs, impeding respiration.— The difficulty of breathing continues to increase for some ASTHMA. 182 length of time ;—both inspiration and expiration are perform- ed slowly, and with a wheezing noise ;—the speech becomes difficult and uneasy ;—a propensity to coughing succeeds, fol- lowed by the most anxious difficulty of breathing;—the pa- tient is threatened 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 morbid- ly pale and shrunk.—These symptoms usually continue till towards the approach of morning, when a copious expecto- ration of mucus comes on, the breathing becomes less labo- rious and more full, the patient speaks and coughs with great- er ease, and, feeling every way relieved, soon falls asleep.— The dyspnoea and tightness across the chest remain for some days after the attack, and for several succeeding evenings an exacerbation occurs similar to that above described. CAUSES. Hereditary predisposition ;—cold and moist atmosphere ;-— sudden changes of temperature ;—retrocedent gout;—sup- pression of long-accustomed evacuations ;—intense study ;— certain fevers ;—irritation of the bronchial system by aerial acrimony or other causes ;—irritation of the stomach, uterus, or other viscera. Proximate cause.—Supposed to be spasm by Dr. Cullen ;— the presence of irritating causes according to Dr. Bree. DIAGNOSIS. The pathognomonic symptoms are, paroxysms generally coming on at night, in which there is frequent and extremely anxious respiration; together with a wheezing noise, and sense of tightness across the chest. PROGNOSIS. Favourable.—The disease occurring in an early period of life, and in an unimpaired constitution.—Arising from acci- dental causes, it is more easy of cure than when spontaneous, or the consequence of predisposition. 184 ASTHMA. Unfavourable.—The disease coming on at an advanced pe- riod of life ;—frequent return of paroxysms, and their long continuance;—symptoms indicating a tendency to phthisis pulmonalis, or to hydrothorax ;—anasarcous swellings of the lower extremities ;—paralysis of the arms ;—tremulous re- spiration ;—weak irregular pulse ;—syncope ;—palpitation of the heart;—paucity of urine ;—cold extremities.—It some- times has induced an aneurism of the heart and large vessels ; and not unfrequently terminates in pneumonia. TREATMENT. r ,. CI. To moderate the violence of the paroxysm. Indications. ■* ., _, . l J ill. To prevent its recurrence. The violence of the paroxysm, is moderated by, 1. Bleeding, where the habit is plethoric; the disease of no long standing ; the face flushed, &c.—On the contrary in elderly persons, where the disease has become habitual; or where the face during the attack is preternaturaUy pale and shrunk ; bleeding is inadmissible. It must be remembered, however, that the propriety of blood-letting in any species of asthma has been much doubt- ed ; and in those cases which appear to demand it, it is bet- ter to take away small quantities at intervals, in order to al- low the contractile power of the vessels to be exerted in pro- portion as the vessel loses its contents. 2. Gentle aperients, especially such as are recommended to obviate costiveness in dyspepsia at page 159 ; and antispas- modic clysters. R. Lactis asafoetidx |viij. Take Milk of asqfetida gviij. Fiat enema pro re nata ad- Make an injection to be given hibendum. according to circumstances. 3. The application of blisters to the chest. ASTHMA. 135 4. Antispasmodics :—opium ted; asafoetida, in cases where ing is obvious. R. Spiritus xtheris vitriolici compositi 3J Tincturx opii gutt. v. Misturx camphorx fortio- ris 3xiij. Syrupi corticis aurantii 3J- Fiat haustus quarta vel sexta quaque hora sumendus. , vitriolic xther, or both uni- spasmodic difficulty of breath- Take Compound spirit of sul- phuric tether X\. Tincture of opium drops x. Strong camphorated mixture 3xiiJ- Syrup of orange peel X\. Make a draught, to be taken every fourth or sixth hour. Take Sulphuric tether dropsXXX. Tincture of opium, —— X. Camphorated mixture 3xiij> Syrup qf saffron XJi. Make a draught, to be taken every fourth or sixth hour. S. Expectorants, where expectoration is difficult, of squills, —tartarized antimony,—and ammoniacum ;—tinctura nico- tianx, in nauseating doses. R. Aqux ammonix acetatx gss. —— menthx sativx 3X- Vini antimonii tartarisati gutt. xv. Syrupi simplicis 3J. Fiat haustus quartis vel sex- tis horis sumendus. R. jEtheris vitriolici gutt.xxx. Tincturx opii gutt. v. Misturx camphorx 3XUJ- Syrupi croci 3J- Fiat haustus quartis vel sex- tis horis capiendus. Take Water of acetite of am- monia gss. ■ of spearmint X^x. Antimonial wine drops xv. Simple syrup Xji. Make a draught to be taken ev- ery four or six hours. R, Lactis ammoniac! 3v. Take Lac ammoniac Xy. Aqux menthxpiperitidis gx Peppermint water Xx. Tincturx scillx gutt. x. Tincture of squills drops X. Fiat haustus sextis horis- ca- Make a draught, to be taken piendus. every six hours. R2 186 ASTHMA. R. Lactis ammoniaci, ——— asafoetidx, aa 3iv- Aqux cinnamomi 3VJ- Fiat haustus sextis horis ad- hibendus. R. Pilulx e scilla gr. X. Fiat pilulx dux octavis horis capiendx. R. Pilulx e scilla gr. vj. Pulveris digitalis gr. f. Fiat bolus sextis horis sumen- dus. R. Aqux ammonix acetats 5UJ- Misturx camphorx Xx. Tincturx nicotians gutt. XXV. Syrupi croci 3j. M. pro haustu ter in die su- mendo. R. Aceti scillx 3j. Spiritus xtheris nitrosiZij. Mellis acetati gss. Aqux menthx sativx gvj. Fiat julapium de quo capiat xger cochleare unum mag- num urgenti tusse vel dy- spnoea. 6. Pediluvium, and the wa: 7. Coffee. Take Lac ammoniac, —— ttsafetida, each jiv. Cinnamon water %yi. Make a draught, to be taken every six hour*. Take Squill pill gr. X. Make two pills to be taken eve- ry eight hours. Tate Squill pill gr. vi. Powder of purple foxglove gr. \. Make a bolus, to be taken every six hours. Take Water of acetite of am- monia 3iij- Camphorated mixture 3X. Tincture of tobacco drops xxv. Syrup of saffron X\.—Mix For a draught, to be taken three times a day. Take Vinegar of squills Xl. Nitrous tether 31J. Acetated honey gss. Water of spearmint gvi. Make a julep, qf which let the patient take a table spoonful when the cough and dyspnoea are urgent. n bath. HOOPING-COUGH. 18f The recurrence of the paroxysm is prevented, 1. By avoiding the exciting causes. 2. By issues, or occasional blisters. 3. Gentle aperients of rhubarb, manna, and magnesia. 4. Emetics, given a short time before the expected parox- ysm, have in some instances prevented its attack. 5. Diaphoretics, particularly the pulvis ipecacuanhx com- positus. 6. Expectorants ; as squills,—ammoniacum,—myrrh,—an- timonium tartarisatum,—a decoction of seneka. 7. Opium combined with a diaphoretic. 8. Digitalis. 9. Oxygen gas. 10. Inhaling the vapour of xther. 11. The smoking or chewing of tobacqp. 12. The occasional use of stomachic bitters and absorbents; Peruvian bark, chalybeate waters, and other remedies re- commended for dyspepsia.—The flatulence accompanying asthma is often relieved by a small portion of acetous acid. 13. Light and nutritive diet; avoiding flatulent and indi- gestible aliment. 14. Warm clothing. 1. Regular exercise; on horseback, or by swinging or sailing. 16. Removal from a cold to a warm climate. PERTUSSIS, OR HOOPING-COUGH. SYMPTOMS. The disease comes on with slight difficulty of breathing, thirst, quick pulse, hoarseness, cough, and all the symptoms of common catarrh.—In the second or in the third week af- ter the attack, it puts on its peculiar and characteristic symp- 188 HOOPING-COUGH. toms.—The expiratory motions, peculiar to coughing, are made with more rapidity and violence than usual; and, after several of these expirations thus convulsively made, a sud- den and full inspiration succeeds, in which, by the air rush- ing through the glottis with unusual velocity, a peculiar sound is caused, which has obtained the name of hoop.— When this sonorous inspiration has happened, the convulsive coughing is again renewed, and continues in the same man- ner as before, till a quantity of mucus is thrown up from the lungs, or the contents of the stomach are evacuated by vom- iting, which generally terminates the fit: the patient is then most frequently enabled to return to the amusements he was employed in before its accession, and often expresses a desire for food; but when the attack has been severe, it is succeed- ed by much fatigue, hurried respiration, and general languor and debility.—After a longer or shorter continuance of the disease, the paroxysms become less severe, and at length en- tirely cease.—In some instances it has, however, been pro- tracted for several months, and even for a year. CAUSES. Children are most commonly the subjects of the disease ; and it is supposed to depend on a specific contagion. DIAGNOSIS. It is distinguished from every other disease by the convul- sive cough, followed by the peculiar sonorous inspiration above described; and terminating in vomiting or expectora- tion. PROGNOSIS. Favourable.—Moderate and free expectoration;—the strength little impaired;—the fits neither frequent nor violent;—in the interval, the respiration free ;—the appetite good;—the ah* seuce of fever;—moderate hxmorrhage from the nose. HOOPING-COUGH. 18& Unfavourable.—The disease occurring in children under two years of age ;—in children born of phthisical or asthmat- ic parents ;—much fever, with symptoms of pneumonia;— very copious or scanty expectoration ;—great debility;—con- vulsions. TREATMENT. f 1. In the early stage of the disease, to mod- erate its violence, and to palliate urgent symptoms. Indications. -( n, in the advanced period, to interrupt its course ; and put a stop to the disease sooner than it would have spontaneously ^ ceased. The first indication is to be effected by, 1. Bleeding;—if there be much pyrexia, or great difficulty of breathing, especially by leeches to the chest. 2. Emetics and nauseating medicines ; of tartarized anti- mony, in divided doses. R. Vini antimonii gij. Fiat haustus emeticus. R. Vini ipecacuanhx gss. Fiat haustus emeticus. Take Antimonial wine 3ij. Make an emetic draught. Take Ipecacuan wine gss—gj. Make an emetic draught. R. Aqux ammonix acetatx g j. Vini antimonii tartarisati 3;J- Aqux menthx sativx gvss, Mellis acetati gss. M. cujus capiat xger coch- leare unum magnum quar- tis vel sextis horis. Take Water of acetite qf am- monia gi. Wine of antimony Sij. Water of spearmint gvss. Acetated honey %ss.—Mix. Let the patient take a table spoonful every four or six hours. 190 THE WATER-BRASH. R. Aceti scillx jij. Take Acetite of squills "X\y Mellis acetati gij. Acetated honey gij.—Mix. M. cujus sit dosis cochleare The dose is a tea-spoonful fre- minimum subinde. quently. R. Succi cicutx spissati gr. Take Spissated juice of hemlock j—iv. gr. i—iv. Fiat pilula quavis nocte su- Make a pill, to be taken every menda. night. 3. Gentle laxatives of senna, manna, and the like. 4. Blisters to the chest. 5. Inhaling the steam of hot water; alone, or medicated with xther. 6. Tepid bath ;—pediluvium. 7. Tinctura cantharidis ; alone, or united with tinctura opii camphorata; and so administered as to produce a slight de- gree of strangury. The second indication is to be fulfilled, 1. By tonics; Peruvian bark, preparations of steel and zinc,—arsenic, proportioning the dose to the age of the pa- tient. 2. Antispasmodics; opium,—musk,—asafoetida,—amber, —castor, administered in like manner. 3. Narcotics ; as, cicuta,—hyoscyamus,—aconite,—bella- donna,—digitalis. A grain of the extract of cicuta and hyo- scyamus may be given every six hours, and a quarter of a grain of the others, and gradually and cautiously increased. 4. Change of air. PYROSIS, OR THE WATER-BRASH. SYMPTOMS. The disease usually comes on in the morning or forenoon, When the stomach is empty; commencing with ardent pain THE WATER-BRASH. 191 at the pit of the stomach, with sense of constriction, as if that organ were drawn towards the back.—The pain is in- creased by an erect position, and therefore the body is bent forward.—After a short time an eructation takes place of a thin watery fluid in considerable quantity ; sometimes of an acid taste, often quite insipid.—The eructation is frequently repeated and at length gives relief to the pain, and puts an end to the fit. CAUSES. Predisposing.—It principally attacks those of a middle age ; females more frequently than males ; and generally the un- married ;—people in low life, who live much on milk and a farinaceous diet, rather than those in better condition ;— fluor albus. Exciting.—Application of cold to the lower extremities ;— violent emotions of the mind. Proximate.—Spasm of the muscular fibres of the stomach, its blood vessels and exhalants. TREATMENT. Pyrosis requires the removal of the exciting causes, and the exhibition of antispasmodics, especially xther,—opium,— musk,—castor,—volatile alkali,—nux vomica,—the smoaking or chewing of tobacco,—and the occasional use of the mine- ral alkali with absorbents, which should be given as recom- mended in the treatment of dyspepsia, 192 THE COLIC* COLICA, OR THE COLIC. rl. Colica spasmodica; with retraction of the navel, and spasms of the abdominal muscles. 2.-----stercorea, in persons subject to costiveness af- ter long-continued constipation. 3. —----accidentalis, from acrid matter in the intes- tines. •{ 4. -----pictonum ; a sense of weight in the lower belly, colic pains, continual, with pain in the arms and back, ending in palsy. 5.-----meconialis, in new-born children. 6. - calculosa, with a fixed hardness in a particalar part of the abdomen ; calculi ejected by the anus. \J7.-----verminosa, from worms. SYMPTOMS. Violent pain and distention of the abdomen, attended with a peculiar sense of twisting or wringing around the navel; which, with the teguments of the belly, is frequently drawn inwards : and often the muscles are spasmodically contracted in separate portions, giving the appearance of a bag full of roundballs.-Obstinate costiveness;—frequently there is abitter taste in the mouth ;—thirst {—slight febrile heat, and other symptoms, which indicate the presence of bile in the alimen- tary canal;—frequently there are hiccup, and flatulent eruc- tations,—Vomiting in some cases continues frequent and bil- ious ; and in some instances stercoraceous matter is thrown up, when generally a high degree of inflammation follows, and the disease is called Ileus, and also Volvulus. causes. Cold applied to the surface of the body, especially to the lower extremities and abdomen;—austere, acid, or, indi- gestible aliment;—redundance of acrid bile ;—collections of indurated fxces, or of calcareous concretions, in the alimen- tary canal j—flatus ;—certain metallic poisons, as lead ;— THE COLIC. 193 hysteria ;—translation of gout;—the imprudent use of as- tringents in diarrhoea and dysentery;—all these increased by a constitutional irritability of the intestines. Another exciting cause of colic to be noticed in this place, is WORMS. The human primx vix are infested by five kinds of worms. 1. Ascaris vcrmicularis : the small white thread, or maw- round worm. 2. Ascaris lumbricoides: the lumbricus teres, or long worm. 3. Trichuris : the long hair-tailed thread worm. 4. Txnia osculis marginalibus ; the solium, or tape-worm. 5. Txnia osculis superficialibus : the broad tape-worm. The ascarides have usually their seat in the rectum ; the lumbrici occupy the small intestines, and sometimes the sto- mach ; the trichurides the cxcum ; the txnix the whole tract of the intestines, more especially the ileum. Worms mostly produce symptoms of colic, and very fre- quently other symptoms ; as variable appetite ;—fetid breath ; —picking of the nose ;—hardness and fulness of the belly ;— sensation of heat and itching in the anus ;—preternaturaUy red tongue, or alternately clean and covered with a white slimy mucus ;—grinding of the teeth during sleep ;—short dry cough ;—frequent slimystools;—emaciation;—slow fever with an evening exacerbation ;— irregular pulse ;—sometimes convulsion fits. Worms appear more frequently in those of a relaxed habit; —those whose bowels contain a preternatural quantity of mu- cus or slimy matter ;---in those who live on vegetable food : — in the dyspeptic ;-• -the eating of unripe fruit is a frequent cause of their production. They are evolved from ovula that exist in the human body, and in no other situ.ition. For further information on this subject, consult " An Attempt to an Arrangement of human in- S 194 THE COLIC. 0 testinal Worms," published by the author in the fifth volume of the Memoirs of the London Medical Society. Ptoximate causes of colic—Spasm of some part of the ali- mentary canal. DIAGNOSIS. From enteritis.—By the peculiar twisting pain, and retrac- tion of the navel;—by the absence of fever, in the early part of the disease ;—by the pain in enteritis being increased, in colic alleviated, by pressure ;—by the irregular contraction of the abdominal muscles. The same characteristic symptoms distinguish it from in- flammation of other abdominal viscera, PROGNOSIS. Favourable.—The pain remitting or changing its situation j —discharges of wind and fxces, followed by an abatement of symptoms. Unfavourable.—Violent fixed pain ;—obstinate costiveness ; —sudden cessation of the pain, followed by more frequent hiccup, great watchfulness, delirium, syncope, cold sweats, weak tremulous pulse ;—the pulse becoming peculiarly hard —see Enteritis ; and the pain before relieved, now much in- creased, upon pressure ;—volvulus :—all the symptoms indi- cating supervening inflammation and mortification, from the accession of which the chief danger arises. TREATMENT. To relax the spasm. To remove the causes, and procure evacu- ations. The first indication requires, 1. Bleeding, if the concomitant strength of constitution and fulness of vessels, with strong pulse, are present; but it is seldom necessary. S1' Indications. < 11. THE COLIC. 195 2. Carminatives and antispasmodics ; opium in large doses, cordial and opiate confection, cardamoms, &c. R. Confectionis aromatic»3ss Pulveris rhabarbari gr.xviij Aqux menthx piperitidis 3xij- Tincturx cardamomi 3Jss, Syrupi zingiberis 3J. Fiat haustus. R. Tincturx cardamomi com- positx, 3HJ. ——----opii gutt. xx. Syrupi croci 3J. Aqux menthx piperitidis 3XU Take Aromatic confection Xfi*. Rhubarb in powder gr. xviij. Peppermint water 3x'j- Tincture of cardamon ^i33- Syrup of ginger 31. Mate a draught. Take Compound tincture of car- damon giij. Tincture of opium drops xx. Syrup of saffron X\. Peppermint water 3x'j- Make a draught. R. Confectionis opiatx ^ss. Olei essentialis carui gutt.ij Pulveris rhxi q. s. Fiat bolus. Take Opiate confection ^ss. Essentialoilqf caraway drops ij Powder of rhubarb q. s. Make a bolus. 3. Warm bath; semicupium, and fomentations to the ab- domen. 4. Blisters, and warm plasters. £i Opiate clysters. 6. If there be great irritation of the stomach, with fre- quent vomiting, the saline medicine in an effervescing state. 7. Colic from the presence of flatus is often relieved by some aromatic cordial, or a small portion of brandy. Evacuations must be procured, 1. By cathartics ;—at first by the more mild ; as rhubarb, magnesia, natron vitriolatum, oleum ricini: if these prove ineffectual, calomel united with extractum colocynthidis com. positum, especially where there has been bilious vomiting. 196 THE COLIC. R. Pulveris rhabarbari 3j. Magnesix albx 3JSS- Tincturx sennx gss. Infusi sennx gvj. Syrupi zingiberis gss. Fiat mistura cujus absumat xger cochlearia tria magna omni bihorio donee alvus purgetur. R. Natri vitriolati gj- Infusi sennx giv. Tincturx sennx gij. Syrupi zingiberis gss. Fiat mistura cujus capiat xger partem tertiam omni bihorio donee alvus probe respondeat. R. Calomelanos gr. xij. Extracti colocynthidis com- positi 3j. Fiat massa in pilulas xii. xquales distribuenda, qua- rum capiat xger duas se- cunda quaque hora, donee alvus bis terve respondeat, superbibendo cochlearia tria magna hujus misturx : R. Kali tartarisati 3'ij. Infusi sennx gvj. Tincturx ejusdem, Syrupi corticis aurantii, aTi 3ss. Fiat mistura. Take powder of rhubarb Q. Carbonate qf-magnesia 'Kiss- Tincture of senna gss. Infusion qf ---• gvi. Syrup of ginger gss. Make a mixture. Let the pa- tient take three table spoon- fuls every two hours, till it purges. Take Sulphate of soda, gi. I'fusion (f ser.r.a giv. Tincture of---■ gij. Syrup of ginger gss. Make a -mixture. Let the pa- tient take a third part every two hours, 'till it operate* freely. Take Submuriate of mercury gr. xij. Compound extract of colo- cynth Xj.. Make a mass to be divided into xij equal pills, qf which let the patient take two, every two hours, 'till two or three stools are procured. Drink- ing after each dose three ta- ble spoonfuls of the following mixture .- Take Tartrite of potash "Zjy Infusion of senna gvi. Tincture of —— Syrup of orange pee I,each g l« Make a mixture. THE COLIC. 197 • 2. Copious clysters ; the common emollient, or with colo- cynthis, or the purging salts.—A copious injection of cold water has in some instances been followed by the desired ef- fect.—Should these be unsuccessful, recourse may be had to the injection of an infusion of tobacco. 3. Cold water dashed upon the extremities ; or ice, snow, &c. applied in a cloth, or bladder, to the abdomen, have sometimes procured evacuations, in cases where every thing else had been unsuccessful. 4. Indurated fxces in the rectum are at times to be remov- ed only after being previously broken down with the finger, or. with an appropriate instrument. Of the colica pictonum. The colic induced by lead, is more obstinate, and longer protracted, than the same disease brought on from common causes ; and most frequently terminates in paralysis of the wrists and upper extremities. Treatment.—Oleum ricini, often repeated, is most effect- ual in procuring stools ; afterwards, mercury united with opi- um, to excite slight salivation ;—alum ;—electricity ;—chaly- beate and sulphureous waters ;—sinapi. R. Calomelanos gr. |-. Take Submuriate of mercury gr l Pilulx ex opio gr. ijss. Opiate pill gi-. ijss. Fiat pilula ter in die sumenda. Make a pill to be taken three times a day. R. Calomelanos gr. i- Take Submuriate of mercury gr. i—i. Sulphuris antimonii prxcip- Prepared sulphuret of ami- itati gr. £. moJly gr. |._i. Conservx rosx gr. v. Conserve of roses gr. v. Fiat pilula ter in die capienda. Make a pill to be taken three times a day, S 2 198 THE COLIC R. Aluminis purificati ^ss Infusi rosx 3xij. Syrupi ejusdem 3J. Fiat haustus ter in die su- mendus. Take Sulphate of alum and potash ^ss. Infusion of rose* 3XU- Syrup of ---- 3i. Make a draught to be taken three times a day. Of colica verminosa. 1. The most esteemed remedies against ascarides and tri- churides are purgatives of calomel, scammony, aloes, rhu- barb, spigelia, dolichos, stannum; also asafoetida, lime-wa- ter, tobacco. R. Calomelanos gr. ij.—vj. Take Submuriate of mercury gr. ij—vi—x. Pulveris rhabarbari 9j. Powder of rhubarb $i. Fiat pulvis ex melle sumen- Make a powder, to be taken in dus. honey. R. Pulveris e scammonio cum T^e powder of scammony with calomelane gr. x-xv. submuriate of mercury gr. x.—xv. Fiat pulvis ex quovis vehicu- Make a powder to be taken in lo crasso sumendus. honey. R. Aloes socotorinx, Extracti tanaceti, aa -zss. Olei essentialis rutx gutt xij. Fiat pilulx xii. quarum sumat xger duas nocte maneque. Take Socotorine aloes, Extract of tansey, each 38s. Essential oil of rue drops xij. Make xij pills, let the patient take two night and morning. R. Herbx spigelix 3vj. Aqux ferventis fly. Macera per horas duas. Take Indian pink £vi. Boiling water fjji. Macerate for two hours. THE COLIC. 199 R. Hujus infusionis rxi'y Tincturx cardamomi 3j. Syrupi zingiberis 3J- Fiat haustus nocte maneque capiendus. Take of this infusion 3xij. Tincture of cardamon XX. Syrup of ginger 31. Make a draught to be taken night and morning. The dolichos pruriens is best prepared by Mr. Chamber- laine, of Aylesbury Street, Clerkenwell, and sold with pro- per directions. R. Aqux calcis f^j. Fiat enema omni nocte inji- ciendum. Take Lime water j^i. Make an injection to be admin- istered every night. i"J- Take Milk qf asaftxtida giij. Cow's milk 5v. R. Lactisasafoetidx ------vaccini gv. Fiat enema tertia quaque ves- Make an injection to be given peri adhibendum. eveU third evening. R. Foliorum nicotianx 33s. Take Tobacco leaves^sa. Aqux ferventis gx. Boiling water gx. Cola liquorem frigefactum Strain the liquor when cold for pro enemate. an injection. R. Limaturx stanni gj, Electuarii e senna gij. Syrupi zingiberis q. s. Fiat electuarium molle, de quo sumantur cochlearia duo minima quovis mane. R. Camphorx 3J. Olei olivx §ij. Solve pro enemate urgente ani prurigine adhibendum. Take filings of tin ?i. Electuary of senna gij". Syrup qf ginger q. s. Make a soft electuary qf which let the patient take two tea- spoonfuls every morning. Take Camphor X\. Olive oil gij. Dissolve for an injection, to be given when the itching at the anus is urgent. 200 THE COLIC. A decoction of the geoffrxa biennis, or cabbage-bark, is a remedy much used, according to Dr. Wright, in the West- Indies. 2. Against the txnix most drastic purges have been resort- ed to. Madame Noufer's remedy is occasionally used with success. She directs as follows : The day before the patient is to take the remedy, he is to avoid all aliment after dinner, till about seven or eight o'clock at night, when he is to take a soup made thus : Take a pint and a half of water, two or three ounces of good fresh butter, and two ounces of bread cut in slices ; add to this salt enough to season it, and then boil it over the fire to the consistence of panada. About a quarter of an hour after this, she gives him a bis- cuit and a glass of white wine, either pure or mixed with water 5 she even gives water alone to those who have not been accustomed to wine. If the patient has not been to stool that day, or is naturally costive (which is not usual, howev- er, with patients in this way), Madame Noufer directs the use of a clyster : Take a handful of the leaves of mallows, and boil them in a sufficient quantity of water, mixing with it a little salt, and when strained off, add two ounces of oih Early the next morning, about eight or nine hours after the supper, the patient takes the following specific : Take two or three drachms of the male fern, gathered in autumn, and reduced to a very fine powder, in four or six ounces of water distilled from fern, or the flowers of the lime- tree. It will be right for the patient to drink two or three times of the same water, rinsing his glass with it, so that none of the powder may remain either in the glass or his mouth, in bed; and to avoid the nausea which this medicine sometimes occasions, it will be right for him to chew lemon, or some- thing else that is agreeable to him, or he may wash his mouth CHOLERA MORBUS. 201 with any thing he likes, but he must be careful not to swal- low any thing. He may likewise smell to vinegar, to check the sickness ; but if, notwithstanding all his efforts, the nau- sea continues, and he is obliged to throw up the specific, it will be right for him to take a fresh dose of it as soon as the sickness is gone off, and then he should try to go to sleep. About two hours after this he must get up, and take a pur- ging bolus. Take of the panacea of mercury fourteen times sublimed, and select resin of scammony, each ten grains ; of fresh and good gamboge 6ix or seven grains : reduce each of these sub- stances separately into a powder, and mix them with some conserve into a bolus. This is to be taken at one or two different times, washing it down with one or two dishes of weak green tea, the pa- tient walking afterwards about his chamber. When the bolus begins to operate, the patient is desired to take a dish of the same tea occasionally, until the worm is expelled; then, and not before, Madame Nouffer gives him broth or soup, and he is directed to dine as is usual after ta- king physic. After dinner he may either lie down or walk out, taking care to conduct himself discreetly, to eat little sup- per, and to avoid every thing that is not of easy digestion, CHOLERA MORBUS. Cholera spontanea, occurring in warm weather without any manifest cause. ------accidentalis, from acrid matter in the stomach and intestines." SYMPTOMS. Nausea, pain, anil distention of the stomach and intestines ; quickly succeeded by a violent and frequent vomiting and pur, ging of bilious matter j—frequent, small, sometimes une.« 203 CHOLERA MORBUS. qual, pulse ;—much thirst and heat, followed by cold sweats -, —great anxiety, spasmodic contractions of the extremities, and sometimes universal convulsions ;—hiccup, and notunfre- quently death, within the space of twenty-four hours. CAUSES. Excessive heat, or sudden transitions from heat to cold $ hence more frequent in autumn, from an exposure to cold evenings after very hot days ;—food of difficult digestion ;— rancid butter ;—the colder fruits ; such as cucumber, melon, 8tc.;—active and violent purgatives ;—poisons ;—violent pas- sions of the mind ;—marsh miasma. Proximate.—Inordinate secretion of bile of a vitiated quali* ty. PROGNOSIS. Favourable.—-A gradual diminution of the symptoms ; es- pecially vomiting, succeeded by sleep, or a gentle moisture on the skin.—The disease, when protracted to the fifth, sixth, or seventh day, seldom proves fatal. Unfavourable.—Spasm of the extremities ;—convulsions ;-•« great prostration of strength;—cold clammy sweats ^--anx- iety ;—short hurried respiration;—continual hiccup;— inter- mitting pulse ;—fetid vomiting;—great distention of the ab- domen. TREATMENT. f 1. To allay the inordinate commotion of the stomach and intestines, by correcting Indications. -4 the acrimony of the secreted bile, and { . by diminishing their irritability. \JL1. To restore the tone of the primx vix. The first indication requires : — 1. Copious tepid diluents of weak chicken broth, decoc* tion of barley, fcc. LOOSENESS. 103 i. Emollient clysters. 3- Opium in large doses, both by the mouth, in the form of enema, or applied externally, by friction, to the abdomen. 4. Warm plasters and fomentations of poppies, with the addition of spiritus camphorx;—the saline medicine in the Ret of effervescence. The tone of the primx vix is to be restored By the use of the stomachic tonics, and other bitter reme- dies recommended for the cure of dyspepsia. DIARRHCEA, OR LOOSENESS. "1. Diarrhoea crapulosa :—the fxces discharged in a more liquid state than is natural, and in greater quantity. 2.-------biliosa:—a great quantity of yellow fxces discharged. •; 3.-------mucosa ;—copious discharge of mucus. "G -^ 4.------- cxliaca :—discharge of a milky humour like i§- chyle. 5. - lienteria :—the food without any material change quickly discharged. 6.-------hepatirrhoea :—discharge of a bloody matter like serum, without pain. CHARACTER. Frequent and copious discharges of a feculent matter by stool, accompanied by much griping ; each dejection is usu- ally preceded by a murmuring noise, and flatulence in the in- testines, together with sense of weight and uneasiness in the lower belly, which cease on the discharge taking place, but are again renewed before the succeeding one ensues.— There is frequently sickness, nausea, and vomiting;—the countenance turns pale, sometimes sallow ;—thirst;—dry- ness and bitterness of the mouth, and yellowness of the tongue, indicating the presence of bile in the alimentary ca- 204 LOOSENESS. nal;—the skin is dry and rigid, and if the disease continue, great emaciation succeeds. Remote.—The application of cold to the surface of the body;— perspiration suppressed by any cause ;—passions of the mind ;—acrid indigestible aliment ;l--acid fruits ;—acidi- ty, generated in the stomach from a deficiency of bile ;—oily and putrid substances ;— the abuse of active purgatives ;— increased secretion of mucus from the mucous follicles of the intestines ;— erythematic inflammation ;—worms ;—retroce- dent gout, or rheumatism ;—diminished action of the absor- bent vessels of the intestines. Proximate.—Increased peristaltic motion of the intestines. DIAGNOSIS. From dysentery.—By being unattended either with inflam- mation, fever, contagion, or tenesmus ;—by the appearance of the matter evacuated;—which in the one disease is fecu- lent, or mixed with alimentary matter; in the other, san- guineous or putrid. TREATMENT. f 1. To obviate or remove the morbid cause. I 11. To suspend the inordinate action of the Indications. -< mtestinal canai. ^111. To restore the impaired tone of the parts. Irritating causes are often lurking in the intestinal canal, and must be removed, 1. By emetics of ipecacuanha. 2. Aperients of rhubarb, magnesia, oleum ricini, and neu- tral salts. LOOSENESS. 205 R. Magnesix albx ^ij. Confectionis aromaticx 3ss Pulveris rhabarbari gr. xv. Syrupi zingiberis 3j- Aqux menthx piperitidis Fiat haustus antacidus aperi- ens. Take Carbonate ofmagnesia^ij Aromatic confection 3ss. Powder of rhubarb gr. xv. Syrup of ginger Xju Peppermint water 3XU- Make an antacid draught. laxative 3. Diluents and demulcents ; as the decoctum lini, decoc- tum hordei, and the like. 4. Alkalies and absorbents. 5. Fomentations and sinapisms to the extremities, in cases of translated gout or rheumatism. 6. Anthelmintics ; if the disease arise from worms. See Worms. 7. Diaphoretics ; if from suppressed perspiration ; as the pulvis ipecacuanhx compositus, or pulvis Jacobi, or antimo- nium tartarisatum, in small and frequent doses. The inordinate action of the intestinal canal is suspended, 1. By opium, with cordial astringents. R. Confectionis aromaticx 9J. Take Aromatic confection ^\. Tincturx catechu §j. Misturx cretacex gvj. Syrupi zingiberis gss. Tincturx opii jss- Fiat mistura cujus capiantur cochlearia duo vel tria post singulassedes liquidas,con- ousso prius vitro. Tincture of catechu gi. Cretaceous mixture gvi. Syrup of ginger gss. Tincture of opium X^ss. Make a Mixture.—Let two or three spoonfuls be taken after each liquid stool. Shaking the phial previously each time. 206 LOOSENESS. R. Confectionis aromaticx 3J- Tincturx catechu gj. Spiritus ammonix compo- siti 3'y. Aqux cinnamomi gvj. Syrupi zingiberis gss. Tincturx opii gutt. xl. Fiat mistura de qua sumantur cochlearia tria magna post singulas sedes liquidas. ft. Confectionis opiatx 3jss. Tincturx kino gj. Syrupi zingiberis 3ss. Misturx cretacex gvjss. Fiat mistura, ut priori capi- enda. R. Confectionis opiatx gr. xxxvj. Olei essentialis caryophyl- lom m aromaticorum gutt. iv Pulveris colombx q. s. Fiat boli quatuor quorum ca- piat xger unum omni triho- rio. R. Confectionis aromaticx 3J- Pulveris Arabici gss. Spiritis myristicx gj. Aqux menthx piperitidis g vj Syrupi zingiberis gss. Tincturx opii gss. Fiat mistura cujus sumantur cochlearia tria magna post unamquamque sedem mol- lem, vitro prius concusso. Take Aromatic confection gi. Tincture of catechu gi. Compound spirit of ammom a Cinnamon water gvi. Syrup of ginger gss. Tincture of opium drops XL. Make a mixture, of which let three table spoonfuls be taken after every liquid stool. Take opiate confection giss. Tincture of kino gi. Syrup of ginger gss. Cretaceous -mixture gviss. Make a mixture, to be taken like the preceding. Take Opiate confectioner, xxxvi Essential oil of cloves drops iv. Powder of columbo q. s. Make four bolusses, let the pa- tient take one every three hours. Take Aromatic confection gi. Gum Arabic in powder gss. Spirit of nutmeg gi. Peppermint water gvi. Syrup of ginger gss. Tincture of opium gss. Make a mixture.—Let the pa- tient take three table spoon- fuls after each liquid stool, first shaking the phial. LOOSENESS. 207 2. Diaphoretics ; pulvis ipecacuanhx compositus ;—astrin- gents ; especially, gum kino,—alum,—resina acaroides,— extractum hxmatoxyh,—simarouba,—lime-water joined with milk,—decoctum ulmi,—lichen islandicus. R. Aluminis purificati gr. x. Conservx rosx rubrx q. s. Fiat bolus bis terve die su- mendus. R. Acaroidis resinx 3"ij. Mucilaginis Arabici gss. Tere simul, et gradatim adde Aqux menthx piperitidis SVJ- Tincturx acaroidis resinx 3J- Syrupi corticis aurantii gss Sit dosis cochlearia tria mag- na quarta quaque hora vel sxpius. R. Kino in pulverem tritigr.x. Pulveris e creta compositi cum opio gr. xv. Syrupi papaveris albi q. s. Fiat bolus quarta vel sexta quaque hora sumendus. R. Catechu in pulverem triti gr. xv. Aluminis purificati gr. vj. Conservx rosx rubrx q. s. Fiat bolus ter in die sumen- dus. Take Sulphate of potash and alumen gr. x. Conserve of red roses q. s. Make a bolus, to be taken three times a day. Take Resin of acaroidis X\'y Mucilage of gum Arabic gss. Rub them together, and add gradually Peppermint water gvi. Tincture of acaroidis gi. Syrup of orange peel gss. The dose may be three large spoonfuls every four hours or oftener. Take Powdered gum kino gr. x. Compound powder of chalk with opium gr. xv. Sjrup of white poppies q. s. Make a bolus, to be taken eve- ry fourth or sixth hour. Take Powder of catechu gr. xv. Sulphate of potash, and alumen gr. vi. Conserve of red roses q. s. Make a bolus, to be taken three times a day. 208 LOOSENESS. R. Extract! hxmatoxyh 3jss. Misturx cretacex gvj. Tincturx cardamomi 3j- Fiat mistura: cujus sit dosis cochlearia tria magna pro re nata. Take Extract oflogviood'xiss. Cretaceous mixture j§vi. Tincture of cardamon gi« Make a mixture.—The dose three large spoonfuls, when necessary. R. Extracti hxmatoxyh 3J. Olei essentialis cinnamomi gutt. vj. Fiat boli sex quorum capiat xger unum pro re nata. R. Radicis simaroubx eontu- sx gss. Corticis granaticontusx3u ------aurantii Hispalensis Aqux ferventis gxyj. Macera per horam, dein cola. R. Hujus infusi gvij. Confectionis aromaticx 3J. Tinctura cardamomi com- positx 3S8. Syrupi zingiberis gss. Fiat mistura cujus sumantur cochlearia tria magna ter quaterve die. Take Extract of logwood gi. Essential oil of cinnamon drops vi. Make six bolusses, let the pa- tient take one when necessary.. Take Simarouba bruised gss. Pomgranate bruised gij. Spanish orange peel 3'iij. Boiling water gxvi. Macerate for an hour &- strain. Take of this infusion gvij. Aromatic confection x>i. Compound tincture of carda- mon gss. Syrup of ginger gss. Make a mixture, of which let three large spoonfuls be taken three or four times a day. The third indication requires, 1. Tonics ; preparations of cinchona,—angustura,—Colom- bo,—cascarilla,—chalybeate waters. 2. Moderate exercise. 3. Light nutritive diet; of lamb, chicken, &c. IMMODERATE PLOW OF URINE. 209 4. The least acescent wines : Madeira or sherry.—Brandy and water should be substituted for malt liquors as common drink. DIABETES, OR IMMODERATE FLOW OF URINE. f 1. Diabetes mellitus, with urine of the smell, col- J our, and taste of honey. Species. < . . ., ....... 12. ——— insipidus, with limpid urine, not v. sweet. CHARACTER. Frequent discharge of urine ; sometimes insipid ("diabetes insipidus J ; sometimes containing a large portion of saccha- rine and other matter (~diabetes mellitus J, voided in a quan- tity far exceeding that of the aliment or fluid introduced;— continued thirst;—generally a voracious appetite ;—impene- trably dry skin ;—swelling of the legs ;—gradual emaciation of the whole body ;—hectic fever. CAUSES. Predisposing.—Constitutional weakness ;—the decline of life ;—preceding diseases, as hysteria;—hypochondriasis j— dyspepsia;—asthma. Exciting.—All those causes inducing debility of the system in general, and of the chylo-poietic organs in particular ;— abuse of spirituous liquors j—cold applied to the body;—ex- cess in venery ;—immoderate evacuations ;—crude farinace- ous diet. Proximate.—According to Dr. Rollo it is an impaired ac- tion or morbid change in the natural powers of digestion and assimilation. T2 210 IMMODERATE FLOW OF URINE. TREATMENT. The following has been found most successful: 1. A diet consisting wholly of animal food ; abstaining ri- gidly from every kind of vegetable matter. 2. Emetics, exhibited occasionally. 3. Diaphoretics : the pulvis ipecacuanhx compositus, re- commended by Dr. M'Cormack in the Medical Commenta- ries ;—antimonial wine with opium, by Dr. Rollo. 4. Alkalis : mephitic alkaline water;—hepatised ammonia, used by Dr. Rollo ;—aqua ammonix purx ;—kali sulphura- tum. R. Aqux ammonix purx gutt. Take water of ammonia dropsy i VJ- -----cinnamomi 3v. ---- cinnamon 3 v. -----. distillatx 3V. — distilled Xx. Syrupi zingiberis 3J- Syrup of ginger X}. Fiat haustus ter in die sumen- Make a draught to be taken dus. three times a day. S. Kali sulphurati gr. x. Conservx rosx q. s. Fiat bolus ter in die sumen- dus. K. Kali sulphurati gr. x. Syrupi zingiberis 3'j- Aqux cinnamomi 3X. Fiat haustus ter in die su- mendus. Take Sulphuret qf potash gr. x. Conserve of roses q. s. Make a bolus, to be taken three times a day. Take Sulphuret of potash gr. X- Syrup of ginger xi'y Cinnamon water 3-- Make a draught to be taken three times a day. 5. Blisters and issues to the region of the kidney. 6. Astringents and tonics : alum,—gum kino,—catechu,— vitriolic acid,—nitric acid,'—lime water,—alum whey,—bark, —myrrh,—chalybeates, as directed for the cure of dyspepsia. HYSTERICS. 211 7. Opium, in large doses. 8. Tincture of cantharides ; Dr. Brisbane. 9. Covering the body with flannel, and the warm bath. 10. Anointing the skin with camphorated oil. 11. Keeping the bowels regularly open with aloes andsoapi. 12. Gentle exercise. 13. Frequent friction over the kidneys, by means of the; flesh-brush or flannel. 14. Chalybeate and sulphureous waters. HYSTERIA, OR HYSTERICS. SYMPTOMS. The disease attacks by paroxysms or fits, generally prece« ded by yawning,—stretching,—dejection of spirits,—anxiety of mind,—effusion of tears,—alternate flushings and pale- ness,—difficulty of breathing,—sickness at the stomach,__ palpitation of the heart,—profusion of limpid urine ;__gener- ally an acute pain in the left side, about the flexure of the co- lon, with sense of distention, giving the idea of a ball or ylobe rolling itself about in the abdomen, and gradually ad- vancing upwards until it gets into the stomach; thence re- moving to the throat it occasions, by its pressure, the sensa- tion of an extraneous, body lodged there, which is called glo- bus hystericus.—-The disease having arrived at its height, the patient appears threatened with suffocation, she becomes faint, and is affected with stupor and insensibility; whilst at the same time the trunk of the body is turned to and fro,— the hmbs variously agitated,—wild and irregular actions take place, in alternate fits of laughter, crying, and screaming, —incoherent expressions are uttered,—a temporary delirium prevails, and a frothy saliva is discharged from the mouth.— The spasms at length abating, a quantity of wind is evac- uated upwards, with frequent sighing and sobbing j and *» 212 HYSTERICS. the patient recovers the exercise of sense and motion, with- out retaining any recollection of what has taken place ; feel- ing, however, a severe pain in her head, and a soreness over her Whole body. CAUSES. Predisposing.—Female sex; generally the unmarried, and between the age of puberty and the thirty-fifth year;—it also attacks the more delicate of the male sex ;—peculiar irrita- bility of the nervous system ;—studious and sedentary life ; —grief;—anxiety of mind. Exciting.—Excessive evacuations ;—suppression of the menses or lochia, or the neglect of usual discharges ;—great proclivity to venery ;—violent commotions of the mind ;—fla- tulent and acescent regimen ;—former diseases which have greatly impaired the tone of the primx vix;—imitation or sympathy. Proximate.—A spasmodic affection of the uterus, accord- ing to Dr. Cullen. DIAGNOSIS. From hypochondriasis.—Hysteria attacks the sanguine and plethoric ; comes on early in life ; its attacks are sudden, and accompanied with the globus hystericus ; it is diminished by time.—Hypochondriasis attacks the melancholic ; comes on about the middle age ; is gradual in its accession, and tedi- ous in its progress ;—it increases as life advances. From epilepsy.—By the preceding symptoms, especially the profusion of limpid urine ;—by the globus hystericus ;—by the convulsive motions in the one disease having the appear- ance of design ; in the other obviously involuntary ;—by the laughing, crying, and other symptoms above mentioned. PROGNOSIS. Hysteria is seldom attended with danger, unless in a very impaired constitution, or in cases where the fits are extreme* HYSTERICS. 213 ly violent; when it sometimes passes into epilepsy, especial- ly if there be a predisposition to that disease. TREATMENT. 1. To allay the spasmodic symptoms which f L I constitute the fit. tions.-^ j j Indications.-< jj To strengthen thetfiervous system during I the intermissions of the paroxysms. 1. By bleeding; if the patient be young and plethoric, and the attack be recent;— but in weak and debilitated constitu- tions, or when the disease is of long standing, it is inadmis- sible. 2. Stimuli applied to the nose ; as the aqua ammoniae,—asa- foetida,—burnt feathers,—the spiritus ammonix succinatus.. 3. Rubbing the temples with xther. 4. Pediluvium. 5. Dashing cold water over the extremities. 6. Clysters ; simply laxative, or with asafoetida, castor, or opium ;—cold water alone has been effectual. 7. Antispasmodics ; especially xther,—castor,—asafoetida, __opium, and valerian, as directed against epilepsy. 8. Cardialgia is relieved by an alkali; the aqua kali puri, or natron preparatum. R. Aqux kali puri 3SS. Take Water qf potash 3ss. Confectionis aromaticx3J98 Aromatic confection X}&$- Misturx camphorx gvj. Camphorated mixture gvi. Syrupi zingiberis gss. Syrup of ginger gss. M. cujus capiat xger cochle- Mix—Let the patient take two aria duo in dolore. tpoonful* when pained. R. Natri preparati 3ss. Take Carbonate of soda Xss, Confectionis aromaticx 3j. Aromatic confection X\. Aqux menthx piperitidis Peppermint water gvi. §vj. Syrupi corticis aurantiigss. Syrup of orange peel gss. M. sumantur cochlearia duo Mix.—Let the patient take two magna in dolore. large spoonfuls when pained, 214 HYDROPHOBIA. The second indication will be effected by: 1. Gentle evacuations from the primx vix. 2. By tonics; Peruvian bark,—bitters,—chalybeates, &e. See Dyspepsia. 3. The occasional use of the antispasmodics above enume- rated. 4. Regular exercise on horseback, with variety of scene. 5. Cold bathing. 6. Mineral waters. 7. The occasional spasms or cramps, to which hysterie women are subject, may be relieved by the pediluvium,—the warm bath,—and by powerful antispasmodics, particularly opium, musk, xther, and camphor. HYDROPHOBIA. SYMPTOMS. At an uncertain time, after a bite from a mad animal, mostly a dog or cat, sometimes not until several months have elapsed, wandering pains are felt in different parts of the body,—restlessness,—heaviness,-disturbed sleep, with fright- ful dreams,—sudden startings and spasmodic contractions,— sighing,—great anxiety and dejection of spirits. These symptoms increase ; in some cases the bitten part becomes inflamed or painful: pains now attack the throat, and a sensation of suffocation occasionally takes place ,-__an aversion is felt to the swallowing of water or other liquids ; this arises to such a degree, that the moment any fluid is brought near the patient, or when the noise of the fluid is heard pouring out of any vessel, it occasions him to start with great dread and horror, and the attempt at deglutition is hurried and accompanied with a convulsive paroxysm. SUious vomitings sometimes take place;—a considerable MELANCHOLY. 213 degree of fever follows, with dry and rough tongue;—the voice becomes hoarse, and the patient is constantly spitting a viscid tenacious saliva; extreme anxiety comes on, and a degree of irritability beyond expression; the slightest motion, or sudden change of position, will excite a sensation of suf- focation and convulsions ;—delirium in some instances takes place ; convulsions now become frequent, and the patient diet exhausted or in a fit. TREATMENT. {1. To prevent the absorption of the poison. 11. To counteract its destructive effects, when already introduced into the system. The first indication is frequently effected by surgeons, who remove the bitten part by excision, caustic, and other means. The second indication is seldom fulfilled ;—various meth- ods have been tried.-—Under an idea that the disease was in- flammatory, the antiphlogistic plan has been strictly enfor- ced :—Upon the idea that it was a nervous disease, antispas- modics have been resorted to:—Mercury has its advocates. ORDER IV. VESANIiE. .CHARACTER. Disorders of the judgment, without any pyrexia or coma. MELANCHOLIA, OR MELANCHOLY. CHARACTER. A partial chronic insanity, characterized by sadness,—de- jection of spirits,-«fondness for solitude,— timidity,—fickle- 216 MELANCHOLY. ness of temper,—great watchfulness,—flatulency,—costivt- ness ; delirium without fury, and unaccompanied by fever.— The mind pursues one certain object or train of thinking; which, in general, bears a near relation to the melancholic himself, or to his own affairs, creating the most groundless, yet anxious, fear, and generally accompanied with a desire of terminating his existence. CAUSES. Hereditary predisposition ;—powerful depressing passions of the mind;—the melancholic temperament in an exquisite degree ;—anxiety;—grief;—love for an absent object;—ex- cessive evacuations ;—intemperance in the use of spirituous liquors. DIAGNOSIS. From hypochondriasis.—By the dyspeptic symptoms being much less, or entirely absent;—by the mental derangement being more considerable, and amounting to the melancholic delirium above described. PROGNOSIS. Favourable.—The disease arising from accidental circum- stances, and being of short duration;—supervening fever;— diarrhoea;—cutaneous eruption ;—the mind still capable of being diverted from its melancholy train of thought to other objects;—sound sleep. Unfavourable.—The disease being the effect of hereditary predisposition, or of the melancholic temperament exquisite- ly Formed;—its being of l»ng standing ;--supervening an ep- ilepsy or palsy. TREATMENT. _ ,. CTo interrupt the attention of the mind to its ac- Indication.^ cust001ed object. RAVING OR FURIOUS MADNESS. 217 By presenting an interesting variety of objects, and sub- jects of attention ; carefully guarding against the appearance of their being intentionally introduced. By travelling;--by resorting to places of public amuse- ment ;—by the society of the gay and the convivial;—by ex- citing passions of a nature opposite to those that have pre- vailed during the disorder ; rousing the courage and resolu- tion of the timid ; cheering the gloomy writh merriment and pleasure ; while the violent and passionate should be restrain- ed by fear. By the introduction of 6ports and rural pastimes ; and like- wise of such employment as consists in a moderate exercise of the faculties of the mind: thus the literati may be amused with philosophical questions ; the farmer with discourses on agriculture, and the sailor with naval affairs. By music of the more exhilarating kind. The melancholic may be conducted to the different places of summer resort, under the pretext of drinking the waters which they afford. MANIA, OR RAVING OR FURIOUS MADNESS. SYMPTOMS. Delirium without fever ;—severe pairts in the head ;—noise in the ears ;—redness of the face ;—peculiar wildness of the countenance ;—rolling and glistening of the eyes ;—grinding of the teeth ;—loud roarings ;—violent exertions of strength ; —absurd incoherent discourse ;—-unaccountable malice to cer- tain persons ; particularly to their nearest relatives and friends; —a dislike to such places and scenes as formerly afforded particular pleasure ;—a diminution of the irritability of the body with respect to the morbid effects of cold, hunger, and Watching; together with a full strong pulse. Maniacs have frequently lucid intervals ; hence called lu- natics. U 218 RAVING OR FURIOUS MADNESS. CAUSES. Hereditary predisposition;—sanguineous temperament j—» violent and stimulating emotions of the mind ;—uncurbed and immoderate indulgence of any passion ;—violent exercise ;— frequent intoxication -,—sedentary life ;—abstruse study ;— suppression of periodical and other evacuations ;—excessive discharges ;—tumors compressing the brain ;—preceding at- tacks of epilepsy, fever, &c. Proximate.—Increased and inordinate excitement of the sensorium. DIAGNOSIS. From phrenitis—By the latter being accompanied with fe- ver, the former not. PROGNOSIS. Favourable.—The mania arising in consequence of some other disease ;—the attacks being slight, and not frequent in •-heir recurrence ;—hxrr.oirhage ;—diarrhoea ;—scabby angry eruptions ;—hxmorrhoidal or menstrual discharge ;—super- vening fever. TREATMENT. (1. To gain aperfect command over the maniac. 11. To diminish the' preternatural action of the f brain. The first indication is sometimes to be effected by gentle and conciliating treatment; but more frequently by inspiring him with awe and dread by coercion; tempered, however, with proper mildness and humanity;— upon gaining the con- fidence of the maniac will in great measure depend the sue- cess of the after-treatment. The second indication is sometimes fulfilled by, 1. Engaging the patient in some exercise or pursuit, that will employ at once both the body and the mind ; and thus RAVING OR FURIOUS MADNESS, 210 tii.ert the latter from pursuing one invariable train of thought;—removing him from those objects with which he was formerly acquainted ;—frequent change of* scene ;—a spare and low diet. 2. By bleeding; if he be of a plethoric habit, and the at- tack recent. 3. Purging; the drastic and the cooling purgatives have both been recommended—perhaps the former are preferable ; —hellebore,—senna,—jalap,—gratiola. 4. Emetics. 5. Cold bath.—Many cases are related of the success of this remedy in various publications. 6. Sedatives ; as cicuta, hyoscyamus,—or the union of these with camphor,—digitalis.—Opium has in general been found prejudicial; opiate friction has, however, been suc- cessfully used by Dr. Chiarugi of Florence. 7. Nauseating medicines ; as antimonium tartarisatum, in small and frequent doses. 8. Blisters to the head;—setons or issues in the neck. 9. Should madness be the consequence of great debility, as sometimes happens at the close of fever, the opposite of the above treatment will be required ; as, a nutritive and re- storative diet;—Peruvian bark, and other bitters ;—chaly- beates, &c. 10. All cases that seem to be connected with scrofulous disease, syphilis, or cutaneous eruptions, should be attacked by a long course of antiscrofulous and antivenereal medicines. 22a CLASS III. CACHEXL-E ; OK, DISEASES ARISING FROM DEPRAVED HABIT. CHARACTER. Depraved habit of the whole, or of a great part, of the body, without any primary febrile or nervous affection. ORDER I. MARCORES. CHARACTER. A wasting of the whole body. PHTHISIS PULMONALIS, OR PULMONARY CONSUMPTION. SYMPTOMS. Regular tubercular phthisis usually begins with a short dry cough, so slight as to become habitual before it excites the attention of the patient.—The breathing is more easily hurri- ed by bodily motion ;—the patient becomes languid and indo- PULMONARY CONSUMPTION. 221 lent, and gradually loses strength;—the pulse is small, soft, and quicker than usual;—at length, from some fresh exciting cause, the cough becomes more considerable, and is partic- ularly troublesome during the night;—the breathing more anxious ;—sense of straitness and oppression of the chest is experienced*;—an expectoration takes place, at first of a frothy mucus, and is most considerable in the morning ; af- terwards becoming more copious, viscid, and opake. The breathing becomes more and more difficult;—the ema- ciation and weakness go on increasing;—a pain arises in some part of the thorax, at first generally referred to the sternum, but as the disease advances is felt on one or both sides, is increased by coughing, and sometimes becomes so acute as to prevent the patient from lying upon the affected side. The face now begins to flush;—the pulse becomes quick and hard ;—the urine is high-coloured, and deposits a bran- ny sediment;— the palms of the hands, and soles of the feet, are affected with burning heat;---the tongue, from being white, is now preternaturaUy clean and red; purulent mat- ter is expectorated;—all the symptoms are increased to- wards the evening;—the fever assumes the hectic form; having an exacerbation twice in the day; the first about noon, which is inconsiderable, and soon suffers a remission ; the other in the evening, which gradually increases until af- ter midnight.—Each exacerbation is usually preceded by se- vere rigors, and terminates in profuse perspiration, and the deposit of a furfuraceous sediment in the urine. The appetite often now mends, and generally becomes bet- ter than in the first stages of the complaint;---the red ves- sels of the tunica conjunctiva assume a pearly white colour; —during the exacerbations, a circumscribed redness appears on each cheek, but at other times the face is pale, and the countenance dejected ; food is returned by vomiting ;-.-a di- arrhoea comes on, and generally alternates with colliquative V 3 222 PULMONARY CONSUMPTION. sweats ;—the emaciation is extreme ;—the countenance as- sumes a cadaverous appearance ; the cheeks are prominent; —the eyes hollow and languid ;— the hair falls off;—the nails are of a livid colour, and much incurvated; the legs swell, and are oedematous;—aphthx appear in the throat;—still the appetite often remains entire, and the patient flatters him- self with hopes of speedy recovery, and is often vainly form- ing distant projects of interest or amusement, when death puts a period to his existence. CAUSES. Predisposing.—Hereditary predisposition ;—particular for- mation of the body ;— marked by long neck, prominent shoul- ders, narrow chest, and long slender fingers ;—the san- guineous temperament ;---constitutional irritability of the lungs; sedentary life ;— the scrofulous diathesis; indicated by a fine clear skin, fair hair, delicate rosy complexion, large veins, thick upper lip, weak voice, and great sensi- bility. Exciting.—Certain preceding diseases ; as, hxmoptysis,— pneumonia,—catarrh,—asthma,—scrofula,—syphilis,—vari- ola,—rubeola.—The dust to which certain artificers are ex- posed ; as, needle-pointers, stone-cutters, millers, &c— The fumes of certain metals or minerals ;—violent and de- pressing passions of the mind, as grief, disappointment, anxiety ;—intemperance of any kind ; profuse evacuations, as diarrhoea, diabetes, fluoi- albus, menorrhagia ; continuing to suckle too long under a debilitated state ;—the application of cold united to moisture ; as the lying in damp beds, sud- den exposure to cold when the body is preternaturaUy warm, especially if made so by previous exertion. Proximate.—The formation of tubercles, which inflame, suppurate^, and become ulcers, communicating with the bron- chi w. PULMONARY CONSUMPTION. 223 DIAGNOSIS. The infallible characteristics of confirmed phthisis are the hectic fever, with its peculiar concomitants above describ- ed ;— the purulent expectoration. The distinction between pus and mucus.—The former is opake, friable, easily miscible with water, of a fetid odour, of greater specific gravity than water, sinking to the bottom of the vessel containing this fluid. Its colour is either white, yeUow, or green—when dissolv- ed in vitriolic acid, if water be added, it either falls to the bottom, or forms an intimate mixture; making the whole uniformly turbid. The latter is transparent, viscid, not miscible with water, inodorous ; upon adding water to its solution in vitriolic acid^ it separates into flocculi, and floats upon the surface. PROGNOSIS. Circumstances more especiaUy unfavourable are, the disease arising in consequence of hereditary predisposition;—from tubercles;—high degree of hectic fever; great emaciation and debility ;—a morbidly clean or fiery red tongue ;— fixed pain in the chest;—colliquative sweats ;—expectoration of pure pus ;—oedema of the legs ;—diarrhoea ;—aphthx. TREATMENT. f To lessen inflammation in the inflammatory Indications. \ stage ; and to promote the healing of ulcers f after suppuration has taken place. 1. By small and repeated bleedings; regulated by the strength of the patient and the period of the disease, unless the disease bear more evident marks of a scrofulous tendency. 2. Gentle laxatives, of cassia, manna, RocheUe salts. 3. Mild diaphoretics, of aqua ammoniae acetatx, or purvis ipecacuanhx compositus. 224 PULMONARY CONSUMPTION. 4. The occasional exhibition of an emetic: the zincum vi- triolatum is preferred; and the cuprum vitriolatum is recom- mended by Senter, in the Transactions of the College of Philadelphia; and by Adair, in the Medical Commentaries. 5. Blisters, issues, or setons, opposite to the part affected with pain, are highly serviceable. 6. Nitre, in small and frequent doses. 7. Inhaling the vapour of hot water, alone, or impregnated with xther and cicuta: this is recommended by Dr. Pearson, in the Medical Commentaries. 8. By inhaling certain factitious airs: Dr. Beddoes, and other pneumatic physicians, recommend hydrogen, and hy- dro-carbonate. 9. Cicuta; beginning with small doses, and gradually in- creasing it. 10. By digitalis; in the praise of which Drs. Beddoes, Drake, Fowler, and others, have written. It is sometimes serviceable, more frequently otherwise. The tincture is the best preparation ; the dose should be small at first, from ten to fifteen drops, and it should be gradually increased until it reduce the energy and frequency of the pulse. 11. Tonics and chalybeates have been administered with advantage ; particularly myrrh alone, or with ferrum vitrio- latum. 12. The pheUandrium aquaticum is praised by Drs. Hertz and Michaelis, in Hufeland's Journal. 13. The agaricus piperatus and deliciosus, by Dr. Dufres- noy. 14. Colliquative sweats should be checked by vegetable and mineral acids. 15. Diarrhoea, by the mistura cretx cum opio,—resina aca- roidis ; or by diaphoretics. See Diarrhaa. 16. The cough, by opiates, especially the syrupus papave- ris albi; and by demulcents. See Catarrhus. 17. A light and nutritive diet: the farinaceous vegetables; milk, especiaUy that of the ass} acescent fruits ; the lichen EMPHYSEMA. 32. islandicus boiled with milk ; the different kinds of shell fish 5 are most esteemed for the general diet. 18. Removal to a warm climate ; to Lisbon, to Madeira, to the south of France, or to the more temperate parts of our own.—Moderate exercise, either by swinging, on horseback, or by sailing ;—carefully guarding against a suppression of cutaneous perspiration, in consequence of the application of cold, by constantly wearing flannel next to the skin ;—a sea voyage ;—Bristol and Seltzer waters ;—stabling with cows. ORDER II. INTUMESCENTLE. CHARACTER. External tumor of the whole, or of the greater part of the body. EMPHYSEMA. This disease consists in a collection of air in the cellular membrane.—It is in general confined to one place; but in a few cases, spreads universaUy over the whole body, and occa- sions a considerable degree of swelling.—It is attended with an evident crackling noise, and elasticity upon pressure; and sometimes with much difficulty of breathing, oppression, and anxiety. CAUSES. Wounds of the lungs.—It sometimes arises spontaneously, or comes on immediately after delivery, without any evident cause. TREATMENT. The air is to be evacuated by scarifications into the ceUular 226 TYMPANY. membrane, assisted by proper pressure with the hand.—Vio- lent dyspnoea and anxiety are to be relieved by bleeding and laxatives ; and the pain and uneasiness, arising from disten- tion, by relaxing applications to the skin; as the unguentum spermatis ceti. TYMPANITES, OR TYMPANY. Tympanites abdominalis ; or collection of air in • the cavity of the peritoneum. ---intestinalis ; or collection of air in the cavity of the intestines. SYMPTOMS. Of the tympanites intestinalis.—The disease sometimes comes on suddenly; at others it is more slow in its progress, and preceded by unusual flatulency,—borborigmus, and a frequent expulsion of air upwards and downwards, attended with col- ic pains ;—the abdomen becomes considerably distended, tense, and elastic ;—costiveness ;—dysuria, and in some in- stances even ischuria ;—impaired appetite ;—thirst,—heat,— emaciation,—hectic fever,—not unfrequently dropsy or gan- grene. Of the tympanites abdominalis.—The swelling is more equal than in the former species ;—the tension greater ;—it is more elastic ; and, upon percussion, sounds like a drum or bladder filled with air.—There are no emissions of flatus. CAUSES. Loss of tone in the intestinal canal:—errors in diet;__ abuse of spirituous liquors -,—suppression of customary evac- uations ;—a crude vegetable aliment;—hysteria;—gangrene. DIAGNOSIS. From ascites.—By the absence of fluctuation, and of those symptoms which characterize the hydropic diathesis. See Ascites. Species. TYMPANY. 227 PROGNOSIS. Favourable.—An unimpaired constitution;—the air contain- ed within the cavity of the intestines, is more favourable than when it is accumulated within the cavity of the peritoneum; —explosions of flatus. Unfavourable.—The disease being of long standing;—great debility ;—emaciation;—difficult respiration ;—cough;—hec- tic fever. The abdominal species mostly proves fatal. Indications. ] TREATMENT. To evacuate the air. To prevent its again accumulating. To fulfil the first indication recourse must be had to, 1. Antispasmodics and carminatives ; opium, xther, oleum anisi, asafoetida, raphanus. R. Spiritus xtheris vitriolici compositi 3fiij. Misturx camphorx ?vlj. Syrupi zingiberis gss. Tincturx opii camphoratx §ss. M.cujus sumantur cochlearia tria magna quarta quaque hora. R. Olei essentialis anisi gutt. xij. Pulveris Arabic! Jiv Syrupi rosx §ss. Aqux anisi §vij. Fiat misturacujus sumatxger cochlearia duo magna ur- genti dolore vel flatu. Take Compound spirit qf sul- phuric tether 2Jiij. Camphorated mixture 5viij. Syrup of ginger, Camphorated tincture of opi- um, each §ss. Mix.—Let three large spoon- fuls be taken every four hours. Take essential oil qf anise drop* xij. Powder qf Gum Arabic SJiv. Syrup ofroses^ss. Water of aniseed gvij. Make a mixture, let the patient take two large spoonfuls when the pain and flatulence are ur~ gext. 228 TYMPANY. R. Asafoetida gr. vj. Pulveris rhxi gr. iv. Olei essentialis anisi gutt.ij. Fiat pilulx dux quarta vel sextaquaquehorasumendx. Take Asafatida gr. vi. Powder qf rhubarb gr. iv. Essential oil qf anise, drops'iy Make two pills, to be taken ev- ery four or six hour*. Take Pill qf opium gr. iss. Cayenne pepper gr. iij. Essential oil of fennel dropi. R. Pilulx ex opio gr. jss. Piperis Cayennensisgr.iij. Olei essentialis foeniculi gutt. j. Fiat pilula sexta quaque hora Make a pill, to be taken every sumenda. six hours. 2. Warm purgative medicines and clysters. R. Pilulx exaloe cum toyrrha Take Pill of aloes toith myrrh gr. vj. gr. vi. Piperis Indici gr. iij. Guinea pepper ("or Capsicum J gr. iij- Fiat pilulx dux. Make two pills. R . Extracti colocynthidis compositi gr. vj. Pilulx galbani compositx gr. iij. Olei essentialis carui gutt.j. Fiat pilulx dux. R. Pulveris aloes cum guaia- co gr viij. Olei essentialis anisi gutt. ij. Fiat pilulx dux. Take Compound extract ofeo- locyntk gr. vi. Compound pill of galbanum gr. "j. Essential oil of caraway drop i. Make two pills. Take Powder of aloes with guaiac gr. viij. Essential oil qf anise drops ij, Male two pills. TYMPANY. 229 R. Tincturx sennx gj. Vini aloes gij. Aqux menthx piperitidis Syrupi zingiberis gj. Syrup of ginger gi. M. cujus capiantur cochlearia Mix.—Let two spoonfuls be ta- duo pro re nata. ken when necessary. Take Tincture of senna g; Aloetic wine gij. Peppermint water giij. R. Kali tartarisati gss. Infusi sennx gvss. Tincturx ejusdem gjss. Syrupi zingiberis gss. Take Tartrite of potash gss. Infusion qf senna gvss. Tincture qf---- giss. Syrup qf ginger gss.—Mix. M. sumantur cochlearia tria Let three spoonfuls of it be ta pro dosi. ken for a dose. R. Seminis focniculi contusi Take Fennel-seed, bruised%\Yy Si'j- Aquae ferventis gxvj. Boiling water gxvi. Macera per horam» dein cola Macerate for an hour, and pro enemate. strain for an injection. R. Infusi fceniculi gxij. Take infusion of fennel-seed^^ Tincturx asafoetidx gss. Tincture of asafoetida §ss. Fiat enema. Make an injection. 3. The application of cold to the abdomen, of ice or snow or of warm stimulating plasters. R. Olei macis gss. Take Oil of mace gss. Cerati saponis gij. Soap cerate gij.—Make a Fiat emplastrum toto abdomi- plaster to be applied over the ni imponendum. whole abdomen. R. Succi cicutx spissati gij. Olei anisi Jss. Fiat emplastrum Take Inspissated juice of hem- lock gij. Oil of anise Jss. Make a plaster. W 230 DROPSY OF THE CELLULAR MEMBRAN&t 4. Friction with warm liniments. R. Camphorx 5ij. Take Camphor Q'y Olei olivx gj. Oil of olives gi. Spiritus terebinthinx recti- Spirits of turpentine g ss. ficati gss. Fiat embrocatio. Make an embrocation. R. Olei cajaputx gj. - Take Oil of cajeput gi. Spiritus terebinthinx rec- Spirit* of turpentine 31J. ficati Jij. Fiat embrocatio. Make an embrocation. 5. Encircling the abdomen with a tight bandage. 6. In the tympanites intestinorum, advantage is occasional- ly obtained by the introduction of a fistula into the rectum, and suffering it to remain for some time. 7. In the latter species, paracentesis with a very small trochar or lancet has been recommended ; but whether ithaa been performed or not, and with what advantage, 1 know not. The second indication requires, 1. Tonics ; such as are recommended against dyspepsia* 2. Regular exercise. 3. Carefully avoiding all food of a flatulent nature. 4. The occasional use of stomachic aperients. ANASARCA, OR DROPSY OF THE CELLULAR MEMBRANE. CHARACTER. A preternatural collection of serous or watery fluid in the cellular membrane of the whole, or part of the body. »ROPSY OF THE CELLULAR MEMBRANE. 231 SYMPTOMS. the disease generally commences in the lower extremities, and first shews itself towards evening with a swelling of the feet and ancles, which by degrees ascends, and successively occupies the thighs and trunk of the body. When it has become very general, the viscera are affected in a similar way ; the cellular membrane of the lungs partakes the affec- tion ; the breathing becomes difficult, and is accompanied by cough, and the expectoration of a watery fluid.—The urine is small in quantity, high coloured, and deposits a reddish sedi- ment ; sometimes, however, it is of a pale whey colour, and more copious.—Costiveness-,—insatiable thirst;—the skin is generally pale and arid ; though sometimes a slight yet gene- ral inflammation takes place, when it becomes tense and shining.—The water often oozes through the pores of the cuticle, or raises it in the form of small blisters ;—the coun- tenance becomes sallow;—torpor;—heaviness ;—troublesome cough;—slow fever. CAUSES. Predisposing.—An hydropic diathesis. Exciting.—Certain organic diseases, producing an obstruc- tion to the free circulation of the blood;—excessive dis- charges ;—suppression of customary evacuations ;—exposure to a moist atmosphere ;—the sudden striking in of eruptive complaints;—crude and indigestible aliment;—drinking large quantities of watery fluids ;»-abuse of spirituous liquors ;— certain preceding diseases, as inflammation, the exanthema, especially scarlatina;—jaundice,—diarrhoea,—dysentery,— phthisis,—gout,—intermittents of long standing. Proximate.—Increased effusion ;—diminished absorption ; —or both united. DIAGNOSIS. From emphysema.—By the swelling in anasarca being oede- matous i in emphysema, elastic and accompanied with ere- 232 BROPSY OF THE CELLULAR MEMBRANE, pitus;—by the particular state of the urine ; and other symp- toms above mentioned. PROGNOSIS. Favourable.—The disease having been induced by causes which admit of easy removal*,—the strength little diminish- ed ;—the constitution of the patient previously unimpaired ; —the appetite remaining entire ;—the respiration free ;—no great thirst;—a gentle moisture on the skin. U;favourable.—Concomitant organic disease ;—great ema- ciation ;—erysipelatous inflammation;—much drowsiness ;— petechix and ecchymoses ;—hxmorrhage ;—feverish heat ;— great thirst;—quick small pulse. 1X1 Indication*. < .. TREATMENT. 1. To evacuate the collected fluid. To prevent its again accumulating. The collected fluid is evacuated by, 1. Scarifications and punctures. 2. Blisters. 3. Friction. 4. Emetics, and nauseating medicines ; especially antim*- nium tartarizatum and squills. The haustus emeticus communis. R. Vini ipecacuanhx gss. Take Ipecacuan wine gss. Tincturx scillx 3ij. Tincture of squills Xi'y Fiat haustus emeticus. Make an emetic draught. 5. Cathartics ; of gamboge,—elaterium,—jalap,—colocynth, —calomel,---gratiola,---crystals of tartar. DROPSY OF THE CELLULAR MEMBRANE. 233 R. Elaterii gr. ij. Sacchari purificati jj. Optime terantur simul, dein in pulveris octo xquales dividantur, quorom capiat _ xger unum omni horx qua- drante donee adsit cathar- sis. R.Extracti colocynthidis com- positi, -------jalapii, aa5j. Gambogix ^ss. Olei juniperi gutt. iv. Fiat pilulx xii. quarum capi- antur tres omni hora donee alvus tar quaterve respon- deat. R. Calomelanos gr. v. Conservx rosx q. s. Fiat pilulx mane sumenda cum haustu cathartico sali- lino. R. Pulveris scammonii cum calomelane ^i. Fiat pulvis catharticus. R. Extracti gratiolx gr. xv. Tincturx sennx 3»j- Infusi sennx 3xj. Syrupi zingiberis X\y Kali vitriolati ^j. Fiat haustus catharticus. Take ofElaterium ("inspissated juice of wild cucumber J gr.ij. Purified sugar Xj.. Let them be well rubbed to- gether, divide into eight equal powders, of which let the pa- tient take one every fifteen minutes,, until they purge freely. Take Compound extract of co- locyntk, ----of Jalap, each Xf\, Gamboge J^ss. Oil of juniper drops iv. Make xij pills, let three be ta- ken every hour 'till they purge three or four times. Take Submuriate of mercury gr. x. Conserve of roses q. s, Make two pills, to be taken in the morning with the saline- cathartic draught. Take Powder of scammony with submuriate of mercury 3i> Make a cathartic powder. Take Extract of hedge hysop gr. xv. Tincture of senna X\'y Infusion of —— 5XI* Syrup of ginger X\y Sulphate of potash $i. Make a cathartic draught. 234 DROPSY OF THE CELLULAR MEMBRANE. R. Herbxgratiolxincisx giij. Foliorum sennx gjss. Succi glycyrrhizx giij. Electuarii e cassia gij, Aqux distillatx Jljjss. Leniter coque per quadran- tem horx, addendo sub finem coctionis, Myrrhx optimx Xy Kali vitriolati 3JSS- Cole pro usu : et sumat xger cyathum parvum pro re na- ta. R. Pilulx e scilla gr. x. Fiat pilulx dux sexta quaque hora sumendsc. Take Hedge hysop, cut giij. Senna leaves giss. Juice of liquorice giij. Electuary of cassia gij. Distilled water Jfciss. Boil gently for fifteen minutes, adding at the end of the boil- ing Best myrrh X}. Sulphate of potash 3'iss. Strain for use, and let tie pa- tient take a small glass full occasionally. Take Squill pill gv. x. Make two pills to be taken ev- ery six hours. R. Cremoris tartari gij. Pulveris zingiberis Jj. Syrupi simplicis q. s. Fiat electuarium molle, de quo capiat xger cochleare medium omni quadrante horx donee alvus copiose respondeat. Take Supertartrite qf potash g ij Powder of ginger Ji. Simple syrup q, s. Make a soft electuary, of which let the patient take a pap- spoonful every fifteen min- utes'till the bowels are freely opened. 6. Diuretics ; of colchicum,—squills,—kali acetatum,— digitalis,—cream of tartar,—spiritus xtheris nitrosi,—can- tharides,—juniperus,— raphanus rusticanus,—sinapi,-genis- ta,— the lactuca virosa,—tinctura nicotianx. R. Aceti colchici gss. Syrupi corticis aurantii gj ss. Fiat syrupus cujus sumat xger cochleare minimum omni bihorio vel subinde donee nauseam promoveat. Take Acetite qfmeadoiu saffron gss. Syrup of orange peel giss. Make a syrup, of which let the patient take a tea-spoon- ful every two hours or oftener till nausea is excited. DROPSY OF THE CELLULAR MEMBRANE. 235 R. Pilulx e scilla gr. vj. Take Squill pill gr. vi. ■ ex hydrargyro gr. Mercurial pill gr. ijss. ijss. Fiat pilulx dux nocte mane- Make two pills, to be taken que capiendx. night and morning. R. Pulveris digitalis gr. ss—j. Take Powder of purple foxglove gr. ss—i. Calomelanos gr. i—ss. Submuriate of mercury gr. ss—i. Pilulx e scilla gr. vj. Squill pill gr. vi. Fiat bolus ter in dies adhiben- Make a bolus, to be given three dus. times a :'.ay. R. Pulveris scillx gr. vj. Take powder 0f squiUs gr. i Pilulx ex hydrargyro gr. Mercurial pill gr. ijss. ijss. Extracti taraxaci gr. j. Extract of dandelion gr. vi. Olei juniper! gutt. j. oi( 0fjuniper drop i. Fiat pilulx dux ter in die su- Make two pills, to be taken menaje- three times a day. R. Tincturx scillx gutt. xx. Take Tincture of squills drops xx, Kali preparati gr. vj. Carbonate of potash gr. vi. Misturx camphorx 3xij. Camphorated mixture 3x'j- Syrupi zingiberis 3J. Syrup of ginger gi. Fiat haustus ter in die sumen- Make a draught to be taken jus three times a day. ?,.. Aceti scillx gutt. xx—XL. Take Acetite of squills drop* XX—XL. Ter in die ex quovis vehiculo To be taken three time* a day idoneo capiendus. in any proper vehicle. 236 DROPSY OF THE CELLULAR MEMBRANE. R. Kali acetati 9j. Infusi quassix 3X1J. Tincturx digitalis gutt. x. Fiat haustus ter in die capi- endus. R. Kali preparati 9j. Aceti distiUati ferventis q. s. Ad saturationem ejus. Misturx camphorx jx. Tincturx digitalis gutt. X.. Syrupi zingiberis gj. Fiat haustus ter in die sv- mendus. R. Cremoris tartari Jj. Kali vitriolati gr. x. Pulveris rhxi gr. ij. Fiat pulvis ter in die sumen- dus. R. Tincturx cantharidis gutt; x—XL. Spiritus xtheris nitrosi3J. Misturx camphorx 3xij. Syrupi zingiberis 2Jj- Fiat haustus ter in die su- mendus. R. Tincturx, nicotianx gutt. X—LX. Infusi gentianx compositi: Aqux pimento 3X- Fiat haustus ter in die su- mendus. Take Acetite of potash ^i. Infusion qf quassia J xij. Tincture of foxglove drops X, Make a draught to be taken three times a day. Take Carbonate of potash ^i. Boiling distilled vinegar suf- ficient to neutralize it. Camphorated -mixture X^x. Tincture qf foxglove drops X. Syrup of ginger Xji. Mako a draught, to be taken- three times a day. Take Supertartrite of potash Xf\. Sulphate of potash gr. x. Powder of rhubarb gr. vi. Make a powder, to be taken three times a day. Take Tincture of cantharidis drops x—xl. Nitrous tether 3L Camphorated mixture Xxiy Syrup of ginger gi. Makeadraught to be taken three times a day. Take Tincture of tobacco drops X—XL. Compound infusion qf gentian Svi. Water of Jamaica pepper$x. Make a draught to be taken three times a day. DROPSY OF THE CELLULAR MEMBRANE. 237 R. Succi lactucx virosx spis- Take inspissated juice of the sati gr. x. strong scented lettuce gr. x. Fiat pilulx dux ter in die ca- Make two pills, to be taken piendx. three times a day. R. Succi lactucx virosx spis- Take Inspissated juice of the sati 5Jss. strong scented lettuce 3iss. Infusi gentianx compositi Compound infusion of gentian xx. 5_. Aqux menthx piperitidis Peppermint water Xfv. Spiritus juniperi compositi Compound spirits of juniper Fiat haustus ter in die su- Make a draught, to be taken mendus. three times a day. R. Radicis raphani rusticani Take Horse raddish root, cut excisx gij. gij- Seminis sinapeos albx g jss. White mustard seed giss. Baccx juniperi contusxgiij. Juniper berries, bruised giij. Vini albi Hispanici ffjiy. Spanish white wine ftiij- Digere per dies octo, dein Digest for eight days and strain. cola:—capiat xger cya- Let the patient take a wine thum parvum vinosum bis glass full twice a day. quotidie. 7. Diaphoretics ; pulvis ipecacuanhx compositus,—cam- phor,—antimony,—assisted by tepid diluents ;—the vapour- bath ;—the copious use of aqueous diluents ;— water impreg- nated with tinctura ferri muriati. 8. Bandage. 9. Mercury ; so exhibited as just to affect the gum. The second indication demands, 1. A light nourishing diet, with pungent aromatic vegeta- bles ; garlic,—mustard,—onions,—cresses j—Rhenish wine, 23* »ROPSY OF THE ABDOMEN. 2. Tonics; cinchona,«-angustura,—quassia,—preparations »f steel, as recommended for dyspepsia. 3. The occasional use of diuretics and aromatics. 4. Regular exercise. 5. Cold bathing. ASCITES, OR DROPSY OF THE ABDOMEN. r Peritoneal. " X Encysted. SYMPTOMS. Of the peritoneal.—It often comes on with loss of appetite j —sluggishness ;—inactivity ;—dryness of the skin;-—oppres- sion of the chest ;—cough;—diminished urine ;—costiveness; —shortly after a protuberance is perceived in the hypogas- trium, which gradually extending, at length occupies the whole abdomen, which uniformly becomes swelled and tense, in a small degree elastic, and communicates to the hand, when struck against it, the sensation of its containing an undulating fluid. See Paracentesis Abdominis in works on surgery. As the distention increases, the difficulty of breathing be- comes more considerable ;-—the countenance exhibits a pale or bloated appearance ;—immoderate thirst;---dry parched skin;—high coloured, thick, and scanty urine; depositing a lateritious sediment;—the pulse sometimes quickened, some- times preternaturaUy slow and soft.—The disease seldom continues long without inducing an anasarcous state of the lower extremities. The encysted dropsy is seldom preceded, or in the first in- stance accompanied, with any cachectic state of the system ; it is distinctly observed to begin in a particular part of the abdomen, and thence gradually to diffuse itself throughout the whole cavity;—the strength of the patient is long unimpair- DROPSY OF THE ABDOMEN. 239 ed; and the appetite and respiration continue good; until the bulk and pressure of the fluid brings on various constitutional effects, which usuaUy attend the true ascites in its early stages. CAUSES. In addition to the general causes of the dropsy (see Ana- sarca J, certain local affections, as diseases of the viscera of the abdomen;—scirrhosities of the liver, spleen, or pancreas ; enlargement of the mesenteric glands;—loss of tone in the peritoneum after pregnancy, or from atonic inflammations- local injury. DIAGNOSIS. The fluctuation of the contained fluid;—the diminished urine;—the general leucophlegmatic appearanceofthepatient. From tympanites.—See Tympanites. From pregnancy.—Consult the signs of pregnancy delivered by authors on midwifery. PROGNOSIS. Favourable.—The urine little diminished, or becoming more copious ;—the swelling of the abdomen diminishing ;—the skin ceasing to be dry ;—the respiration becoming free ;—the strength originally little impaired. Unfavourable.—Great emaciation;—sympathetic fever ;— intense local pain ;—coma;—the disease having been induced by a state of the liver, brought on by the abuse of spirituous liquors ; or the constitution otherwise impaired. TREATMENT. C 1. To evacuate the fluid. (.11. To prevent a second accumulation. The first is effected by, 1. Purgatives, such as are recommended against anasarca 2. Diuretics, similar to those ordered for anasarca. .40 DROPSY OF THE CHEST. 3. Friction of the abdomen with camphorated oil. 4. After a fair trial has been given to these remedies, which increase the natural secretions, without effect, and the pi^s- sure and tension of the abdomen become insupportable^ re- course must be had to paracentesis of the abdomen; the per- forming of which belongs to surgeons. The re-accumulation is sometimes prevented, 1. By removing the causes which induced the disease ; and by strengthening the tone of the parts in particular, and of the system in general. 2. If the disease proceed from chronic visceral obstruction, by mercury, administered both internally, and externally by friction to the abdomen ;—the union of squill with calomel; or of calomel with antimony. 3. If from relaxation, by tonics,—aromatics,—stimulants ; as directed for anasarca. HYDROTHORAX, OR DROPSY OF THE CHEST. „ . CI. In the cavity of the pleura. - " ell. In the cavity of the pericardium. SYMPTOMS. Of water in the cavity of the pleura.—Great difficulty of breathing, increased upon exertion ; and most considerable during the night, when the body is in an horizontal posture ; —distressing sense of weight and oppression at the chest; —the countenance is pale ; sometimes, however, it has the asthmatic purple tinge, and conveys a peculiar and striking expression of anxiety;—the urine is in small quantity;— great thirst;—anasarca of the upper extremities ;—the pulse is irregular ; often intermitting for two, sometimes for three strokes ;—palpitation of the heart; sometimes so great as to be both seen and heard;—cough, with expectoration gener- • ROPSY OF THE CHEST. 241 ally tinged with blood ;—in describing his complaint, the pa- tient frequently mentions his having the sensation of breath- ing through water;—difficulty of lying upon one side ; and when the disease exists in both cavities of the chest, the pa- tient is incapable of lying down at ah, and is obliged to be supported by pillows in an erect position ;—his sleep is dis- turbed by dreadful dreams, of fire, of drowning, of falling down precipices, &c. ; and frequently he awakes with a sense of suffocation, suddenly starts from his bed, and is sometime before he recovers his recollection;—the arm of the side in which the water is collected is generaUy cold and torpid, and often affected with numbness. Of water in the cavity qf the pericardium.—In addition to many of the above symptoms, the heart in this disease is greatly enlarged, so as to be felt to palpitate, even as low as the seventh or eighth rib.—The irregularity of the pulse is more remarkable ; at one instant it is imperceptibly small and rapid, in the next a remarkably hard wire.—The difficulty of breathing often assumes an intermittent form, and in the par- oxysm is much more severe and distressing.—Anasarca of the extremities takes place in the advanced period of the dis- ease ; and there is the same starting from sleep as in the true hydr-othorax. CAUSES. The general causes of dropsy (see Anasarca J ,—-obstruc-^ tion to the free circulation of the blood through the lungs, by disease of the thoracic viscera, or loss of tone in the membranes lining the chest. DIAGNOSIS. The distinguishing symptoms are, the extreme difficulty of breathing ;—the incapacity of lying upon one, sometimes upon either side -.—the sudden starting from sleep ;—the pe- culiar pulse before described;—the striking appearance of X 242 BROPSY OF THE CHEST. the countenance ;—the numbness of the arms ;— palpitation of the heart. From collections of matter and blood.—By the characteristic marks enumerated by writers on surgery, when treating of such diseases of the chest. From syncope anginosa.—The one disease consists of dis- tinct paroxysms ; each of which is brought on by certain ex- citing causes (see Sync»pc Anginosa J.—In the other the symp;- toms are usually permanent; the peculiar sensation of heat extending to the arms, which takes place in syncope angino- sa, is rarely felt in hydrothorax.—When syncope has long ex- isted, and the symptoms have become less marked than in its first attack, a distinction is extremely difficult to be formed. PROGNOSIS Will always be unfavourable ; more especially when hydro- thorax is the consequence of organic disease ;—when it oc- curs in a shattered constitution;—when the symptoms be- come more and more severe, and are attended with coma and ■jpitting of blood. TREATMENT. The same evacuant plan is here to be pursued as re'com^ mended for the cure of anasarca and ascites. The diuretics most usually employed are, digitalis,— squill,—crystals of tartar. See Treatment of Anasarca. If there be much debility, myrrh combined with spiritus xtheris nitrosi, or other tonics and diuretics united; with the addition of frequent blisters to the chest. R. Myrrhx optimx ^ss. Take best Myrrh ^ss. Spiritus xtheris nitrosi ij. Nitrous tether Xj\. Infusi rosx ^xiij. Infusion of roses 3xiij- Syrupi ejusdem 3j- Syrup of —— X^i. Fiat haustus ter in die capi- Make a draught, to be taken endus. three times a day. WATER IN THE HEAD. 243 R. Myrrhx optimx ^ss. Take best Myrrh ^ss. Olei essentialis juniperi Essential oilofjuniper drops ij. gutt. ij. Pulveris rhxi q. Si Powder of rhubarb q. s. Fiat bolus ter in die sumen- Make a bolus, to be taken three dus. times a day. If these means should be ineffectual, and the disease ap- pear to be purely local, recourse should be had to the opera- tion of paracentesis thoracis. Inhalation of oxygen gas is said to have been successfully tried. HYDROCEPHALUS, OR WATER IN THE HEAD. SYMPTOMS. Languor, inactivity, loss of appetite, nausea, vomiting, parched tongue, hot dry skin, flushing of the face, and other symptoms of pyrexia ;—pain over the eyes;—great sensibili- ty to light;—suffused redness of the eye;—the pain in the head becomes extremely acute; it comes on at intervals, and occasions the sufferer to utter piercing screams, at the same time compressing the forehead with his hand;—disturbed sleep;—extreme restlessness;—flushed countenance;—cos- tiveness. In a short time the pupils of the eye begin to dilate;—stra- bismus comes on ;—the vomiting and pain in the head become more violent, especially in the evening; at length the pain diminishes, and sleepiness succeeds a constant state of watch- ing ;- —the pulse, before increased in quickness, is now pre- ternaturaUy slow and often intermitting ;-—the strabismus in- creases ;—the pupils become more dilated, and cease to con- tract on their being exposed to light;— double vision, or com- plete loss of sight, with lethargic torpor, succeed. '-44 WATER IN THE HEAD. After a shorter or longer continuance of the second stage, the pulse again returns to a febrile state, and becomes so ex- tremely small and rapid as to be with difficulty numbered ; — the eyes are now inflamed ;—extreme difficulty of breathing : stertor;—the evacuations become involuntary ;---maculx sometimes appear about the joints, and in different parts of the body ; and at length the patient expires in dreadful con- vulsions, CAUSES, The disease is almost peculiar to children, and more fre- quently attacks the scrofulous ;---it seems to originate in a weakened state of the organ itself. The proximate cause in some cases appears to be inflam- mation, which terminates by inducing an effusion of watery fluid. In other cases the proximate cause would seem to be the same as that of the other species of dropsy ;—increased ex- halation, or diminished absorption, or both. DIAGNOSIS. The pathognomonic symptoms are the excruciating pain in the head,—vomiting,—impatience of light;—followed by strabismus, dilated pupil, and profound stupor.—-The pulse at first preternaturaUy quick,—afterwards becoming inordin- ately slow. PROGNOSIS Will ever be unfavourable,—more especially where the co« ma is great, with total loss of sight, and weak intermitting pulse ;—the head greatly enlarged,—apoplectic stertor,— difficult respiration,—and involuntary evacuations. WATER IN THE HEAD. 245 Indication*. TREATMENT. To lessen inflammation in the inflammato- ry stage. 111. To promote the absorption of the fluid, when effusion has taken place. The inflammation is subdued by, 1. Bleeding; the application of leeches to the temples, by opening the temporal artery, or the jugular vein. 2. Cathartics ; of jalap, calomel, or soluble tartar. R. Pulveris e scammonio cum calomelane 9ss.—3SS. Fiat pulvis catharticus ex pauxillo mellis sumendus. Take Powder of scammony with submuriate ofmercury^ss— 3ss. Make a cathartic powder, to be taken in a little honey. R. Calomelanos gr. ij. Pulveris antimonialis gr.j. Fiat pulvis omni bihorio ad- hibendus ex quovis vehicu- lo crasso. 3. Diaphoretics ; especiaUy 4. Nitre in large doses with R. Nitri purificati gr. vj. Tincturx digitalis gutt. x —XL. Aqux ammonix acetatx3ij. _— — distillatx 5V, Syrupi croci Jj. Fiat haustus infanti xt. 4 ad- hibendus tertia quaque ho- ra. X Take Sub-muriate of -mercury gr- iij- Antimonial powder gr. i. Make a powder to be given eve- ry two hours in arty thing thick. antimonials, digitalis. Take Nitrate of potash gr. vi. Tincture of purple foxglove drops x—xl. Water of acetite qf ammonia 5a- ---- distilled X,v. Syrup of saffron Xx. Make a draught, to be given ev* ery three hours, to a child four years cfage, 2 246 RICKETS. 5. Blisters, and cold applications to the head ; cloths wet- ted with cold water, or vinegar and water, and so applied as not to interfere with blistering. The second indication requires, 1. Mercury ; mercurial friction externally,—calomel taken internaUy. 2. Digitalis; either alone, or united with calomel. 3. Tonics ; the ferrum ammoniacale,—ferrum vitriolatum, —or those recommended for the cure of anasarca. RACHITIS, OR RICKETS. This disease is peculiar to infants and children, between the sixth month and the second year of their age. Its usual symptoms are weakness ;—a white or leucophlegmatic ap- pearance of the whole body ;—a bloated or very florid coun- tenance ;—soft flesh;—disinclination and dislike to motion ;— enlarged abdomen, head, and joints ;—the wrists and ancles enlarge first, then all the bones as it were swell and become eoft, especially the more spongy ones. The pulse is quick and feeble ;—the appetite and digestion usually bad. Den- tition is generally late, though not frequently difficult, but the teeth decay soon after they appear, and fall out, When the disease has made much progress, the cylindri- cal bones bend; the ribs also, and even the spine, incurvate. CAUSES. Scrofula;—any cause inducing general weakness and re- laxation. It frequently arises from unhealthy parents; es- peciaUy from mothers who pass too sedentary a fife in bad air, and feed upon a poor and watery diet;—from children's food being weak, watery, or too viscid to be properly digest- ed ; but, above all, perhaps from bad nursing, or children being left wet, dirty, or exposed to a cold moist air without RICKETS. 24f sufficient covering;—from want of proper exercise, and from close and crowded apartments ;—from being kept too long at the breast -,—from sucking a nurse whose milk is impov- erished by irregularity;—lastly, from the constitution being enfeebled by disease in early infancy, especially weak bowels. TREATMENT. f 1. To brace and strengthen the solids. Indications. 262 WORMS. dered chalk, covered with the plaister; and if the process be tedious, a poultice of bread and milk is apphed over the plais- ter. In very severe and extensive accidents of this kind (says Mr. Kentish) I have used this method throughout the whole cure after the formation of pus, and have in general found it prevent the necessity of either astringent or caustic applica- tions ; nor on the other hand.have I found it retard the cure, by repressing the necessary secretions. The internal treatment, is also stimulant in the first stage, but after suppuration has taken place, stimulants are to he carefully avoided. If the secretion of pus should continue too great, gentle laxatives and a spare diet are indicated. To, defend .the new skin, camphorated oil, or camphorated oil and lime water, equal parts, are very good topical applica- tions. Should the strength fail, bark taken in milk three or fi>ur times a day, will be the best method of obviating debU- fcy. WORMS. There are three general classes of worms that infest the human body. The Ascarides, or small round worm; the Teres, or round long worm; and the Txnia, or tape-worm. The Ascarides, for the most part, occupy the lower part of, the intestinal canal, about the rectum. The Teres, are gen- eraUy found in the small intestines and stomach; while the Txnia frequently occupy the whole of the intestinal tube, and have been described from two to forty feetin length. The symptoms of worms are few and equivocal, and are common to the several species.—They are dyspepsia with va- riable appetite, foul tongue, foetid breath, hard, full and tense belly, occasionally griping about the navel, heat and itching about the rectum ; the eyes are heavy and dull, the nose itches, there is a short dryxough, grinding of the teeth, WORM5, 26$ and starting during sleep, frequently attended with a slow fever. The only decisive symptom is the discharge of worms. CAUSES. Nothing in the animal oeconomy is involved in greater mys- tery than the origin of intestinal worms. They are generally found in persons of weak digestive organs, and indigestion may benoticed, if not the principal cause, at least as favour- ing their generation.—Were they found to live in situations out of the bodies of living animals, it might naturally be sup- posed that their eggs had been taken into the body, with their food or drink, and there gradually evolved into animals. This, however, is not the case, for they are evidently inca- pable of existing for any length of time in any situation, ex- cept within a living animal body, which appears to be the proper place for their growth and residence. They seem to Form a part of a healthy constitution, and are scarcely inju- rious, but from accidental circumstances. Their formation is assisted by accumulation of mucus in the intestines, and they consequently become inconvenient in children and ca- chectic persons. They are soon destroyed by every kind of fever. It is not the existence, but the accumulation and con- sequent irritation produced by worms, that constitutes dis- eases. The indications of cure are, f 1- To evacuate the stomach and intestines of re- 1 dundant slime. Cure ■< j 11. To strengthen the stomach and bowels so as to £ destroy the disposition to their generation. The first object is best accomplished by brisk cathartic medicines, as the Basilic powder. R. Scammony, Submuriate of mercury, Supertartrite of potash, Powder of jalap, each equal parts, %64 WORMS. The scammony and supertartrite of potash are to be ground together in a marble mortar, 'till reduced to a very fine pow- der, when the other articles are to be added, and the whole intimately mixed—this forms the Basilic powder. This may be given to children of all ages, in a dose of four or five grains to a child of a year old, increasing in propor- tion to the age and strength of the child.—This should be re- peated every second or third morning, for a fortnight. On the intervening days, some tonic medicine should be given; the red oxyd of iron, answers extremely well, and may be given in a dose of from five to thirty grains every morning, to children from one to ten years of age, in a little currant jelly. In some cases it is found difficult to dislodge the Ascarides even by the most drastic purges, in such cases the following injection is frequently effectual. Take Ferrum ammoniacale (flores martiales) gr. xx. Lime water, eight ounces. Dissolve for an injection. This injection should be followed by a brisk cathartic. For the Tape-worm, the root of the male fern, the poly- podium filix mas. of Linnxus, is found to be a specific.—For the success of this remedy, it is necessary that it be recent- ly gathered, and brought to a state fit for powdering by dry- ing it in a moderately heated oven, or before the fire. Two or three drachms of the powder are to be taken in the morning in a little water, no supper having been taken the night before. It generally sickens a little. A brisk purga- tive, with a little calomel, is to be given a few hours after, which sometimes brings off the worm entire ; if not, the same course is to be pursued at proper intervals. SCALD HEAD. 265 TINEA CAPITIS, OR SCALD HEAD. This disease consists of small ulcers oozing out a fluid, at the roots of the hair, which forms a white friable scab. It is sometimes of a contagious nature ; and has been communica- ted by a change of hats at school. The discharge is often so acrimonious, as to cause swellings of the lymphatic glands of the neck. On the early appearance of this disease, it will only be ne- cessary to cut the hair short in the places affected ; to remove the scabs; and rub a little of the following ointment weU over the parts: Take of Citrine ointment 3'iij. Olive oil Xji. Mix for an ointment. In the more inveterate stages of the disease, Banyer and Parr have found the following ointment invariably success- ful. Take white oxyd of lead one ounce. Lytharge two drachms and a scruple. Burnt alum two drachms. Muriate of mercury two drachms. Hogs-lard six drachms. Venice turpentine one ounce. Mix for an ointment. Sometimes an epispastic, applied over the whole of the scalp, previously shaved, has proved successful. Z A GLOSSARY, OR EXPLANATION OF TERMS. A. Adynhnite, (Adynamia, x, f. from « privative, and S'vyx/At?, power). A defect of vital power. The second order of the class Neuroses. Alteratives (Alterantia; from altero, to change). Medicines which re-establish health without producing any sensible evacuation. Anasarca (Anasarca, x, f. from *»cc, along, and **£f» the flesh.) Dropsy of the cellular membrane. Anomalous. A disease whose symptoms do not appear with regularity; and also a disease with such varied symptoms as not to come under the description of any known affection. Antiphlogistic ( Antiphlogistica; from *v7f, against, and^Ae y«, to burn). Medicines or diet which oppose inflammation. Antisceptics (Antisceptica; from #v7<, against, and c-jja-w, to putrefy). Medicines which prevent and stop the pro- gress of putrefaction. Antispasmodics (Antispasmodica; fromtfv?', and o"?rcto"fA,as} a spasm). Medicines which allay spasmodic affections. 268 GLOSSARY. Aperient* (Aperientia; from aperio, to open.) Medicine* which gently open the bowels. Aphtha (Aphthx, arum, f. from *v\u, to inflame.) The thrush. Apoplexia (Apoplexia, x, f. from ccwowAqa-oet, to strike or knock down). Apoplexy. Apyrexia (Apyrexia, x, f. from « and irv§t£tx, a fever.) Without fever. Ascaris (Ascaris, idis, f. from tto-Ktu, to move about). A genus of intestinal worms. Ascites (Ascites, x, m. from ««■*©•', a sac or bottle). Drop- sy of the belly. Asthma, (Asthma, atis, n. from *o-(h*«£ a habit). A bad habit of body. Cachexix is the name of the third class of diseases in Cullen's nosology. Carminatives (Carminativa ; from carmen, a verse or charm, because practitioners in ancient times ascribed their ope- ration to a charm or enchantment). A term given to those substances which aUay pain and dispel flatulency in the primx vix. Catarrhus (Catarrhus, i, m. from x.*T»ppeet, to flow down). A catarrh, or cold. Cathartics (Cathartica; from x«0«tgo, to purge). Medi- cines which increase the number of alvine evacuations. Chlorosis (Chlorosis, is, f. from #A«f as, green, pale ; from the yellow greenish look those have who are affected with it). The green sickness. Cholera (Cholera, x, f. from #oAjj, bile, and ftu, to flow). A disease that consists in a purging and vomiting of bile. GLOSSARY. 269 Chorla Pancti Viti (Chorea, from %ogettt, dancing). St. Vi- tus's dance ; so caUed from some devotees of St. Vitus hav- ing exercised themselves so long in dancing that their in- tellects were disordered, and could only be restored by dancing again at the anniversary of St. Vitus. Colica (Colica, ae, f. from *« Aa*, the colon, one of the large intestines). The colic. Coma (Coma, atis, n. from *«*, to lie down.) A propen- sity to sleep. Comata (Comata; from coma, sleep). The first order of the class Neuroses. Corysa (Coryza, x, f. from xxpct, the head, and £*«, to boil). An increased discharge of mucus from the nose. Crisis (Crisis, is, f. from xpna, to judge). The sudden change of symptoms in acute febrile diseases indicating recovery or death. Cynanche (Cynanche, es, f, from xvav, a dog, and «v#**, to suffocate ; so called from dogs being said to be subject to it). Sore throat. Cystitis (Cystitis, idis, f. from ~VS", to seize upon,; so called from the suddenness of its attack). Epilepsy. Epiphora (Epiphora, x, f. from fsr/^ffw, to carry forcibly), Involuntary flow of tears. Epistaxis (Epistaxis, is, f. from errata, to distil from). Hxmorrhage from the nose. Errhines (Errhina, from tv, in, and ptv, the nose). Those medicines which, when topically applied to the internal membrane of the nose, excite sneezing, and increase Se- cretion, independent of an^ mechanical irritation, GLOSSARY. 27L Erysipelas (Erysipelas, atis, n. from t^vu, to draw, and sreA«?, adjoining). St. Anthony's fire. Exacerbation (Exacerbatio ; from exacerbesco, to become vi- olent). An increase of febrile symptoms. Exciting cause. That which, when applied to the body under a state of predisposition, excites a disea.se. Exanthemata (Exanthema, atis, n. from efavflf-', to spring forth, to bud). The third order of the class Pyrexix. Expectorants (Expectorantia; from expectoro, to discharge from the breast). Medicinas which increase the discharge of mucus from the lungs. G. Gangrene (Gangrxna, x, f. from y*, the stomach). In- flammation of the stomach. H. famorrhagtx (Hxmorrhagix,'arum,f. from xifAX, blood, and. ptiyvvfti, to break out). The fourth order of the class Pyrexise. Hemoptysis (Hxmoptysis, is, f. from eUf&x, blood, and Trrvaif to spit). A spitting of blood. Hematcmesis (Hxmatemesis, is, f. from tcif*.x} blood, and cf^eu, to vomit). A vomiting of blood. Hematuria (Hematuria, x, f. from «<^t«j blood, and vpot^ urine). Bloody urine. Hepatitis (Hepatitis, idis, f. from '*)irap> the fiver). Inflam* mation of the liver. Hydrocephalus (Hydrocephalus, i, m. from voup, water, and xt^xXii, the head). Water in the head. Hydrophobia (Hydrophobia, x, f. from vdcop, water, and floGSU) to fear). Canine madness. Hydrothorax (Hydrothorax, acis, m. from u^up^ water, and $-upet%, the chest). Dropsy of the chest. 372 GLOSSARY. Hypochondriasis (Hypochondriasis, is,f.from v*r«X«» ty i«_s?, one who is hipped). Hypochondriac affections j lownesa of spirits. Hysteria (Hysteria, x, f. from vrtp«, the womb). Hysterics. I. Icterddes (from i*Tege«, the jaundice, and ttefof, resem- blance). A species of typhus is so caUed from the resem- blance of the skin to that of jaundice. Icterus (Icterus, i, m). The jaundice. Ileus (from ilia, the small guts). The iliac passion » an af- fection of the smaU intestines. Impetigtnes (Impetigo, ginis, f. from impeto, to infest). The third order in the class Cachexix of Cullen. Indication (Indicatio, onis, f from indico, to show). That which demonstrates in a disease what ought to be done. Influenza (Influence, Ital.; so named because it was suppo- sed to be produced by a peculiar influence of the stars). An infectious catarrh. Intumescentite (from intumesco, to swell). SweUings. The second order of the class Cachexix. L. Lumbricus (Lumbricus, i, m. d labricitate, from its slipperU ness). M. Mania (Mania, x, f. from /a«Jve^«*, to rage). Raving 01? furious madness. Marcores (Marcor, 5ris, m.). Universal emaciation. An order in the class Cachexix. Melancholia (Melancholia, x, f. from f&eA««, black, and #«Atf» bile; because the ancients supposed that it proceeded from a redundance of black bile). Melancholy madness. Menorrhagia (Menorrhagia, x, f. from ^.JjH «, the menses, and faytvpi) to break out). Au immoderate flow of the men. ses. GLOSSARY. 2^5 yiiliaria (MUiaria, x, f. from milium, mUlet; so called be- cause the small pustules or vesicles upon the skin resemble millet-seed). Milliary fever. N. Narcotics (Narcotica; from vxpxoay to stupefy). Medicines which ease pain and procure sleep. Nephritis (Nephritis, idis, f. from it$po?} a kidney). In* flanimation of the kidney. Neurises (Neuroses, is, f. from ttvpot) a nerve). Nervoua diseases. The second class of Cullen's nosology. O. Opisthotonos (Opisthonus, i, n. from «tio-<«», backwards, and Ttttu, to draw). A tonic spasm of the muscles, in which the body is drawn backwards. P. Paralysis (Paralysis, is f. from wxpxXvu, to loose). T_« palsy. Paroxysm (Paroxysmus, i, m. from _*«f af w»#, to aggra- vate). A periodical exacerbation or fit of a disease. Pathognomic (Pathognomics, i, m. from «r«fles, a disease, and yiiuvnot, to know). A term given to those symp- toms which are pecuhar to a disease. Pediluvium (Pediluvium, i, n. from pedes, the feet, and lavo, to wash). A bath for the feet. Pemphigus (Pemphigus, i, m. from ire ftp t%, a bubble). Peripneumonia (Peripneumonia, x, f.from ire pi and irvevfbav, the lung). Inflammation of the lungs. Pertussis (Pertussis, is, f. from per, much, and tussis, cough). The hooping-cough. Petechia (Petechia, x, f. from the Italian petechia, a fleabitej because they resemble the bites of fleas). Phlegmasia: (Phlegmasia, x, f. from ^A«y«, to burn). Jr.. -animations. The second order in the class Pyrexia 574 GLOSSARY. Phrenitis (Phrenitis, idis, f. from Ppevet, the mind). In- flammation of the brain or its membranes. Phthisis (Phthisis, is, f. from 00*«, to consume). Pulmo- nary consumption. Pleuritis (Pleuritis, idis, f. from ^Af vp«, the membrane li- ning the lungs). Pleurisy, or inflammation of the pleura. Pneumonia (Pneumonia, x, f. from trvevftet*, a lung). In- flammation of the lungs. Podagra (Podagra, x, f. from «r»s} the foot, and xfpx, a taking or seizure). The gout. Predisposing cause. That which renders the body suscepti- ble of disease. Profluvia (Profluvium, i, n. from profiuo, to run down). Fluxes. The fifth order in the class Pyrexix of Cohen's nosology. Prognosis (Prognosis, is, f. from trpo, before, and yivucx*, to know). The judgment of the event of a disease by par- ticular symptoms. Pyrexia (Pyrexia, x, f. from rrvp, fire). Febrile diseases, The first class of CuUen's nosology. Pyrosis (Pyrosis, is, f. from WvP°"i to burn). The heart- burn. Q: Quartan (Quartanus; from quartus, the fourth). A fourth day ague. Quotidian (Quotidianus; from quotidie, daily). A daily ague. R. Rachitis (Rachitis, idis, f. from j»«X<$j the spine of the back). The rickets. Refrigerant* (Refrigerantia; from refrigero, to cool). Med- icines which allay the heat of the body or blood. Resolution. A termination of febrile and inflammatory affec- tions, in which the diseases disappear without inducing any oti^er disease. GLOSSARY. 279 Rheumatismus (Rheumatismus, i, m, from pevfictTi^a} to be afflicted with defluxions). Rheumatism. .Rubeola (Rubeola, x, f. from ruber, red; from rubio, to be- come red). The measles. S. Scarlatina (Scarlatina, x, f. from scarlatto, Ital. a Uvely red). The scarlet fever. Scirrhus (Scirrhus, i, m. o-xtppof, from trxippoa, to hard- en). An indolent hard tumour. Scorbutus, (Scorbutus, i, m. from scorboet, Germ.). Scurvy. Scrofula (Scrofula, x, f. from scrofula, a swine; because this animal is said to be much subject to a similar disor- der). The king's evil. Sedatives (Sedativa; from sedo, to ease or assuage)• Those medicines which diminish animal energy, without destroy- ing life. Spasmi (Spasmus, i, m. from o-ireta, to draw). Spasmodic diseases. The third order of the class Neuroses of Cullen. Stimulants (Stimulantia; from stimulo, to stir up). Medi- cines which rouse the animal energy. Subsultus tendinum (from subsilio, to jump a little, and tendo, a tendon). An involuntary movement or leaping of the tendons. Sincope (Syncope, is, f. from «"»v, with, and xoTrla, to cut or strike down). A fainting fit. Synocha (Synocha, x, f. from ~£>v£#6>, to continue). In- flammatory fever. Synochus (Synochus, i, f. from -t/Vfjs*', to continue). A mixed fever. T Tama (Txnia, x, f. a Hebrew word signifying a fillet ; so named from its resemblance to a fillet or piece of tape). The tape-worm. Tertian (Tertianus ; from tertius, third). A third day's ague. 'Tetanus (Tetanus, i, m, from rettw, to stretch). Spasm with rigidity. 37« CLOSSART. Tinnitus aurium (from tinnio, to tingle). A ringing in the ear. Tonic* (Tonica,- from ~av«#, to strengthen). Medicines which increase the tone of the muscular fibre. Trichuris (Trichuris, idis, f. from *pi%t a hair). The long hair-worm. Tympanites (Tympanites, x, f. from rvfiirecvoi, a drum ; so called because the belly is distended with wind, and sounds like a drum when struck). Tympany, or drum-beUy. Typhus (Typhus, i. m. from Tt^aj, stupor. A species of continued fever. V. Varicella (Varicella, x, f. a diminutive of variaj. The chicken-pox; so called from its being changeable. Variola (Variola, x, f. from varius, changing colour; be- cause it disfigures the skin). The small-pox. Vesania (Vesania, x, f). The fourth order of the class Neu- roses of Cullen. Vermicularis (from vermis, a worm). Long and slender like a worm. Volvulus (from volvo, to roll up). A twisting of the guts. The iliac passion. Vomica (Vomica, x, f). An abscess of the lungs. U. Urticaria (Urticaria, x, f. from urtica, a nettle). The net- tle-rash. Urtication (Urtlcatio; from urtica, the nettle). The whip- ping or stinging with nettles. INDEX, A. Page Abdomen, dropsy of 238 dropsy of - - - ib. ---------, encysted dropsy of - - - ib. Accidental cholera - 201 •---------colic - 192 Acute rheumatism - 74 Adynamix - - - 153 Ague - - - - 2 ——, quotidian - ib. ——, tertian - ib. ———, quartan - ib. Anasarca - - - 230 Angina pectoris - 155 Aphthx - - - 118 Apoplexia - - - 144 Apoplexy - - - - ib. --------, sanguineous ib. - 145 Ascaris vermicularis - 193 ------lumbricoides - ib. Ascites ... - 238 Asthma - - - - 182 Atonic gout - - - - 84 B. Benign measles - - - 98 Bilious diarrhoea - - - 203 Bitter tonics . - - 11 A Page Bladder, inflammation of 72 ———, acute inflamma- tion of - - - - ib. ————-, chronic inflam- mation of - - - - ib. ----—, hxmorrhage from - - - - 130 Bleeding from the nose 121 -------from the lungs 124 -----______---sto- mach .... 129 ----------_—__ blad- der .... 130 Bleedings, involuntary 121 Blood, involuntary dis- charges of - - - - 121 Bowels, inflammation of 62 —-----, erysipelatous in- flammation of - - - ib. ------, phlegmonous in- flammation of - - - ib. Brain, inflammation of 36 Broad tape-worm - - 193 C. Cachexix .... 220 Calculous colic ... 192 Camphire, strong mixture of ... 24 Canine madness - - - 214 a INDEX. Page Catarrh - - - - 132 Catarrhus - - - - ib. --------a frigore - 132 ——----, contagious - ib. Cellular membrancjdn'p- syof - - - - 230 Chest, dropsy of - - 240 Chicken pox - ... 97 Chlorosis .... 165 Cholera morbus - - - 201 ------ spontanea - - ib. ------ accidentalis - - ib. Chorea Sancti Viti - - 181 Chronic inflammation of the liver .... 66 ———.- inflammation of the bladder - - - 72 -------rheumatism - 75 Cocliac diarrhu-a - - - 203 Colic .....192 CoUca ..... ib. -----spasmodica - - ib. -----stercorea ... ib —— accidentalis - - ib —:— meconialis - - ib. —— calculosa - - - ib. - verminosa - - 193 —---pictonum - - - 197 Comata ..... 141 Common saline draught ■> Confluent small-pox - 92 Consumption, pulmonary 220 Cough, hooping - - - lu? Cramp - - - - - 170 Crapulous diarrhoea - - 20.3 Cynanche tonsillaris - 40 —---- maligna - - 44 ------- trachealis - - 50 .-------pharvng-ea - 53 -------parotidea - - ib. Cystitis.....72 D. Dance of St. Vitus - - 181 P?.ge Diabetes .... - 2C9 -------mellitus - - ib. -------insipidus - - ib. Diarrhoea.....203 ------------rr.ijMil.«.ja - ib. --------bjiiosa - - ib. --------mucosa - - ib. --------c celiac a - - ib. --------licnteria - - ib. --------hepatirrha-a ib. Discharges of blood, in- voluntary .... 121 Di.vascs, febrile - - 1 --------arising from de- praved habit - - - 220 Distinct small-pox - - 91 Dropsy of the chest - 240 ------of the pleura - ib. ■ of the pericardi- um .....241 ------of the cellular membrane - - - - 230 ------of the abdomen 238 ------, encysted, of the abdomen - - - - ib. ------, peritoneal, of the abdoi»<;n - ib. Dysenteria .... 135 Dysentery - - - ib. Dyspepsia - - . - 157 E. F.fFcrvescmgsalinedraught49 Emetic powder ... 7 Emphysema ... 225 Emprosthoi oiios - - 171 Empyema - - - 55 Encysted dropsy of the abdomen .... 238 Enteritis - . . . 62 Epilepsia .... 174 Epilepsy - - - - ib. Epistaxis - - - - 121 Page Erysipelas .... lyg --------vt riculosum ib. •■ ---phlyctxnodes ib. ■--------infantum - ib. Erysipelatous inflamma- tion of the stomach - 60 '* ■----- inflamma- tion of the intestines 62 F. Fainting - . . -153 Febres .... J Febrile diseases ... 1 Fever, inflammatory - 14 -----, low nervous - 19 —---, mixed ... 35 —---, nervous - - - 19 —---, putrid - - - 30 -----, remittent - - 13 Fevers ..... 1 -----, intermittent - 2 Flooding - - - .127 Flow of the menses, im- moderate .... 127 Flux .....135 Fluxes with pyrexia - 132 Furious madness - - 217 G. Gastritis ... Gout .... ----, atonic - - ----, fixed - - ——, misplaced ----, retrocedent Green sickness II. Hxmatemesis Hxinaturia - - Hxmoptysis - - 60 84 85 84 85 85 165 129 130 124 Page Hxmorrhage from the nose .....121 ----------from the lungs.....124 ----------from the uterus.....127 ----------from the bladder.....130 Hxmorrhagix - - - 121 Haustus salinus commu- nis .....5 -------emeticus - - 7 ------—salinus efferves- cens ------ 49 Head, water in - - - 243 Hemiplegic paralysis - 148 Hepatic diarrhoea - 203 Hepatitis.....65 Hooping-cough - - 187 Hydrocephalus - - 243 Hydrophobia - - 214 Hydrothorax - - 240 Hypochondriasis - - 163 Hysteria ... 211 Hysteric* - - - ib, I. Icterus - - - 252 Ileus .....192 Iliac passion - - - - ib. Immoderate flow of the menses .... 127 Impetigines - - - - 248 Indigestion .... 157 Infants, erysipelas of - 109 Inflammation of the pha- rynx .....53 ■■ of the lungs 54 -----———of the sto- mach .....60 -----——■ of the intes- tines .....62 INDEX. Page Inflammation of the liver 65 ■----- ■ of the kid- ney .....70 ■•<—■---------of the blad- der .....72 —----------of the blad- der, acute - - - ib. ' ------of the blad- der, chronic - - ib. 11 ------of the liver, acute .... 65 —----------of the liver, chronic .... 66 Inflammations - - 35 Inflammatory fever - 14 -------sore throat 40 Influenza .... 132 Intermittent fevers - 2 Intestines, inflammation of ......62 ———, erysipelatous inflammation of - ib. ———, phlegmonous inflammation of - ib. Intumescentix - - 225 Involuntary discharges of blood - T - - - 121 Jaundice Jaw, locked 252 171 K. Kidney, inflammation of 70 L. Lienteric diarrhoea - 203 Liver, inflammation of 65 —-, acute inflammation of ..... 65 =----, chronic inflamma- tion of .... 66 Locked jaw - - - 171 Page Long round worm - 193 ----hair-tailed thread-. worm - - - - ib. Looseness .... 203 Low nervous fever - 19 ---spirits ... 163 Lumbricus teres - - 193 Lungs, inflammation of 54 M. Madame Noufer's cure for tape-worm - - 200 Madness .... 217 -----:— canine - - 214 Mxnorrhagia - - - 127 Malignant measles - 99 ——-----sore throat - 44 Mania......217 Marcores .... 220 Maw-worm - - - - 193 Measles - .... 98 -------, benign - - ib. ------, malignant - - 99 Meconial colic - - - 192 Meconium, colic from re- tention of .... ib. Melancholia - - - - 215 Melancholy - - - - ib. Menses, immoderate flow ofthe.....127 Mild typhus - - - - 19 Miliaria.....113 Misplaced gout - - - 85 Mistura camphorx fortior 24 Mixed fever .... 35 Morbilli.....98 Mucous diarrhoea - - 203 Mumps.....53 N. Nephritis.....70 Nervous fever - - - 19 low fever - - 19 index! Nettle-rash Neuroses - Page - 116 - 144 O. Opisthotonos - - - - 171 P. Painters' colic ... 197 Palsy......148 Paralysis.....ib. ——— partialis - - ib. ——---hemiplegica - ib. -------paraplegica - ib. ----— venenata - - ib. Paraplegic paralysis - 148 Parotide al cynanche - 53 Partial paralysis - - - 148 Pemphigus .... 116 Pericardium, dropsy of 240 Peripneumonia - - - 54 Peritoneal dropsy of the abdomen .... 238 Pertussis ----- 187 Pharyngeal cynanche - 53 Pharynx, inflammation of......53 Phlegmasix ... - 35 Phlegmonous inflamma- tion of the intestines 62 —-——-—-—- inflamma- tion of the stomach 60 Phrenitis.....36 Phthisis pulmonalis - 220 Pleura, inflammation of 54 -----, water in the ca- vity of .....240 Pleuritis.....54 Pneumonia - - - - ib. Pock, chicken - - - 97 Podagra ----- 84 Profluvia.....132 Pulmonary consumption 220 Pulvis emeticus commu- nis .... Putrid fever - - ——— sore throat Page Pyrexia fluxes with 7 30 44 1 132 2 ib. 246 116 217 84 13 165 Q: Quartan ague Quotidian ague R. Rachitis - - Rash, nettle - Raving madness Regular gout Remittent fever Retention of the menses ——— of meconium, colic from - - - - 192 Retrocedent gout - - 85 Rickets.....246 Rheumatism - - - - 74 —----—, acute - - ib. ----- . , chronic - 75 Rubeola.....98 S. St. Anthony's fire - - 109 St. Vitus's dance - - 181 Saline draught, common 5 ———------, efferves- cing ------ 49 Sanguineous apoplexy 144 Scarlatina.....104 ————— simplex - - ib. —— ——— cynanchica - ib. Scarlet fever - - - - ib. Scorbutus.....250 Scrofula.....248 Scurvy......250 Serous apoplexy - - - 145 I .VI)EX. Page Sickness, green - - - 165 Small white thread-won:^ 193 Small-pox.....91 --------, distinct - - ib. --------, confluent' - 92 Solium .....193 Solutio arsenicnlis Dr. Fowler.....11 Spasmi .....170 Spasmodic diseases - - ib. ---------colic - - 192 Spirits, low .... 163 Spitting of blood - - 124 Spontaneous cholera - 201 Stercoraceous colic - - 192 Stomach, inflammation of......60 -------, erysipelatous inflammation of - *• 60 ------, phlegmonous inflammation of - 60 -------, hemorrhage from - - - - - -129 Syncope.....153 ■■ anginosa - - 155 —----accidentalis - 153 ■- cardiaca - - ib. Synocha.....14 Synochus.....35 Syrupus cinchonx - - 9 T. Txnia, Madame Noufct-'s remedy against - - 200 ------osculis marginali- bus......193 -----osculis supeffic'udi- bus......193 Page I -.pe-worm - - - - 193 ——----, broad - - ib. Tertian .uv.ie .... 2 Tetanus .... - 17(j Throat, inflammation of 10 Thrush .....118 Tonics, bitter - - - 11 Tonsillar cynanche - - 44 Tracheal cynanche - - 50 Trichuris.....193 Trismus.....171 Tympanites .... 226 ■ ----abdominalis ib. ---------intestinalis ib. Tympany - - - - - ib. Typhus mitior - - - 19 ------gravior - - 30 V. Vapours.....16.1 Varicella.....97 Variola ----- 91 -1 discreta - - ib. ■■ confluent - - 92 Vesicular fever - - 116 Venenate paralysis - 148 Verminous colic - - 193 Volvulus - - - - 192 Voiding of blood by urine 130 Vomica - - - - 55 Vomiting' of blood - 129 W. Water in the cavity of the pleura .... 240 ----in the cavity of the pericardium - - ib. ----in the head - r 243 Worms .... 193 THE END. I J f if '. -N it V • ■* «&